Premature ejaculation: the calm guide
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What actually works
Three classes have evidence: low-dose daily SSRIs (paroxetine, sertraline) which delay ejaculation as an off-label side effect; topical lidocaine/prilocaine sprays applied 10-15 minutes before intercourse; and behavioral techniques (stop-start, squeeze). PDE5 inhibitors (sildenafil, tadalafil) help when PE coexists with ED but don't directly treat PE in isolation.
Telehealth's role
Async telehealth is fine for PE. The history-taking and screening is checklist-able. Avoid programs that prescribe topical sprays + SSRIs together at first visit without screening for serotonin-syndrome risk or other meds you take.
Costs and refunds
Topical sprays: $30-60/month compounded, $90+/month branded. Daily SSRI: $10-25/month generic. Combination programs: $50-100/month bundled. Refund windows are usually 30 days but watch for auto-renewals — every PE brand we cover auto-renews monthly by default.
When to skip telehealth
PE that started recently after relationship change, anxiety, or a new medication is worth discussing with a clinician who sees you in person. PE bundled with depression or relationship distress benefits more from therapy than a topical spray.