I no longer offer consultations for premature ejaculation. This article remains a reading resource; to explore further, I recommend Étienne Vallon’s book.

You typed “Priligy reviews” or “paroxetine premature ejaculation” into Google. You find pharmaceutical websites praising their effectiveness, forums where some men say they changed their lives, and others where people describe side effects they had not anticipated. And you do not know what to believe.

This article is an honest clinical reading. Neither promotion nor demonisation. What I tell patients in the practice when the question returns — “should I take something?”.

Three things to know before continuing:

  • I am not a doctor. Only a doctor (medical sexologist, urologist or informed GP) can prescribe and assess contraindications in your particular case. This article is not treatment advice.
  • Medication exists. It works, to an extent. Refusing to look at it honestly is as misleading as praising it without nuance.
  • My underlying position: medication for premature ejaculation can be a useful temporary support, not a solution to the underlying problem. And some of its costs are discussed far too little.

Priligy (dapoxetine) — what is praised, what is hidden

The medicine dapoxetine, sold under the name Priligy, is the only medicine in France with a marketing authorisation specifically for premature ejaculation. It is a serotonin reuptake inhibitor — the same family as SSRI antidepressants — but short-acting. It is taken on demand, one to three hours before intercourse. Not every day.

The authorisation covers adult men whose intravaginal ejaculatory latency time (IELT) is below two minutes. Before prescribing, the doctor must rule out numerous contraindications: certain heart conditions, a history of fainting, combination with monoamine oxidase inhibitors, certain other antidepressants, lithium, tramadol and other drugs. The doctor carries out this check, not you.

The real benefit — modest, not miraculous

Clinical studies show that Priligy multiplies IELT by 2 to 3. In practical terms: if you ejaculate after 1 minute, you may reach 2–3 minutes. That is a real gain — especially for breaking a vicious circle of performance anxiety. But it is not the transformation the adverts suggest.

Many men tell me: “it changes something, but it doesn’t resolve what I’m really feeling”. The speed decreases, yes. The feeling of being on absent autopilot, the disconnection from their partner, the anxiety that returns before the next dose — all of that remains.

What is less often said: 70% stop within the first year

This is the figure you do not find on the box. Around 70% of men who start Priligy stop taking it within the first year. Three main reasons recur in the practice and in follow-up studies:

  • Side effects. Nausea, dizziness, light-headedness, sometimes an odd mood during the evening. For some, it is manageable. For others, the fatigue cancels out the benefit.
  • The modest benefit. A few more minutes, not a transformation. If your expectations were high, disappointment comes quickly.
  • Taking it on demand kills spontaneity. You have to anticipate. Plan the occasion 1 to 3 hours ahead. Wait for the effect. For many couples, this ritual adds pressure instead of removing it — the opposite of the desired effect.

In practical terms: Priligy can be an occasional safety net during a period when you want to break a vicious circle (for example, rebuild some confidence before an important holiday as a couple, or while beginning behavioural work). As a long-term treatment over months, it disappoints the vast majority who try it.

Daily SSRIs — the off-label route that works better but carries a greater cost

Many doctors faced with PE prescribe off-label daily SSRIs: paroxetine (Deroxat), sertraline, escitalopram, fluoxetine — or clomipramine (Anafranil), a tricyclic that also acts on serotonin.

These medicines are taken every day, independently of intercourse. They delay ejaculation by increasing serotonin in the brain. The delaying effect is generally more marked and more reliable than with on-demand Priligy. In some studies, clomipramine shows the best results for duration, but with a different side-effect profile.

These are antidepressants, prescribed here for their delaying effect on ejaculation, not their effect on mood. The choice of medicine, dose and duration all fall strictly within medical prescribing.

What many prescribers do not mention

Here I am going to be very direct, because this is the subject on which I have seen the most poorly supported men in the practice.

SSRIs taken long term for PE are not sexually insignificant. Three effects often recur, and all three are insufficiently named at the time of prescribing:

  • Libido can plummet. Not for everyone, not by 100%, but a decline is common. You last longer, but you want sex less. The relationship erodes in a different way.
  • Orgasm can become dulled. Yours first (partial anorgasmia, less intense sensation, sometimes no orgasm). But also — and this is rarely said — your partner’s, through a knock-on effect on the quality of intercourse.
  • PSSD — persistent post-SSRI sexual dysfunction. A rarer but well-documented phenomenon: some men describe genital numbness and loss of pleasure that continue after stopping the medication, sometimes for months or years. Medical science is only beginning to recognise this syndrome. It is rare. It exists. It needs to be named.

This is not a reason to refuse treatment when it is indicated and properly supervised. It is a reason not to take it as the first option without first seriously exploring behavioural and body-based work.

What about combining an SSRI with Viagra?

A question that comes up regularly: “if I’m already taking an SSRI for my PE, can I add Viagra?”

The answer, under medical supervision, is often yes. It can even be a useful combination in certain situations:

  • When ejaculation is rapid and erections are unreliable (a common situation — anxiety affects both), the SSRI delays ejaculation and Viagra supports the erection.
  • When the SSRI itself has reduced libido and erection firmness — a known side effect — Viagra can compensate and allow treatment to continue.

