The two major categories of oral medications for PE are PDE5i and SSRI. PDE5i are primarily used to treat erectile dysfunction (ED), which is distinct from (although often confused with) PE.
ED means that a man has difficulty getting or maintaining an erection and the term implies that losing an erection is not related to ejaculating prematurely. Men with PE ejaculate too soon and have associated distress or bother. Men with PE may have excellent rigidity and no difficulty achieving erections in the first place, but after ejaculating will likely lose the erection (as most men do shortly after ejaculation, regardless of how quickly it occurs). In some cases, men will have both ED and PE - that is, they have difficulty achieving or maintaining an erection in general and, in addition, ejaculate sooner than desired on some or all occasions.
When men have both ED and PE, sildenafil (and other PDE5i like Cialis) is an excellent choice because it can help with both conditions. Men with ED often attempt to keep themselves erect by vigorously stimulating themselves, and this intense stimulation can inadvertently result in PE. When rigidity is supported by PDE5i, vigorous stimulation is often not needed to maintain an erection. With less vigorous stimulation, men gain more control over the timing of their ejaculation.
SSRIs (like sertraline) are a category of medication that are indicated for anxiety and/or depression. It was quickly realized that men on SSRI for anxiety or depression had a side effect that many of them considered bothersome: it took more time and stimulation to reach ejaculation. This side effect of delayed ejaculation has become a common treatment choice for men with PE, because they actually desire the side effect of a delay in ejaculation. This is considered an “off-label” use of these medications, but they are recommended as a first-line treatment for PE by the American Urological Association (AUA). Although there are potential side effects with any medication, men without a diagnosis of anxiety of depression don’t typically experience any changes in mood. For men with excellent erectile function and PE, sertraline is an excellent choice because it delays ejaculation and does not depend on improving erectile function to do so.
For any given patient, the choice between sildenafil and sertraline may also depend on other factors including preference, medical history, and other medications taken. Your provider will work with you to determine the best choice for you.