Managing Side Effects of PE Medications

It's typical to feel embarrassed when talking about sexual problems.

Class Summary

Examples include Trojan Extended Pleasure and Durex Prolong. Creams, gels and sprays that contain a numbing agent — such as benzocaine, lidocaine or prilocaine — are sometimes used to treat premature ejaculation. They're applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation. However, a cream containing both lidocaine and prilocaine (EMLA) is available by prescription. Although topical numbing agents are effective and well tolerated, they have potential side effects.

What Causes Premature Ejaculation?

They may cause decreased feeling and sexual pleasure in both partners. These drugs aren't approved by the Food and Drug Administration to treat premature ejaculation, but some are used for this purpose. They include antidepressants, pain relievers and drugs for erectile dysfunction. These medications might be prescribed for either on-demand or daily use. Also, they may be prescribed alone or with other treatments. But you can trust that your health care provider has had similar conversations with many others. Premature ejaculation is a very common condition. And it's one that can be treated.

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Being ready to talk about premature ejaculation will help you get the treatment you need to put your sex life back on track.

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A side effect of certain antidepressants is delayed orgasm. For this reason, selective serotonin reuptake inhibitors (SSRIs) are used to treat premature ejaculation. The SSRI dapoxetine is often used as the first treatment for premature ejaculation in some countries. It's not currently available in the United States. Of the drugs approved for use in the United States, paroxetine seems to be the most effective.

Topical Treatments for Premature Ejaculation

These medications usually take 5 to 10 days to begin working. But it might take 2 to 3 weeks of treatment to see the full effect. If SSRIs don't improve the timing of your ejaculation, your health care provider might prescribe the tricyclic antidepressant clomipramine (Anafranil). Side effects of antidepressants might include nausea, perspiration, drowsiness and decreased sex drive. Tramadol (Ultram, Conzip, Qdolo) is a medication used to treat pain. The information below should help you prepare to make the most of your appointment. When you make your appointment, ask if there are any restrictions you need to follow in the time leading up to your visit. How often do you ejaculate before you or your partner would wish? How long after you begin having intercourse do you typically ejaculate?

Does Viagra help premature ejaculation?

It also has side effects that delay ejaculation. Tramadol might be prescribed when SSRIs haven't been effective. Tramadol can't be used in combination with an SSRI. Side effects might include nausea, headache, sleepiness and dizziness. Tramadol can become habit-forming when taken long-term.

Pelvic floor exercises

Some medications used to treat erectile dysfunction also might help premature ejaculation. Side effects might include headache, facial flushing and indigestion. These medications might be more effective when used in combination with an SSRI. Research suggests that several drugs might be helpful in treating premature ejaculation. This is a treatment for the sleeping disorder narcolepsy. Think back on your relationships and sexual encounters since you became sexually active. Have you had problems with premature ejaculation before? Write down any other fildena 100mg medical conditions with which you've been diagnosed, including mental health conditions. Also note the names and strengths of all medications you are currently taking or have recently taken, including prescription drugs and those you buy without a prescription. Questions to ask your health care provider. Write down questions in advance to make the most of your time with your provider. The list below suggests questions to ask your health care provider about premature ejaculation. Don't hesitate to ask more questions during your appointment.

Side Effect	Medication Type	Incidence Rate	Severity Level	Management Strategies	Notes
Nausea	SSRIs, topical anesthetics	10-15%	Mild to Moderate	Dose adjustment, timing	Usually transient
Dizziness	SSRIs, topical anesthetics	8-12%	Mild	Standing slowly, hydration	Common with beginning treatment
Headache	SSRIs, topical anesthetics	5-10%	Mild	Analgesics, time to adjust	Typically diminishes over time
Reduced Sensation	Topical anesthetics	10-20%	Mild	Reduced dose, application timing	Can affect partner satisfaction

What may be causing my premature ejaculation?

