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Lifelong premature ejaculation: from authority-based to evidence-based medicine
1Department of Psychiatry and Neurosexology, Leyenburg Hospital, The Hague, The Netherlands. post@m-waldinger.demon.nl
BJU International
|December 24, 2003
Summary
Evidence-based medicine supports drug treatments like SSRIs for premature ejaculation, showing greater efficacy than psychological approaches. Research suggests a link between premature ejaculation and serotonin neurotransmission.
Area of Science:
- Urology
- Psychopharmacology
- Evidence-Based Medicine
Background:
- Historically, psychotherapy was the primary treatment for premature ejaculation.
- Limited evidence supports psychological and behavioral treatments for premature ejaculation.
- Drug treatments have been available for decades.
Purpose of the Study:
- To evaluate the evidence supporting different treatment approaches for premature ejaculation.
- To explore the neurobiological underpinnings of premature ejaculation.
Main Methods:
- Review of controlled trials for drug treatments (SSRIs, clomipramine, anesthetics).
- Analysis of evidence supporting psychological and behavioral therapies.
- Examination of psychopharmacological and animal studies on neurotransmission and neural circuits.
Main Results:
- Drug treatments, including selective serotonin reuptake inhibitors (SSRIs) and anesthetics, demonstrate consistent efficacy in delaying ejaculation.
- Evidence supporting psychological and behavioral treatments is limited.
- Premature ejaculation is associated with diminished serotonergic neurotransmission and potential disturbances in 5-HT2C or 5-HT1A receptors.
Conclusions:
- An evidence-based approach, favoring pharmacotherapy, is replacing traditional psychological attitudes towards premature ejaculation treatment.
- Pharmacological interventions are effective for managing premature ejaculation.
- Further research is needed to elucidate the role of central nervous system neural circuits in premature ejaculation.