The treatment of premature ejaculation, using the "pause" and "squeeze" procedures developed by Semans and by Masters and Johnson, has been found to be highly effective. Research has demonstrated that such procedures work well in group as well as in individual treatment, and in self-help programs; they can be practiced in individual masturbation with relatively good transfer of therapeutic gains when sex with a partner is resumed. Success rates of 90 percent to 98 percent are reported.

In the stop-start or pause procedure, the penis is manually stimulated until the man is fairly highly aroused. The couple then pauses until his arousal subsides, at which time the stimulation is resumed. This sequence is repeated several times before stimulation is carried through to ejaculation, so the man ultimately experiences much more total time of stimulation than he ever has before and thus learns to have a higher threshold for ejaculation. The squeeze procedure is much like the stop-start procedure, with the addition that when stimulation stops, the woman firmly squeezes the penis between her thumb and forefinger, at the place where the glans of the penis joins the shaft. This squeeze seems to further reduce arousal. After a few weeks of this training, the necessity of pausing diminishes, with the man able to experience several minutes of continuous penile stimulation without ejaculating. Next, the couple progresses to putting the penis in the vagina but without any thrusting movements. If the man rapidly becomes highly aroused, the penis is withdrawn and the couple waits for arousal to subside, at which point the penis is reinserted. When good tolerance for inactive containment of the penis is achieved, the training procedure is repeated during active thrusting. Generally, two to three months of practice is sufficient for a man to be able to enjoy prolonged intercourse without any need for pauses or squeezes.

We have no real understanding of why the pause and squeeze procedures described by Semans in 1956 and Masters and Johnson in 1970 work. The pause procedure fits Guthrie's theoretical paradigm for counter conditioning by "crowding the threshold." Additionally, the stimulation and pause procedure is typically repeated by the patient several times per week, thus raising the frequency of sex and raising the sensory threshold of the penis. Either or both of these mechanisms may underlie the effectiveness of treatment.

Some variations on the pause and squeeze procedures have been reported, typically as clinical case reports. One variation described by LoPiccolo involves reversing one of the physiological changes that occurs during high arousal. During high arousal, the scrotum contracts and elevates the testes close to the body. As well as having the patient cease stimulation or squeeze on the penis, the patient may also be instructed to stretch out the scrotum and reverse this testicular elevation. However, during high arousal, any additional stimulation of the scrotum and perineum may trigger an ejaculation and thus may make the pause and squeeze procedure ineffectual. Empirical data on the effectiveness of this technique are lacking.

Segraves reported that drugs and medications that block sympathetic arousal often have the effect of delaying ejaculation. Such agents include anti-anxiety, antidepressant, and major tranquilizing medications; sedatives; some medications used to treat high blood pressure; and some antihistamines. However, because of serious side effects, the use of medication in treating premature ejaculation is not recommended, especially when the effectiveness of the behavioral retraining procedure is considered. Many of the recreational or "street" drugs such as alcohol, marijuana, cocaine, "downers" (barbiturates), and heroin also delay ejaculation, and although some men do use such agents to deal with their premature ejaculation, this is even more unwise than the use of prescription medications.
It is somewhat puzzling that although there is little agreement about the definition or cause of premature ejaculation, and no real understanding of how the treatment procedure works, treatment is virtually 100 percent effective. If one has to have a sexual dysfunction, this is the one to have.