What is premature ejaculation?

You’re not alone. PE may be the most common sexual disorder for men. Some studies estimate that 1 in 3 men have PE.

Premature ejaculation is defined as consistently ejaculating with minimal stimulation before or during sex. Men with PE have little or no control over when they ejaculate, causing distress for both themselves and their partners.

Some men supplement prescription medicines with behavioral techniques that involve pausing or squeezing when feeling the urge to ejaculate. The most effective way to treat PE is often a combination of medicine, techniques and behavioral practices.

How PE medicines work

Ejaculation is controlled by a complex process involving sensory and motor pathways between the penis and the brain. The neurotransmitter serotonin plays a central role in these pathways.
Sertraline is a selective serotonin reuptake inhibitor (SSRI) that is FDA approved for treating anxiety and depression. Patients taking SSRI medicines like sertraline found that a “side effect” they experienced was a delay in ejaculation. Sertraline is prescribed off-label for daily use (most effective) or as needed before sex for treatment of PE. Sertaline has been well studied and is commonly prescribed by doctors for this purpose.

Sildenafil, Viagra, Cialis, Levitra
These medicines are prescribed for erectile dysfunction (ED). Often times, men experiencing ED may also experience PE. In men with both conditions, treatment of ED has been shown to be beneificial for PE. When the ED is a treated, it can lead to a reduction in stress and performance anxiety, as well as needing less stimulation to stay erect. This is thought to help delay ejaculation in these cases. We most commonly prescribe Sildenfil (active ingredient in Viagra) to take as needed before sex.

Treatment & risks

Sertraline (Zoloft), sildenafil 20mg, Viagra, Cialis, and Levitra are the most common medicines we prescribe for PE. Our medical team can discuss the differences in your consultation and can recommend the one that’s best for you, based on your health history.

Although the FDA hasn’t approved these medicines for treatment of PE, they have been well studied and are commonly prescribed by doctors for this purpose. Do not take them recreationally. They are generally safe but can cause serious side effects. This includes gastrointestinal bleeding, seizures, coma, impairment of cognitive or motor functions, irritability, a painful erection lasting more than 4 hours, sudden loss of vision in one or both eyes, sudden decrease or loss of hearing, allergic reaction, permanent disability, and death. Each medicine has a unique set of side effects.

Before taking any medicine, always read the package insert that comes with the medicine for a full list of side effects and warnings.

See a doctor in person if any of the following apply

  • Under 25
  • 73 or older
  • Have not had a physical exam by a doctor in the past 5 years which included a genital exam
  • Any condition where sex is not advised
  • Don't know your blood pressure
  • Low blood pressure or unexplained fainting or dizziness
  • Bipolar disorder
  • You’re suicidal or have uncontrolled depression
  • Taking the medicine nitroglycerin or other medicines that contain nitrates
  • Taking an SSRI medicine (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline)
  • Taking MAOIs or have taken MAOIs in the previous 2 weeks
  • Seizure history
  • Kidney disease
  • Liver disease
  • You have HIV
  • Abnormal heart rhythm
  • Heart disease, stroke, or other cardiovascular disease
  • You have a bleeding disorder, or taking medications that increase risk of bleeding
  • Physical abnormality of the penis, including Peyronie's disease
  • You're a woman