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Premature ejaculation: definition and drug treatment
1Department of Psychiatry and Neurosexology, HagaHospital Leyenburg, The Hague, The Netherlands. md@waldinger.demon.nl
Drugs
|March 14, 2007
Summary
Premature ejaculation (PE) treatment effectiveness varies. Daily selective serotonin reuptake inhibitors (SSRIs) show consistent results, while on-demand treatments offer limited ejaculation delay. Novel drug combinations show promise for future PE therapies.
Area of Science:
- Neuroscience and Pharmacology
- Male Sexual Health
- Psychiatry
Background:
- Premature ejaculation (PE) is a common male sexual dysfunction primarily linked to serotonergic and oxytocinergic neurotransmission.
- Current diagnostic criteria for PE lack predictive value for research and clinical application.
- Proposed new diagnostic categories for PE aim to improve clinical and research utility.
Purpose of the Study:
- To review and meta-analyze the efficacy of various pharmacological treatments for premature ejaculation (PE).
- To evaluate the effectiveness of daily versus on-demand medication strategies for PE.
- To explore potential novel therapeutic targets and drug combinations for PE management.
Main Methods:
- Conducted a meta-analysis of published drug treatment studies for PE according to evidence-based medicine standards.
- Reviewed studies on daily and on-demand selective serotonin reuptake inhibitors (SSRIs), topical anesthetics, tramadol, and phosphodiesterase type 5 inhibitors.
- Examined findings from animal studies investigating combined SSRI and receptor antagonist administration.
Main Results:
- Daily treatment with SSRIs (paroxetine, clomipramine, sertraline, fluoxetine) demonstrated similar efficacies, with paroxetine showing the strongest effect.
- On-demand SSRI treatment, including dapoxetine, showed a weaker ejaculation-delaying effect compared to daily regimens.
- Topical anesthetics and tramadol are effective for on-demand PE treatment; PDE5 inhibitors are only recommended if erectile dysfunction is present.
Conclusions:
- Daily SSRI administration is an effective treatment for PE, with paroxetine being particularly potent.
- On-demand SSRI treatment is less effective for delaying ejaculation than daily use.
- Future PE treatments may involve combinations of SSRIs with receptor antagonists for enhanced efficacy.
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