Premature ejaculation: Does medication work?

Men who decide to have treatment with medication usually choose a type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is usually taken in tablet form. These medications are taken as tablets. SSRIs are typically used to treat depression. When treating premature ejaculation, one of their side effects becomes useful: SSRIs increase the time it takes until ejaculation occurs.

Creams, gels or sprays that contain a local anesthetic are an alternative. They are applied to the head of the penis and make it less sensitive.

Medications can also interfere with other drugs being taken at the same time. So it’s a good idea to let your doctor know about any other medication you are using before you start treatment with a new medication. This is also important because of medication intolerances or allergies.

The only medication approved for the treatment of premature ejaculation is the short-acting SSRI dapoxetine. Studies have shown that other SSRIs are more effective, though. These include long-acting SSRIs, such as citalopram, fluoxetine, paroxetine and sertraline. With long-acting SSRIs, the active ingredient remains in the blood for a longer period of time.

Long-acting SSRIs are approved for the treatment of depression, among other conditions – but not for premature ejaculation. When doctors prescribe one of these drugs for premature ejaculation, it is known as “off-label” use. This means that because they are not approved for this purpose, they are not being used as intended. Certain regulations may apply, and then doctors must provide particularly detailed explanations.

The suitability of a medication also depends on how well it is tolerated. If bothersome side effects occur, you can switch to a different medication.

According to the latest research, dapoxetine is not only less effective than other SSRIs that may be considered for the treatment of premature ejaculation, it is also much more expensive.

When used to treat premature ejaculation, SSRIs may be taken at a different dose and more or less often than they are when treating depression.

Depending on the active ingredient, SSRIs can be taken daily or as they are needed. When taken as needed, the medication is used a few hours before having sex. When taken daily, you start at a low dose and then increase it over the course of several weeks, if necessary. It may take two to three weeks to reach the full effect.

The most suitable drug will depend on your individual situation – for instance, how often you have sex. Some men would rather not take medication every day – also because that increases the risk of side effects. Others prefer to use them daily because sex isn’t always something that’s planned, and then they don’t have to worry about the exact time they need to take the medication.

In studies, SSRIs delayed ejaculation by up to five minutes when compared to a placebo (fake medication). Long-acting SSRIs like citalopram and paroxetine delayed ejaculation the longest, by 3 to 5 minutes. Dapoxetine had the weakest effect: It increased the time until ejaculation by 1 to 1.5 minutes, depending on the dose. However, there are very few studies comparing these two treatments directly with one another.

These studies also suggested that SSRIs were able to improve control over ejaculation somewhat and increased sexual satisfaction. The medication can also be combined with sex therapy, which is more effective than taking medication alone.

SSRIs may cause nausea, diarrhea, headaches, dizziness, a dry mouth or sleep problems. They can also lower sexual desire and, in rare cases, cause erection problems.

Depending on the active ingredient and the dose, up to 10% of men in the studies stopped the treatment due to these kinds of side effects.

But occasional headaches, sleep problems or not wanting to have sex are also a normal part of everyday life. If these kinds of problems occur during treatment, it doesn’t automatically mean that the medication is to blame. So it might make sense to wait and see if these problems go away. Some side effects occur only at the start of the treatment as well.

Creams, gels or sprays containing the local anesthetics lidocaine or prilocaine can be used as an alternative to SSRIs. They are applied to the head of the penis 5 to 20 minutes before having sex. This can increase the time it takes to ejaculate by about 3 to 6 minutes.

Local anesthetics may cause numbness and burning sensations in the sensitive skin on the head of the penis. One drawback of these medications is that they can also get inside a woman’s vagina during sex and cause similar side effects there. So it’s important to use a condom whenever possible and to talk with your partner about the treatment. It's also important to know that if the medication is applied more than 20 minutes before having sex, the penis may become so numb that it’s temporarily impossible to have an erection.

One alternative is condoms that already contain a local anesthetic. These are available in most drugstores.

Impotence treatments are also an option for men who have both erection problems and premature ejaculation. These include various drugs known as PDE-5 inhibitors, such as sildenafil. German statutory health insurers don’t cover the costs of this treatment.

The pain reliever tramadol is only rarely considered as an option. It can cause side effects such as weight gain and fatigue, and there is also a risk of becoming dependent on the drug. Tricyclic antidepressants should only be considered if SSRIs are not effective enough.

Some doctors offer Botox injections. Among other things, they are supposed to delay ejaculation, but the pros and cons of this treatment are not clear.