From the Guidelines
Premature ejaculation should be treated with daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics as first-line agents of choice, as these have been shown to be effective in delaying ejaculation and improving quality of life 1.
Treatment Options
When considering treatment for premature ejaculation, it is essential to prioritize the patient's quality of life and morbidity. The following options are recommended:
- Daily SSRIs, such as paroxetine (10-40mg), sertraline (50-200mg), fluoxetine (20-40mg), and citalopram (20-40mg), have been shown to be effective in delaying ejaculation 1.
- On-demand administration of clomipramine, paroxetine, sertraline, and fluoxetine 3-6 hours before intercourse is also an option, although it may be less effective than daily treatment 1.
- Topical penile anesthetics, such as lidocaine or benzocaine sprays and creams, can be applied 10-15 minutes before sex to reduce sensitivity 1.
Combination Therapy
Combining behavioral and pharmacological approaches may be more effective than either modality alone, as it can lead to a significantly greater increase in ejaculatory latency time (ELT) and sexual satisfaction 1. Behavioral strategies, such as the stop-start technique and the squeeze technique, can be used in conjunction with pharmacological treatments to develop control and improve outcomes.
Important Considerations
When prescribing SSRIs, it is essential to be aware of the potential risks, such as serotonin syndrome, and to advise patients to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs, as this may precipitate SSRI withdrawal syndrome 1. Additionally, treatment with SSRIs should be avoided in men with a history of bipolar depression due to the risk of mania 1.
From the Research
Definition and Treatment of Premature Ejaculation
- Premature ejaculation (PE) is defined by short ejaculatory latency and inability to delay ejaculation causing distress 2.
- Management may involve behavioral and/or pharmacological approaches 2.
Behavioral Therapies for Premature Ejaculation
- There is limited evidence that physical behavioral techniques for PE improve Intravaginal Ejaculatory Latency Time (IELT) and other outcomes over waitlist 2.
- Behavioral therapies combined with drug treatments give better outcomes than drug treatments alone 2, 3.
- Cognitive behavioral therapy (CBT) combined with selective serotonin reuptake inhibitors (SSRIs) can significantly prolong the IELT of PE patients, and improve perceived control over ejaculation, sexual life satisfaction, and spouses' sexual life satisfaction 3.
Efficacy and Safety of Behavioral Therapy
- The efficacy and safety of behavioral therapy in patients who suffer from PE have been evaluated in several studies 4, 2.
- Behavioral therapy is widely used worldwide as an effective treatment for premature ejaculation 4.
- There is no significant increase in adverse reactions when using CBT combined with SSRIs 3.
Treatment Options for Premature Ejaculation
- Currently available treatment methods for PE include behavioural therapy, local anaesthetics, tricyclic antidepressants, selective serotonin reuptake inhibitors, and selective phosphodiesterase inhibitors 5.
- Most PE treatments are either experimental or used off-label 5.
- Selective serotonin reuptake inhibitors have an interesting side effect of prolonging ejaculatory latency, but may also cause erectile dysfunction 6.