Content Area

They may cause decreased feeling and sexual pleasure in both partners. These drugs aren't approved by the Food and Drug Administration to treat premature ejaculation, but some are used for this purpose. They include antidepressants, pain relievers and drugs for erectile dysfunction. These medications might be prescribed for either on-demand or daily use. Also, they may be prescribed alone or with other treatments. A side effect of certain antidepressants is delayed orgasm. For this reason, selective serotonin reuptake inhibitors (SSRIs) are used to treat premature ejaculation.

Contraindication	Reason	Alternatives
Nitrate medication	Risk of severe hypotension	Use other treatments
Cardiovascular disease	Potential for adverse cardiovascular events	Consultation before use
Severe hepatic impairment	Altered drug metabolism	Avoid or adjust dosage

The SSRI dapoxetine is often used as the first treatment for premature ejaculation in some countries. It's not currently available in the United States. Of the drugs approved for use in the United States, paroxetine seems to be the most effective.

Cited by (115)

Be careful not to flex the muscles in your abdomen, thighs or buttocks. Aim to do at least three sets of 10 repetitions a day. Your health care provider might instruct you and your partner to use the pause-squeeze technique. Begin sexual activity, including stimulating the penis, until you feel almost ready to ejaculate. Then you or your partner can squeeze the end of your penis where the head joins the shaft.

Rapid ejaculation: a review of conceptual, etiological, and treatment issues

Keep squeezing for several seconds until the urge to ejaculate passes. By repeating as many times as needed, you can reach the point of entering your partner without ejaculating. After some practice, delaying ejaculation might become a habit that no longer requires the pause-squeeze technique. If the pause-squeeze technique causes pain or discomfort, you can try the stop-start technique. It involves stopping sexual stimulation just before ejaculation. These medications usually take 5 to 10 days to begin working. But it might take 2 to 3 weeks of treatment to see the full effect.

• Sildenafil is a PDE5 inhibitor used mainly for erectile dysfunction.
• Some men use sildenafil to delay ejaculation temporarily.
• Sildenafil may improve confidence in sexual performance.
• It does not treat underlying causes of premature ejaculation.
• Sildenafil's effects can last up to 4-6 hours.
• Using sildenafil for PE is off-label and not medically approved.
• Combining sildenafil with other ED medications can be risky.
• Timing of sildenafil intake affects its effectiveness.
• Side effects include headaches, flushing, and nasal congestion.
• It may interact with nitrates, causing dangerous blood pressure drops.
• Always consult a doctor before using sildenafil for PE.

If SSRIs don't improve the timing of your ejaculation, your health care provider might prescribe the tricyclic antidepressant clomipramine (Anafranil). Side effects of antidepressants might include nausea, perspiration, drowsiness and decreased sex drive. Tramadol (Ultram, Conzip, Qdolo) is a medication used to treat pain.

Product	Dosage	Quantity + Bonus	Price
Kamagra Polo	100mg	120 + 6 Pills	327.15€ 311.57€	Buy
Viagra Generic	200mg	90 + 6 Pills	170.79€ 162.66€	Buy
Viagra Generic	50mg	120 + 6 Pills	129.64€ 123.47€	Buy
Viagra Generic	100mg	60 + 4 Pills	96.36€ 91.77€	Buy
Kamagra	100mg	360 + 6 Pills	839.95€ 799.95€	Buy
Viagra Generic	100mg	120 + 6 Pills	149.50€ 142.38€	Buy
Viagra Generic	50mg	20 Pills	40.52€ 38.59€	Buy
Viagra Generic	200mg	20 Pills	61.69€ 58.75€	Buy
Kamagra	100mg	20 Pills	86.09€ 81.99€	Buy
Viagra Generic	100mg	360 + 10 Pills	330.21€ 314.49€	Buy
Viagra Generic	150mg	30 + 2 Pills	72.32€ 68.88€	Buy
Viagra Generic	50mg	30 + 4 Pills	54.26€ 51.68€	Buy
Kamagra Soft Tabs	100mg	180 + 8 Pills	425.45€ 405.19€	Buy
Viagra Generic	50mg	10 Pills	26.87€ 25.59€	Buy

It also has side effects that delay ejaculation. Tramadol might be prescribed when SSRIs haven't been effective. Tramadol can't be used in combination with an SSRI. Side effects might include nausea, headache, sleepiness and dizziness. Tramadol can become habit-forming when taken long-term.

