The American Urological Association treatment guidelines definition is: "premature ejaculation is ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners." This is the most common sexual problem experienced by men. Patients are evaluated and offered several treatments, either alone or used in combination. Treatments include medications such as Viagra that help not only the ability to achieve erections, but also improving the timing of ejaculation. Other medicines such as Paxil and Zoloft have been used successfully at low doses, in an attempt to minimize side effects. Behavioral exercises including increasing the time of foreplay may be utilized. Use of a condom or topical anesthetic creams to decrease penile stimulation is occasionally helpful as well.