Premature ejaculation affects as much as 39% of all men at some point in life, making it one of the most common male sexual problems. While premature ejaculation can be stressful and challenging to deal with, it doesn’t need to be a problem you live with for your entire life. Today, a variety of treatments are available to help you last longer in bed. These treatment options include premature ejaculation pills, which work by delaying ejaculation and helping you avoid orgasming too early.
Most premature ejaculation pills are selective serotonin reuptake inhibitors, or SSRIs. There are also other types of medication used to treat premature ejaculation, including PDE5 inhibitors like sildenafil (Viagra) and topical anesthetics.
Below, we’ve explained how the best premature ejaculation pills work, as well as the alternative options that are available to help avoid premature ejaculation.
Why Does Premature Ejaculation Happen?
Premature ejaculation (PE) can occur for a variety of reasons. Sometimes, it occurs as a result of psychological factors such as performance anxiety, a form of anxiety about your performance in bed. Other psychological factors that can cause PE include depression and stress.
It’s also possible for physical factors to contribute to PE. If your penis is very sensitive to touch, stimulation from foreplay or vaginal sex can cause you to orgasm early. Experts also think that thyroid and prostate issues might contribute to early ejaculation during sexual activity.
Our guide to premature ejaculation (yes, we wrote one of those, and you're all welcome for it) goes into more detail on the key causes of premature ejaculation, as well as the factors used to diagnose PE.
How Premature Ejaculation Pills Work
Premature ejaculation is a very common problem, affecting tens of millions of men in the United States alone. As such, a variety of treatments are available to help you avoid orgasming too early.
The most popular and best premature ejaculation pills can be sorted into one of two categories:
- Over-the-counter supplements or premature ejaculation home remedies. These pills are available from sex stores, supplement stores, Amazon and other marketplaces. Most of the time, they contain herbal ingredients like horny goat weed, tongkat ali and maca root.
Many of these supplements make bold claims about their ability to improve your sexual performance. While they can sound appealing—à la "horny goat weed"—it’s important to remember that most of these claims are not backed up by real, provable scientific evidence.
They’re also untested and unapproved by the FDA as treatments for PE, meaning it’s best to take their claims with a grain of salt.
- Prescription medications. Several prescription medications are used to treat premature ejaculation. The most common are SSRIs such as sertraline, as well as PDE5 inhibitors such as sildenafil (Viagra) and tadalafil (Cialis). SSRIs are drugs that have been approved by the FDA for treatment of depression and certain other conditions, but have not been specifically approved for use in the treatment of premature ejaculation. However, doctors will sometimes prescribe drugs for a condition for which the FDA has not specifically reviewed and approved the use of the drug if they believe the drug is medically appropriate to treat the condition. In such a case, the drug is being prescribed by doctors for an “off-label use”.
SSRIs and PDE5 inhibitors both work differently to help you avoid premature ejaculation.
How SSRIs Treat Premature Ejaculation
Selective serotonin reuptake inhibitors, or SSRIs, are a class of medication designed to treat depression. As a treatment for depression, SSRIs work by increasing the amount of serotonin present in your brain at any one time, potentially alleviating depression.
When it comes to treating depression, SSRIs work extremely well. However, they have a big, well-known side effect: For many people, SSRIs can increase the amount of time and effort required to reach orgasm during sexual activity.
This means that some SSRIs, such as sertraline, can work effectively as treatments for premature ejaculation. Sertraline (commonly sold as Zoloft) is one of the most prescribed psychiatric medicines available.
Studies of sertraline and other SSRIs show that it can treat premature ejaculation symptoms when used daily, often by a significant amount.
In one study from 1998, men with premature ejaculation were given a 25mg dose of sertraline daily. After three weeks, the dose was increased 50mg per day. After another three weeks, the men were given a higher 100mg daily dose of sertraline.
Before using the sertraline, the men in the study had a mean ejaculation time of approximately one minute. With a 25mg daily dose, the mean ejaculation time of the group increased from one minute to 7.6 minutes. Once the men started to take the higher 50mg 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. However, at the 50mg and 100mg doses, a small number of men involved in the study experienced anejaculation, or an inability to orgasm during sex.
How PDE5 Inhibitors Treat Premature Ejaculation
PDE5 inhibitors such as sildenafil (Viagra) and tadalafil (Cialis) are best known as treatments for erectile dysfunction, or ED. However, studies show that they’re also effective at improving some symptoms of premature ejaculation.
Sildenafil works by increasing the amount of blood that can flow into the soft tissue of your penis when you feel aroused. By increasing blood flow, sildenafil makes it easier to become and stay hard during sexual activity.
While sildenafil doesn’t directly affect your ability to ejaculate, studies show that it’s effective as a treatment for premature ejaculation.
