Background: Primary premature ejaculation (PE) can be effectively treated with sildenafil citrate, according to recent research. This study evaluated sildenafil citrate efficacy in primary PE treatment, considering the female perspective. Methods: Sixty sexually active men diagnosed with primary PE were split into two groups randomly and followed for 6 months. Group A received 50 mg of sildenafil citrate one hour before sexual activity in accordance with standard dosing guidelines (not fewer than once a week), while Group B received paroxetine 20 mg daily for six months. At baseline, 3 months, and 6 months following therapy, the intravaginal ejaculatory latency time (IELT), PE grade, intercourse satisfying score (ISS), intercourse frequency, and drug-associated side effects were noted. Results: Both groups showed significant improvements in all measurements following 3 or 6 months of therapy, with no critical changes between two time points. However, sildenafil citrate was found to be significantly more effective than paroxetine in improving all parameters at both 3 and 6 months (P = 0.001). Conclusion: Sildenafil citrate is a highly beneficial treatment for primary PE and is more effective than paroxetine.