Precautions: monitor blood pressure, space out doses to limit cumulative headaches, rule out cardiac contraindications. It is neither a harmless cocktail nor a perfect route. It is an option to discuss with a doctor who understands sexology.

Above all: the combination remains a temporary support. It creates a window of safety in which behavioural work can take shape. When the work holds, the supports are removed — in this order: Viagra first, then the SSRI, always under supervision to avoid withdrawal effects.

My clinical position — the “temporary support” strategy

I will summarise the practical approach I have discussed in consultations when a man asks me this question.

When medication makes sense (yes, occasionally)

  • Breaking a vicious circle of performance anxiety that has lasted a long time. A few weeks of on-demand Priligy to regain some confidence and defuse fear.
  • Profile B (lifelong neurobiological), where rapid ejaculation is longstanding and congenital, and behavioural work alone progresses slowly. A well-dosed daily SSRI can change the dynamic — provided it is supervised and there is a plan for stopping.
  • While deeper work is getting under way (pelvic floor rehabilitation, presence/breathing, psychological work on anxiety). Medication buys time. It does not replace the work.
  • With a clear view of how it will end. Take it for X months, work alongside it, review, withdraw. Not “I’ll take this for life”.

When medication is a poor choice

  • As the first option, without exploring the body. Too many men take SSRIs for years without ever being asked whether they breathe into their belly, know where their pelvic floor is or how it moves. PE has an enormous bodily dimension that no medicine addresses.
  • As the only, ongoing solution. You can last a long time during penetration and have no pleasure, no connection, no libido. You have resolved a symptom and lost your sex life.
  • When the issue is actually psychological (performance anxiety, trauma, fear of intimacy). Medication masks the problem. It does not treat it. And you put off the real work for five years.
  • Without honest information about long-term side effects. If your doctor mentions neither libido, orgasm nor PSSD, ask explicitly. You have the right to know.

What I always suggest alongside it

Whatever the choice of medication, the approach includes body work (diaphragmatic breathing, pelvic floor relaxation, sometimes male pelvic floor physiotherapy) and psychological work on performance anxiety and presence during intercourse. It is this work that lasts when medication stops.

Medication shifts duration. The work changes your sex life.

Three questions to ask your doctor before a prescription

If you are considering medication for PE, these are the questions I suggest patients ask before a prescription. A doctor who understands sexology will answer them directly.

1. “What is my profile — situational, lifelong, anxious?” The answer strongly guides the choice of medicine and reasonable expectations. If your PE is recent and linked to performance anxiety, medication is an option, but psychological work is probably more appropriate.

2. “What sexual side effects can occur, and what is PSSD?” A simple test: if the doctor dismisses the question or has never heard of it, seek a second opinion from someone who specifically practises sexology.

3. “What is the plan for stopping? How long, what criteria for stopping, what work alongside it?” PE medication without a plan for stopping is not care — it is an income stream for the manufacturer.

What about anaesthetic sprays and creams (EMLA, lidocaine)?

A question outside systemic medication, but often asked. I will summarise briefly.

Anaesthetic sprays and creams (based on lidocaine, sometimes pilocaine — such as EMLA) applied to the glans before intercourse can delay ejaculation by reducing sensitivity. Advantage: local action, no systemic effect. Disadvantages: possible transfer to the partner (clitoral or vaginal numbness), loss of pleasure for you (numbing the glans means numbing erotic sensation) and — like everything else — they do not treat the cause.

Useful occasionally. Not an underlying strategy.

Summary

  • On-demand Priligy: modest benefit (2–3 times IELT), 70% stop within the first year, useful as an occasional safety net, not as ongoing treatment.
  • Daily off-label SSRIs (paroxetine, sertraline, clomipramine): a more reliable delaying effect, but a real sexual cost — libido, orgasm and a risk of PSSD that needs to be named explicitly.
  • SSRI + Viagra combination: possible and useful under medical supervision, but still a temporary support to remove when behavioural work holds.
  • The “temporary support” strategy: medication to buy time + body and psychological work for lasting change. Not one without the other.
  • Anaesthetic sprays: useful occasionally; anticipate transfer to the partner and loss of pleasure.
  • The right questions to ask: which PE profile, which long-term sexual effects and PSSD, what plan for stopping.

Premature ejaculation is neither inevitable nor a disease resolved with a pill. It is a difficulty that responds very well to combined work — body, anxiety and sometimes properly supervised medication. Men who move beyond it in a lasting way are not those who take a tablet for ten years. They are those who used medication as a transition and did the work behind it.

Going further:

📖 With or without medication, the deeper work remains the same. That is what Sortir de votre éjaculation précoce contains: the programme that begins with the body, and an honest conversation about medicines. Available on Amazon in French.

This article is informative and does not constitute medical advice. Any prescription, change or discontinuation of treatment must be discussed with a qualified doctor. Scarlett Kaplan is a sex therapist in Paris; she works alongside specialist doctors and physiotherapists, never as a substitute.