Q. What are the most effective treatments for premature ejaculation? Do erectile dysfunction drugs like Viagra help with this problem?

A. Premature ejaculation, usually defined as ejaculation within one minute of starting intercourse, is initially treated with behavioral techniques to delay climax. This includes the squeeze technique, which involves applying pressure just behind the head of the penis when ejaculation approaches and maintaining pressure until the
sensation passes. However, in many men, this doesn't prevent ejaculation.

There are a number of medications used for premature ejaculation, although none are specifically FDA-approved for this purpose. The most effective appear to be the antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa) and fluoxetine (Prozac, Sarafem). You would need to take the medication every day, and it may take several weeks to show an effect. If these medications don't work or cause unacceptable side effects, a different type of antidepressant, called clomipramine (Anafranil, Clofranil), may help. Another option is to apply a topical anesthetic (numbing cream) to the head of the penis to decrease sensation.

Sildenafil (Viagra) is used to treat erectile dysfunction (difficulty obtaining or maintaining erections). These drugs increase blood flow to the penis following sexual arousal, helping to produce an erection. They do not inhibit ejaculation, so they are not prescribed for premature ejaculation. However, they may be helpful in men who experience both erectile dysfunction and premature ejaculation.

— William Kormos, M.D.
Editor in Chief, Harvard Men's Health Watch