Pharmacologic Therapy

Your care provider might recommend avoiding intercourse for a period of time. Focusing on other types of sexual play may remove the pressure you might feel during sexual intercourse. The male pelvic floor muscles support the bladder and bowel and affect sexual function. Kegel exercises can help strengthen these muscles. Weak pelvic floor muscles might make it harder to delay ejaculation.

What to expect from your doctor

Pelvic floor exercises (Kegel exercises) can help strengthen these muscles. To find your pelvic floor muscles, stop urinating in midstream. Or tighten the muscles that keep you from passing gas. Both actions use your pelvic floor muscles. Once you've identified your pelvic floor muscles, you can exercise them in any position.

Pregnancy and breastfeeding while taking sildenafil

However, you might find it easier to do them lying down at first. Tighten your pelvic floor muscles, hold for three seconds and then relax for three seconds. Try it a few times in a row. When your muscles get stronger, try doing Kegel exercises while sitting, standing or walking. For best results, focus on tightening only your pelvic floor muscles. Some medications used to treat erectile dysfunction also might help premature ejaculation.

• Sildenafil may enhance arousal and delay climax.
• The drug is not a cure for premature ejaculation.
• Overuse of sildenafil can lead to adverse effects.
• Combining sildenafil with alcohol can decrease effectiveness.
• Sexual timing and foreplay are natural PE remedies.
• Using sildenafil does not address orgasm control issues.
• Some men report increased confidence with sildenafil.
• The drug can cause priapism if misused.
• Psychological counseling can be beneficial for PE.
• Erectile health impacts PE treatment outcomes.
• Consistent use under medical supervision is recommended.

Side effects might include headache, facial flushing and indigestion.

Evaluation of ED Characteristics and Overall Satisfaction

Then waiting until the level sildenafil citrate 100 mg of arousal has diminished and starting again. Condoms might make the penis less sensitive, which can help delay ejaculation. Specially designed "climax control" condoms are available without a prescription. These condoms contain numbing agents such as benzocaine or lidocaine to delay ejaculation. They might also be made of thicker latex. These medications might be more effective when used in combination with an SSRI. Research suggests that several drugs might be helpful in treating premature ejaculation. This is a treatment for the sleeping disorder narcolepsy.

Parameter	Value	Explanation
Absorption	Fast, begins within 30 min	Peak plasma concentration achieved in 1 hour
Bioavailability	~40%	Due to first-pass metabolism
Metabolism	Liver (CYP3A4 enzyme)	Adjust dose if on CYP3A4 inhibitors
Excretion	Feces (~60%), urine (~30%)	Slow process, affects timing of doses

Researchers are studying whether injecting Botox into the muscles that help cause ejaculation can treat premature ejaculation.

Ethics declarations

If you’re concerned about premature ejaculation, focus on improving and maintaining your mental health. If you’re affected by premature ejaculation or if you simply think you reach orgasm too early, you can also try the following techniques to enhance your sexual experiences. Many men find that they’re more able to delay ejaculation on “round two.” If you’re prone to PE, try masturbating a few hours before sex — just make sure to keep your refractory period (the time after orgasm during which it is difficult or impossible to orgasm again) in mind. Some condoms contain a topical anesthetic to reduce sensitivity, which may allow you to last longer during sex. You can find these in most convenience stores and supermarkets.

Behavioral techniques

When premature ejaculation is caused by a psychological issue or a problem in your sexual relationship, talking openly and honestly with your partner may help you overcome it together. Deciding to focus on foreplay, for example, is one way you can extend your intimate time together and have other types of sexual stimulation. Erectile dysfunction is a condition in which you have trouble getting or keeping an erection firm enough for satisfying sex. Background: Recently, sildenafil has been demonstrated to be effective in treating premature ejaculation (PE). However, these studies ignored female factors and could not exclude the probability of drug interaction when combined with paroxetine.

