How are premature ejaculation and erectile dysfunction treated when they come together? Usually the erection problem is treated first. The two often go together — a man with erection problems may hurry to ejaculate before he loses the erection — and treating the erectile dysfunction can settle the early ejaculation too. What is never done is combining dapoxetine, the tablet approved for premature ejaculation, with an ED medicine such as Viagra or Cialis.
Why do premature ejaculation and erectile dysfunction go together?
A review for Australian GPs notes that erectile dysfunction and premature ejaculation "frequently co-exist", because men with erectile dysfunction might try to ejaculate early, before the erection is lost (RACGP). That is why a doctor asks whether the erection goes before or after ejaculation: the answer points to which problem comes first.
What is treated first?
The erection. International Society for Sexual Medicine guidance is to treat erectile dysfunction first where the two coexist (ISSM). The ED medicines available in Australia — sildenafil, tadalafil, vardenafil and avanafil — are all prescription-only (healthdirect); the options are compared in medications for erectile dysfunction. On their own, these medicines do not lengthen the time to ejaculation (RACGP).
Can you take dapoxetine and Viagra together?
No. The Australian product information for Priligy (dapoxetine) says it "should not be used in men with erectile dysfunction (ED) who are using PDE5 inhibitors" — the class of Viagra and Cialis — because the pair may lower blood pressure on standing (Priligy PI). The question is answered in full in can dapoxetine be taken with sildenafil?
What treats premature ejaculation itself?
Dapoxetine is the tablet approved for premature ejaculation in Australia; some antidepressants are used off-label, and a numbing spray or cream applied to the penis is another option (RACGP). Each needs a doctor's assessment first, and none is combined with an ED medicine without one. The full list, ranked by status in Australia, is in our guide to lasting longer in bed.
Do techniques and counselling help?
They can. The stop-start and squeeze techniques work for some men, though the RACGP review finds them of little benefit on their own; counselling or sex therapy helps where anxiety or relationship problems play a part, and it can be combined with medicine (healthdirect).
Can both problems be cured?
Often they can be controlled rather than cured; it depends on the cause. When erectile dysfunction is linked to a health problem such as heart disease or diabetes, treating that helps both. More on this in is erectile dysfunction curable? and can erectile dysfunction go away on its own?
The short answer
When both problems come together, a GP usually treats the erection first, and that can fix the early ejaculation too. Dapoxetine and ED medicines are never combined. Techniques and counselling help alongside. More treatments are covered in our guide to managing erectile dysfunction.
