By the Medsmingle Team · Updated 13 November 2026

Treatment depends on your symptoms, health and preferences. Prescription treatments require assessment by a qualified clinician.

Premature ejaculation (PE) means regularly ejaculating sooner than you or your partner would like, often within about 1 minute of penetration, and feeling distressed by it. It’s one of the most common sexual concerns in men, and there are several effective options.

Types and causes

• Lifelong PE: present from the first sexual experiences, likely linked to how the brain uses serotonin
• Acquired PE: starts later, often linked to anxiety, relationship stress, erectile dysfunction, prostate inflammation or thyroid problems

Behavioral techniques

• Stop-start: stop stimulation just before the point of no return, wait, then continue
• Squeeze technique: gently squeeze the head of the penis to reduce arousal
• Pelvic floor exercises may be useful for some men when guided by a trained clinician
• Couples or sex therapy for anxiety and communication

Topical numbing products

Over-the-counter lidocaine or benzocaine sprays and creams reduce sensitivity. Follow the specific product instructions to avoid numbing a partner; check whether it is compatible with your condom material.

Prescription options

• SSRIs such as sertraline or paroxetine, usually prescribed daily for this purpose, can delay ejaculation. This is an off-label use in the US, so it needs a doctor’s assessment.
• Dapoxetine is a short-acting SSRI made specifically for PE. It’s approved in many countries, including the UK and much of Europe and Asia, but not by the FDA in the US. Combination tablets that pair dapoxetine with an ED medicine aren’t approved in the US either.
• ED medicines can help men who have both ED and PE.

Safety

SSRIs can cause nausea, dizziness and, rarely, fainting, and they interact with other antidepressants, migraine triptans and tramadol. Don’t combine medicines for PE and ED without medical advice.

When to see a doctor

See a doctor if PE is causing distress, if it started suddenly, or if you also have ED, pain or urinary symptoms.

Frequently asked questions

Is premature ejaculation permanent?

Acquired PE often improves when the cause is treated. Lifelong PE can usually be well managed.

Does masturbating before sex help?

Some men find it helps, but evidence is limited.

For questions about a prescription or symptoms, speak with your own doctor or pharmacist. For website enquiries, contact our team.

General information only. It isn’t a substitute for advice from your doctor or pharmacist.

Source

AUA/SMSNA: disorders of ejaculation guideline.

By the Medsmingle Team · Updated 13 November 2026

This is a prescription medicine. Only take it if it has been prescribed for you after a medical assessment, and follow your doctor’s and pharmacist’s instructions.

Avanafil, sold as Stendra, is the newest PDE5 inhibitor approved in the US for erectile dysfunction. Some prescribed doses may be taken as little as 15 minutes before sex; timing and response vary.

Timing

• Can work from about 15 minutes (for the higher doses), typically within 30 minutes
• Lasts up to about 6 hours
• Can be taken with or without food

Dosing

The usual starting dose is 100 mg about 15 to 30 minutes before sex, adjusted to 50 mg or 200 mg, no more than once a day. Lower doses are used with some interacting medicines.

Side effects

• Headache
• Flushing
• Stuffy nose
• Back pain (less common)

Some studies suggest fewer visual side effects than older ED medicines, but large comparison trials are limited.

Who must avoid it or needs specialist assessment

• Anyone taking nitrates (nitroglycerin, isosorbide mononitrate or dinitrate) or recreational “poppers” (amyl nitrite): the combination can cause a dangerous drop in blood pressure
• Anyone taking riociguat (Adempas) for pulmonary hypertension
• Do not use if your clinician says sexual activity is unsafe. A recent heart attack or stroke requires individual specialist assessment.
• Very low blood pressure, severe liver disease or inherited eye conditions require assessment before treatment; suitability differs between medicines.

Get emergency help (call 911) if you have

• Chest pain, fainting or severe dizziness during or after sex: tell the medical team you took an ED medicine, including the exact medicine and when you last took it
• An erection lasting more than 4 hours (priapism), which can permanently damage the penis
• Sudden loss or decrease of vision in one or both eyes
• Sudden decrease or loss of hearing, with or without ringing or dizziness
• Swelling of the face, lips or throat, or trouble breathing

Interactions

• Do not take with strong CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin)
• Lower maximum dose with moderate inhibitors such as erythromycin, fluconazole or verapamil
• Alpha-blockers: start low under medical advice
• Don’t combine with other ED medicines

Frequently asked questions

Is avanafil generic?

Availability of generics varies by country. Ask a licensed pharmacist to verify current availability and the approval status of the exact product you are offered.

Is it stronger than Viagra?

