Premature ejaculation
Can sildenafil help with premature ejaculation?
LAST UPDATE
MEDICALLY REVIEWED BY
Bibian Schäffer, general practitioner
TIME
6 min
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KEY WORDS
What is sildenafil and what is it used for?
Sildenafil is probably the most well-known medication for erectile dysfunction. It was launched in 1998 under the brand name Viagra and has since helped millions of men with erection problems. But can it also help with premature ejaculation?
How sildenafil works
Sildenafil belongs to the group of PDE5 inhibitors (phosphodiesterase type 5 inhibitors). It works by blocking an enzyme that causes blood vessels in the penis to constrict. By inhibiting this enzyme, blood vessels remain relaxed, allowing increased blood flow to the penis. This makes it easier to achieve and maintain an erection³.
The key point: sildenafil was developed for erectile dysfunction, not premature ejaculation. Nevertheless, it is sometimes prescribed off-label for PE, meaning doctors use it for an indication for which it was not originally approved².
Off-label use in premature ejaculation
Why would an erectile dysfunction medication help with early ejaculation? The reasoning is that many men with PE also experience some degree of erectile dysfunction, or that anxiety about ejaculating too quickly negatively affects erection quality. By improving erections, sildenafil may indirectly help men gain better control over ejaculation¹,².
It is important to emphasize that sildenafil is not the first choice for pure premature ejaculation without erectile problems. Medications such as dapoxetine are more effective in that case because they directly affect the ejaculatory reflex⁷.
How can sildenafil help with premature ejaculation?
Sildenafil works differently from medications specifically developed for PE. It does not have a direct effect on the ejaculatory reflex, unlike dapoxetine. Instead, it helps in indirect ways.
Better erection quality provides more control
A firmer, more reliable erection can increase confidence during sex. If you are not focused on maintaining your erection, you can pay more attention to bodily sensations and signals. This may help you better recognize when ejaculation is approaching, allowing for improved control¹.
In addition, a stronger erection may slightly alter penile sensation, which for some men helps delay ejaculation. The exact mechanism is not fully understood, but clinical experience suggests it can make a difference for certain individuals¹.
Reduces performance anxiety
Many men with premature ejaculation also experience performance anxiety. They worry about disappointing their partner or ejaculating too quickly again. This anxiety can itself lead to faster ejaculation - a vicious cycle².
Sildenafil can help break this cycle by providing reassurance that the erection will remain firm. This reduces pressure and tension, which may help prolong sexual activity. The psychological aspect of sexual performance is often underestimated but plays a crucial role.
Most effective in PE + ED combination
The group that benefits most from sildenafil for PE consists of men who experience both erectile dysfunction and premature ejaculation. In these men, sildenafil addresses two issues simultaneously: it improves erection quality and indirectly helps with ejaculatory control¹˒².
If you have premature ejaculation without any erectile difficulties, sildenafil is less likely to make a meaningful difference. In that case, treatments such as dapoxetine or topical agents are generally more appropriate.
What does the research say?
Scientific literature on sildenafil for premature ejaculation shows mixed results. Some studies report positive effects, while others find no significant benefit.
The McMahon study (2005)
A key study by McMahon et al. investigated sildenafil in men with premature ejaculation. The researchers found that sildenafil could increase ejaculation latency time, particularly in men with mild erectile dysfunction. The improvement was modest but measurable¹. Importantly, the greatest benefit was observed in men with both PE and ED. Results were less consistent in men with isolated PE.
Systematic reviews and meta-analyses
A large systematic review published in 2017 evaluated all available studies on PDE5 inhibitors (such as sildenafil) for premature ejaculation. The conclusion: PDE5 inhibitors can be helpful, but the effects are moderate and not universal².
The review noted that sildenafil is most effective:
In men with both PE and ED
When combined with other treatments such as SSRIs
In men where psychological factors (e.g. anxiety) play a major role
Combination with other treatments
Some studies suggest that combining sildenafil with SSRIs (such as paroxetine or dapoxetine) may be more effective than SSRIs alone. This indicates that improved erection quality can be a valuable addition to PE treatment⁵,⁷.
Limitations of the evidence
Many studies included small sample sizes and showed variable outcomes. More high-quality research is needed to determine precisely which men benefit most from sildenafil for PE².
Who is sildenafil suitable for in premature ejaculation?
Sildenafil is not the right choice for every man with PE. It is best suited to specific groups.
Primary target group: PE + ED combination
If you experience both early ejaculation and difficulty achieving or maintaining an erection, sildenafil is a logical option. It addresses both problems: improving erections and indirectly helping prolong intercourse¹,².
