Understanding Premature Ejaculation and Medication Options

But a recent study shows that the drugs eliminate PE in fewer than half of men and that within one year almost three-quarters of users—72 percent—stop taking them. The sex-therapy training approach works better, costs less, has no side effects, usually produces permanent cure, and increases women’s pleasure, not just because men last longer, but because the sex therapy program reorients lovemaking in ways most women prefer.

• Some PE pills are designed to be used as needed before sex.
• Side effects vary based on pill composition and individual health.
• It's important to differentiate between temporary and chronic PE.
• Combining pills with mindfulness training can improve sexual control.
• Educating oneself about PE helps in making informed choices.

The Little-Known Downsides of PE Medication The drugs used to treat PE belong to the most popular class of antidepressants: selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, Paxil, Lexapro, Luvox, Celexa, Viibri, and Brintellix. But soon after the FDA’s 1987 approval of the first SSRI, Prozac, it became clear that the SSRIs have a side effect—delay of orgasm, and possibly loss of ability to climax at all. Drug makers discovered that in men with PE, lowering the dose could delay but not totally suppress orgasm/ejaculation. Several analyses of low-dose SSRIs show the drugs help men last one to five minutes longer.

When to call a professional

It is important to wash the penis prior to intercourse, or wear a condom, to avoid desensitizing the partner, however. At UCLA Health—The Men’s Clinic, physicians are trained to treat rapid ejaculation and have a number of methods available. Treatment for PE and RE centers around behavioral, neurologic and hormonal modifications. Behavioral Therapy: Some patients respond to techniques such as starting and stopping. This basically involves interrupting intercourse to decrease stimulation to the penis in hopes of cooling the nerves down.

Intromission time

Although effective at times, most patients report limited sexual satisfaction with these methods. Topical medications: One of the simplest treatment option is to temporarily desensitize the head of the penis by using a topical anesthetic medications for premature ejaculation. They are effective, easy-to-use, low-cost and have a negligible risk of systemic side effects. Topical numbing sprays and creams are available with either a prescription or over the counter. They all work by gently numbing the sensitive areas of the penis so the nerves don’t fire so fast and the man can prolong intercourse.

Ejaculation Problems: Too Fast, Too Slow or Not at All

The agent must be washed off prior to intercourse or a condom must be worn to make sure the partner is not also desensitized. One option for patients is a new product, Promescent®, from Absorption Pharmaceuticals, which provides improved ejaculatory latency (the time from penetration to ejaculation) with minimal loss of sexual sensation. Oral medications: Some men respond well to low doses of the antidepressants known as selective serotonin reuptake inhibitors (SSRIs), that block serotonin, one of the hormones important in ejaculation. These are prescribed off-label, with some side effects. These pills have been around for over 20 years, are relatively safe, but are not FDA approved for PE / RE. The review authors call this “significant effectiveness.” Actually, that’s an exaggeration that borders on medical irresponsibility.

• Some pills may suppress ejaculation entirely if misused.
• Not all pills are suitable for men with certain health issues.
• Combining medication with pelvic exercises can enhance control.
• Expect gradual improvement; immediate effects are uncommon.
• Open communication with partner improves treatment outcomes.

Say a man lasts a few seconds to half-a-minute on his own.

SSRIs typically extend that into the range of 90 seconds to five or six minutes. But many men hope to last much longer. So even when the drugs “work,” they don’t deliver what many men want. Low-dose SSRIs may also cause side effects: drowsiness (8 percent of users), headache, nausea, and nervousness (5 percent each), and dizziness (4 percent). Around half of men who experience side effects call them moderate to severe, which may interfere with sexual function, pleasure, and satisfaction. Most men don’t want the hassle of managing pill use.

• Topical anesthetic creams and sprays are alternative options.
• Lifestyle modifications, like reducing stress, are helpful adjuncts.
• Natural pills should be scrutinized for scientific validation.
• Contraceptive pills do not treat PE but are often confused with treatments.
• Medications may have different durations of action depending on formulation.

And they don’t want to depend on costly, potentially problematic medication for life. They’d rather learn reliable ejaculatory control once and for all. The new study makes SSRIs look even less attractive.

The researchers, urologists at Memorial Sloan Kettering in New York, prescribed low-dose SSRIs to 130 PE sufferers, then tracked them for one year.

Take Control and Restore Your Confidence

Posted January 15, 2020 Reviewed by Gary Drevitch Rapid, involuntary “premature” ejaculation (PE) is men’s number-one sex problem. Erectile dysfunction gets more publicity, but few men develop it until sex power tablet after age 50. Meanwhile, from the teen years to late adulthood, the best research shows that PE plagues one-quarter to one-third of sexually active men. There are two treatments for PE—low-dose antidepressants or the program developed by sex therapists that tinkers with how men make love. Advocates of drug treatment claim it’s effective. Self-rated “poor” control dropped to 41 percent of the men—that is, 59 percent reported lasting at least a little longer. But after a year, only 28 percent were still taking the pills.