Not stronger; it may work faster for some men.

For questions about a prescription or symptoms, speak with your own doctor or pharmacist. For website enquiries, contact our team.

General information only. It isn’t a substitute for advice from your doctor or pharmacist.

Source

MedlinePlus: avanafil.

By the Medsmingle Team · Updated 13 November 2026

This is a prescription medicine. Only take it if it has been prescribed for you after a medical assessment, and follow your doctor’s and pharmacist’s instructions.

Vardenafil (brand names Levitra and, as a dissolving tablet, Staxyn) is a PDE5 inhibitor for erectile dysfunction. It works in a similar way to sildenafil and lasts a similar time, but some men respond better to one than another.

How it works and timing

• Helps blood flow into the penis when you’re sexually aroused; it doesn’t increase desire
• Starts working in about 25 to 60 minutes
• Lasts about 4 to 5 hours
• A very high-fat meal may delay the standard tablet

Dosing

Film-coated tablet: usual start 10 mg about 1 hour before sex, adjusted to 5 or 20 mg, no more than once a day. Older men (65+) usually start at 5 mg.

Orally dissolving tablet (10 mg): placed on the tongue to dissolve without water. It isn’t interchangeable mg-for-mg with the standard tablet.

Common side effects

• Headache, flushing
• Stuffy nose
• Indigestion
• Dizziness

Who must avoid it or needs specialist assessment

• Anyone taking nitrates (nitroglycerin, isosorbide mononitrate or dinitrate) or recreational “poppers” (amyl nitrite): the combination can cause a dangerous drop in blood pressure
• Anyone taking riociguat (Adempas) for pulmonary hypertension
• Do not use if your clinician says sexual activity is unsafe. A recent heart attack or stroke requires individual specialist assessment.
• Very low blood pressure, severe liver disease or inherited eye conditions require assessment before treatment; suitability differs between medicines.

Get emergency help (call 911) if you have

• Chest pain, fainting or severe dizziness during or after sex: tell the medical team you took an ED medicine, including the exact medicine and when you last took it
• An erection lasting more than 4 hours (priapism), which can permanently damage the penis
• Sudden loss or decrease of vision in one or both eyes
• Sudden decrease or loss of hearing, with or without ringing or dizziness
• Swelling of the face, lips or throat, or trouble breathing

Extra cautions with vardenafil

• Heart rhythm: vardenafil can slightly prolong the QT interval. Avoid vardenafil if you have congenital long-QT syndrome or take class IA or III antiarrhythmics such as quinidine, procainamide, amiodarone or sotalol; discuss alternatives with your prescriber
• Strong CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin) greatly raise levels; lower doses or avoidance are needed
• Alpha-blockers: start at the lowest dose under medical advice

Frequently asked questions

Is vardenafil better than sildenafil?

Studies show similar effectiveness. Some men who don’t respond to one respond to another.

Can I take it with alcohol?

Ask your prescriber about alcohol. Heavy drinking can worsen ED and dizziness; a blanket safe amount cannot be given.

For questions about a prescription or symptoms, speak with your own doctor or pharmacist. For website enquiries, contact our team.

General information only. It isn’t a substitute for advice from your doctor or pharmacist.

Source

MedlinePlus: vardenafil.

By the Medsmingle Team · Updated 13 November 2026

This is a prescription medicine. Only take it if it has been prescribed for you after a medical assessment, and follow your doctor’s and pharmacist’s instructions.

Sildenafil and tadalafil are the two most prescribed medicines for erectile dysfunction. Both are PDE5 inhibitors, but response and tolerability vary. The main differences are timing, flexibility and side effects.

At a glance

Which suits whom?

Sildenafil may suit men who have sex less often, prefer a shorter-acting medicine, or prefer as-needed treatment.

Tadalafil may suit men who want more spontaneity, are sexually active several times a week (daily dosing), or also have urinary symptoms from an enlarged prostate.

Neither is “stronger” overall. If one doesn’t suit you after reviewing the prescribed dose and correct use, your doctor may suggest switching.

Important safety points for both

• Never take either with nitrates, “poppers” or riociguat
• Get emergency help for chest pain, an erection lasting over 4 hours, or sudden vision or hearing loss
• Do not combine them or switch without a prescriber’s plan; tadalafil can remain active beyond the day it is taken
• Tell your doctor about all medicines, especially alpha-blockers, antifungals, HIV medicines and some antibiotics

Read the full guides: sildenafil and tadalafil.

Frequently asked questions

Can I switch from sildenafil to tadalafil?

