Premature ejaculation (PE) is among the most commonly reported sexual complaints in men, and one of the least commonly raised with a doctor. In their joint Disorders of Ejaculation guideline, the American Urological Association and the Sexual Medicine Society of North America describe lifelong PE as ejaculation that consistently occurs within roughly two minutes of penetration, combined with a sense of having little control over the timing and real personal distress about it. That last element matters as much as the clock. Timing alone does not make a diagnosis. If it bothers you or your partner, it is worth evaluating; if it genuinely does not, it may not need treatment at all.
At Atlanta Medical Institute, we approach PE as a medical question, not a character flaw. The first task is distinguishing lifelong PE, present since a man's earliest sexual experiences, from acquired PE, which develops after a period of normal ejaculatory control. The two behave differently and are worked up differently. Acquired PE in particular is often tied to something identifiable — erectile dysfunction, performance anxiety, relationship strain, chronic prostatitis or pelvic pain, an overactive thyroid, or the effect of a medication or substance. When one of those is in play, addressing it is usually where meaningful progress starts.
We also want to say plainly what a lot of clinics leave out. The FDA has not approved any medication specifically for premature ejaculation in the United States. Every drug used for PE here is prescribed off-label. Dapoxetine, a short-acting SSRI developed specifically for this condition, is approved in parts of Europe but was declined by the FDA and is not available as an approved product in the U.S. Off-label prescribing is legal, routine, and explicitly supported by the AUA/SMSNA guideline — but it is not the same thing as an FDA-approved indication, and you should understand that distinction before starting anything.
AMI has practiced in Atlanta since 2010 and sees patients at a single location: 5009 Roswell Road NE, Suite 201, in Buckhead. Whether any specific treatment is appropriate for you, and what dose it should be if a medication is involved, is a decision your physician makes after an in-person evaluation — not something to be settled by a website or an online questionnaire.
Program Benefits
- A private, unhurried evaluation with a physician rather than a checkbox intake form
- A working diagnosis that separates lifelong PE from acquired PE, since the causes and approach differ
- Screening for contributing factors such as erectile dysfunction, hormonal issues, prostatitis or pelvic pain, medication effects, and anxiety
- A candid walk-through of behavioral, pelvic floor, topical, and off-label oral options, including what the evidence does and does not show for each
- Coordination with our other men's health services when PE overlaps with ED or low testosterone
- Scheduled follow-up so the plan can be adjusted based on what is actually helping and what side effects show up
Understanding What Is Actually Happening
Ejaculation is a reflex coordinated by the spinal cord and modulated by serotonin signaling in the brain, along with pelvic floor muscle activity and, importantly, how aroused and how anxious a man is in the moment. There is no single cause of PE, which is why there is no single fix for it.
Lifelong PE appears to involve how a man's ejaculatory reflex is wired and tends to be consistent across partners and situations. Acquired PE usually has an identifiable trigger. Erectile dysfunction is one of the most common: a man who is subconsciously rushing because he is worried about losing an erection may present with what looks like PE but is functionally an erection problem. Sorting that out changes the entire treatment plan, which is why we do not skip it.
Who Is a Candidate for Evaluation
You are a reasonable candidate for evaluation if ejaculation happens sooner than you want it to, you feel you have little control over when it happens, and the situation is causing you or your partner distress or avoidance of intimacy. How long you have had it does not disqualify you. Neither does age.
Some situations need a broader medical workup before PE is treated on its own.
- Ejaculation that became noticeably faster over a period of months, rather than being lifelong
- PE that appeared alongside difficulty getting or keeping an erection
- Painful ejaculation, blood in the semen, or persistent pelvic or perineal pain
- New symptoms of thyroid overactivity, such as unexplained weight loss, tremor, or heat intolerance
- PE that started after beginning, stopping, or changing a medication or substance
- Significant depression, anxiety, or relationship conflict, which deserves attention in its own right
What to Expect at Your Visit
The visit begins with a conversation. Your physician will ask when the pattern started, whether it happens with every partner and during masturbation, how much control you feel you have, what has already been tried, and what medications and supplements you take. Partners are welcome to attend and often add useful context.
A focused physical exam follows. Bloodwork is ordered when the history points toward something specific rather than as a reflex — the AUA/SMSNA guideline does not support routine thyroid screening in every man with PE, but it is clearly appropriate when there is clinical suspicion. If your history suggests low testosterone, prostatitis, or a metabolic issue, we test for it.
You will leave with an explanation of what we think is going on, the options that fit your situation, and what each one realistically involves in terms of effort, cost, and side effects. Nothing is prescribed before that conversation happens.
Treatment Options and What the Evidence Shows
The AUA/SMSNA Disorders of Ejaculation guideline names three categories as first-line: daily SSRIs, on-demand clomipramine or dapoxetine, and topical anesthetic creams. In the United States, all of these are used off-label, and dapoxetine is not available as an FDA-approved product at all.
Behavioral approaches — the stop-start and squeeze techniques, sensate focus, and working on performance anxiety directly — remain a legitimate part of care and carry no drug side effects. They ask more of you and your partner in terms of practice and consistency. Pelvic floor muscle training has been studied for PE and a systematic review published in Physiotherapy reported improvement, but the authors themselves noted the underlying studies were of low to moderate methodological quality and that no optimal training protocol has been established. We mention it as a reasonable adjunct, not a proven cure.
