Anecdotal experiences of some men have shown that sildenafil could be a good treatment for premature ejaculation. Paroxetine and other SSRIs have long been used for treating this condition. But could their combined use be greater than the sum of their parts?
Sildenafil is a drug designed to combat erectile dysfunction. It is better known as Viagra and is most often prescribed to older men encountering erectile difficulties. A number of younger men are also taking this drug for recreation rather than medical reasons due to the lower refractory period that it allows. Some men have noticed that sildenafil can also prolong intravaginal ejaculatory latency time (IELT).
SSRIs have been used for many years to treat men with premature ejaculation. Doctors have tried varying doses and drugs but paroxetine has been found to have the greatest effect on prolonging IELT[1]. Unfortunately, it also produces some of the severest side effects and a number of class action lawsuits have taken place due to the possibility of SSRI discontinuation syndrome. The greatest drawback of SSRIs from a premature ejaculation point of view lies in their half-life and duration. They are most efficient at delaying ejaculation when a longer-action daily dose is used. Shorter action “on-demand” SSRIs do not give as great an increase in IELT[2] but wear off quicker and therefore have fewer effects after intercourse is completed.
The efficacy of paroxetine as a treatment for premature ejaculation is well known and beyond doubt and I will not explore it further here. However, let’s first look at the efficacy of sildenafil alone.
Sildenafil Alone
A number of studies have been done over the last 10 years to test the efficacy of sildenafil. The results are mixed but generally promising. While one study found no difference in IELT [3] they did report an increased perception of ejaculatory control, sexual satisfaction and decreased refractory period. Other studies have concluded differently. A 2001 study published in the International Journal of Impotence Research found sildenafil to be superior to other modalities such as SSRIs and the pause-squeeze technique[4]. A more recent study had similar findings and determined that sildenafil “has much higher efficacy than paroxetine and squeeze technique”[5]. However, a study by Pfizer determined that there was no direct effect on IELT after 8 weeks.
There is no effect of sildenafil on ejaculatory latency that can thus far be explained except for a few experimental studies[6]. We could conclude that any improvements may solely psychosexual such as increases in confidence, perceived ejaculatory control and reduced performance anxiety.
Sildenafil & Paroxetine Combined
A few studies have investigated the effects on IELT from combining both drugs. One concluded that combining both drugs with psychological and behavioral counseling had a beneficial effect but did not compare against either drug used on its own[7]. Another study found that another SSRI (fluoxetine) gave an increase in IELT when combined with sildenafil compared to fluoxetine alone[8].
Conclusion
More research needs to be done to confirm the efficacy of sildenafil and the mechanism that it uses to potentially prolong IELT. However, it appears so far that there is significant evidence to suggest that sildenafil alone and sildenafil combined with an effective SSRI are both good treatments for premature ejaculation.
1. http://www.medicine.ox.ac.uk/bandolier/band128/b128-3.html
2. http://www3.interscience.wiley.com/journal/118719205/abstract
3. http://www3.interscience.wiley.com/journal/118719247/abstract?CRETRY=1&SRETRY=0
4. http://www.nature.com/ijir/journal/v13/n1/abs/3900630a.html
5. http://www.ingentaconnect.com/content/bsc/iju/2007/00000014/00000004/art00013
6. http://www3.interscience.wiley.com/journal/118508165/abstract
7. http://cat.inist.fr/?aModele=afficheN&cpsidt=14488234
8. http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=102909&Ausgabe=233211&ProduktNr=224282
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