Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 3/22/2023
Here’s the reality of modern premature ejaculation treatment: it’s actually one of the most common male sexual problems, affecting as much as 39 percent of us. And yet, we don’t technically have a pill to treat it.
Don’t get us wrong — there are treatments that work by delaying ejaculation and helping you avoid orgasming too early. But most “premature ejaculation pills” are actually antidepressants or PDE5 inhibitors like sildenafil (the active ingredient in Viagra®). Or they’re treatments in the form of local anesthetics like lidocaine or benzocaine.
So what does ED treatment with antidepressants or PDE5 inhibitors look like? You’ve got questions, so we’ve got answers — specifically, answers to questions including:
Why do these medications treat PE?
Are they safe to use?
Are there alternative treatment options?
Premature ejaculation pills are pills that treat premature ejaculation — duh. And they’re some of the most reliable and safe treatments a healthcare provider can offer you. They’re just not approved for PE treatment by the FDA — every medication prescribed for premature ejaculation is actually a pill originally intended for another purpose.
For the best example, we need to look no further than selective serotonin reuptake inhibitors. SSRIs are a class of medications generally used to treat depression. They’re believed to work by helping regulate the amount of serotonin in your brain at any one time, which is believed to help alleviate some of the symptoms of depression.
Sertraline (commonly sold as Zoloft®) is one of the most widely-used psychiatric medications available, but it’s one of the most popular SSRIs among people with PE problems because one of its main “side effects” is delayed ejaculation. Like, actually.
Another commonly used PE pill, meanwhile, is actually another sexual dysfunction drug — the ED pill — known as a phosphodiesterase-5 inhibitor.
PDE5 inhibitors like sildenafil (Viagra), tadalafil (Cialis®) and avanafil (Stendra®) are technically intended to work as vasodilators.
They improve your sex life by increasing blood flow to your penis. Since healthy erections are all about blood flow, increased blood supply makes developing and maintaining an erection easier when you feel sexually aroused.
For the ED-free among us (lucky you), these same drugs are sometimes used off-label as treatments for premature ejaculation for a more subtle list of reasons we’re about to dig into.
SSRIs are typically used to treat depression and anxiety. However, since they often help to slow down orgasm and ejaculation, some healthcare providers will prescribe them “off-label” for premature ejaculation.
In addition to a selective serotonin reuptake inhibitor, healthcare professionals may also recommend prescription erectile dysfunction (ED) medications such as sildenafil (Viagra®).
If a doctor prescribed you boner pills for an injured elbow or antidepressants for a stomach ache, you’d rightfully check to see if their degrees were printed by an inkjet printer or designed in MS Paint. But let’s take a closer look at why these medications are surprisingly well-targeted when used to treat PE.
Most of us don’t realize how much sexual experiences and sexual activity are mental exercises, but SSRIs can treat PE regardless of whether there are psychological issues or psychological causes at fault.
SSRIs are all different, and while you may see benefits from any of the medications in this class, in reality, there’s one champion by volume of evidence: sertraline.
Studies of sertraline show that these medications can often treat premature ejaculation symptoms when used daily, usually by a significant amount.
One study from 1998 gave men with premature ejaculation 25mg of sertraline daily, then 50 mg per day after three weeks, then 100 mg another three weeks later.
After taking a 25mg daily dose of sertraline, the mean ejaculation time of the group increased from one minute to 7.6 minutes.
Once the men started to take the higher 50mg per day dose of sertraline, their ejaculation time increased to a mean of 13.1 minutes.
At a 100mg dose, the men had a mean ejaculation time of 16.4 minutes.
At the 50mg and 100mg doses of sertraline, a small number of men involved in the study started to develop anejaculation, or an inability to orgasm during sex.
While SSRIs are the most common medication for the treatment of premature ejaculation, healthcare providers also sometimes prescribe tricyclic antidepressants (TCAs) like Clomipramine.
Our guide to sertraline for premature ejaculation goes into more detail about the latest research behind sertraline as a PE treatment.
Research has found that many men with PE experience improvements after using ED medications such as sildenafil. Look at the data:
A 2007 study compared the effects of sildenafil, paroxetine (an SSRI) and the squeeze technique (a self-care technique for PE that involves squeezing the penis during sex) to see which option best treated PE. At the end of six months, the researchers found that sildenafil was the most effective treatment.
Another study from 2005 found that while sildenafil doesn’t directly increase the time before orgasm, it can improve confidence and increase the perception of ejaculatory control.