When to seek medical attention

If you are a Mayo Clinic patient, we will only use your protected health information as outlined in our Notice of Privacy Practices. You may opt out of email communications at any time by clicking on the unsubscribe link in the email. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Please, try again in a couple of minutes Several alternative medicine treatments have been studied, including yoga, meditation and acupuncture. However, more research is needed to determine their effectiveness. How soon after I begin treatment can I expect improvement? How much improvement can I reasonably expect?

• Topical anesthetic creams temporarily desensitize the penis to delay ejaculation.
• SSRI medications like paroxetine are prescribed off-label for premature ejaculation.
• Dapoxetine is a short-acting SSRI specifically approved for PE treatment.
• Tramadol, an opioid, can help delay ejaculation but carries dependency risks.
• Topical sprays offer quick, localized numbing effects to control ejaculation timing.
• PDE5 inhibitors like sildenafil may improve performance in men with PE and ED.
• Behavioral therapies include the stop-start and squeeze techniques to extend duration.
• Kegel exercises strengthen pelvic muscles, potentially delaying ejaculation.
• Counseling and sex therapy can address psychological causes of PE.
• Combining medication with behavioral techniques enhances treatment effectiveness.
• Herbal supplements lack robust clinical evidence but are used by some for PE.
• Consultation with a healthcare provider is essential to tailor appropriate therapy.

Am I at risk of this problem recurring? Is there a generic alternative to the medicine you're prescribing?

• Dapoxetine is contraindicated with certain medications and health conditions.
• Topical creams should be used sparingly to prevent partner numbness.
• SSRI treatment may cause emotional blunting or decreased libido.
• Tramadol's risk of dependency requires careful medical supervision.
• Mechanical devices can provide temporary ejaculation delay.
• Behavioral training involves specific sex exercises for control.
• Mindfulness and relaxation techniques benefit PE management.
• Proper diagnosis is essential to rule out underlying disorders.
• Incorporate partner feedback to improve treatment results.
• Avoid abrupt discontinuation of prescribed medication.
• Lifestyle modifications can include weight management.
• Ongoing research aims to develop more effective PE treatments.

Are there any brochures or other printed material that I can take home with me? Your health care provider might ask very personal questions and might also want to talk to your partner. To help your provider determine the cause of your problem and the best course of treatment, be ready to answer questions, such as: How often do you have premature ejaculation? When did you first experience premature ejaculation?

Key takeaways:

There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form. Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. We use the data you provide to deliver you the content you requested. To provide you with the most relevant and helpful information, we may combine your email and website data with other information we have about you. Do you have premature ejaculation only with a specific partner or partners? Do you experience premature ejaculation when you masturbate? Do you have premature ejaculation every time you have sex? How much are you bothered by premature ejaculation? How much is your partner bothered by premature ejaculation? How satisfied are you with your current relationship?

Therapy Type	Description	Typical Duration	Success Rate	Noted Benefits	Noted Drawbacks
SSRI Medications	Selective serotonin reuptake inhibitors, delay ejaculation	4-12 weeks	70%	Long-term control	Possible side effects
Behavioral Therapy	Techniques like start-stop and squeeze method	Several sessions	60-80%	No medication needed	Requires patient commitment
Topical Anesthetics	Numbing creams or sprays applied to glans penis	As needed	65-75%	Fast onset	Reduced sensation, partner sensitivity
Pelvic Floor Exercises	Exercises to strengthen pubococcygeus muscles	6-12 weeks	50-65%	Improves control	Time-consuming

Are you also having trouble getting and keeping an erection (erectile dysfunction)? If so, what medications have you recently started or stopped taking? Deciding to talk with your health care provider is an important step. In the meantime, consider exploring other ways in which you and your partner can connect. Although premature ejaculation can cause strain and anxiety in a relationship, it is a treatable condition. Premature ejaculation — Current concepts in the management: A narrative review. Disorders of ejaculation: An AUA/SMSNA guide. Pelvic floor muscle training improves erectile dysfunction and premature ejaculation: A systematic review. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. National Institute of Diabetes and Digestive and Kidney Diseases. Khera M. Treatment of male sexual dysfunction. Premature ejaculation occurs when you ejaculate (cum) earlier than you or your partner would like during sex. It’s a common problem, affecting 30% to 40% of people with a penis. Causes include physical problems, chemical imbalances and emotional/psychological factors.

