Phosphodiesterase 5 inhibitors in the treatment of premature ejaculation

Int J Androl. 2006 Oct;29(5):503-09. doi: 10.1111/j.1365-2605.2006.00689.x.


To date, there is no FDA-approved therapy for premature ejaculation (PE). Recently, phosphodiesterase 5 inhibitors (PDE5-Is) have been demonstrated to have encouraging results in the treatment of PE by a few studies. The aim of this review was to assess the updated manuscripts and thereafter present the practical recommendations and possible mechanisms concerning PDE5-Is for treating PE. Using MEDLINE, we searched and assessed the peer manuscripts published from 1 January 1996 to 1 September 2005 about PDE5-Is for treating PE. The results show that the number of patients in all the reports is very few and most of the studies do not employ double-blinded and placebo-controlled tests, though they are prospective and randomized. Therefore, the results and conclusions might be biased. PDE5-Is are suggested to be used in PE with old age or associated with erectile dysfunction (ED), or to be employed alone or in combination with selective-serotonin reuptake inhibitors (SSRIs) when SSRIs fail to treat PE; behavioural therapy is proposed to be used for preventing the recurrence of PE following withdrawal of PDE5-Is. In addition, for the PE patient with a definite aetiological cause, the aetiology should be cured first, if PE still exists, followed by PDE-Is prescription. Possible mechanisms that are involved include relaxing the smooth muscles of vas deferens, seminal vesicle, prostate and urethra; decreasing the central sympathetic output; inducing peripheral analgesia; prolonging the duration of erection; and increasing confidence, the perception of ejaculatory control, overall sexual satisfaction, and decreasing the post-orgasmic refractory time to achieve a second erection after ejaculation. Well-designed multicentre studies are urgently warranted to further elucidate the efficacies and safety as well as mechanisms of PDE5-Is in the treatment of PE.

Publication types

  • Review

MeSH terms

  • 3',5'-Cyclic-GMP Phosphodiesterases*
  • Carbolines / therapeutic use
  • Cyclic Nucleotide Phosphodiesterases, Type 5
  • Ejaculation / drug effects*
  • Humans
  • Imidazoles / therapeutic use
  • Male
  • Phosphodiesterase Inhibitors / therapeutic use*
  • Piperazines / therapeutic use
  • Purines
  • Sexual Dysfunction, Physiological / drug therapy*
  • Sildenafil Citrate
  • Sulfones / therapeutic use
  • Tadalafil
  • Triazines / therapeutic use
  • Vardenafil Dihydrochloride


  • Carbolines
  • Imidazoles
  • Phosphodiesterase Inhibitors
  • Piperazines
  • Purines
  • Sulfones
  • Triazines
  • Vardenafil Dihydrochloride
  • Tadalafil
  • Sildenafil Citrate
  • 3',5'-Cyclic-GMP Phosphodiesterases
  • Cyclic Nucleotide Phosphodiesterases, Type 5
  • PDE5A protein, human