Contents
Premature ejaculation (PE) can be frustrating, awkward, and at times, a serious mood killer. You’re not alone- millions of men deal with PE. Luckily, there are many treatment options that are effective in improving PE and other sexual dysfunctions. Newer research is pointing to combination therapies that tackle PE from two angles: the brain and the body.
Let's break down the science, the benefits, and why this dual approach could be your ticket to lasting longer and performing better.
An Overview of Premature Ejaculation: Causes and Treatments
Premature ejaculation is typically defined as ejaculation that occurs sooner than desired, often within one to two minutes of penetration, and with little control. It can stem from both psychological and biological factors: anxiety, hormone and neurotransmitter imbalances (especially serotonin), heightened penile sensitivity, and more. (Crowdis, 2023)
Many providers will suggest treatments that are focused on just one side of the equation. SSRIs have been prescribed off-label to delay climax by affecting serotonin levels in the brain. ED meds have sometimes been used to improve confidence or erection quality. But what if you could treat both brain and body simultaneously, with a single solution?
The Case for Combination Therapy
Multiple studies show that combining an SSRI like paroxetine with a PDE5 inhibitor like tadalafil or sildenafil results in significantly improved outcomes for men with PE compared to either medication alone. (Salonia, 2002) (Moudi, 2016)
Why does this combo work so well? SSRIs like paroxetine increase serotonin activity in the brain, which is key in delaying ejaculation and giving you more control over climax. (Sunder, 2022) PDE5 inhibitors like tadalafil enhance blood flow to the penis, helping you get and maintain an erection with more confidence. They also target performance anxiety, which can be a major driver of PE. Some studies show that PDEs can even shorten the refractory period, helping you go again faster. (Dhaliwal, 2023)
Together, these two medications help target the root causes of PE on both the psychological and physical levels.
What the Research Says
A growing body of literature backs up this dual-action approach:
A prospective study published in The Journal of Urology found that combining paroxetine with sildenafil significantly improved ejaculatory latency time and intercourse satisfaction compared to paroxetine alone. (Salonia, 2002)
A systematic review in European Urology Focus concluded that PDE5 inhibitors are more effective than placebo and that combining them with SSRIs yields even better outcomes than SSRIs alone in treating PE and increasing intravaginal ejaculatory latency time (IELT). (Martyn-St James, 2016)
A research study concluded that sildenafil combined with paroxetine and psychological and behavioral counseling alleviated PE in patients in whom other treatments failed. (Chen, 2003)
The results speak for themselves. Combination therapies for PE offer a more effective, targeted approach that can lead to a better sex life.
Potential Side Effects
As with any medication, it’s important to know what to expect and what to watch out for. While research shows that SSRIs and PDE5s are an effective approach to treating PE, there are some side effects that can arise with these medications.
Fortunately, most side effects are mild and temporary, but you should always consult with a provider about any symptoms that do arise as a result of a new medication.
Paroxetine (SSRI) side effects may include (Shrestha, 2023) :
Nausea or upset stomach
Loss of appetite
Drowsiness or fatigue
Increased perspiration
Difficulty sleeping
Mild headache
Temporary decrease in libido (though this is more common with daily use)
Dry mouth
Tadalafil (PDE5 Inhibitor) side effects may include (Dhaliwal, 2023):
Mild headache
Flushing (warmth or redness in the face)
Abdominal pain or discomfort
Altered color vision
Nasal inflammation or congestion
Muscle or back aches
Dizziness and low blood pressure
Rugiet Go Long: Dual-Action PE Treatment
At Rugiet, we are committed to improving sexual health for people through online, affordable treatment options. We took this research, gathered real feedback and concerns from men struggling with sexual dysfunction, and created a treatment that’s practical, powerful, and performance-ready.
Unlike traditional SSRIs, which you have to take daily (and wait weeks for results), Rugiet Go Long is taken as needed— making it ideal for spontaneous, stress-free sex. It combines paroxetine and tadalafil, targeting both the brain and the body in one discreet dose.
What Makes Rugiet Different:
As-needed dosing: You don’t have to commit to daily pills. Just take it when you need it.
Fast-acting, long-lasting: Tadalafil starts working in about 30-60 minutes and stays active for up to 36 hours.
Clinically-backed ingredients: Both medications are proven to delay climax and improve sexual performance.
Discreet and doctor-approved: Order your Rugiet medication and be seen by a board-certified physician, all 100% online.
Treating PE Requires a Targeted Approach
Premature ejaculation is complex. An effective treatment should target multiple aspects of PE. By approaching PE from both the psychological and physiological angles, combination treatments of SSRIs and PDE5 inhibitors offer a smart, synergistic solution. And when you combine them into a single, on-demand treatment like Rugiet Go Long, you’re getting the best of both worlds in one sleek, doctor-prescribed medication.
So whether you're new to PE treatment or you've tried one-size-fits-all solutions that didn’t stick, it might be time to go dual-action. Increased control. Increased confidence. More satisfactory sexual experiences.
Citations:
Crowdis M, Leslie SW, Nazir S. Premature Ejaculation. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546701/
Salonia, A., Maga, T., Colombo, R., Scattoni, V., Briganti, A., Cestari, A., Guazzoni, G., Rigatti, P., & Montorsi, F. (2002). A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation. The Journal of urology, 168(6), 2486–2489. https://doi.org/10.1016/S0022-5347(05)64174-2
Moudi, E., & Kasaeeyan, A. A. (2016). Comparison Between Tadalafil Plus Paroxetine and Paroxetine Alone in the Treatment of Premature Ejaculation. Nephro-urology monthly, 8(1), e32286. https://doi.org/10.5812/numonthly.32286
Sunder M. (2022). SSRIs and SNRIs for Premature Ejaculation in Adult Men. American family physician, 105(6), 591–592. https://pubmed.ncbi.nlm.nih.gov/35704830/.
Dhaliwal A, Gupta M. PDE5 Inhibitors. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549843/
Martyn-St James, M., Cooper, K., Ren, S., Kaltenthaler, E., Dickinson, K., Cantrell, A., Wylie, K., Frodsham, L., & Hood, C. (2017). Phosphodiesterase Type 5 Inhibitors for Premature Ejaculation: A Systematic Review and Meta-analysis. European urology focus, 3(1), 119–129. https://doi.org/10.1016/j.euf.2016.02.001
Chen, J., Mabjeesh, N. J., Matzkin, H., & Greenstein, A. (2003). Efficacy of sildenafil as adjuvant therapy to selective serotonin reuptake inhibitor in alleviating premature ejaculation. Urology, 61(1), 197–200. https://doi.org/10.1016/s0090-4295(02)02075-7
Shrestha P, Fariba KA, Abdijadid S. Paroxetine. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526022/
