Amy M. Pearlman, MD, presents “Premature Ejaculation.”
How to cite: Pearlman, Amy. “Premature Ejaculation.” September 16, 2025. Accessed Nov 2025. https://grandroundsinurology.com/premature-ejaculation/
Premature Ejaculation – Summary
Diane K. Newman, DNP, ANP-BC, FAAN, FAUNA, BCB-PMD, Urology and Pelvic Floor Nurse Specialist, University of Pennsylvania, Philadelphia, Pennsylvania, and Adjunct Professor of Surgery Division of Urology, Perelman School of Medicine Emerita, introduces Amy Pearlman, MD, Prime Institute, Coral Gables, Florida, as she reviews current options and real‑world limitations in premature ejaculation (PE) care. She notes there are currently no FDA‑approved therapies specifically for PE. First‑line pharmacologic options include selective serotonin reuptake inhibitors (SSRIs) and topical penile anesthetics. Second‑line choices mentioned include on‑demand tramadol and α‑blockers. Barriers include access to mental‑health care, side effects, and variable efficacy across modalities.
Dr. Pearlman then demonstrates contemporary, over‑the‑counter tools and how to teach patients to use them:
- Delay sprays (lidocaine): Apply 1–2 targeted sprays (e.g., frenulum/ventral glans), rub in, wait 5–10 minutes, and wipe residue; the sprays are designed to absorb to minimize partner transfer. Dr. Pearlman contrasts sprays with less potent wipes.
- Erection ring (e.g., MaxPR): An elastomer ring that sits around the scrotum and penile base; may prolong post‑ejaculatory erection duration. In a 21-subject study Dr. Pearlman led, the mean time from climax to complete detumescence increased from ~95s (no therapy) to ~160s (ring) in some patients.
- Wearable transcutaneous electrical nerve stimulation (TENS) patches aimed at neuromodulating the ejaculatory reflex: the single-use In2 and smartphone‑controlled reusable MOR system have both shown promise. Dr. Pearlman advises several solo trials to calibrate settings before partnered use.
- Masturbation trainers to retrain latency (e.g., MyhixelⓇ device paired with cognitive behavioral therapy [CBT]) and disposable “men’s training cups,” used within structured programs.
Dr. Pearlman frames care as building a personalized toolbox: Some patients prefer on‑demand aids (spray/TENS/ring), others commit to longer‑term behavioral retraining (CBT plus trainers). Shared decision‑making, clear technique coaching (start low, go slow), and expectation setting are central to successful outcomes.