When performance anxiety plays a role
If anxiety or stress is a major contributor to your premature ejaculation, sildenafil may help by reducing pressure through improved erection confidence². Some men find that once confidence is restored, their PE improves significantly.
Less suitable as standalone treatment for pure PE
If you have premature ejaculation without any erectile dysfunction, sildenafil is probably not the best first-line option. In that case, medications specifically developed for PE (such as dapoxetine) are more effective⁷. That does not mean sildenafil does not work at all in isolated PE - some men do experience improvement - but the likelihood of benefit is lower and better alternatives are available.
Lifestyle and health
Sildenafil is suitable for most healthy men. It is not suitable if you:
Use certain heart medications (especially nitrates)
Have serious heart conditions
Have recently had a heart attack or stroke
Have severe liver or kidney problems
A doctor will discuss this with you before prescribing sildenafil⁶,⁷.
How to use sildenafil for premature ejaculation
Dosage
The standard dose for erectile dysfunction is 50 mg, which is also commonly used when sildenafil is prescribed off-label for PE. There is no officially approved PE-specific dose.
Timing
Take sildenafil 30–60 minutes before sexual activity. It reaches peak effect after about one hour and remains effective for 4–6 hours⁶.
Frequency
Do not use sildenafil more than once per day. It is an on-demand medication, not intended for daily use.
Side effects
Sildenafil is generally well tolerated. The most common side effects are mild and usually resolve on their own⁶:
• Headache
• Flushing
• Nasal congestion
• Indigestion
Rare but serious side effects include visual or hearing changes and prolonged erections lasting longer than four hours. Seek immediate medical attention if these occur.
Alcohol
Moderate alcohol consumption (1–2 drinks) is usually acceptable, but excessive alcohol can reduce effectiveness and increase side-effect risk.
Sildenafil vs dapoxetine: what is the difference?
Mechanism of action
Dapoxetine acts directly on the nervous system to delay the ejaculatory reflex by increasing serotonin⁵.
Sildenafil improves penile blood flow and erection quality, indirectly influencing ejaculation through reduced anxiety and better control¹,².
Indications
Dapoxetine: Specifically developed for premature ejaculation; first-line treatment for isolated PE⁵,⁷.
Sildenafil: Developed for erectile dysfunction; used off-label for PE, particularly in PE + ED cases¹,².
Timing and use
Dapoxetine: Take 1–3 hours before sex; the effect lasts for several hours.
Sildenafil: Take 30–60 minutes before sex; the effect lasts for 4–6 hours⁶.
When to choose which?
Choose dapoxetine if you have premature ejaculation without erectile problems
Choose sildenafil if you have both PE and ED or if erection quality/anxiety contributes to PE
Combination therapy may be possible but only under medical supervision⁵,⁷
Menkind’s offering
After an online medical consultation, Menkind can prescribe both dapoxetine and sildenafil, depending on which treatment best fits your situation. A registered physician reviews your questionnaire and advises on the most appropriate option. Honest completion of the medical questionnaire helps ensure the safest and most effective treatment choice.
References
McMahon CG, Stuckey BG, Andersen M, et al (2005). "Efficacy of sildenafil citrate (Viagra) in men with premature ejaculation". The Journal of Sexual Medicine, 2(3):368-375. https://pubmed.ncbi.nlm.nih.gov/16422868/
Martyn-St James M, Cooper K, Ren S, et al (2017). "Phosphodiesterase Type 5 Inhibitors for Premature Ejaculation: A Systematic Review and Meta-analysis". European Urology Focus, 3(1):119-129. https://pubmed.ncbi.nlm.nih.gov/28720356/
Crowdis M, Nazir S. Premature Ejaculation. [Updated 2023]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. https://www.ncbi.nlm.nih.gov/books/NBK546701/
Raveendran AV, Agarwal A (2021). "Premature ejaculation - current concepts in the management: A narrative review". International Journal of Reproductive Biomedicine, 19(1):5-22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851481/
Sathianathen NJ, Hwang EC, Mian R, et al (2021). "Selective serotonin re-uptake inhibitors for premature ejaculation in adult men". The Cochrane Database of Systematic Reviews, 3(3):CD012799. https://pubmed.ncbi.nlm.nih.gov/33745183/
Porst H, Burri A (2019). "Novel treatment for premature ejaculation in the light of currently used therapies: a review". Sexual Medicine Reviews, 7(1):129-140. https://pubmed.ncbi.nlm.nih.gov/30057136/
Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan G, et al (2014). "An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation". Sexual Medicine, 2(2):60-90. https://pubmed.ncbi.nlm.nih.gov/25356302/
