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Men with subjective premature ejaculation have a similar lognormal IELT distribution as men in the general male population and differ mathematically from males with lifelong premature ejaculation after an IELT of 1.5 minutes (Part 2).

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Pharmacotherapy for premature ejaculation.

Marcel D Waldinger1

  • 1a Drexel University College of Medicine, Department of Pharmacology and Physiology , Philadelphia , USA.

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Summary

Premature ejaculation (PE) can be treated with off-label medications like SSRIs, but men with normal ejaculation times seeking delays need specific "ejaculation delaying drugs." Further research is needed for these individuals.

Keywords:
clomipraminedapoxetinelocal anestheticspost selective serotonin reuptake inhibitors sexual dysfunctionpremature ejaculationselective serotonin reuptake inhibitorsserotonin

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Area of Science:

  • Pharmacology
  • Sexual Medicine
  • Urology

Background:

  • Premature ejaculation (PE) is classified into four subtypes based on intravaginal ejaculation latency time (IELT), life course, and complaint frequency.
  • Pharmacological treatments for PE, including oral drugs and local anesthetics, have been used since the 1930s.
  • Most current PE treatments, except dapoxetine, are used off-label, and men with normal IELT may also desire to postpone ejaculation.

Purpose of the Study:

  • To review evidence-based recommendations for PE pharmacotherapy.
  • To differentiate between treatments for diagnosed PE and ejaculation delaying drugs for men with normal IELT.
  • To suggest research directions for developing effective ejaculation delaying drugs.

Main Methods:

  • Review of the International Society for Sexual Medicine guideline for PE pharmacotherapy.
  • Analysis of the mechanism of action of Selective Serotonin Reuptake Inhibitors (SSRIs) in delaying ejaculation.
  • Consideration of both common and rare side effects of SSRIs.

Main Results:

  • SSRIs delay ejaculation by modulating central nervous system serotonin neurotransmission.
  • Existing PE treatments are primarily for diagnosed PE subtypes (lifelong, acquired).
  • Men with normal IELT seeking ejaculation delay require distinct pharmacological agents.

Conclusions:

  • Men with normal IELT desiring delayed ejaculation require "ejaculation delaying drugs," not "drugs for the treatment of PE."
  • Pharmacological research should focus on developing and testing these specific drugs in individuals with normal IELT, including those with subjective or variable PE and male volunteers.