Oral Medications Sometimes Used for PE

A total of 265 participants were randomized to clomipramine 15 mg (Group A), 266 were randomized to sildenafil 50 mg (Group B), and 264 were randomized to a combination of clomipramine 15 mg and sildenafil 50 mg (Group C). The primary outcome of interest for the study were stopwatch-measured IELT at 12 weeks. Additional outcomes of interested included changes in Premature Ejaculation Profile (PEP) and Patient Global Impression of Change (PGIC).1 Results of the trial indicated all groups showed significant increases in IELT over 12 weeks: Group A: 191.72±12.72 seconds (P <.001) Group B: 168.35±12.29 seconds (P <.001) Group C: 279.41±20.06 seconds(P <.001) Further analysis demonstrated the increase in IELT was significantly greater in group C compared to either monotherapy group (each P <.001). Improvements in PEP scores were 91.46%, 85.59%, and 96.10% for groups A, B, and C, respectively, with group C achieving significantly greater rates of improvement than groups A (P = .037) or B (P <.001). Additionally, a consistent trend was observed for PGIC score improvements, with improvement rates of 41.87%, 34.50%, and 54.98%, respectively, again favoring group C relative to groups A (P = .004) and B (P <.001).1 Safety data suggested treatment-emergent adverse events occurred among 17.36%, 16.17%, and 25.00% of patients in groups A, B, and C, respectively, with no statistically significant differences between groups (P = .098).

Paroxetine (Paxil®) for PE

The most common treatment-emergent adverse events in group C were headache (9.09%), nausea (7.58%), flushing (7.95%), and dizziness (3.41%). Nearly all adverse events were mild to moderate in severity, and no serious treatment-emergent adverse events were reported.1 IP10-04 EFFICACY AND SAFETY OF ON-DEMAND THERAPY WITH CLOMIPRAMINE/SILDENAFIL COMBINATION COMPARED TO CLOMIPRAMINE OR SILDENAFIL ALONE IN PATIENTS WITH PREMATURE EJACULATION: MULTI-CENTER, PHASE 3 TRIAL. doi:10.1097/01.JU.0001109900.23127.a9.04 Crowdis M, Leslie SW, Nazir S. Premature Ejaculation. Treasure Island (FL): StatPearls Publishing; May 30, 2023. Almost three-quarters—72 percent—had quit for the reasons just mentioned: side effects, the hassles of pill-taking, and not lasting as long as they’d hoped.

Premature Ejaculation FAQs

It is therefore up to the patient and his doctor to make the call to use this class of drugs off label. Don’t be afraid to seek treatment for premature or rapid ejaculation. It is a very common condition, and one of the most common sexual dysfunctions. Your UCLA Men’s Clinic provider will be understanding and likely have an effective treatment that will please you and your partner. Board-certified urologists staff The Men’s Clinic at UCLA and you can be assured you are getting an experienced physician performing your evaluation and procedure in a relaxed and comfortable environment.

When should I see a doctor about premature ejaculation?

For more information and to schedule an appointment, please call the UCLA Urology Appointment line at 310-794-7700. Combination therapy of sildenafil and clomipramine significantly improves ejaculatory latency time and patient-reported outcomes in men with PE compared to monotherapies. The phase 3 trial involved 795 men across 24 sites in Korea, showing greater efficacy of combination therapy in improving IELT, PEP, and PGIC scores. A phase 3 trial reveals a combination therapy for premature ejaculation significantly enhances treatment outcomes. Use of a combination therapy could be a game-changer for management of Results of a phase 3 trial presented at the “This is the first approved multicenter phase 3 super p force 200mg trial of sildenafil 50 mg/clomipramine 15 mg combination for the treatment of premature ejaculation in the world and designate as incrementally modifying the drug,” said Du Geon Moon, MD, PhD, a professor in the Department of Urology at Korea University College of Medicine.

Key Takeaways

“The study results suggest that the on-demand therapy of this combination has the potential in the treatment of the PE without ED for better efficacy with similar safety as clomipramine alone for PE.” Despite being among the most common sexual health disorders, with estimates suggesting prevalence could exceed 30% of men, satisfactory management of PE remains an elusive target for urologists. With no agents sporting indications specific to PE, providers are left with the challenge of determining proper treatments, with common choices including selective serotonin reuptake inhibitors, topical anesthetics, and behavioral therapies. Sponsored by CTC Bio, the AUA 2025 study from NAME was a 3-arm, prospective, randomized, double-blind, active-controlled, multi-center trial. The trial enrolled 795 men with PE without erectile dysfunction across 24 sites in Korea between October 2019 and April 2022. For the purpose of analysis, PE was defined based on DSM-V criteria, a PEDT score of 11 or higher, and an intravaginal ejaculatory latency time (IELT) of less than 3 minutes. The Better Way: Learning Reliable Ejaculatory Control During the 1960s, pioneering sexologists William Masters and Virginia Johnson discovered that a quick, easy self-training program could cure most PE and teach the large majority of men dependable ejaculatory control. Over the past 60 years, other sexologists have refined their program.

• Certain herbal combinations claim to naturally delay ejaculation.
• Clinical trials are essential to confirm the efficacy of PE pills.
• Over-the-counter products should be approached with caution.
• Proper storage of pills ensures potency and safety.
• Monitoring emotional health helps manage PE effectively.

Some people call erotic arousal “sexual tension,” but the word “tension” is counterproductive.