Perspective | Published:

Sildenafil/Viagra in the treatment of premature ejaculation

International Journal of Impotence Researchvolume 31pages6570 (2019) | Download Citation


The arrival of Pfizer’s blue pill Sildenafil in 1998 brought a great relief both to patient and physician signalling the start of a great era of medical therapy in sexual medicine. Since then the sexual medicine experts have been prescribing sildenafil in erectile dysfunction with acceptable minor adverse events. But the use of sildenafil in premature ejaculation (PE) is still debated. 2018 being the 20th anniversary of sildenafil, we have compiled interesting facts about the role of sildenafil in PE from various original articles, systematic reviews, meta-analyses, economic brochures and sexual medicine committee guidelines. The major issues in most of these studies were the heterogeneity in the definition of PE and estimating the exact ejaculatory latency time. This perspective article highlights the positive role of sildenafil in the management of PE (even without ED) with acceptable adverse events. Now that we have a standardised definition of PE from International Society of Sexual Medicine (ISSM) and a psychogenic component in PE definition, more randomised placebo-controlled studies are required to further establish its role.

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  1. 1.

    20895ltr.pdf [Internet]. Available from: [cited 2018 Oct 27]

  2. 2.

    Keith A. The economics of Viagra. Health Aff Proj Hope. 2000;19:147–57.

  3. 3.

    A History of Viagra. Available from:; 2017 Dec 11 [cited 2018 Oct 27]

  4. 4.

    Pfizer to lose patent of drug Viagra, Indian companies gear up with copycat versions [Internet]. 2018. Available from: [cited 2018 Sep 21]

  5. 5.

    Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, et al. An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. J Sex Med. 2014;11:1423–41.

  6. 6.

    Rowland D, McMahon CG, Abdo C, Chen J, Jannini E, Waldinger MD, et al. Disorders of orgasm and ejaculation in men. J Sex Med. 2010;7(4 Pt 2):1668–86.

  7. 7.

    Hull EM, Du J, Lorrain DS, Matuszewich L. Extracellular dopamine in the medial preoptic area: implications for sexual motivation and hormonal control of copulation. J Neurosci. 1995;15:7465–71.

  8. 8.

    Donatucci CF. Etiology of ejaculation and pathophysiology of premature ejaculation. J Sex Med. 2006;3(Suppl. 4):S303–S8.

  9. 9.

    Sato Y, Zhao W, Christ GJ. Central modulation of the NO/cGMP pathway affects the MPOA-induced intracavernous pressure response. Am J Physiol Regul Integr Comp Physiol. 2001;281:R269–278.

  10. 10.

    Dixon JS, Jen PY. Development of nerves containing nitric oxide synthase in the human male urogenital organs. Br J Urol. 1995;76:719–25.

  11. 11.

    Chen J, Keren-Paz G, Bar-Yosef Y, Matzkin H. The role of phosphodiesterase type 5 inhibitors in the management of premature ejaculation: a critical analysis of basic science and clinical data. Eur Urol. 2007;52:1331–9.

  12. 12.

    Abdel-Hamid IA, Jannini EA, Andersson K-E. Premature ejaculation: focus on therapeutic targets. Expert Opin Ther Targets. 2009;13:175–93.

  13. 13.

    Uckert S, Bazrafshan S, Sonnenberg JE, Kuczyk MA. Effects of phosphodiesterase inhibitors on the contractile responses of isolated human seminal vesicle tissue to adrenergic stimulation. J Sex Med. 2009;6:408–14.

  14. 14.

    Birowo P, Uckert S, Kedia GT, Sonnenberg JE, Sandner P, Thon WF, et al. Exposure of human seminal vesicle tissue to phosphodiesterase (PDE) inhibitors antagonizes the contraction induced by norepinephrine and increases production of cyclic nucleotides. Urology 2010;76:1518.e1-6.

  15. 15.