Topical anesthetics reduce sensation on the glans and are applied before intercourse. Lidocaine-prilocaine spray is approved in Europe as Fortacin but has no equivalent FDA approval here. Oral off-label options work by delaying the ejaculatory reflex through serotonin signaling; whether one is appropriate for you, which one, and at what dose is determined by your physician after your evaluation. We do not publish dosing, because the right regimen depends on your history, your other medications, and your response.
Safety, Side Effects, and Monitoring
No PE treatment is risk-free, and the off-label status of the medications makes an honest side effect conversation more important, not less. SSRIs can cause nausea, drowsiness, reduced libido, delayed or absent orgasm, and sweating. Their FDA labeling carries a boxed warning about suicidal thoughts and behaviors in children, adolescents, and young adults, and they can interact with other serotonergic medications. Stopping them abruptly can cause discontinuation symptoms. Clomipramine, a tricyclic, has its own side effect profile including dry mouth, sedation, and cardiac considerations.
Topical anesthetics can cause numbness that is more than you want, can transfer to a partner and reduce her sensation, and occasionally cause local irritation or an allergic reaction. Barrier methods and careful application reduce but do not eliminate this.
We schedule follow-up rather than writing a prescription and disappearing. At each visit we ask what changed, what side effects appeared, and whether the trade-off still makes sense to you. Treatment that improves the clock but leaves you feeling flat or disconnected is not a success, and we would rather adjust it than have you quietly stop.
How PE Care Fits With Our Other Men's Health Services
Sexual concerns rarely arrive one at a time. When PE coexists with erectile dysfunction, the ED is usually addressed first, and our erectile dysfunction program (/services/erectile-enhancement-ed) is often the right starting point. When symptoms include low energy, low libido, and mood changes alongside sexual difficulty, a testosterone evaluation (/services/low-testosterone-treatments) may be appropriate. Curvature or pain with erection is evaluated separately (/services/peyronies-disease).
We also offer acoustic wave therapy, marketed under the GAINSWave name (/services/gainswave). We want to be straightforward about it: low-intensity shockwave therapy is not FDA-approved for erectile dysfunction, the AUA guideline classifies it as investigational on the basis of Grade C evidence, and study quality across the published literature varies considerably. Some men report improvement and the safety profile in published work has been reasonable, but it is not a proven treatment and it is not a treatment for premature ejaculation. If you ask us about it, that is the answer you will get in the office too.
To discuss any of this in person, call (404) 264-9553 or use our contact page (/contact). You can read more about the physicians who would be seeing you on our about page (/about).
Frequently Asked Questions
Is there an FDA-approved medication for premature ejaculation?+
No. As of 2026, the FDA has not approved any medication specifically for premature ejaculation in the United States. Every drug used for PE here is prescribed off-label. Dapoxetine, developed specifically for PE, is approved in parts of Europe but was declined by the FDA. Off-label prescribing is legal and supported by the AUA/SMSNA Disorders of Ejaculation guideline, but any clinic telling you they have an FDA-approved PE drug is not being accurate with you.
How short is too short? Is there an actual number?+
The AUA/SMSNA guideline uses an average of roughly two minutes or less from penetration to ejaculation as part of the definition of lifelong PE, but timing is only one of three elements. The other two are a lack of control over when ejaculation happens and genuine distress about it. Plenty of men fall under two minutes and are perfectly content; plenty fall above it and are not. Distress is the reason to come in.
Could this actually be an erection problem instead?+
It might be, and this is one of the more common things we sort out. A man who is unconsciously hurrying because he is anxious about losing his erection can look exactly like a man with PE. That is why we evaluate erectile function as part of the same visit. If ED is the driver, treating the ED is the priority, and our erectile dysfunction program at /services/erectile-enhancement-ed is usually where that starts.
Will GAINSWave or acoustic wave therapy fix premature ejaculation?+
No, and we would not offer it to you on that basis. Low-intensity shockwave therapy is studied in erectile dysfunction, not premature ejaculation. Even for ED it is not FDA-approved, the AUA guideline calls it investigational based on Grade C evidence, and the quality of published studies varies widely. If you are interested in it for erectile concerns, we will discuss it honestly, including its limitations.
Do the medications have to be taken forever?+
That depends on the situation and is something to discuss with your physician. Some men use an off-label medication for a period while working on behavioral techniques or resolving an underlying cause, then taper under supervision. Others continue longer. SSRIs in particular should not be stopped abruptly, because discontinuation symptoms can occur. Your physician will set the plan and revisit it at follow-up.
Do I need my partner to come with me?+
It is not required, and many men come alone. That said, partners often have useful observations, and PE is frequently tangled up with relationship dynamics that are easier to address together. If a relational or anxiety component is significant, we may suggest working with a sex therapist or counselor alongside medical treatment. Either way, the conversation in our office is confidential.
How do I get started at Atlanta Medical Institute?+
Call (404) 264-9553 or reach us through /contact to schedule an evaluation. We are at 5009 Roswell Road NE, Suite 201, in Buckhead — our only location — and we see patients Monday through Thursday from 9 to 6 and Friday from 9 to 4. The first visit is a conversation and an examination; no treatment is started before we have explained what we found and what the options involve.
Costs and appointment planning
Review pricing questions, insurance and coverage information, and telehealth visit planning before booking. Confirm the costs and services that apply to your individual care.
Ready to Get Started?
Call us at (404) 264-9553 or book a telehealth consultation. New patients qualify for our 1st month Semaglutide special — $399 (regularly $450).