From the Guidelines
Premature ejaculation can be effectively treated with a combination of behavioral and pharmacological approaches, with daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics being the first-line agents of choice 1.
Treatment Options
The treatment of premature ejaculation should prioritize the patient's quality of life and satisfaction, with a focus on minimizing risks and maximizing benefits 1. The following options are available:
- Daily SSRIs, such as paroxetine (10-40mg), which have been shown to be effective in delaying ejaculation 1
- On-demand clomipramine or dapoxetine, which can be taken 3-6 hours before intercourse 1
- Topical penile anesthetics, such as lidocaine sprays or creams, which can be applied 10-15 minutes before sexual activity to reduce sensitivity
- Behavioral techniques, including the stop-start method and the squeeze technique, which can help improve control over ejaculation
- Pelvic floor exercises, which can help improve physical control over ejaculatory reflexes
Combination Therapy
Combining behavioral and pharmacological approaches may be more effective than either modality alone, with a significant increase in ejaculatory latency time (ELT) and sexual satisfaction 1. Clinicians should advise men with premature ejaculation that combining behavioral and pharmacological approaches may be more effective than either modality alone 1.
Safety Considerations
When prescribing SSRIs, clinicians should be aware of the potential risks, including serotonin syndrome, which can be a serious complication 1. Patients should be advised to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs, as this may precipitate SSRI withdrawal syndrome 1. Additionally, SSRIs should be used with caution in patients with a history of bipolar depression, due to the risk of mania 1.
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 Table 5 Adverse EventSertraline Hydrochloride TabletsPlacebo Ejaculation Failure1(Primarily Delayed Ejaculation) 14% 1% The most commonly observed adverse events associated with the use of paroxetine (incidence of 5% or greater and incidence for PAXIL at least twice that for placebo, derived from Table 3) were: ... abnormal ejaculation Table 3 ... Urogenital System Abnormal Ejaculationb23%1%21%1%28%1%
Premature ejaculation treatment can be managed with SSRIs such as sertraline and paroxetine, which are known to cause delayed ejaculation as a side effect.
- Sertraline has been shown to cause ejaculation failure (primarily delayed ejaculation) in 14% of patients, compared to 1% with placebo 2.
- Paroxetine has also been associated with abnormal ejaculation, with an incidence of 23% in some studies, compared to 1% with placebo 3. It is essential to note that while these medications may be used off-label for premature ejaculation, they are not specifically approved for this indication, and their use should be carefully considered and monitored by a healthcare professional.
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) 4
- Topical anaesthetics and SSRIs have been confirmed to be effective in delaying ejaculation in many well-designed controlled trials 4
- New-generation SSRIs, α1-adrenoceptor antagonists, and oxytocin antagonists are being researched as potential treatment options for premature ejaculation 4, 5
- Surgical intervention and neuromodulation have been proposed as potential treatment options, but are not currently recommended due to safety concerns 4
Pharmacologic Treatments
- Dapoxetine has been shown to achieve significant improvements in ejaculatory latency, control over ejaculation, and satisfaction with sexual intercourse 5
- Other pharmacologic drugs, such as phosphodiesterase type 5 inhibitors and alpha-blockers, are being evaluated for the treatment of premature ejaculation 5, 6
- Lidocaine/prilocaine spray has been launched in the UK for the treatment of primary premature ejaculation, and has been shown to be effective in delaying ejaculation 7
Behavioural Therapies
- Behavioural therapies, such as the squeeze method and the "stop-and-start" technique, have been shown to be effective in improving control over ejaculation 8
- A new functional-sexological treatment has been developed, which aims to improve control over ejaculation without interrupting sexual activity, and has been shown to be effective in improving duration of intercourse, sexual satisfaction, and sexual functioning 8