Viagra Does Not Cause Premature Ejaculation
Viagra (sildenafil) does not cause premature ejaculation; in fact, it may actually help improve ejaculatory control and sexual satisfaction in men with PE, particularly when erectile dysfunction coexists. 1
Evidence from Clinical Studies
Effects on Ejaculatory Function
Sildenafil has been studied specifically in men with premature ejaculation, and the findings demonstrate:
Improved ejaculatory control: Men taking sildenafil reported significantly increased perception of ejaculatory control (1.8 vs. 1.5 on the Index of Premature Ejaculation scale, P < 0.05) compared to placebo 1
Enhanced ejaculatory confidence: Sildenafil significantly improved ejaculatory confidence scores (2.2 vs. 1.9, P < 0.05) 1
Better overall sexual satisfaction: Overall sexual satisfaction scores improved significantly (3.1 vs. 2.8, P < 0.05) with sildenafil versus placebo 1
Reduced refractory period: The postejaculatory erectile refractory time decreased substantially (3.2 minutes vs. 6.4 minutes) with sildenafil, allowing for earlier resumption of sexual activity 1, 2
Mechanism of Benefit
The improvement in PE symptoms with sildenafil appears to work through two pathways:
Direct erectile enhancement: In men with PE complicated by erectile dysfunction, treating the ED component with sildenafil (50-100 mg) resulted in PE improvement in 60% of cases, with an 88.88% erectile improvement rate 3
Psychological confidence: Better erectile quality reduces performance anxiety, which is a major contributor to premature ejaculation 3
Important Clinical Context
When ED and PE coexist, treat the erectile dysfunction first - this is a fundamental principle in managing ejaculatory disorders 4. Many patients with ED develop secondary PE due to anxiety about maintaining erections or the need for intense stimulation 4. The PE often improves once the ED is effectively managed 4.
What Viagra Does NOT Do
Sildenafil is not effective for:
- Endocrine-related impotence 5
- Loss of libido 5
- Primary premature ejaculation without erectile dysfunction 5
- Infertility 5
In young healthy men without erectile dysfunction, sildenafil does not improve erection quality (12/30 vs. 10/30 with placebo, P=0.79), though it does reduce the postorgasmic refractory time 2.
Clinical Recommendations
For men with PE alone (no ED): Sildenafil is not the appropriate first-line treatment 4. Instead, use serotonin reuptake inhibitors or topical anesthetics as recommended by the AUA/SMSNA guidelines 4.
For men with both PE and ED: Sildenafil (50-100 mg) should be tried first to address the erectile dysfunction, which may secondarily improve the premature ejaculation 4, 3.
Dosing considerations: When used for PE with comorbid ED, flexible dosing of 50-100 mg taken 1-3 hours before sexual activity is appropriate 3.
Common Pitfalls to Avoid
- Do not prescribe sildenafil for isolated PE without ED - it will not significantly prolong ejaculatory latency time in these patients 1
- Do not assume all sexual dysfunction is ED - obtain a detailed sexual history to distinguish between PE and ED, as they require different treatments 4
- Do not overlook the chronology - determine whether ED or PE came first, as this guides treatment sequencing 4