Premature Ejaculation Pills: How They Work and Alternatives

Kristin Hall, FNP

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 11/16/2021

Premature ejaculation, or rapid 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 (the active ingredient in 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.

What is Premature Ejaculation?

Premature ejaculation, or PE, is a common form of male sexual dysfunction. Men with PE tend to reach orgasm and ejaculate early during sex -- typically either after less than a

minute of sex, or in some cases, before penetration.

Although precise definitions vary, most experts define premature ejaculation as ejaculating less than one minute after penetration, or between one minute and 90 seconds.

Like other male sexual performance issues, premature ejaculation can have a major impact on your sexual confidence and self-esteem. If you’re affected by PE, you might feel nervous before sex, or avoid sexual activity because you’re concerned about ejaculating too quickly.

For some men, premature ejaculation is a lifelong sexual issue that begins in adolescence and continues throughout adulthood. For others, it’s an acquired issue that develops at some point in life.

Our full guide to premature ejaculation goes into more detail about this common sexual issue, from how it can develop to symptoms and treatment options. 

What are the Symptoms of Premature Ejaculation?

The most significant symptom of premature ejaculation is reaching orgasm and ejaculating too early during sex. Some men with PE reach orgasm almost immediately after penetration, while others may be able to have sex for a short period of time before ejaculating. 

If you

have premature ejaculation, you may notice the following symptoms:

  • You ejaculate very quickly after penetration. During penetrative sex, you may reach orgasm and ejaculate in a minute or less, or in a shorter amount of time than you and/or your partner desire.

  • You’re unable to control your orgasm and ejaculation. Some experts define PE as a lack of self-control over orgasm and ejaculation, especially when this causes you or your partner to feel sexually dissatisfied.

  • You have persistent symptoms that don’t improve over time. Occasionally reaching orgasm too early doesn’t necessarily mean that you have PE. Premature ejaculation is a persistent issue that usually occurs for six months or longer.

  • Your symptoms cause you to feel distress. For most men, the symptoms of PE are a source of stress and frustration. You may feel less confident in bed, or avoid having sex because you feel unhappy or ashamed about your sexual performance. 

The symptoms of premature ejaculation can vary in severity. If you have mild PE, you might find it easy to have sex for a minute, but difficult to continue for much longer. If you have severe PE, you might find it difficult to avoid reaching orgasm even a few seconds after penetration.

Sometimes, premature ejaculation can be situational. For example, you might experience PE in certain sex positions, with specific types of stimulation or with sexual partners that cause you to feel particularly aroused. 

delay spray for men

longer sex is yours for the taking

Causes of Premature Ejaculation

Premature ejaculation (PE) can occur for a variety of reasons. Sometimes, it occurs as a result of physical factors, such as penile sensitivity. In other cases, it can develop from psychological issues, such as stress, sexual performance anxiety or feelings of guilt about sex.

Physical Causes of PE

For many guys, premature ejaculation is a physical issue that occurs because of the sensations of sex. Physical factors that may cause or worsen PE include:

  • Penis sensitivity. Research suggests that the sensitivity level of your penis may play a role in premature ejaculation. In one study, researchers found that men who were more sensitive to penile stimulation were more likely than their peers to suffer from PE.

  • Sexual stimulation. Sometimes, the physical sensation and mental stimulation of sex may cause you to reach orgasm and ejaculate earlier than you’d like to.

  • Thyroid issues. Some research suggests that hyperthyroidism (high levels of thyroid hormone) and premature ejaculation may be related. 

Psychological Causes of PE

Not all cases of PE are caused by physical factors. In fact, research suggests that lots of cases of PE are primarily psychological in nature. Psychological factors that can cause or contribute to PE include:

  • Depression. You may have a higher risk of experiencing premature ejaculation if you’re depressed. Research shows that depression is associated with a significantly higher risk of PE.

  • Anxiety. PE may occur because of anxiety, whether general or about sex specifically. In a review of case studies, researchers found that men with PE tend to have high rates of anxiety about their sexual performance.

  • Unrealistic expectations about sex. Sometimes, PE may be related to unrealistic and unachievable expectations about sexual performance.

  • Lack of confidence/poor body image. Premature ejaculation may be caused or made worse by a lack of self-confidence, which can add to performance anxiety and make sex more stressful.

  • Relationship problems. In some cases, PE may occur as a result of a problem in your relationship, such as stress or anxiety. 

Sometimes, a combination of different physical and psychological factors may all contribute to premature ejaculation. 

How Premature Ejaculation Pills Work

Because premature ejaculation is such a common problem, numerous products are marketed as “proven” treatments for PE. While some PE treatments really are effective, others are much less effective and are generally best avoided. 

In general, the most popular premature ejaculation pills can be sorted into one of two different categories.

Over-the-Counter PE Supplements

Step into your local sex store, gas station or search online and you’ll find countless supplements marketed as treatments for PE. Most of the time, these products contain herbal ingredients such as tongkat ali, horny goat weed and maca root. 

