The phrase "staying long in bed" can refer to two very different physiological issues, each with its own set of treatments. First, premature ejaculation (PE) involves ejaculating sooner than desired. The second is erectile dysfunction (ED), which is the inability to achieve or sustain an erection. A proper diagnosis is the first and most critical step before considering any medication.
Medications for Premature Ejaculation
For premature ejaculation, the goal is to delay the ejaculatory response. The most common oral medications used for this purpose are certain types of antidepressants, which are typically prescribed off-label.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are primarily used to treat depression, but they have a side effect of delaying orgasm. This effect has been leveraged for the management of PE. The following SSRIs are frequently used:
- Dapoxetine: This is a short-acting SSRI specifically developed and licensed for the on-demand treatment of premature ejaculation in many countries outside the United States. It's taken 1 to 3 hours before sexual activity.
- Sertraline (Zoloft): Often used off-label, sertraline can be taken daily to increase ejaculatory latency over time. Research has shown that daily use can significantly increase the time before ejaculation.
- Paroxetine (Paxil): Another SSRI used off-label for PE, paroxetine has shown strong efficacy in delaying ejaculation.
- Fluoxetine (Prozac): This SSRI can also be effective in delaying ejaculation when used daily.
Other Oral Medications
- Tramadol (Ultram): Originally a pain reliever, tramadol has been found to have side effects that delay ejaculation and may be prescribed when other SSRIs are ineffective. However, it comes with the risk of dependence and other side effects.
Medications for Erectile Dysfunction
Erectile dysfunction treatments focus on increasing blood flow to the penis to help achieve and maintain an erection firm enough for intercourse. The most common are phosphodiesterase-5 (PDE5) inhibitors.
Phosphodiesterase-5 (PDE5) Inhibitors
These medications work by inhibiting the PDE5 enzyme, which allows for increased cyclic guanosine monophosphate (cGMP) in the penis during sexual stimulation. This leads to relaxation of smooth muscles and increased blood flow.
- Sildenafil (Viagra): A well-known PDE5 inhibitor, sildenafil is taken 30 minutes to 4 hours before sexual activity. It works by enhancing the effects of nitric oxide, a chemical that relaxes muscles in the penis to allow more blood to flow in.
- Tadalafil (Cialis): Known for its long duration of action (up to 36 hours), tadalafil can be taken as needed before sexual activity or in a lower daily dose for more spontaneity.
- Vardenafil (Levitra): Similar to sildenafil, vardenafil is taken shortly before sex to improve erectile function.
- Avanafil (Stendra): This is a newer, faster-acting PDE5 inhibitor.
Topical Treatments and Combination Therapy
For those who prefer not to take an oral tablet or want an alternative option, topical treatments are available.
- Topical Anesthetics: Creams or sprays containing benzocaine or lidocaine can be applied to the penis 10 to 15 minutes before intercourse to reduce sensitivity and delay ejaculation. Condoms are often recommended for use with these to avoid numbing the partner.
- Combination Therapy: For men who experience both PE and ED, or for cases where a single medication is not fully effective, a doctor may recommend a combination of therapies. This can include an SSRI with a PDE5 inhibitor or combining medication with behavioral techniques.
Comparison of Common Oral Medications
Medication Category | Common Examples | Primary Function | Administration | Duration of Action | Notes |
---|---|---|---|---|---|
SSRI (On-Demand) | Dapoxetine (Priligy) | Delays ejaculation by increasing serotonin activity. | Oral tablet, 1-3 hours before sexual activity. | Short-acting, for on-demand use. | Licensed for PE in some countries, but not the US. |
SSRI (Daily) | Sertraline (Zoloft), Paroxetine (Paxil) | Delays ejaculation by chronic increase of serotonin levels. | Oral tablet, taken daily. | Continuous effect over time. | Used off-label for PE. |
PDE5 Inhibitors (As-Needed) | Sildenafil (Viagra) | Increases blood flow to the penis to achieve and maintain an erection. | Oral tablet, 30 min-4 hrs before sex. | Up to 8 hours. | Requires sexual arousal to work. |
PDE5 Inhibitors (Daily/Extended) | Tadalafil (Cialis) | Increases blood flow to the penis. | Oral tablet, daily or as needed. | Up to 36 hours. | Provides greater spontaneity with daily dosing. |
Important Considerations
- Prescription Required: The oral tablets discussed for both ED and PE are prescription-only medications. You must consult with a healthcare provider to receive a prescription.
- Consult a Professional: A thorough medical history and evaluation by a doctor are necessary to determine the root cause of the problem and the most appropriate treatment. Do not self-medicate or use unregulated products.
- Side Effects: All medications carry risks. Side effects of PDE5 inhibitors can include headaches, flushing, and indigestion. SSRIs may cause nausea, drowsiness, and decreased libido. Inform your doctor of any existing health conditions or other medications you take.
- Lifestyle Factors and Behavioral Therapy: For many, pharmaceutical treatment is most effective when combined with other approaches. Psychological factors like anxiety can contribute to sexual dysfunction, so counseling and therapy can be beneficial. Behavioral techniques such as the 'squeeze' or 'stop-start' methods can also improve control over ejaculation. Addressing lifestyle factors like exercise, diet, and stress management can also play a significant role in improving sexual health.
Conclusion
While there is no single "tablet for staying long in bed," there are effective medical and non-medical strategies tailored to address the specific causes, whether they are related to premature ejaculation or erectile dysfunction. The right solution begins with a confidential consultation with a healthcare provider who can accurately diagnose the problem and recommend a safe and effective treatment plan. For many, a multi-faceted approach involving medication, behavioral therapy, and open communication with a partner offers the best path to a healthier and more satisfying sex life.
Visit the Mayo Clinic for more information on diagnosing and treating premature ejaculation.