Premature ejaculation: state of the art.

Area of Science:

• Urology
• Psychiatry
• Pharmacology

Background:

• Premature ejaculation (PE) is a common male sexual complaint, but current diagnostic criteria may lead to overdiagnosis.
• A new classification system for PE, proposing four distinct syndromes, is pending for the DSM-V.

Purpose of the Study:

• To review the pathophysiology and treatment options for premature ejaculation based on a new classification system.
• To evaluate the efficacy of various pharmacotherapies for premature ejaculation.

Main Methods:

• Meta-analysis of studies on selective serotonin reuptake inhibitors (SSRIs) and clomipramine for PE treatment.
• Review of evidence for on-demand treatments including topical anesthetics, tramadol, and phosphodiesterase type 5 inhibitors.

Main Results:

• Daily SSRI treatment (paroxetine, clomipramine, sertraline, fluoxetine) demonstrated similar efficacy, with paroxetine showing the strongest effect.
• On-demand SSRI treatment was less effective than daily regimens.
• Limited evidence supports the efficacy of phosphodiesterase type 5 inhibitors and intracavernous vasoactive drugs for PE.

Conclusions:

• Treatment for PE should be tailored to the specific syndrome, considering neurobiological, medical, or psychological factors.
• Daily SSRI therapy is an effective treatment for PE, while on-demand options and other drug classes require further investigation.