Premature ejaculation affects about 1 in 3 men between the ages of 18 and 59 at some point in their lives. Treatment options include behavioral therapy and counseling, as well as topical and oral medications.
One type of medication commonly used that may help treat premature ejaculation (PE) is sertraline, an antidepressant belonging to a group of drugs called selective serotonin reuptake inhibitors (SSRIs). The brand name is Zoloft.
Research suggests sertraline is both safe and effective, though like any medication, it does come with some side effects. Sertraline may be most effective for treating premature ejaculation if you use it alongside behavioral or psychological treatments.
Sertraline, like other SSRIs, is primarily prescribed for mood disorders including:
- major depressive disorder (MDD)
- obsessive-compulsive disorder (OCD)
- panic disorder
- post-traumatic stress disorder (PTSD)
- social anxiety disorder
- premenstrual dysphoric disorder (PMDD) (a severe form of premenstrual syndrome that affects mood and behavior)
SSRIs can have several side effects, including delayed orgasm. For this reason, they’re sometimes prescribed to people with penises to help treat premature ejaculation.
Researchers found that a 25-milligram (mg) dose of sertraline lengthened the average ejaculatory interval (the time between the start of intercourse and ejaculation) from 1 minute to 7.6 minutes.
A 50-mg dose led to an average ejaculatory interval of 13.1 minutes, while a 100-mg dose resulted in an average ejaculatory interval of 16.4 minutes.
The researchers also noted a few of the men experienced side effects from the medication, such as:
- anejaculation, or the inability to ejaculate semen
- erectile dysfunction (ED)
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And in a 2021 study, researchers compared the effectiveness of daily sertraline use with on-demand use. On-demand use means that it’s only taken 4 hours before intercourse.
They found that while both methods were effective, on-demand use was associated with fewer side effects and was therefore considered more tolerable. It may be a more helpful approach for men who don’t find other methods of PE treatment effective.
Sertraline is sold under a brand name (Zoloft) and as a generic drug in both pill and solution form. It’s generally well tolerated, but because of certain side effects, it may not be appropriate for everyone.
Black box warning
Sertraline, like other SSRIs, also comes with a black box warning by the Food and Drug Administration (FDA). It warns that taking sertraline may increase suicidal thoughts and harmful behaviors, particularly in younger people.
If you already have thoughts of self-harm or harming others, sertraline may not be a safe option for you. Have an open and honest conversation with your doctor regarding suicidal thoughts or similar concerns.
A 2019 study found that while sertraline was helpful in delaying ejaculation, it also increased the risk of gastrointestinal distress.
If you’re prone to ulcers or bleeding complications, sertraline may not be safe for you. Taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may also raise the risk of bleeding complications.
If you’ve ever had an allergic reaction to an SSRI, be sure to tell your doctor. Another medication or treatment option should be considered.
The most common side effects of sertraline include nausea, diarrhea, and headache. Other typical side effects can include restlessness, anxiety, and insomnia.
Less common but more serious potential side effects include:
- reduced sodium levels in the blood
- closed-angle glaucoma
- serotonin syndrome, which is a dangerous spike in the body’s serotonin levels
These and other side effects, including the higher risk of suicidal thoughts, tend to lessen after you’ve taken sertraline for a few months. But they may develop at any time.
Be sure to talk with your doctor about what to possibly expect if you start taking sertraline.
There are several clinical and nonclinical options to help treat ED.
In addition to sertraline, other SSRIs may have similar effects on PE. Those include:
- fluoxetine (Prozac)
- citalopram (Celexa)
- escitalopram (Lexapro)
- paroxetine (Paxil)
Another type of drug, called α1-Adrenoceptor antagonists, may help you delay ejaculation, though these drugs may cause anejaculation, too.
Also known as alpha-blockers, these drugs are typically prescribed for high blood pressure and benign prostatic hyperplasia, called BPH or an enlarged prostate.
PE can be related to conditions such as:
- low self-confidence
- guilt or relationship difficulties
Because of this, psychological therapy may be helpful. Therapy focuses on identifying the underlying cause of your PE and helps ease your anxiety or other concerns to give you greater confidence.
Couples therapy also may be helpful, too. Try to find a therapist with experience in treating various types of sexual dysfunction.
Behavioral therapy is another approach, training you to delay ejaculation. The stop-squeeze technique, for example, is designed to help you better sense when you’re about to ejaculate.
After stimulating your penis until you’re close to ejaculating, your partner squeezes your penis so that your erection subsides, along with the feeling that you’re about to ejaculate.
By becoming more aware of this feeling, you may learn to manage the pace of arousal and ejaculation yourself.
One other way to decrease the intensity of sexual arousal is with numbing sprays, creams, or wipes. Products containing lidocaine or benzocaine are available online from companies that sell medications for ED and other sexual health concerns.
These numbing agents are usually applied to the head of the penis about 30 minutes before sexual activity. It should be washed off shortly before intercourse if you’re having sex without a condom or other barrier method.
Premature ejaculation is not uncommon. It can affect younger men with limited sexual experience, as well as older men dealing with age-related changes to their sexual function, and everyone in between.
If you experience PE once in a while, but overall you and your partner are satisfied with the intimate part of your relationship, then there’s no need to consult a doctor.
However, if PE is a frequent occurrence and it’s interfering with your relationship, consult a doctor and discuss your treatment options.
If you’ve started taking sertraline and it doesn’t help or you experience side effects, tell your doctor. Mild and transient symptoms, such as nausea and headaches, should be noted. Your doctor may say to give your body more time to get used to the medication before giving up on it.
However, some symptoms may be signs of serious side effects. For example, difficulty concentrating and weakness may be signs of low sodium resulting from sertraline use. Shivering, fever, and diarrhea, as well as muscle tightness may be signs of serotonin syndrome.
Sertraline is a type of SSRI used to treat depression and other mood disorders. But because one of its side effects can be delayed orgasm, it’s sometimes prescribed for premature ejaculation.
It may be worth trying, especially if nonpharmacological methods such as behavioral therapy or psychological therapy have not been effective for you.
The combination of therapy and sertraline may be the best solution, but be aware of SSRI side effects and talk with your doctor about how to respond if serious or ongoing side effects occur.