What are the treatment options for premature ejaculation (PE) in a 24-year-old male?

From the Guidelines

For a 24-year-old experiencing premature ejaculation, daily SSRIs, such as paroxetine 10-40 mg, sertraline 50-200 mg, fluoxetine 20-40 mg, or citalopram 20-40 mg, are recommended as first-line treatment, as they have been shown to be effective in delaying ejaculation 1. When considering treatment options, it's essential to weigh the potential benefits and risks of each medication.

• Daily SSRIs have been found to be effective in delaying ejaculation, with paroxetine exerting the strongest ejaculation delay, increasing ejaculatory 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 is also an option, although it is associated with substantially less ejaculatory delay than daily treatment in most studies 1.
• Topical anesthetics, such as lidocaine and prilocaine, may be used to reduce penile sensitivity and delay ejaculation, but may be associated with significant penile hypoesthesia and possible absorption by the receptive partner, resulting in discomfort and/or numbness 1. It's crucial to consult a healthcare provider before starting any medication to determine the most appropriate option based on individual health factors and to discuss potential side effects, such as nausea, headache, dizziness, or decreased libido.
• Patients should be advised to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs, as this may precipitate SSRI withdrawal syndrome 1.
• Combining medication with behavioral techniques, like the stop-start or squeeze methods, and psychological counseling often provides the best results.

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 | 1(Primarily Delayed Ejaculation) 14% | 1% Decreased Libido | 26% | 1%

Medications for Premature Ejaculation:

• Sertraline is a selective serotonin reuptake inhibitor (SSRI) that can cause delayed ejaculation as a side effect, which may be beneficial for patients with premature ejaculation.
• The incidence of ejaculation failure (primarily delayed ejaculation) in male patients taking sertraline was 14%, compared to 1% in the placebo group 2.
• However, it is essential to note that sertraline is not specifically approved for the treatment of premature ejaculation, and its use for this purpose is off-label.
• Patients should consult their physician to discuss the potential benefits and risks of using sertraline for premature ejaculation.

From the Research

Medications for Premature Ejaculation

• Dapoxetine is a potent selective serotonin reuptake inhibitor (SSRI) that has been evaluated in several randomized, double-blind, placebo-controlled studies for the treatment of premature ejaculation in men aged 18-64 years 3, 4.
• The medication is administered on demand, 1-3 hours before planned sexual contact, and has been shown to significantly improve intravaginal ejaculatory latency time (IELT), Premature Ejaculation Profile (PEP) items, and clinical global impression of change (CGIC) in PE compared to placebo 3, 4.
• Dapoxetine has a favorable side effect profile, with the most common adverse events including nausea, dizziness, and headache 3, 4.
• Other treatment options for premature ejaculation include off-label use of oral SSRIs, topical anesthetics, phosphodiesterase type 5 inhibitors, and tramadol hydrochloride 5, 6, 7.
• Daily dosing of SSRIs may be associated with superior fold increases in IELT compared to on-demand SSRIs, but on-demand SSRIs may still be effective for many patients 5.
• Dapoxetine is currently considered the oral drug of choice for on-demand treatment of premature ejaculation due to its clinical efficacy and safety profile 7.

Treatment Considerations

• The treatment of premature ejaculation should be individualized, taking into account the patient's medical history, preferences, and treatment goals 5.
• A combination of pharmacotherapy and cognitive behavioral therapy (CBT) may achieve superior treatment outcomes in some patients 5.
• Patients with acquired premature ejaculation secondary to comorbid erectile dysfunction may benefit from treatment with phosphodiesterase type 5 inhibitors alone or in combination with SSRIs 5.