How to Last Longer in Bed: Tips from a Urologist

Dr. Rena Malek, a urologist and pelvic vision specialist, discusses how to last longer in bed in this video sponsored by Promescent, a sexual wellness provider. Dr. Malek begins by explaining the average duration of sex, which is about 5.7 minutes, and the desired duration as reported in surveys, which ranges from 7 to 13 minutes. She then delves into premature ejaculation, defining it as ejaculation within 1-2 minutes of penetrative intercourse, the inability to delay ejaculation consistently, and the negative consequences it causes. Dr. Malek discusses potential causes of premature ejaculation and treatment options including psychotherapy, the stop-start method, topical anesthetics (such as Promescent), and medical therapies like antidepressants or off-label medications. She emphasizes that communication with one’s partner is crucial and encourages exploring alternative sources of pleasure.

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Key Insights:

– The average time for vaginal penetration to ejaculation is about 5.7 minutes, but surveys show that many people desire sex to last between 7 to 13 minutes.
– Premature ejaculation is defined as ejaculation that happens within one to two minutes of penetrative intercourse, the inability to delay ejaculation in most sexual encounters, and the negative personal consequences it causes (such as stress or anxiety).
– Primary premature ejaculation occurs throughout a person’s life, while secondary premature ejaculation can develop later in life.
– Abnormal serotonin transmission in the brain may contribute to premature ejaculation, as serotonin receptors that inhibit ejaculation do not function properly.
– Ejaculation is a reflex response mediated by the spinal ejaculation center in the spinal cord, triggered by sexual stimulation and the brain’s perception of pleasure.
– Psychotherapy or sex therapy can be beneficial in addressing psychological factors that contribute to premature ejaculation, such as stress, anxiety, guilt, or depression.
– The stop-start method involves your partner squeezing your penis when you are close to ejaculation to delay ejaculation. This method can be performed three times a week.
– Topical anesthetics, such as delay sprays like Promescent, can numb the penis to reduce sensitivity and delay ejaculation. Promescent is a clinically studied delay spray available over the counter.
– Other topical anesthetics, like Emla cream or Fortacin spray, may require a prescription and have similar effects.
– Antidepressant medications that work on serotonin, like selective serotonin reuptake inhibitors (SSRIs), can be prescribed to delay ejaculation. Clomipramine and Dapoxetine are other medications used as on-demand treatment options.
– Alpha blockers like Tamsulosin or Silodosin, typically used for an enlarged prostate, can also be used off-label to treat premature ejaculation.
– Treating any underlying erectile dysfunction may also help improve premature ejaculation.
– It’s essential to have open communication with your partner about sexual needs and preferences beyond penetrative intercourse.


Dr. Rena Malek, a urologist and pelvic vision specialist, discusses how to last longer in bed in this sponsored video by Promescent, a sexual wellness brand. She starts by explaining the average duration of sex, which is around 5.7 minutes from vaginal penetration to climax. However, surveys show that people desire sex to last anywhere between 7 to 13 minutes.

Dr. Malek emphasizes the importance of communication with your partner about sexual satisfaction. If both you and your partner are happy with the duration of sex, there is no need to make any changes. She suggests discussing other forms of stimulation, such as oral or manual, that may be equally or more pleasurable than longer penetrative intercourse.

Premature ejaculation is the focus of the video, and Dr. Malek explains its three major components: ejaculation occurring within one to two minutes of penetrative intercourse, the inability to delay ejaculation in most sexual encounters, and negative personal consequences such as stress and anxiety. Premature ejaculation can be primary or secondary, with primary indicating a lifelong issue and secondary suggesting a change in ejaculatory function over time.

The cause of premature ejaculation is related to abnormal transmission of serotonin, a chemical messenger in the brain. Dr. Malek describes how ejaculation is a reflex, organized by the spinal ejaculation center located in the spinal cord. This reflex is triggered by stimulation and signals from the brain, as well as sensory pleasure from friction.

Dr. Malek explains that seeing a psychotherapist or sex therapist can be helpful, as depression, stress, anxiety, and guilt can influence ejaculation time. These professionals can address these issues and provide guidance. The stop-start method, where your partner squeezes your penis to delay ejaculation, is another technique that can be combined with therapy. Seeing a pelvic floor physical therapist may help identify the muscles that control ejaculation.

She then discusses medical therapies for premature ejaculation. The first line of treatment is topical anesthetics, which reduce the sensitivity of the penis and inhibit the reflex leading to ejaculation. Dr. Malek recommends delay sprays and highlights Promescent as a clinically studied product available over the counter in the United States. The study showed that using Promescent increased average ejaculation time from 6.5 minutes to 11.5 minutes, with a higher rate of orgasm satisfaction for both partners.

Other topical anesthetics include EMLA cream (off-label use) and Fortacin (available in Europe). These creams should be applied before sex, and EMLA cream needs to be washed off before use. Side effects may include penile numbness and irritation.

Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, paroxetine, or sertraline, are another treatment option. SSRIs delay ejaculation as a side effect. On-demand medications, such as clomipramine and dapoxetine, can also be used, but they require prescriptions and have similar side effects to SSRIs.

Clomipramine inhibits the uptake of serotonin and norepinephrine and is taken a few hours before sex, while dapoxetine is shorter-acting and can be taken closer to sex. Dr. Malek advises treating erectile dysfunction before addressing premature ejaculation, as successful treatment of the former can often improve the latter.

Two off-label therapies for premature ejaculation include tramadol (a pain medication that weakly inhibits serotonin) and alpha-blockers like tamsulosin and silodosin (prescribed for an enlarged prostate). These medications have shown some improvement in ejaculation time, but there are few high-quality studies and potential side effects.

Dr. Malek concludes by encouraging viewers to take care of their sexual wellness and to consider trying Promescent. The brand offers other sexual wellness products like condoms and lubricants and provides discreet packaging and a 60-day money-back guarantee. She reminds viewers to prioritize their own satisfaction and well-being.