Does Cialis Help with Premature Ejaculation?

Cialis (tadalafil) is not approved for premature ejaculation (PE). It is a phosphodiesterase type 5 (PDE5) inhibitor approved for erectile dysfunction (ED) and for urinary symptoms of an enlarged prostate (CIALIS label). Any benefit for PE is usually indirect: a more reliable erection can reduce worry that the erection will fail, especially when PE and ED occur together (AUA/SMSNA 2020).

Many men say they come too soon. Self-reported PE is as high as 30%, but clinical PE (poor control, bother, and ejaculation within about 2 minutes) is under 5% (AUA/SMSNA 2020).

What Cialis is

Cialis blocks PDE5. That raises cyclic GMP in penile smooth muscle, which increases blood flow into the penis when there is sexual stimulation, and can help a man with ED get and keep an erection (CIALIS label). The mean terminal half-life in healthy adults is 17.5 hours. As-needed doses improved erectile function compared with placebo for up to 36 hours, which is why people call it "the weekend pill" (CIALIS label).

It is not approved for PE. No PE drug has FDA approval in the United States; SSRI and topical PE use is off-label (AUA/SMSNA 2020).

How Cialis might affect premature ejaculation

Cialis does not treat the ejaculatory reflex the way an SSRI does. Proposed reasons a PDE5 inhibitor might still change the experience of PE include a longer-lasting erection, more confidence, a greater sense of control, and higher sexual satisfaction (Asimakopoulos 2012). Those mechanisms are partly theoretical. A 2012 systematic review of PDE5 inhibitors in men with PE and no ED called the clinical evidence inadequate (Asimakopoulos 2012).

PE and ED often occur together. When they do, the AUA/SMSNA guideline says to treat the ED using the AUA ED guideline, which includes oral PDE5 inhibitors such as tadalafil or sildenafil (Viagra) (AUA/SMSNA 2020).

What the research says

A 2017 systematic review and meta-analysis of 15 randomized trials found PDE5 inhibitors, including tadalafil, increased intravaginal ejaculatory latency time (IELT, the time from penetration to ejaculation) compared with placebo (231 men). PDE5 inhibitors plus an SSRI beat an SSRI alone (521 men). PDE5 inhibitors alone did not differ from SSRIs alone (405 men). Sexual satisfaction and ejaculatory control looked better with PDE5 inhibitors than with placebo. Most trials were of unclear quality, and the results were statistically heterogeneous (I² ≥ 40%), so the size of the benefit is uncertain (Martyn-St James 2017).

That review also found, from single trials, that sildenafil plus behavioral therapy beat behavioral therapy alone (Martyn-St James 2017). That matches the AUA/SMSNA advice that combining behavioral and drug approaches may work better than either alone (Moderate Recommendation; Grade B) (AUA/SMSNA 2020).

Other treatments for premature ejaculation

If PE is the main problem, first-line drugs in the AUA/SMSNA guideline (Strong Recommendation; Grade B) are daily SSRIs, on-demand clomipramine or dapoxetine where it is available, and topical penile anesthetics. In the United States those oral options are off-label; dapoxetine is not sold here (AUA/SMSNA 2020).

• Daily SSRIs. The guideline discussion names paroxetine, sertraline, fluoxetine, and citalopram (AUA/SMSNA 2020).
• Topical anesthetics. Lidocaine, prilocaine, or benzocaine on the glans can reduce sensitivity (AUA/SMSNA 2020).
• Behavioral techniques. A 2015 systematic review of 10 trials found limited evidence that physical methods such as stop-start and squeeze improve IELT compared with a waitlist, and that adding them to a drug beat the drug alone (Cooper 2015).

The same AUA/SMSNA guideline says there is not enough evidence to support alternative therapies for PE, so pelvic-floor exercises are not a first-line PE treatment (AUA/SMSNA 2020).

Who should not take Cialis

Do not take tadalafil with any organic nitrate (including nitroglycerin or "poppers") or with a guanylate cyclase stimulator such as riociguat. Both combinations can drop blood pressure to an unsafe level (CIALIS label). Sex itself may be unsafe after a recent heart attack or stroke, or if a clinician has already said sexual activity is a bad idea (CIALIS label).

Common reactions (2% or more) include headache, indigestion, back pain, muscle aches, stuffy nose, flushing, and limb pain (CIALIS label). An erection lasting more than 4 hours needs emergency care (CIALIS label). The prescriber sets the dose.

Should you try Cialis for premature ejaculation?

If you have both ED and PE, Cialis is a reasonable option to discuss, because the ED should be treated and tadalafil is approved for that (AUA/SMSNA 2020). If PE is your only concern, first-line PE treatments are more directly aimed at ejaculatory control. A licensed clinician can sort out which one is the main problem and what to try first.

Bottom line

Cialis is not a PE drug. It can help the erection for up to 36 hours, and that may help when ED is part of the picture. Trials of PDE5 inhibitors for PE show a longer IELT than placebo and a larger effect when an SSRI is added, but the studies are mixed and often poorly reported. For PE alone, daily SSRIs, topical anesthetics, and behavioral techniques remain the guideline first line. AlphaMD's licensed providers can review symptoms and discuss Cialis or other options by telehealth.