How can I get rid the PE which is actual nightmare

Premature ejaculation (PE) can indeed be frustrating and when initial strategies don’t work, it’s important to reassess your approach. The start and stop technique and dapoxetine are common initial treatments, but if they’re not effective, further evaluation is sometimes necessary. First, consider behavioral therapy options like the ‘squeeze’ technique, which your partner can assist you with. This involves applying slight pressure to the head of your penis until the urge to ejaculate passes, allowing you to gradually build endurance over time. If behavioral techniques and dapoxetine aren’t sufficient, sometimes other medications may be considered. Off-label use of certain antidepressants like sertraline or paroxetine might be discussed with your doctor as they have shown efficacy in some cases. These medications are typically started at low doses to assess responsiveness and to minimize side effects, with follow-up to adjust dosing as needed. Topical anesthetic creams are another option, as they can decrease sensation and help delay ejaculation. Applying them before intercourse is necessary but be cautious, as they might cause numbness for your partner as well. Consider discussing with your doctor about the potential for pelvic floor exercises, which can strengthen the muscles involved in ejaculation and improve control. On a more physical health front, ensure you have good general wellbeing; regular exercise and stress reduction can have indirect benefits on sexual health. Pay attention to mental factors – stress and anxiety play a role in PE and working with a therapist skilled in sexual health can sometimes offer additional benefit. If your PE persists despite trying these strategies, a referral to a specialist, such as a urologist or a men’s health expert, might be warranted for more specialized evaluation and tailored treatment.