Medication Name	Type	Typical Dosage	Onset Time	Duration of Effect	Common Side Effects	Approval Status	Available By Prescription	Estimated Cost (USD)
Dapoxetine	SSRI	30 mg	1-3 hours	12-24 hours	Nausea, dizziness, headache	Approved	Yes	2-5
Paroxetine	SSRI	20 mg/day	1-2 hours	24 hours	Fatigue, dry mouth	Approved	Yes	1-4
Sertraline	SSRI	50 mg/day	2-4 hours	24 hours	Diarrhea, insomnia	Approved	Yes	2-4
Topical Anesthetics	Local anesthetic	Varies	Immediate	30-60 minutes	Loss of sensation in area	Approved	Yes	3-7

Treatments include learning techniques to delay ejaculation, counseling and medications. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.

Risk factors of premature ejaculation

Researchers are studying whether injecting Botox into the muscles that help cause ejaculation can treat premature ejaculation. This approach involves talking with a mental health provider about your relationships and experiences. Sessions can help you reduce performance anxiety and find better ways of coping with stress. Counseling is most likely to help when it's used in combination with drug therapy. With premature ejaculation, you might feel that you lose some of the closeness shared with a sexual partner.

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You might feel angry, ashamed and upset, and turn away from your partner. Your partner also might be upset with the change in sexual intimacy. Premature ejaculation can cause partners to feel less connected or hurt. Talking about the problem is an important step. Relationship counseling or sex therapy also might be helpful. Premature ejaculation (PE) is a type of sexual dysfunction that occurs when a person has an orgasm and ejaculates sooner than they or their partner would like. It often happens before or shortly after penetration during intercourse. Premature ejaculation can be a frustrating experience for both you and your sexual partner and make your sex lives less enjoyable. PE can be lifelong, meaning you’ve had it since your first sexual experience. It can also be acquired, which means you’ve had sex previously where PE wasn’t an issue.

• Dapoxetine is effective when taken 1-3 hours before intercourse.
• Topical anesthetics can reduce sensation but risk partner numbness.
• SSRIs may take several weeks to reach full efficacy for PE.
• Tramadol's use for PE is off-label; consult a doctor before use.
• Combining medication with therapy can optimize outcomes.
• Avoiding excessive alcohol and stress can improve sexual performance.
• Pelvic exercises increase muscle strength and ejaculatory control.
• Psychological support can address anxiety-related PE.
• Devices like constriction rings may be used as mechanical aids.
• Open communication with partner improves treatment success.
• Regular follow-up with healthcare provider is recommended.
• Natural remedies lack solid clinical proof but are popular.

Many healthcare providers would define premature ejaculation as ejaculating within one minute of beginning intercourse. The exact timing for premature ejaculation varies and only your healthcare provider can make a diagnosis. Most healthcare organizations consider ejaculation “premature” if it: Occurs sooner than you or your partner desires. Causes distress to one or both partners.

How Do You Diagnose Premature Ejaculation?

Keep squeezing for several seconds until the urge to ejaculate passes. By repeating as many times as needed, you can reach the point of entering your partner without ejaculating. After some practice, delaying ejaculation might become a habit that no longer requires the pause-squeeze technique. If the pause-squeeze technique causes pain or discomfort, you can try the stop-start technique. It involves stopping sexual stimulation just before ejaculation.

Symptoms of Premature Ejaculation

Then waiting until the level of arousal has diminished and starting again. Condoms might make the penis less sensitive, which can help delay ejaculation. Specially designed "climax control" condoms are available without a prescription. These condoms contain numbing agents such as benzocaine or lidocaine to delay ejaculation. They might also be made of thicker latex. Happens during all or almost all sexual activity. Has been occurring for longer than six months to one year.