How Do Premature Ejaculation Pills Work?

If you want to last longer in bed, pills may be your answer. But we’re not talking about those sketchy male enhancement supplements you can pick up at the gas station. There are a number of FDA-approved medications that can help you gain better control of your erectile function.

But, first, here’s a reality check, guys: premature ejaculation (PE) is actually one of the most common male sexual health conditions, affecting as much as 30 to 75 percent of us (although reports are subjective and estimates vary widely). So if you’re looking for pills to make you last longer, you’re definitely not alone. 

There are treatments that can help by delaying ejaculation, but all “premature ejaculation pills” are actually not designed to treat PE. Instead, they typically are used off-label and include antidepressants like selective serotonin reuptake inhibitors (SSRIs) or local anesthetics like lidocaine or benzocaine. In some cases, doctors may even prescribe phosphodiesterase type -5 inhibitors (PDE5 inhibitors) like sildenafil (the active ingredient in Viagra®).

If you want to prolong your erections, keep reading to find out which treatments are available, how these medications affect erectile function and why you should be cautious with over-the-counter treatments for PE.

Premature ejaculation pills are an unofficial term for several types of medications prescribed off-label to treat premature ejaculation. These medications include SSRIs like sertraline and PDE5 inhibitors like Viagra. Though these drugs are widely prescribed for PE and other sexual dysfunctions, they are not FDA-approved for these purposes. In fact, every PE medication is actually a pill originally intended for another purpose.

Some of the top pills that help you last longer in bed include:

• SSRIs: SSRIs like sertraline (commonly sold as Zoloft®), are popular among people with PE problems because one of its main “side effects” is delayed ejaculation. Yes, you read that right: the side effect is the treatment here.

• PDE5 inhibitors: Another commonly used PE pill is actually intended for another sexual dysfunction — erectile dysfunction. PDE5 inhibitors like sildenafil (Viagra), tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Stendra®) are sometimes prescribed off-label for premature ejaculation because they improve the perception of ejaculatory control in addition to blood flow. Talk about “bang for your buck” eh? 

We’ll go into more detail on how these pills work (and how well they work) in the following sections. 

SSRIs are typically used to treat depression and anxiety. They regulate the amount of serotonin between neurons at any one time, which is believed to help alleviate some of the symptoms of depression.

Some healthcare providers prescribe these drugs “off-label” for premature ejaculation because they help slow down orgasm and ejaculation. This effect is typically regarded as a side effect of medications like paroxetine, sertraline and others. But for people with PE, it can be beneficial.

Healthcare professionals may also recommend combining a selective serotonin reuptake inhibitor with a prescription erectile dysfunction (ED) medication such as sildenafil (Viagra®), a PDE5 inhibitor. PDE5 inhibitors work as vasodilators. They improve your sex life by increasing blood flow to your penis, helping you obtain and sustain erections. Some research also shows they improve the perception of ejaculatory control.

We understand why you’d be a little concerned about taking a medication designed for one purpose to treat something else, but you might be surprised to learn that healthcare professionals prescribe medications to treat issues outside their FDA approval status all the time. 

In fact, these medications are surprisingly well-targeted when used to treat PE — let’s look at why.

Our sexual experiences and sexual activity are very much mental exercises, but it’s not the emotional element of sexual dysfunction that SSRIs are addressing here. Instead, they make it harder for a person to reach orgasm. And there’s even research to prove it can help people with PE.

You may have read about medications like dapoxetine, fluoxetine and others having this “side effect,” but one of the most commonly prescribed SSRIs for PE is sertraline.

Studies of sertraline, for instance, show that these medications can often treat premature ejaculation symptoms when used daily, usually by a significant amount.

One study from 1998 gave men with premature ejaculation 25mg of sertraline daily, then 50 mg per day after three weeks, then 100 mg another three weeks later.

• 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. 

• 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.

While SSRIs are among the most common medications for the treatment of premature ejaculation, healthcare providers also sometimes prescribe tricyclic antidepressants (TCAs) like clomipramine.

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

Can Viagra make you last longer? It’s possible that everyone’s favorite last longer in bed pill may also function as a PE pill. Research has found that many men with PE experience improvements after using ED medications such as Viagra (sildenafil). Look at the data:

• In a 2007 study, 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. At the end of six months, the researchers found that sildenafil was the most effective treatment.

• Another study from 2005 found that while sildenafil doesn’t directly increase the time before orgasm, it can improve confidence and increase the perception of ejaculatory control.

• The same researchers also found that sildenafil reduces refractory time, making it easier for men with premature ejaculation to get a second erection shortly after sex.

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.

Like all medications, PDE5 inhibitors and SSRIs can cause potential side effects, and not all of them are actually PE benefits in disguise.

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 potential 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

If your goal is to last longer during sex without prescription medication, there are some alternative treatments for PE that are worth considering, either as part of a broader treatment plan or on their own. 

Nothing’s going to replace medical advice from a doctor, but you might see improvements from:

• Lidocaine premature ejaculation spray. Lidocaine is a topical anesthetic that, when applied to your penis, helps you avoid premature ejaculation by reducing sensitivity. Lidocaine is a good alternative to prescription medications for PE. You can find it as an active ingredient in Hims 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 anesthetics such as lidocaine to lower the sensitivity level of your penis and help you avoid ejaculating too soon. Benzocaine is another ingredient commonly used in premature ejaculation treatments.

• Climax control condoms. Some condoms have benzocaine on the inside to desensitize the penis during sex and help you stay safe at the same time.

• PE prevention techniques. Techniques like the stop-start strategy and squeeze technique appear to help prevent PE. We’ve covered the squeeze technique and others (and the scientific research on their effectiveness) in our guide to stopping premature ejaculation.

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

• Masturbating before sex. While it’s certainly far from scientific, some people claim that masturbation before sex helps to delay orgasm and ejaculation by keeping you in the post-sex refractory period.

• Hold off from the main event. Some men with PE can last longer by focusing more on foreplay instead of penetrative sex.

Step into your local sex store, gas station or search online and you’ll find countless supplements to help improve sexual intercourse and last longer in bed. You can also grab a 64-ounce soda and some lottery tickets.

Most of the time, these products contain herbal ingredients like horny goat weed that may help to improve your sexual performance in a general “yay vitamins” kind of way, but they’re far from anything close to a treatment. 

These products also aren’t really regulated by the FDA in the same way as prescription medications, meaning they can be marketed using claims that might be misleading.

Until PE gets its own medication class, antidepressants and ED meds are your best treatment options for premature ejaculation. Regardless of whether you’re ready to try pills to last longer in bed or want to give the home remedies more time to work, here’s what you should remember:

• You’re not alone if you’re dealing with PE. Premature ejaculation is a common issue that can affect men of all ages. 

• Don’t be ashamed. As with erectile dysfunction and other common medical conditions, there’s no shame in using premature ejaculation medication to treat PE and improve your sexual performance, sexual relationship with your partner(s), sexual health or your own personal sexual pleasure. 

• The solution is to get treated — safely. Stick to proven prescription treatments such as sertraline, paroxetine or sildenafil, or use over-the-counter options like products that contain lidocaine or benzocaine. 

We offer access to these prescription 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 delay ejaculation.