In a study from 2007, researchers compared sildenafil to SSRIs such as paroxetine. After six months of treatment, they determined that sildenafil is “very effective and safe” as a treatment for premature ejaculation, with a higher efficacy rate than paroxetine.
In another study from 2005, researchers found that while sildenafil doesn’t directly increase the average amount of time before orgasm in men with PE, it can improve confidence and increase the perception of ejaculatory control.
The researchers also found that sildenafil reduces refractory time, making it easier for men with premature ejaculation to get a second erection shortly after sex.
Alternatives to Premature Ejaculation Pills
While SSRIs like sertraline and PDE5 inhibitors like sildenafil can help you last longer during sex and avoid premature ejaculation, they aren’t the only treatment options available. Other options for treating premature ejaculation include:
- Lidocaine spray. Lidocaine is a topical anesthetic that reduces sensitivity when it’s applied to your penis, helping you avoid premature ejaculation from overstimulation.
If you prefer not to use oral medication to treat PE, lidocaine is a good alternative. Our guide to lidocaine spray goes into more detail on how lidocaine spray works, as well as the scientific data to back up its benefits as a premature ejaculation treatment.
- Lidocaine cream. Lidocaine is also available as a cream, although this type of topical lidocaine doesn’t work as quickly as most sprays.
- Premature ejaculation prevention techniques. The internet is awash with premature ejaculation home remedies and techniques, and some of them are definitely viable options. Some techniques, like the “stop-start” strategy and “squeeze” technique, can help to prevent PE. We’ve covered these in our guide to stopping premature ejaculation.
- Supplements. Some supplements—namely, magnesium and zinc—might improve your sexual performance. However, the evidence for these supplements as treatments for premature ejaculation is limited.
Learn More About Premature Ejaculation
Our guide to premature ejaculation explains how and why premature ejaculation happens in more detail, as well as the key symptoms used to diagnose premature ejaculation, statistics and study data about PE and more.
Important Safety Information
IMPORTANT SAFETY INFORMATION
Do not take Sildenafil (sildenafil citrate) if you:
- take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
are allergic to sildenafil, as contained in Sildenafil and REVATIO, or any of the ingredients in Sildenafil
Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or nausea during sex, seek immediate medical help
Sildenafil can cause serious side effects. Rarely reported side effects include:
- an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, get medical help right away. If it is not treated right away, priapism can permanently damage your penis
- sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking Sildenafil and call your healthcare provider right away if you have any sudden vision loss
sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking Sildenafil and contact a doctor right away
Before you take Sildenafil, tell your healthcare provider if you:
- have or have had heart problems such as a heart attack, irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
- have had heart surgery within the last 6 months
- have pulmonary hypertension
- have had a stroke
- have low blood pressure, or high blood pressure that is not controlled
- have a deformed penis shape
- have had an erection that lasted for more than 4 hours
- have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia
- have retinitis pigmentosa, a rare genetic (runs in families) eye disease
- have ever had severe vision loss, including an eye problem called NAION
- have bleeding problems
- have or have had stomach ulcers
- have liver problems
have kidney problems or are having kidney dialysis have any other medical conditions
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Sildenafil may affect the way other medicines work, and other medicines may affect the way Sildenafil works, causing side effects. Especially tell your healthcare provider if you take any of the following:
- medicines called nitrates
- medicines called guanylate cyclase stimulators such as Adempas (riociguat)
- medicines called alpha-blockers such as Hytrin (terazosin HCl), Flomax (tamsulosin HCl), Cardura (doxazosin mesylate), Minipress (prazosin HCl), Uroxatral (alfuzosin HCl), Jalyn (dutasteride and tamsulosin HCl), or Rapaflo (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. In some patients, the use of Sildenafil with alpha-blockers can lead to a drop in blood pressure or to fainting
- medicines called HIV protease inhibitors, such as ritonavir (Norvir), indinavir sulfate (Crixivan), saquinavir (Fortovase or Invirase), or atazanavir sulfate (Reyataz)
- some types of oral antifungal medicines, such as ketoconazole (Nizoral) and itraconazole (Sporanox)
- some types of antibiotics, such as clarithromycin (Biaxin), telithromycin (Ketek), or erythromycin
- other medicines that treat high blood pressure
- other medicines or treatments for ED
Sildenafil contains sildenafil, which is the same medicine found in another drug called REVATIO. REVATIO is used to treat a rare disease called pulmonary arterial hypertension (PAH). Sildenafil should not be used with REVATIO or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca tadalafil)
Sildenafil does not protect against sexually transmitted diseases, including HIV.
The most common side effects of Sildenafil: headache; flushing; upset stomach; abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision; stuffy or runny nose; back pain; muscle pain; nausea; dizziness; rash.
Sildenafil (sildenafil citrate) is prescription medicine used to treat erectile dysfunction (ED).
Sildenafil is not for women or children.