From the Guidelines
The most effective treatment for premature ejaculation is a combination of daily SSRIs, such as paroxetine 10-40mg, and behavioral techniques, as this approach has been shown to significantly delay ejaculation and improve sexual satisfaction 1. When considering treatment options, it's essential to weigh the benefits and risks of each approach. The American Urological Association (AUA) and the Society for Male Reproductive and Urology (SMSNA) recommend daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics as first-line treatments for premature ejaculation 1. Some key points to consider when treating premature ejaculation include:
- Daily SSRIs, such as paroxetine, can increase ejaculation latency time (ELT) by a mean of 8.8-fold over baseline 1
- On-demand administration of clomipramine, paroxetine, sertraline, and fluoxetine 3-6 hours before intercourse can also be effective, but may result in less ejaculatory delay than daily treatment 1
- Behavioral strategies, such as the stop-start technique and the squeeze technique, can be used in combination with pharmacological approaches to increase ELT and sexual satisfaction 1
- Topical anesthetics containing lidocaine or prilocaine can reduce penile sensitivity when applied 20-30 minutes before intercourse It's crucial to discuss these options with a healthcare provider to determine the most appropriate approach based on individual circumstances and to rule out any underlying conditions. Additionally, patients should be advised to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs, as this may precipitate SSRI withdrawal syndrome 1.
From the FDA Drug Label
Male and Female Sexual Dysfunction with SSRIs ... some evidence suggests that selective serotonin reuptake inhibitors (SSRIs) can cause such untoward sexual experiences 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. Table 5 below displays the incidence of sexual side effects reported by at least 2% of patients taking sertraline in placebo-controlled trials Ejaculation Failure1(Primarily Delayed Ejaculation) 14% 1% Decreased Libido26%1%
The best treatment for premature ejaculation is not directly supported by the provided drug labels, as they discuss the incidence of ejaculation failure (primarily delayed ejaculation) as a side effect of sertraline treatment, rather than its use as a treatment for premature ejaculation. Therefore, no conclusion can be drawn about the best treatment for premature ejaculation based on the provided information 2 2.
From the Research
Treatment Options for Premature Ejaculation
- Behavioral therapies, such as sex therapy and cognitive therapy, are available treatment options for premature ejaculation (PE) 3, 4.
- Topical anaesthetics and selective serotonin reuptake inhibitors (SSRIs), including dapoxetine, are commonly used pharmacotherapeutic options for PE 5, 6, 7.
- Dapoxetine is a potent SSRI that is administered on demand 1-3 hours before planned sexual contact and has been shown to be effective in improving intravaginal ejaculatory latency time (IELT) and patient satisfaction 7.
- Combination therapy integrating pharmacologic drugs with psychologic and/or behavioral therapy techniques may be the optimal approach to the management of PE 3, 4.
Efficacy and Safety of Treatment Options
- The efficacy and safety of topical anaesthetics and SSRIs in delaying ejaculation have been confirmed in many well-designed controlled trials 5.
- Dapoxetine has been evaluated in five randomized, double-blind, placebo-controlled studies and has been shown to be effective and safe in treating PE 7.
- The most common adverse events associated with dapoxetine include nausea, dizziness, and headache 7.
Emerging Treatment Options
- New-generation SSRIs and other pharmacotherapeutic options, such as α1-adrenoceptor antagonists and oxytocin antagonists, are being developed and tested for the treatment of PE 5.
- Surgical intervention and neuromodulation have been proposed as potential treatment options for PE, but are not currently recommended due to safety concerns 5.