The same researchers also found that sildenafil reduces refractory time, making it easier for men with premature ejaculation to get a second erection shortly after sex.
Even if there’s no improvement in ejaculation time the first time you have sex, sildenafil might make it easier to enjoy round two with your partner.
Like all medications, PDE5 inhibitors and SSRIs can cause potential side effects, and not all of them are actually PE benefits in disguise.
Potential side effects of sertraline include:
Appetite and/or weight changes
Changes in sex drive and/or sexual performance
Many of these are common potential side effects of all antidepressants. You can learn more about what to expect from SSRIs in our guide to antidepressant side effects.
Sildenafil and other PDE5 inhibitors, on the other hand, generally only cause mild side effects while they’re active in your body. Potential side effects of sildenafil include:
Numbness or tingling in the limbs
Increased sensitivity to light
Changes in your ability to perceive color
If your goal is to last longer during sex without prescription medication, there are some alternative treatments for PE that are worth considering, either as part of a broader treatment plan or on their own.
Nothing’s going to replace talking with a healthcare professional, but you might see improvements from:
Lidocaine premature ejaculation spray. Lidocaine is a topical anesthetic that, when applied to your penis, helps you avoid premature ejaculation by reducing sensitivity. Lidocaine is a good alternative to prescription medications for PE. You can find it as an active ingredient in our Delay Spray for Men, which is designed for quick and easy use 10 to 15 minutes before you have sex.
Premature ejaculation cream. Like premature ejaculation sprays, these creams contain topical anesthetics such as lidocaine to lower the sensitivity level of your penis and help you avoid ejaculating too soon.
PE prevention techniques. Techniques like the stop-start strategy and squeeze technique, appear to help prevent PE. We’ve covered the squeeze technique and others (and the scientific research on their effectiveness) in our guide to stopping premature ejaculation.
Behavioral therapy. Fun fact: PE is sometimes psychological. Because of that, some forms of behavioral therapy may help treat it. Common forms of therapy used to treat sexual performance issues include cognitive-behavioral therapy (CBT) and sex therapy.
Pelvic floor exercises. Also referred to as kegel exercises, pelvic floor exercises involve strengthening the pelvic floor muscles to control ejaculation. Research shows that kegel exercises can often improve ejaculatory control and delay orgasm in men with PE.
Masturbating before sex. While it’s certainly far from scientific, some people claim that masturbating a few hours before sex helps to delay orgasm and ejaculation by keeping you in the post-sex refractory period.
Step into your local sex store, gas station or search online and you’ll find countless supplements to help improve sexual intercourse and last longer in bed. You can also grab a 64-ounce soda and some lottery tickets.
Most of the time, these products contain herbal ingredients such as:
Some of these ingredients (those last three) may help to improve your sexual performance in a general “yay vitamins” kind of way — they’re far from anything close to a “treatment” though.
However, there’s only limited scientific evidence to support most over-the-counter supplements for premature ejaculation. And gas station pills aren't alternatives — they're unregulated and potentially dangerous and should be avoided at all costs.
Many of these delayed ejaculation supplements and male enhancement pills make bold, ambitious claims about their ability to prevent premature ejaculation and improve your sexual performance.
While they can sound appealing — à la "horny goat weed" — it’s important to remember that they generally aren’t backed up by real, provable scientific evidence.
It’s also important to remember that these products aren’t really regulated by the FDA, meaning they can be marketed using claims that real medications can’t make. These products don’t face any real testing, so they can get away with saying whatever they want, pretty much.
Until PE gets its own medication class, antidepressants and ED meds are your best bet. Regardless of whether you’re ready to try medication to last longer or want to give the home remedies more time to work, here’s what you should remember:
You’re not alone if you’re dealing with PE. Premature ejaculation is a common issue that can affect men of all ages.
Don’t be ashamed. As with erectile dysfunction and other common medical conditions, there’s no shame in using medication to treat PE and improve your sexual performance, sexual relationship with your partner/s, sexual health or your own personal sexual pleasure.
The solution is to get treated — safely. Avoid medications sold over the counter for your safety. Instead, stick to proven prescription treatments such as sertraline, paroxetine or sildenafil.
We offer these premature ejaculation treatments online, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.
Worried about premature ejaculation? Our guide to premature ejaculation explains how and why PE occurs, what you might notice if you’re prone to PE, and your options to improve your sexual stamina and delay ejaculation.