Only with a prescriber’s advice. The waiting period depends on the medicines, doses, interactions and your kidney or liver function; there is no switching rule suitable for everyone.

Which has fewer side effects?

They’re similar overall. Sildenafil more often causes flushing and vision tinge; tadalafil more often causes back pain.

For questions about a prescription or symptoms, speak with your own doctor or pharmacist. For website enquiries, contact our team.

General information only. It isn’t a substitute for advice from your doctor or pharmacist.

Sources

MedlinePlus: sildenafil and tadalafil.

By the Medsmingle Team · Updated 13 November 2026

This is a prescription medicine. Only take it if it has been prescribed for you after a medical assessment, and follow your doctor’s and pharmacist’s instructions.

Tadalafil, first sold as Cialis, is a PDE5 inhibitor used for erectile dysfunction (ED) and for urinary symptoms of an enlarged prostate (BPH). Its standout feature is how long it lasts, which is why it’s sometimes called “the weekend pill”.

How it works

Like sildenafil, tadalafil blocks the PDE5 enzyme so blood vessels in the penis relax and an erection is easier when you’re sexually aroused. It also relaxes smooth muscle in the prostate and bladder, which eases BPH symptoms such as a weak stream and needing to pee at night. See enlarged prostate (BPH).

How long it lasts

• Starts working in about 30 minutes to 2 hours
• The window of effect lasts up to 36 hours
• Food doesn’t affect it, unlike sildenafil

Two ways to take it

As needed: the usual starting dose is 10 mg before sexual activity, adjusted to 5 mg or 20 mg, no more than once a day.

Once daily: a low dose (2.5 mg or 5 mg) taken every day at the same time. This keeps a steady level, so there’s no need to plan around a pill. Daily 5 mg is also the dose used for BPH, alone or together with ED.

Your doctor will choose based on how often you’re sexually active, side effects, other medicines, and kidney or liver function (lower doses are used if these are impaired).

Common side effects

• Headache
• Indigestion, heartburn
• Back pain and muscle aches, more common than with other ED medicines, usually 12 to 24 hours after a dose
• Flushing, stuffy nose
• Dizziness

Vision color changes are less common than with sildenafil.

Who must avoid it or needs specialist assessment

• Anyone taking nitrates (nitroglycerin, isosorbide mononitrate or dinitrate) or recreational “poppers” (amyl nitrite): the combination can cause a dangerous drop in blood pressure
• Anyone taking riociguat (Adempas) for pulmonary hypertension
• Do not use if your clinician says sexual activity is unsafe. A recent heart attack or stroke requires individual specialist assessment.
• Very low blood pressure, severe liver disease or inherited eye conditions require assessment before treatment; suitability differs between medicines.

Get emergency help (call 911) if you have

• Chest pain, fainting or severe dizziness during or after sex: tell the medical team you took an ED medicine, including the exact medicine and when you last took it
• An erection lasting more than 4 hours (priapism), which can permanently damage the penis
• Sudden loss or decrease of vision in one or both eyes
• Sudden decrease or loss of hearing, with or without ringing or dizziness
• Swelling of the face, lips or throat, or trouble breathing

Never take nitrates yourself after tadalafil. In a life-threatening situation, a medical team may consider nitrates only after at least 48 hours and under close monitoring; this is not permission to self-administer them.

Important interactions

• Alpha-blockers (doxazosin, tamsulosin): risk of low blood pressure; not usually combined for BPH treatment
• Strong CYP3A4 inhibitors such as ketoconazole, itraconazole, ritonavir and clarithromycin: increase tadalafil levels, so a lower maximum dose is used
• Rifampin and some seizure medicines: reduce its effect
• Alcohol: heavy drinking adds to dizziness and low blood pressure
• Don’t combine with other ED medicines

Who it suits best

Tadalafil often suits men who want spontaneity, are sexually active several times a week, or also have BPH symptoms. Sildenafil may suit men who prefer a shorter-acting medicine. For a side-by-side comparison, see sildenafil vs tadalafil.

Frequently asked questions

Can I take tadalafil every day?

Yes, the low-dose daily regimen (2.5 to 5 mg) is designed for this, but don’t take daily tablets and as-needed doses together.

Does tadalafil work for BPH without ED?

Yes, 5 mg daily is approved for urinary symptoms of BPH.

How long until daily tadalafil works?

It reaches a steady level in about 5 days.

For questions about a prescription or symptoms, speak with your own doctor or pharmacist. For website enquiries, contact our team.

General information only. It isn’t a substitute for advice from your doctor or pharmacist.

Sources

MedlinePlus: tadalafil; FDA Cialis prescribing information.