    Orhan I, Onur R, Taşdemir C, Ayar A, Kadioğlu A. Sildenafil citrate inhibits agonist induced contractions in isolated rat seminal vesicles. J Urol. 2006;175:2350–3.

  16. 16.

    McMahon CG, Stuckey BGA, Andersen M, Purvis K, Koppiker N, Haughie S, et al. Efficacy of sildenafil citrate (Viagra) in men with premature ejaculation. J Sex Med. 2005;2:368–75.

  17. 17.

    ISSM-Quick-Reference-Guide-to-PE.pdf [Internet]. Available from: [cited 2018 Sep 21]

  18. 18.

    Hatzimouratidis K, Eardley I, Giuliano F, Moncada I, Salonia A. Male sexual dysfunction [Internet]. Uroweb. Available from: [cited 2018 Sep 21].

  19. 19.

    McMahon CG. Current and emerging treatments for premature ejaculation. Sex Med Rev. 2015;3:183–202.

  20. 20.

    Cartwright C, Gibson K, Read J, Cowan O, Dehar T. Long-term antidepressant use: patient perspectives of benefits and adverse effects. Patient Prefer Adherence. 2016;10:1401–7.

  21. 21.

    Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JPW, Lue TF, et al. AUA guideline on the pharmacologic management of premature ejaculation. J Urol. 2004;172:290–4.

  22. 22.

    Jannini EA, McMahon C, Chen J, Aversa A, Perelman M. The controversial role of phosphodiesterase type 5 inhibitors in the treatment of premature ejaculation. J Sex Med. 2011;8:2135–43.

  23. 23.

    Wang W-F, Wang Y, Minhas S, Ralph DJ. Can sildenafil treat primary premature ejaculation? A prospective clinical study. Int J Urol J Jpn Urol Assoc. 2007;14:331–5.

  24. 24.

    Gameel TA, Tawfik AM, Abou-Farha MO, Bastawisy MG, El-Bendary MA, El-Gamasy AE-N. On-demand use of tramadol, sildenafil, paroxetine and local anaesthetics for the management of premature ejaculation: a randomised placebo-controlled clinical trial. Arab J Urol. 2013;11:392–7.

  25. 25.

    Gökçe A, Halis F, Demirtas A, Ekmekcioglu O. The effects of three phosphodiesterase type 5 inhibitors on ejaculation latency time in lifelong premature ejaculators: a double-blind laboratory setting study. BJU Int. 2011;107:1274–7.

  26. 26.

    Shaeer O. The Global Online Sexuality Survey (GOSS): the United States of America in 2011 chapter II: phosphodiesterase inhibitors utilization among English speakers. J Sex Med. 2013;10:532–40.

  27. 27.

    Men C, Yu L, Yuan H, Cui Y. Efficacy and safety of phosphodiesterase type 5 inhibitors on primary premature ejaculation in men receiving selective serotonin reuptake inhibitors therapy: a systematic review and meta-analysis. Andrologia. 2016;48:978–85.

  28. 28.

    Bai Y, Pu C, Han P, Li J, Yuan H, Tang Y, et al. Selective serotonin reuptake inhibitors plus phosphodiesterase-5 inhibitors for premature ejaculation: a systematic review and meta-analysis. Urology. 2015;86:758–64.

  29. 29.

    Sun Y, Luo D, Yang L, Tang C, Yang T, Hu X, et al. Efficacy of phosphodiesterase-5 inhibitor in men with premature ejaculation: a new systematic review and meta-analysis. Urology. 2015;86:947–54.

  30. 30.

    Abu El-Hamd M, Abdelhamed A. Comparison of the clinical efficacy and safety of the on-demand use of paroxetine, dapoxetine, sildenafil and combined dapoxetine with sildenafil in treatment of patients with premature ejaculation: a randomised placebo-controlled clinical trial. Andrologia. 2018;50.

  31. 31.

