What is the remedy for anxiety-provoking premature ejaculation?

From the Guidelines

To address anxiety-provoking premature ejaculation, clinicians should recommend daily SSRIs, such as paroxetine 10-40 mg or sertraline 50-200 mg, as first-line agents of choice, 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 approach.

• Daily SSRIs have been found to be effective in delaying ejaculation, with paroxetine exerting the strongest ejaculation delay, increasing ELT 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 may be associated with substantially less ejaculatory delay than daily treatment in most studies 1.
• Topical penile anesthetics, such as lidocaine spray, can provide immediate relief and may be used in combination with SSRIs or behavioral techniques 1.
• Behavioral strategies, such as relaxation techniques, the "stop-start" or "squeeze" technique, and combination therapy with pharmacological approaches, may also be effective in increasing ELT and sexual satisfaction 1. It's crucial to note that treatment with SSRIs should be avoided in men with a history of bipolar depression due to the risk of mania, and caution is suggested in prescribing SSRIs to adolescents with PE and to men with PE and a co-morbid depressive disorder, particularly when associated with suicidal ideation 1. When initiating treatment, patients should be advised to start with a low dose and increase gradually over 2-4 weeks as needed, and to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs to prevent SSRI withdrawal syndrome 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 6 Incidence of Sexual Adverse Events in Controlled Clinical Trials PAXIL Placebo n (males) 1446 1042 Decreased Libido 6-15% 0-5% Ejaculatory Disturbance 13-28% 0-2% Impotence 2-9% 0-3%

The remedy for anxiety-provoking premature ejaculation is not directly stated in the provided drug labels. However, SSRIs such as paroxetine and sertraline can cause ejaculatory disturbances, including ejaculatory delay, which may be beneficial in treating premature ejaculation.

• Paroxetine has been shown to cause abnormal ejaculation in 13-28% of male patients, and ejaculatory disturbance in 25% of male patients.
• Sertraline has been shown to cause ejaculation failure in 11-14% of male patients. It is essential to note that these medications are not specifically approved for the treatment of premature ejaculation, and their use for this purpose should be approached with caution and under the guidance of a healthcare professional 2, 3.

From the Research

Treatment Options for Premature Ejaculation

• Pharmacotherapy for premature ejaculation (PE) predominantly targets the multiple neurotransmitters and receptors involved in the control of ejaculation, which include serotonin, dopamine, oxytocin, norepinephrine, gamma amino-butyric acid (GABA) and nitric oxide (NO) 4.
• Selective serotonin reuptake inhibitors (SSRIs) are being used to treat PE, and have been shown to improve self-perceived PE symptoms, satisfaction with intercourse, and perceived control over ejaculation compared to placebo 5.
• Daily dosing of SSRIs is likely to be associated with superior fold increases in intravaginal ejaculation latency time compared with on-demand SSRIs 4.
• On-demand SSRIs are less effective but may fulfill the treatment goals of many patients 4.
• Cognitive behavioral therapy (CBT) combined with SSRIs can significantly prolong the intravaginal ejaculation latency time (IELT) of PE patients, and improve perceived control over ejaculation, sexual life satisfaction, and spouses' sexual life satisfaction 6.

Efficacy and Safety of Treatment Options

• SSRIs have been shown to be effective in delaying ejaculation, with a significant increase in IELT compared to placebo 5, 7.
• The efficacy and safety of topical anesthetics and SSRIs in delaying ejaculation have been confirmed in many well-designed controlled trials 8.
• CBT combined with SSRIs has been shown to be a viable alternative for the treatment of PE, with no significant increase in adverse reactions 6.
• SSRIs may increase treatment cessations due to adverse events compared to placebo, and may also increase adverse events compared to placebo 5.

Emerging Treatment Options

• New-generation SSRIs are being developed, and clinical trials are ongoing to assess their efficacy and safety in treating PE 8.
• On-demand PE therapies targeting neurotransmitters other than serotonin, such as α1-adrenoceptor antagonists and oxytocin antagonists, have shown promising results in clinical trials 8.
• Surgical intervention and neuromodulation have been proposed as potential treatment options for PE, but current guidelines do not recommend these treatments due to safety concerns 8.