How to last longer in bed: what 264 sexual-medicine experts recommend in 2026

Premature ejaculation affects roughly 1 in 5 European men — 20.3% in Germany and 20.0% in Italy in the well-known PEPA survey — making it the most common male sexual complaint, ahead of ED. In 2025–26, two major expert bodies published updated guidance: the European Association of Urology (EAU) guidelines and the Global Andrology Forum consensus built from 264 specialists across 41 countries. Here's what they actually recommend — ranked, practical, and honest.

First-line medicine: dapoxetine, the experts' pick

Asked which drug they actually prefer, the Global Andrology Forum's 264 experts put dapoxetine clearly first (37.9%), ahead of daily paroxetine (24.8%) and sertraline (12.3%). Dapoxetine is the only SSRI designed for PE: taken 1–3 hours before sex — not daily — it typically doubles to triples time-to-ejaculation. The EAU 2025 guideline keeps on-demand dapoxetine first-line for lifelong PE. It's available in Duratia 30/60/90mg and combined formats — full detail in our premature ejaculation guide.

The behavioural techniques with real evidence

The guidelines endorse stop-start (pause all stimulation as climax approaches, resume when the urge fades — repeat 3–4 times) and the squeeze technique (firm pressure just below the glans at the edge). A 2025 meta-analysis in Andrology (15 RCTs, 1,200+ patients) found combining behavioural training with medication significantly outperforms medication alone — for time, control, and both partners' satisfaction. Pelvic-floor training adds further benefit: several small trials show kegels alone can meaningfully extend latency in lifelong PE.

When PE and ED overlap: the combination approach

Around a third of men with PE also struggle with erections — often because anxiety drives both. For them the EAU guidance explicitly supports combining dapoxetine with a PDE5 inhibitor. That's exactly what combination tablets deliver: Super Kamagra (sildenafil 100mg + dapoxetine 60mg) and Cenforce D. One tablet, both mechanisms — the erection is reliable AND the finish is delayed, which dismantles the anxiety feeding both problems. Compare the options in longer sex medicine for men.

What about sprays and creams?

Topical anaesthetics (lidocaine/prilocaine sprays) are also guideline-endorsed: a well-studied spray produced a ~2.5× latency increase versus placebo, and Google Trends interest in 'delay spray' grew roughly 400% over the past decade. They work locally with minimal systemic side effects, though some couples dislike the numbing transfer. They combine well with behavioural techniques, and can be layered with dapoxetine under medical advice for stubborn cases.

The honest ranking for most men

Synthesising the 2025–26 guidance: start with technique + pelvic floor (free, no side effects, works for mild cases); add on-demand dapoxetine if you want reliable, studied pharmacological delay; choose a combination tablet if erections wobble too; consider sprays if you prefer non-systemic. And normalise it: PE prevalence doesn't rise with age — it's not something you 'grow out of', it's something you treat. The experts treat it as routine medicine; so should you.

References & research

• Global Andrology Forum PE Clinical Practice Guidelines — World Journal of Men's Health 2025 (264 experts, 41 countries)
• EAU Guidelines on Sexual and Reproductive Health — 2025/2026 update
• Li et al., Andrology 2025 — CBT + SSRI meta-analysis (15 RCTs)
• NHS: Dapoxetine/Priligy overview · PDE5 inhibitors — StatPearls

General information, not medical advice. Consult a healthcare professional before starting any medication.

Key points to remember

• First-line medicine: dapoxetine, the experts' pick: Asked which drug they actually prefer, the Global Andrology Forum's 264 experts put dapoxetine clearly first (37.9%), ahead of daily paroxetine (24.8%) and sertraline (12.3%). Dapoxetine is the only SSRI designed for PE: taken 1–3 hours before sex — not daily — it typically doubles to triples time-to-ejaculation.
• The behavioural techniques with real evidence: The guidelines endorse stop-start (pause all stimulation as climax approaches, resume when the urge fades — repeat 3–4 times) and the squeeze technique (firm pressure just below the glans at the edge). A 2025 meta-analysis in Andrology (15 RCTs, 1,200+ patients) found combining behavioural training with medication significantly outperforms medication alone — for time, control, and both partners' satisfaction.
• When PE and ED overlap: the combination approach: Around a third of men with PE also struggle with erections — often because anxiety drives both. For them the EAU guidance explicitly supports combining dapoxetine with a PDE5 inhibitor.
• What about sprays and creams?: Topical anaesthetics (lidocaine/prilocaine sprays) are also guideline-endorsed: a well-studied spray produced a ~2.5× latency increase versus placebo, and Google Trends interest in 'delay spray' grew roughly 400% over the past decade. They work locally with minimal systemic side effects, though some couples dislike the numbing transfer.
• The honest ranking for most men: Synthesising the 2025–26 guidance: start with technique + pelvic floor (free, no side effects, works for mild cases); add on-demand dapoxetine if you want reliable, studied pharmacological delay; choose a combination tablet if erections wobble too; consider sprays if you prefer non-systemic. And normalise it: PE prevalence doesn't rise with age — it's not something you 'grow out of', it's something you treat.
• References & research: - Global Andrology Forum PE Clinical Practice Guidelines — World Journal of Men's Health 2025 (264 experts, 41 countries)
• EAU Guidelines on Sexual and Reproductive Health — 2025/2026 update
• Li et al., Andrology 2025 — CBT + SSRI meta-analysis (15 RCTs)
• NHS: Dapoxetine/Priligy overview · PDE5 inhibitors — StatPearls

General information, not medical advice. Consult a healthcare professional before starting any medication.

Common questions

What do doctors recommend most for premature ejaculation?

In the 2025 Global Andrology Forum consensus, dapoxetine was the single most-preferred medicine (37.9% of 264 experts) — an on-demand SSRI taken 1–3 hours before sex that typically doubles to triples latency. Guidelines recommend combining it with behavioural techniques.

Does the stop-start technique actually work?

Yes — it's endorsed by the EAU guidelines, and a 2025 meta-analysis of 15 trials found behavioural training combined with medication beats medication alone on time, control and satisfaction.

Can I treat PE and ED at the same time?

Yes — European guidance explicitly supports combining dapoxetine with a PDE5 inhibitor. Combination tablets like Super Kamagra (sildenafil + dapoxetine) deliver both in one dose.

Is premature ejaculation something you grow out of?

No — unlike ED, PE prevalence stays flat with age (~20% of men at every age in European surveys). It doesn't fade on its own, but it responds very well to treatment.

References & further reading

• NHS: Sildenafil (Viagra) — uses, dosage, side effects — official UK guidance on the active ingredient.
• Goldstein I, et al. NEJM 1998 — the pivotal sildenafil trial — lead-authored by Dr. Irwin Goldstein (San Diego Sexual Medicine).
• Phosphodiesterase 5 Inhibitors — StatPearls, NCBI Bookshelf — clinical pharmacology reference.

This article is general information, not medical advice. Always consult a healthcare professional before starting any medication.