Many of these supplements 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, meaning it’s best to take their claims with a grain of salt.

Prescription Medications for PE

Several types of prescription medication are used to treat PE. The most common are selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft®).

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 other conditions, such as premature ejaculation. 

In addition to SSRIs like sertraline, premature ejaculation is sometimes treated with prescription erectile dysfunction (ED) medications such as sildenafil (Viagra®). 

How SSRIs Treat Premature Ejaculation

Selective serotonin reuptake inhibitors, or SSRIs, are a class of medications that are generally used to treat depression. 

As a treatment for depression, SSRIs work by increasing the amount of serotonin in your brain at any one time. This often helps to alleviate the symptoms of depression.

When it comes to treating depression, SSRIs work extremely well. However, they have a big, well-known side effect. 

This side effect is that for many people, SSRIs significantly increase the amount of time and effort that’s required to reach orgasm during sex. This means that SSRIs, such as sertraline, can work effectively as treatments for premature ejaculation.

Sertraline (commonly sold as Zoloft) is one of the most widely-used psychiatric medications available. 

Studies of sertraline and other SSRIs show that these medications can often treat premature ejaculation symptoms when used daily, usually 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 to 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. 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. However, 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.

Our guide to sertraline for premature ejaculation goes into more detail about the latest research behind sertraline as a PE treatment. 

How PDE5 Inhibitors Treat Premature Ejaculation

PDE5 inhibitors such as sildenafil (Viagra), tadalafil (Cialis®) and avanafil (Stendra®) are best known as treatments for erectile dysfunction, or ED.

These medications work by increasing blood flow to your penis. Since healthy erections are all about blood flow, this increase in blood supply makes it easier for you to develop and maintain an erection when you feel sexually aroused. 

Most PDE5 inhibitor medications come in tablet form and can be taken 30 to 60 minutes before sex.

In addition to treating PE, some PDE5 inhibitors are used off-label as treatments for premature ejaculation. 

For example, research has found that many men with PE experience improvements after using ED medications such as sildenafil. 

In a study published in the International Journal of Urology in 2007, researchers 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.

The men that took part in the study were instructed to use their medication or technique over a period of six months. At the end of the study, the researchers found that sildenafil was the most effective treatment. 

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.

In short, 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. 

Can Premature Ejaculation Pills Cause Side Effects?

Like all medications, SSRIs and PDE5 inhibitors can cause side effects. Potential side effects of sertraline include:

  • Nausea

  • Diarrhea

  • Constipation

  • Dizziness

  • Tiredness

  • Headache

  • Nervousness

  • Shaking

  • Vomiting

  • Difficulty sleeping

  • Dry mouth

  • Heartburn

  • Excessive sweating

  • Appetite and/or weight changes

  • Changes in sex drive and/or sexual performance

Many of these are common 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:

  • Headache

  • Facial flushing

  • Heartburn

  • Nosebleeds

  • Difficulty sleeping

  • Muscle aches

  • Numbness or tingling in the limbs

  • Increased sensitivity to light

  • Changes in your ability to perceive color

Our guide to the side effects of Viagra goes into more detail about these side effects, as well as what you can expect when using PDE5 inhibitors to treat PE or ED.

Alternatives to Premature Ejaculation Pills

Although 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 premature ejaculation spray. These PE sprays contain lidocaine, a topical anaesthetic that reduces sensitivity when it’s applied to your penis, helping you to avoid premature ejaculation from overstimulation. 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 anaesthetics such as lidocaine to lower the sensitivity level of your penis and help you avoid ejaculating too soon. 

  • PE prevention techniques. The internet is awash with premature ejaculation remedies and behavioral techniques, and some of them are viable options. Some techniques, like the stop-start strategy and squeeze technique, appear to help prevent PE.We’ve covered these techniques and the scientific research on their effectiveness in our guide to stopping premature ejaculation.

  • Behavioral therapy. Since PE is often psychological, some forms of behavioral therapy may help to 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, these involve strengthening the pelvic floor muscles to control ejaculation. Research shows that these exercises can often improve ejaculatory control and delay orgasm in men with PE.

  • Masturbating before sex. While it’s cetainly 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.

  • Dietary supplements. Some supplements, such as folic acid, zinc and biotin, may help to improve your sexual performance. However, there’s only limited scientific evidence to support most over-the-counter supplements for premature ejaculation.

premature ejaculation treatment

improve performance with doctor-trusted treatments

Learn More About Premature Ejaculation Pills

Premature ejaculation is a common issue that can affect men of all ages. Just like with erectile dysfunction and other common sexual problems, there’s no shame in using medication to treat PE and improve your sexual performance. 

When it comes to PE pills, it’s best to avoid anything sold over the counter and instead stick to proven prescription treatments. This means talking to a healthcare provider about options 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 delaying ejaculation. 

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

📫 Get updates from hims

Insider tips, early access and more.