Lifelong premature ejaculation has been defined by the International Society of Sexual Medicine as men ejaculating in less than one minute, having the condition all their lives, and having distress and anxiety as a result. Do they really have to include distress and anxiety? Isn’t that obvious?
So what the best treatment options?
Option 1. I suggest seeing a urologist who specializes in sexual medicine. Here’s the Sexual Medicine Society of North America Find a Provider which 
can help you find a sexual medicine expert in your geographic area.
After an exam to determine if you have another medical issue that may be causing PE (e.g. hyperthyroidism), the expert in sexual medicine will likely first recommend a topical desensitizing spray. They’re very safe and work for many guys. In some cases of lifelong PE, desensitizers may not be powerful enough or you need to use so many sprays that you lose too much sensation. In these cases, the urologist may prescribe a daily anti-depressant in the form of an SSRI. Maybe used together with a desensitizer in order to keep the SSRI does as low as possible in order to avoid the side effects.
If you’ve had PE all your adult life, there’s a pretty good chance that you don’t have medical condition that is causing it. However, seeing a doctor about it is still a good idea.
I recommend against one of the men’s health clinics. They’re OK for testosterone replacement or erectile dysfunction – these problems have proven treatment plans. Lifelong premature ejaculation could be more complicated.
What about my normal urologist? If he/she is part of large urology group, ask to see the sexual medicine expert. Most large urology groups have at least one. If it’s a small urology office, there’s a pretty good chance that the doctor won’t know the best solution or immediately put you on a high dose anti-depressant or use a old topical cream called EMLA. That stuff is OK but the new topical sprays are much better.
Option 2. If you can’t afford a trip to a doctor or you live too far away from a sexual medicine expert, you can simply try a desensitizer yourself. They have very few side effects (read the safety information first). If it doesn’t work to your satisfaction, then a trip to the doctor may be in order. Or try a different delay spray. I have found a big difference in sexual satisfaction among these many products. Here are my favorite desensitizing sprays.
Note: Do not replace this advice with medical advice from a physician. I am simply trying to give you an opinion which may help my PE brothers.
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