Clinical Evidence on Sildenafil for Rapid Ejaculation

A new combination treatment for premature ejaculation: A sex therapist’s perspective. Symonds T, Perelman MA, Althof S, Giuliano F, Martin M, May K, Abraham L, Crossland A, Morris M. Development and validation of a premature ejaculation diagnostic tool. Azam U. Late-stage clinical development in lower urogenital targets: Sexual dysfunction. Taber MT, Wright RN, Molski TF, Clarke WJ, Brassil PJ, Denhart DJ, Mattson RJ, Lodge NJ. Neurochemical, pharmacokinetic, and behavioral effects of the novel selective serotonin reuptake inhibitor BMS-505130. Pharmacol Biochem Behav 2005;80:521–8. Aloosh M, Hassani M, Nikoobakht M. Seminal plasma magnesium and premature ejaculation: A case-control study. Q. I am in a new sexual relationship and surprised that at age 63 I have 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

My partner is understanding, but it bothers me. Premature ejaculation is common in older men, especially when beginning a new relationship. Even men with erectile dysfunction (ED), who have difficulty getting and holding an erection, can experience premature ejaculation. It's great that your partner is so understanding, and it benefits you both to be open about the issue and discuss your options together. The official definition of premature ejaculation is uncontrolled and unwanted ejaculation within a minute or less of penetration. Personally, I think this definition is too limiting.

• Premature ejaculation is classified as lifelong or acquired.
• Lifelong PE begins from the first sexual experience.
• Acquired PE develops after a period of normal function.
• Sensory sensitivity might influence PE severity.
• Partner communication can improve PE management.
• Pelvic floor exercises may help control ejaculation.
• Squeeze techniques can delay climax.
• Pharmacological options include SSRIs, dapoxetine.
• Biofeedback therapy is an emerging PE treatment.
• Erectile dysfunction and PE can coexist.
• Proper diagnosis ensures effective treatment.

Of course, men need to be realistic about their expectations for staying power. But if a man is consistently ejaculating before he wants to, and it causes him distress, then he should speak with his doctor. However, there are two techniques you and your partner can try right away that may help. They are the "stop-start" and "stop-squeeze" methods. With stop-start, you begin sexual intercourse and keep going until you are close to the point of orgasm. You stop all sexual stimulation until the feeling passes and then resume intercourse.

• 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.

When you approach orgasm, you pause, and you (or your partner) use the thumb and two fingers to gently apply pressure just below the head of the penis for about 20 seconds.

• Sildenafil's role in PE is still under research.
• Off-label use requires informed consent.
• Behavioral techniques are first-line in many cases.
• The impact of psychological health on PE should not be ignored.
• Educating patients on realistic expectations is important.
• Sometimes, medication just masks underlying issues.
• Regular sexual activity can decrease PE severity.
• Consulting a urologist is recommended for persistent PE.
• Combining medication with therapy often improves outcomes.
• Delaying ejaculation involves both physical and mental strategies.
• Support and understanding enhance treatment adherence.

Then release the squeeze, and resume sexual activity. Both techniques can be repeated as often as needed. Another option is to apply a topical numbing agent to the head of the penis. The most convenient types are sprays that contain lidocaine or a similar anesthetic product.

Research Design

Salonia A, Maga T, Colombo R, Scattoni V, Briganti A, Cestari A, Guazzoni G, Rigatti P, Montorsi F. A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation. FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. Available at NEW01624.html (accessed March 24, 2008). Rosen RC, Casey R, Levine SB, Mudumbi R, Tesfaye F, Hasmonay R.

FAQs on ED Medications and Premature Ejaculation

Treatment of premature ejaculation (PE) with dapoxetine (DPX) is not associated with suicidality. Healy D, Whitaker C. Antidepressants and suicide: Risk-benefit conundrums. Girgis SM, El-Haggar S, El-Hermouzy S. A double-blind trial of clomipramine in premature ejaculation.

Phosphodiesterase type 5 inhibitors

Clomipramine as a treatment for rapid ejaculation: A double-blind crossover trial of fifteen couples. Effective daily treatment with clomipramine in men with premature ejaculation when 25 mg (as required) is ineffective. Maier U, Koinig G. Andrological findings in young patients under long-term antidepressive therapy with clomipramine. Mousavizadeh K, Ghafourifar P, Sadeghi-Nejad H. You will need to test this out to see if your partner finds it causes irritation. (Using condoms also might help by reducing sensation.) Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), can counter premature ejaculation because delayed orgasm is a common side effect. Some studies suggest that paroxetine (Paxil) may be the most helpful, but any of the other SSRIs also should work, such as fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). However, they need to be taken daily, since they don't work on an as-needed basis. Men who have both ED and premature ejaculation should first address their ED. That usually entails taking medication like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), or avanafil (Stendra).

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After this, they can add an SSRI. Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.

Effect	Description	Onset Time	Duration	Notes
Vasodilation	Dilates blood vessels to improve blood flow	30-60 min	4-6 hours	Main mechanism for erectile support
Neural modulation	May influence neural pathways involved in ejaculation	N/A	N/A	Not fully understood
Side effects	Headache, flushing, dizziness	Within hours	Varies	Common with higher doses

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Counseling and Sex Therapy

Calcium channel blocking activity of thioridazine, clomipramine and fluoxetine in isolated rat vas deferens: A relative potency measurement study. Tramadol HCL has promise in on-demand use to treat premature ejaculation. J Sex Med 2008;5:188–93. Safety and efficacy of tramadol in the treatment of premature ejaculation: A double-blind, placebo-controlled, fixed-dose, randomized study. Laumann EO, Nicolosi A, Glasser DB, Paik A, sildenafil tablet manforce 50 mg Gingell C, Moreira E, Wang T.