The pathophysiology of acquired premature ejaculation

Therefore, the aim of this study was to evaluate the efficacy and safety of sildenafil alone in the treatment of primary PE, taking female factors into consideration. Methods: One hundred and eighty potent men with primary PE were randomly divided into three groups and followed up for 6 months. Group A were treated with 50 mg sildenafil as needed, group B with 20 mg paroxetine daily and group C with squeeze technique daily. Intravaginal ejaculatory latency time (IELT), PE grade, intercourse satisfactory score (ISS), frequency of intercourse, and adverse effects of drugs were recorded before treatment, and 3 and 6 months after treatment. Results: Compared with pretreatment, the three groups had significant differences in all the parameters after 3 or 6 months treatment, except the frequency of intercourse in Group C (all P = 0.00). This approach involves talking with a mental health provider about your relationships and experiences.

LinkOut - more resources

However, there were no significant differences between 3 and 6 months. Compared with paroxetine and squeeze technique, after 3 or 6 months, sildenafil had significant differences in all the parameters (all P = 0.00). After 6 months, 1.7%, 18.3% and 36.7% patients in groups A, B and C, respectively, withdrew from the study and 86.7%, 60.0% and 45.0% patients, respectively, wanted to be treated further with the original administration, and this was statistically significant (both P = 0.00). Conclusion: Sildenafil is very effective and safe to treat PE, and has much higher efficacy than paroxetine and squeeze technique. Your health care provider asks about your sex life and your health history.

Curr Opin Neurobiol

Your provider might also do a physical exam. If you have both early ejaculation and trouble getting or keeping an erection, your provider might order blood tests. The tests may check your hormone levels. In some cases, your care provider might suggest that you go to a urologist or a mental health provider who specializes in sexual problems. Common treatment options for premature ejaculation include behavioral techniques, medications and counseling.

Penile sensitivity in patients with primary premature ejaculation

It might take time to find the treatment or combination of treatments that work for you. Behavioral treatment plus drug therapy might be the most effective. In some cases, therapy for premature ejaculation involves simple steps. They may include masturbating an hour or two before intercourse. This may allow you to delay ejaculation when you have sex with your partner. Sessions can help you reduce performance anxiety and find better ways of coping with stress.

Dose (mg)	Recommended Timing	Food Interaction	Max Dose per Day	Special Considerations
50	1 hour before sex	Can be taken with or without food	100 mg	Lower doses may be effective for PE
100	1 hour before sex	Avoid high-fat meals to improve absorption	100 mg	Use under medical supervision
25	As needed	Slow onset, less side effects	100 mg	Not typically recommended for PE

Counseling is most likely to help when it's used in combination with drug therapy.

How ED and PE Are Connected: Exploring Shared Causes

Examples include Trojan Extended Pleasure and Durex Prolong. Creams, gels and sprays that contain a numbing agent — such as benzocaine, lidocaine or prilocaine — are sometimes used to treat premature ejaculation. They're applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation. However, a cream containing both lidocaine and prilocaine (EMLA) is available by prescription. Although topical numbing agents are effective and well tolerated, they have potential side effects. With premature ejaculation, you might feel that you lose some of the closeness shared with a sexual partner. You might feel angry, ashamed and upset, and turn away from your partner.

• Early ejaculation is a normal variation for some men.
• Understanding personal sexual response helps manage PE.
• Sensory-enhancing devices may delay climax.
• Medications are not the only solution to PE.
• Regular exercise benefits erectile and ejaculatory health.
• Stress management techniques can improve PE outcomes.
• PE can be a sign of underlying medical issues.
• clinician-guided treatment yields better safety profiles.
• Support from partners encourages successful treatment.
• Combining therapy approaches often gives the best results.
• Healthy lifestyle choices support sexual function.

Your partner also might be upset with the change in sexual intimacy. Premature ejaculation can cause partners to feel less connected or hurt. Talking about the problem is an important step. Relationship counseling or sex therapy also might be helpful. There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form. Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. We use the data you provide to deliver you the content you requested. To provide you with the most relevant and helpful information, we may combine your email and website data with other information we have about you. If you are a Mayo Clinic patient, we will only use your protected health information as outlined in our Notice of Privacy Practices.