Is Paroxetine or Sertraline Better for Premature Ejaculation?

Published: 2025-08-15

Updated: 2025-08-15

5 mins

Millions of men deal with premature ejaculation (PE), performance anxiety, and other sexual health concerns. Still, it’s not the easiest to talk about at the dinner table, with other male friends, or even with your healthcare provider. Premature ejaculation is most often described as ejaculating within the first two to three minutes of sexual intercourse. 

At least a third of men aged 18 to 59 years old in the U.S. experience premature ejaculation. However, telehealth platforms provide plenty of options for men to receive discreet treatment for premature ejaculation. 

Medications like paroxetine (Paxil®) and sertraline (Zoloft®) can help men with PE enjoy intimate moments with a partner without nervousness or fear around PE. Paroxetine and sertraline work by altering serotonin levels in the brain to delay ejaculation for longer. 

In some cases, a healthcare professional may recommend behavioral therapy and physical exercises to improve PE in addition to medication to help manage premature ejaculation.

What is the Difference Between Paroxetine and Sertraline?

Paroxetine and sertraline are both SSRIs (selective serotonin reuptake inhibitors). SSRIs are typically used to treat depression, anxiety, and other mental health conditions. However, they have often been used as off-label medication for premature ejaculation. In some cases, emotional distress may contribute to PE. Both medications can be used daily or occasionally as needed. It may take several weeks before you see improvements after starting either medication.

Dosages for paroxetine and sertraline for PE differ slightly. A healthcare provider may recommend 10 to 40 mg (milligrams) of paroxetine daily. On the other hand, sertraline dosages range from 50 to 200 mg daily. 

Some clinical trials suggest that paroxetine delays ejaculation for longer. Studies also show conflicting evidence about whether on-demand use of paroxetine or sertraline is more effective. However, this can vary depending on several factors like preexisting health conditions you may have, the cause of your PE, and your recommended dosage. Generally, studies suggest there is no major difference in effectiveness among sertraline, paroxetine, and other SSRIs in treating premature ejaculation.

What are the Side Effects of Paroxetine?

Common side effects of paroxetine include the following:

• Nausea

• Constipation

• Diarrhea

• Dry mouth

• Dizziness

• Excessive sweating

• Nervousness

• Trouble sleeping

One key difference between paroxetine and sertraline is the likelihood of experiencing certain side effects while taking either medication. Men taking paroxetine for depression may have an increased risk of other sexual side effects, like low libido. 

Still, the sexual side effects of SSRIs like paroxetine and sertraline may vary and tend to last for a short amount of time. A licensed healthcare provider can give you a better idea of how SSRIs may affect your sex life based on your personal health history.

Paroxetine may also increase your risk of suicidal thoughts more than sertraline. Both sertraline and paroxetine may lead to withdrawal symptoms if you abruptly stop the use of either medication. Don’t hesitate to reach out to a mental health provider if you begin to experience suicidal ideation or other severe symptoms.

What are the Side Effects of Sertraline?

The risk of experiencing an upset stomach and other gastrointestinal symptoms may increase while taking sertraline. However, when compared with other SSRIs like clomipramine, studies suggest sertraline may cause fewer side effects than other SSRI medications for premature ejaculation.

Other common symptoms of sertraline include the following:

• Fatigue

• Diarrhea

• Nausea

• Trouble sleeping

• Excessive sweating

• Headache

Weight gain may occur with either paroxetine or sertraline. However, some studies suggest weight gain is more strongly associated with paroxetine. Weight fluctuations and the longevity of certain symptoms may differ between sertraline and paroxetine. 

Which Medication is More Effective for Premature Ejaculation?

More research is still needed comparing sertraline and paroxetine specifically. However, health experts have found improvements in PE in men taking SSRIs in comparison to men who don’t. 

In some cases, SSRIs may be used together to treat premature ejaculation. For example, a healthcare provider may recommend joint use of the SSRIs fluoxetine and paroxetine on a case-by-case basis. However, health experts do not recommend taking sertraline and paroxetine together.

Other Treatment Options for Premature Ejaculation

Generally, a healthcare provider will start with a psychological evaluation. This can help them assess whether any mental barriers are causing premature ejaculation. Psychotherapy may also help men who struggle with performance anxiety. The next step is often to see if any physical exercises can help with ejaculation. If not, a healthcare provider will then prescribe medications as part of your treatment plan. 

Other than paroxetine and sertraline, a healthcare provider may recommend one of the following SSRIs as part of your treatment plan:

• Clomipramine

• Fluoxetine

• Citalopram

A healthcare provider may also recommend topical medications like lidocaine-prilocaine cream. Lidocaine-prilocaine cream can be applied to the penis to delay premature ejaculation around 20 minutes before having sex. However, with creams and sprays, there is a risk of the products causing numbness in a partner’s genitals when used without a condom or other barrier method.

Where Can I Learn More About Treatment for Premature Ejaculation?

The thought of going into a doctor’s office and bringing up PE may make your stomach drop. Fortunately, telehealth platforms like Rex MD offer a chance to receive treatment without the hassle of an in-person doctor’s visit. Rex MD can deliver premature ejaculation medications like sertraline in discreet packaging for those who qualify. 

Get started today by filling out a short questionnaire to find the best premature ejaculation medication to fit your needs.