Neurobiology of sexual behavior

Sexual problems among women and men aged 40–80 y: Prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Ejaculatory abnormalities in mice lacking the gene for endothelial nitric oxide synthase (eNOS-/-). Abdel-Hamid IA ENE, El Gilani A-H. Assessment of as needed use of pharmacotherapy and the pausesqueeze technique in premature ejaculation. Efficacy of sildenafil citrate in treatment of erectile dysfunction: Impact of associated premature ejaculation and low desire. Sildenafil (Revatio, Viagra) is a generic prescription medication used to treat erectile dysfunction and pulmonary arterial hypertension in adults. Sildenafil, which is also called sildenafil citrate, comes as an oral tablet.

Surgical Intervention

Safety and efficacy of escitalopram in the treatment of premature ejaculation: A doubleblind, placebo-controlled, fixed-dose, randomized study. Giuliano F, Clement P. Serotonin and premature ejaculation: From physiology to patient management. Clomipramine and sexual function in men with premature ejaculation and controls. Giuliano F.

More Information

5-Hydroxytryptamine in premature ejaculation: Opportunities for therapeutic intervention. Giuliano F. Interview with Dr Francois Giuliano (by Christine McKillop). New avenues in the pharmacological treatment of premature ejaculation. Relevance of an evidence-based ejaculation time cutoff point for neurobiological research of premature ejaculation.

Male pelvic floor muscles

Animal models of premature and retarded ejaculation. Waldinger MD, Schweitzer DH, Olivier B. On-demand SSRI treatment of premature ejaculation: Pharmacodynamic limitations for relevant ejaculation delay and consequent solutions. J Sex Med 2005;2:121–31. Peripheral and central neurochemical effects of the selective serotonin reuptake inhibitors (SSRIs) in humans and nonhuman primates: Assessing bioeffect and mechanisms of action. The drug also comes as an oral liquid suspension and IV infusion. However, this article does not cover these forms.

Can ED Medications Boost Confidence and Sexual Stamina?

Goldmeier D, Lamba H. Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation by Abdel-Hamid et al. Intracavernous medication for treatment of premature ejaculation. Chen J, Mabjeesh NJ, Matzkin H, Greenstein A. Efficacy of sildenafil as adjuvant therapy to selective serotonin reuptake inhibitor in alleviating premature ejaculation. It only covers the side effects of sildenafil oral tablets.

Access options

Sprouse J, Braselton J, Reynolds L, Clarke T, Rollema H. Activation of postsynaptic 5-HT(1A) receptors by fluoxetine despite the loss of firingdependent serotonergic input: Electrophysiologicaland neurochemical studies. Sprouse J, Clarke T, Reynolds L, Heym J, Rollema H. Comparison of the effects of sertraline and its metabolite desmethylsertraline on blockade of central 5-HT reuptake in vivo. Anderson GM, Barr CS, Lindell S, Durham AC, Shifrovich I, Higley JD.

Arch Sex Behav

Time course of the effects of the serotonin-selective reuptake inhibitor sertraline on central and peripheral serotonin neurochemistry in the rhesus monkey. Waldinger MD, Zwinderman AH, Olivier B. On-demand treatment of premature ejaculation with clomipramine and paroxetine: A randomized, double-blind fixed-dose study with stopwatch assessment. Eur Urol 2004;46:510–5; discussion 516. Modi NB, Dresser MJ, Simon M, Lin D, Desai D, Gupta S.

Construction of scales for the Center for Marital and Sexual Health (CMASH) sexual functioning questionnaire

Single- and multiple-dose pharmacokinetics of dapoxetine hydrochloride, a novel agent for the treatment of premature ejaculation. Pryor JL, Althof SE, Steidle C, Rosen RC, Hellstrom WJ, Shabsigh R, Miloslavsky M, Kell S. Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: An integrated analysis of two double-blind, randomised controlled trials. McMahon CG, Touma K. Treatment of premature ejaculation with paroxetine hydrochloride as needed: 2 single-blind placebo controlled crossover studies. If you’d like to learn more about these forms, talk with your doctor.

• Erectile function and PE may influence each other.
• Sildenafil can improve erectile rigidity, indirectly helping PE.
• Psychological factors often underpin PE.
• A detailed sexual history is essential for diagnosis.
• PE is a common condition, not a reflection of masculinity.
• Non-pharmacological methods include start-stop techniques.
• Partner cooperation enhances treatment outcomes.
• Some men experience placebo effects from medications.
• Regular follow-up is necessary to assess progress.
• Emotional well-being is linked to sexual health.
• Combining therapy modalities can provide best results.

As with other drugs, sildenafil can cause side effects (adverse effects). It’s typically taken as a long-term treatment. Read on to learn about potential common, mild, and serious side effects. For a general overview of sildenafil, including details about its uses, refer to this article. Your doctor can also tell you more about sildenafil. Sildenafil can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist. These are just a few of the more common side effects reported by people who took sildenafil in clinical trials:* * To learn more about the clinical trials of sildenafil, refer to the drug’s prescribing information for erectile dysfunction and pulmonary arterial hypertension.