From the Guidelines
Premature ejaculation can be effectively treated with a combination of daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics as first-line agents of choice, as recommended by the AUA/SMSNA guideline 1. The treatment of premature ejaculation should prioritize a multimodal approach, incorporating behavioral techniques, medications, and psychological counseling.
- Behavioral techniques include the stop-start technique and the squeeze technique, which can help delay ejaculation.
- Medication options, such as selective serotonin reuptake inhibitors (SSRIs) like dapoxetine (30-60mg taken 1-3 hours before sex) or daily paroxetine (10-40mg), can delay ejaculation by increasing serotonin levels, which naturally delays orgasm 1.
- Topical anesthetics like lidocaine sprays applied 10-15 minutes before intercourse can reduce sensitivity and are recommended as first-line agents of choice 1.
- Psychological counseling, particularly cognitive behavioral therapy, can address underlying anxiety or relationship issues contributing to the condition.
- Pelvic floor exercises (Kegels) performed daily can improve ejaculatory control by strengthening relevant muscles. It is essential to note that combining behavioral and pharmacological approaches may be more effective than either modality alone, as suggested by the AUA/SMSNA guideline 1. When selecting a treatment, it is crucial to consider the potential side effects and interactions of medications, such as the risk of serotonin syndrome associated with simultaneous use of multiple serotonergic drugs 1. Daily SSRIs, such as paroxetine (10-40mg), are effective in delaying ejaculation and are recommended as a first-line treatment option 1.
From the Research
Treatment Options for Premature Ejaculation
- Current standard treatment regimens include behavioural therapies, topical anaesthetics, dapoxetine, and other selective serotonin reuptake inhibitors (SSRIs) 2, 3
- Topical anaesthetics and SSRIs have been confirmed to be effective in delaying ejaculation in many well-designed controlled trials 2
- New-generation SSRIs, α1-adrenoceptor antagonists, and oxytocin antagonists are being researched as potential treatment options for premature ejaculation 2
- Surgical intervention and neuromodulation have been proposed as potential treatment options, but are not currently recommended due to safety concerns 2
Behavioural Therapies
- Behavioural therapies, such as squeeze and stop-start, sensate focus, and pelvic floor rehabilitation, have been shown to improve intravaginal ejaculatory latency time (IELT) and other outcomes in some studies 4
- Combined behavioural and drug treatment has been shown to be more effective than drug treatment alone in some studies 4
- However, the evidence for behavioural therapies is limited, and further research is needed to fully understand their effectiveness 4
Pharmacological Treatments
- Dapoxetine, an on-demand short-acting selective serotonin reuptake inhibitor, is in advanced stages of clinical development as a treatment for premature ejaculation 3
- PSD502, a metered-dose aerosol containing lidocaine and prilocaine, is also in development as an on-demand treatment for premature ejaculation 3
- Tramadol, a weak opioid, is being researched as a potential on-demand treatment for premature ejaculation 3
- Lidocaine/prilocaine spray has been launched in the UK for the treatment of primary premature ejaculation, but its effectiveness is still being evaluated 5