    Martyn-St James M, Cooper K, Ren S, Kaltenthaler E, Dickinson K, Cantrell A, et al. Phosphodiesterase Type 5 inhibitors for premature ejaculation: a systematic review and meta-analysis. Eur Urol Focus. 2017;3:119–29.

  32. 32.

    Tsertsvadze A, Yazdi F, Fink HA, MacDonald R, Wilt TJ, Bella AJ, et al. Oral sildenafil citrate (viagra) for erectile dysfunction: a systematic review and meta-analysis of harms. Urology. 2009;74:831–836.e8.

  33. 33.

    McMurray JG, Feldman RA, Auerbach SM, DeRiesthal H, Wilson N. Long-term safety and effectiveness of sildenafil citrate in men with erectile dysfunction. Ther Clin Risk Manag. 2007;3:975–81.

  34. 34.

    Ballard SA, Gingell CJ, Tang K, Turner LA, Price ME, Naylor AM. Effects of sildenafil on the relaxation of human corpus cavernosum tissue in vitro and on the activities of cyclic nucleotide phosphodiesterase isozymes. J Urol. 1998;159:2164–71.

  35. 35.

    Moschos MM, Nitoda E. Pathophysiology of visual disorders induced by phosphodiesterase inhibitors in the treatment of erectile dysfunction. Drug Des Devel Ther. 2016;8:3407–13.

  36. 36.

    Wirostko BM, Tressler C, Hwang L-J, Burgess G, Laties AM. Ocular safety of sildenafil citrate when administered chronically for pulmonary arterial hypertension: results from phase III, randomised, double masked, placebo controlled trial and open label extension. Br Med J. 2012;344:e554.

  37. 37.

    Laties A, Sharlip I. Ocular safety in patients using sildenafil citrate therapy for erectile dysfunction. J Sex Med. 2006;3:12–27.

  38. 38.

    Pentyala S, Rahman A, Mishra S, Muthiki S, Hughes E, Bikkani A, et al. Pharmacokinetic drug interactions of phosphodiesterase-5 inhibitors mediated by cytochrome P450 3A4 isoform. 10.

  39. 39.

    Shaeer O, Shaeer K. The Global Online Sexuality Survey (GOSS): ejaculatory function, penile anatomy, and contraceptive usage among Arabic-speaking Internet users in the Middle East. J Sex Med. 2012;9:425–33.

  40. 40.

    Shaeer O, Shaeer K, Serefoglu EC, Fode M. 381 Premature ejaculation among english-speaking male internet users in the USA: Results From the Global Online Sexuality Survey (GOSS) 2015. J Sex Med. 2017 (1):S112–3.

  41. 41.

    McMahon CG, McMahon CN, Leow LJ, Winestock CG. Efficacy of type-5 phosphodiesterase inhibitors in the drug treatment of premature ejaculation: a systematic review. BJU Int. 2006;98:259–72.

  42. 42.

    Fisher WA, Gruenwald I, Jannini EA, Lev-Sagie A, Lowenstein L, Pyke RE, et al. Standards for Clinical Trials in Male and Female Sexual Dysfunction: III. Unique Aspects of Clinical Trials in Male Sexual Dysfunction. J Sex Med. 2017;14:3–18.

  43. 43.

    Tang W, Ma L, Zhao L, Liu Y. Efficacy and safety of Sertraline, Viagra and Cardura in patients with premature ejaculation [Internet]; 2014. Available from: [cited 2018 Sep 21]

  44. 44.

    Kim SW, Paick JS. Short-term analysis of the effects of as needed use of sertraline at 5 PM for the treatment of premature ejaculation. Urology. 1999;54:544–7.

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  1. Department of Urology, NU Hospitals, Bangalore, India

    • Pramod Krishnappa
  2. Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain

    • Pramod Krishnappa
    • , Esau Fernandez-Pascual
    • , Joaquin Carballido
    •  & Juan Ignacio Martinez-Salamanca


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The authors declare that they have no conflict of interest.

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Correspondence to Pramod Krishnappa.

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