Does tadalafil delay ejaculation? This is a common question among men seeking solutions for premature ejaculation. Tadalafil (Cialis) is a phosphodiesterase type 5 (PDE5) inhibitor licensed in the UK for erectile dysfunction and benign prostatic hyperplasia, but it is not approved for treating premature ejaculation. Whilst some research has explored whether tadalafil might indirectly help with ejaculatory control—particularly when erectile dysfunction and premature ejaculation occur together—the evidence remains limited and inconsistent. This article examines what tadalafil does, the established treatments for premature ejaculation available in the UK, and when to seek medical advice for ejaculation concerns.

What Is Tadalafil and How Does It Work?

Tadalafil is a prescription medication primarily licensed in the UK for the treatment of erectile dysfunction (ED) and benign prostatic hyperplasia (BPH). It belongs to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors, which also includes sildenafil (Viagra) and vardenafil.

The mechanism of action involves inhibiting the PDE5 enzyme, which is responsible for breaking down cyclic guanosine monophosphate (cGMP) in smooth muscle cells. When sexual stimulation occurs, nitric oxide is released in the erectile tissue of the penis, leading to increased cGMP levels. By blocking PDE5, tadalafil allows cGMP to accumulate, promoting smooth muscle relaxation and increased blood flow to the penis, thereby facilitating an erection.

Tadalafil is available in the UK under brand names such as Cialis and as generic formulations. It comes in various strengths (2.5mg, 5mg, 10mg, and 20mg). For on-demand use, the standard dose is 10mg taken at least 30 minutes before sexual activity (may be increased to 20mg if needed), with effects lasting up to 36 hours. For daily treatment, the dose is 2.5-5mg once daily for ED and 5mg once daily for BPH. Tadalafil has a notably long half-life of approximately 17.5 hours, which allows for its extended duration of action compared to other PDE5 inhibitors.

It is important to note that tadalafil is not licensed for the treatment of premature ejaculation in the UK. The Medicines and Healthcare products Regulatory Agency (MHRA) has approved it specifically for erectile dysfunction and lower urinary tract symptoms associated with BPH. Tadalafil requires sexual stimulation to be effective and does not cause spontaneous erections.

Key safety information: tadalafil is contraindicated with nitrates and riociguat due to potentially dangerous blood pressure drops. Caution is needed when used with alpha-blockers, and cardiovascular status should be considered before starting treatment. Tadalafil should not be taken more than once daily.

Treatments for Premature Ejaculation in the UK

Premature ejaculation (PE) is defined as ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to one or both partners. It is a common male sexual dysfunction, with prevalence estimates varying by definition—approximately 2-5% of men meet the International Society for Sexual Medicine's strict criteria for lifelong PE, though self-reported early ejaculation is more common.

In the UK, NICE Clinical Knowledge Summaries (CKS) recommend a stepped approach to managing premature ejaculation. First-line treatments typically include:

• Behavioural techniques: The "stop-start" method and "squeeze" technique can help men gain better control over ejaculation timing

• Topical anaesthetics: Prescription-only Fortacin (lidocaine-prilocaine spray) or over-the-counter lidocaine products applied to the penis before intercourse can reduce sensitivity. Using a condom or washing off before intercourse can prevent numbness transferring to partners

• Psychological interventions: Cognitive behavioural therapy (CBT) or psychosexual counselling, particularly when anxiety or relationship issues contribute to PE

When these approaches are insufficient, pharmacological treatments may be considered. Dapoxetine (Priligy) is the only medication licensed in the UK specifically for premature ejaculation. It is a short-acting selective serotonin reuptake inhibitor (SSRI) taken 1-3 hours before sexual activity, starting at 30mg and potentially increasing to 60mg if needed. Dapoxetine works by increasing serotonin levels in the nervous system, which can delay ejaculation. Side effects may include nausea, dizziness, headache and, rarely, syncope.

Off-label use of daily SSRIs (such as paroxetine, sertraline, or fluoxetine) may also be prescribed under healthcare professional supervision, as these medications can have ejaculation-delaying effects. Common side effects include nausea, sleep disturbance, and sexual side effects.

A comprehensive assessment by a GP or sexual health specialist is essential to identify any underlying causes, such as erectile dysfunction, prostate problems, or psychological factors, and to tailor treatment accordingly.

When to Speak to Your GP About Ejaculation Concerns

Many men feel embarrassed discussing sexual health concerns, but premature ejaculation is a common and treatable condition. You should consider speaking to your GP if:

• Ejaculation consistently occurs within one minute of penetration (lifelong PE) or has become significantly faster than previously (acquired PE)

• The issue is causing distress, anxiety, or relationship difficulties

• You are avoiding sexual intimacy due to concerns about ejaculation timing

• You have noticed other sexual problems, such as difficulty achieving or maintaining erections

• You experience pain, discomfort, or other urinary symptoms alongside ejaculation concerns

Your GP will take a confidential medical and sexual history to understand the nature and duration of the problem. They may ask about:

• The timing of ejaculation and whether it occurs in all sexual situations

• Any psychological factors, such as stress, anxiety, or relationship issues

• Medical history, including cardiovascular conditions, diabetes, or neurological disorders

• Current medications, as some drugs can affect sexual function

• Lifestyle factors, including alcohol consumption and recreational drug use

In most cases, no physical examination or investigations are required unless there are concerns about underlying medical conditions. Your GP can discuss appropriate treatment options, provide reassurance, and refer you to specialist sexual health services or urology if needed.

It is important to seek prompt medical advice if you experience sudden changes in ejaculation accompanied by pain, blood in semen, fever, testicular pain or swelling, urinary symptoms, penile discharge, or suspected STI, as these may indicate conditions requiring further investigation. For urgent concerns outside of GP hours, consider contacting NHS 111 or visiting an NHS sexual health clinic. Remember that healthcare professionals are experienced in discussing sexual health matters and are there to help without judgement.

Does Tadalafil Delay Ejaculation?

There is no official link between tadalafil and delayed ejaculation as recognised by UK regulatory authorities. Tadalafil is not licensed or approved for the treatment of premature ejaculation by the MHRA. The evidence for its effectiveness in treating premature ejaculation is limited and inconsistent.

However, some research has explored whether PDE5 inhibitors like tadalafil might have a role in managing premature ejaculation, particularly when it occurs alongside erectile dysfunction. The theoretical rationale is that by improving erectile function and reducing performance anxiety, these medications might indirectly help some men feel more relaxed and in control during sexual activity. Some studies have suggested modest improvements in ejaculatory latency time when tadalafil is used, but the evidence remains limited and variable.

Systematic reviews indicate that while some men report subjective improvements in ejaculatory control when taking PDE5 inhibitors, the effect is generally small and may be related to improved confidence rather than a direct pharmacological action on ejaculation mechanisms. The European Association of Urology guidelines note that PDE5 inhibitors are not recommended as first-line treatments for PE alone, but may be considered when PE coexists with erectile dysfunction.

Important considerations:

• Tadalafil should only be taken as prescribed by a healthcare professional

• Using tadalafil specifically to delay ejaculation would be considered off-label use and should only occur under healthcare professional guidance after discussing risks and benefits

• Men experiencing premature ejaculation should discuss evidence-based treatments with their GP, such as dapoxetine, behavioural techniques, or topical anaesthetics

• Combining treatments without medical supervision can increase the risk of adverse effects and drug interactions

• Report any suspected side effects to the MHRA Yellow Card scheme

If you are experiencing both erectile dysfunction and premature ejaculation, discuss this with your GP, who can assess both conditions and recommend appropriate, evidence-based treatment options tailored to your individual circumstances.

Frequently Asked Questions