From the Guidelines
Premature ejaculation at 3 minutes falls at the borderline of what's clinically considered PE, and treatment options should be considered to improve quality of life and sexual satisfaction. Given the recent guidelines from the American Urological Association and the Society for Male Reproductive and Urology (AUA/SMSNA) 1, the most effective approach for managing premature ejaculation involves a combination of behavioral techniques, pharmacological interventions, and psychological counseling.
Treatment Options
- Behavioral techniques: The stop-start method and the squeeze technique can help improve control over ejaculation.
- Pharmacological interventions:
- Daily selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (10-40mg daily), sertraline (50-200mg daily), or fluoxetine (20-40mg daily) are effective in delaying ejaculation 1.
- On-demand administration of clomipramine, paroxetine, sertraline, or fluoxetine 3-6 hours before intercourse can also be considered, although it may be less effective than daily treatment 1.
- Topical penile anesthetics can reduce sensitivity and are recommended as first-line agents of choice in treatment of premature ejaculation 1.
Combination Therapy
Combining behavioral and pharmacological approaches may be more effective than either modality alone, as suggested by the AUA/SMSNA guideline 1. This combination can lead to a significantly greater increase in ejaculatory latency time (ELT) and improvement in sexual satisfaction.
Important Considerations
- Patients should be advised about the potential risks and benefits of treatment options, including the risk of serotonin syndrome with simultaneous use of multiple serotonergic drugs 1.
- Treatment with SSRIs should be avoided in men with a history of bipolar depression due to the risk of mania 1.
- Regular exercise, stress management, and communication with your partner about preferences and concerns can also help improve sexual satisfaction and control. The most effective treatment plan should be individualized, considering the patient's preferences, medical history, and the presence of any comorbid conditions, with the goal of improving quality of life and sexual satisfaction.
From the FDA Drug Label
Male and Female Sexual Dysfunction with SSRIs Although changes in sexual desire, sexual performance and sexual satisfaction often occur as manifestations of a psychiatric disorder, they may also be a consequence of pharmacologic treatment. In particular, some evidence suggests that selective serotonin reuptake inhibitors (SSRIs) can cause such untoward sexual experiences Reliable estimates of the incidence and severity of untoward experiences involving sexual desire, performance and satisfaction are difficult to obtain, however, in part because patients and physicians may be reluctant to discuss them. Accordingly, estimates of the incidence of untoward sexual experience and performance cited in product labeling, are likely to underestimate their actual incidence Table 5 below displays the incidence of sexual side effects reported by at least 2% of patients taking sertraline in placebo-controlled trials Table 5 Adverse Event | Sertraline Hydrochloride Tablets | Placebo Ejaculation Failure | 14% | 1% (Primarily Delayed Ejaculation) Decreased Libido | 26% | 1%
The answer to the question of premature ejaculation, specifically 3 minutes, is not directly addressed in the provided FDA drug label for sertraline.
- Ejaculation Failure is reported, but it is primarily delayed ejaculation, not premature ejaculation.
- The label does not provide information on the duration of ejaculation.
- Therefore, no conclusion can be drawn regarding the effect of sertraline on premature ejaculation lasting 3 minutes 2.
From the Research
Definition and Treatment of Premature Ejaculation
- Premature ejaculation (PE) is a common male sexual dysfunction characterized by reduced ejaculatory latency, lack of control, and associated negative personal consequences 3.
- The International Society for Sexual Medicine (ISSM) has defined PE, which includes these key characteristics 3.
Treatment Options for Premature Ejaculation
- Selective serotonin reuptake inhibitors (SSRIs) are often used as a first-line treatment for PE, as they have been shown to prolong ejaculatory latency 4.
- SSRIs, such as paroxetine, sertraline, fluoxetine, and clomipramine, are effective in treating PE, but may have limitations and side effects 5.
- Other treatment options, including topical lidocaine-prilocaine cream, dapoxetine, and PSD502, are also available 5.
Efficacy of SSRIs in Treating Premature Ejaculation
- SSRIs have been shown to improve self-perceived PE symptoms, satisfaction with intercourse, and self-perceived control over ejaculation compared to placebo 6.
- Paroxetine, in particular, has been found to be effective in increasing intra-vaginal ejaculatory latency time (IELT) and improving symptoms of PE 7.
- Combination therapy, such as paroxetine combined with tadalafil or behavior therapy, may be more efficacious than paroxetine alone 7.
Side Effects of SSRIs
- SSRIs may increase the risk of adverse events, such as nausea, muscle soreness, palpitation, and flushing, but these side effects are often mild and tolerable 6, 7.
- Treatment cessation due to adverse events may be more common with SSRIs compared to placebo 6.
Increase in Intravaginal Ejaculatory Latency Time (IELT)
- SSRIs may increase IELT by an average of 3.09 minutes compared to placebo, although the certainty of this evidence is low 6.
- Paroxetine has been shown to increase IELT compared to placebo, fluoxetine, and escitalopram, but the increase in IELT was not statistically significant when compared to other treatments, such as tramadol, sertraline, and dapoxetine 7.