From the Guidelines
Premature ejaculation can be effectively treated with a combination of behavioral techniques, medications, and psychological approaches, with the most recent guidelines recommending daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics as first-line agents of choice 1. The treatment of premature ejaculation involves a multi-faceted approach, including:
- Behavioral methods, such as the stop-start technique and the squeeze technique, to develop better ejaculatory control
- Medications, including:
- Topical anesthetics like lidocaine sprays or creams, applied 10-15 minutes before intercourse
- SSRIs, such as dapoxetine (30-60mg taken 1-3 hours before sex), paroxetine (10-40mg daily), or sertraline (50-200mg daily), which work by delaying the ejaculatory reflex or reducing penile sensitivity
- Psychological counseling or sex therapy to address underlying anxiety or relationship issues contributing to the condition Combining these approaches often yields the best results, and regular pelvic floor exercises (Kegels) can also improve control 1. It's essential to maintain open communication with your partner during treatment and to consult a healthcare provider before starting any medication, as they can have side effects and may interact with other drugs 1. The choice of treatment should be based on the patient's and partner's reports of efficacy, side effects, and acceptance of the therapy, as well as on a regular review of alternative approaches 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
The treatment for premature ejaculation is not directly stated in the provided drug labels. However, SSRIs such as sertraline and paroxetine are known to cause ejaculatory delay as a side effect, which may be beneficial in treating premature ejaculation.
- Sertraline has been reported to cause ejaculation failure (primarily delayed ejaculation) in 14% of patients.
- Paroxetine has been reported to cause abnormal ejaculation in 13% to 28% of patients, depending on the condition being treated. It is essential to consult a healthcare professional for proper diagnosis and treatment of premature ejaculation, as they can recommend the most suitable treatment option based on individual needs and medical history. 2 3
From the Research
Treatment Options for Premature Ejaculation
The treatment for premature ejaculation (PE) includes various options, such as:
- Behavioral therapies
- Topical anesthetics
- Selective serotonin reuptake inhibitors (SSRIs) like dapoxetine, fluoxetine, paroxetine, and sertraline 4, 5, 6, 7
- Phosphodiesterase type 5 inhibitors, alone or in combination with SSRIs, for men with acquired PE secondary to comorbid erectile dysfunction (ED) 5
- Off-label use of antidepressants and/or alpha-blockers 4
- New on-demand rapid-acting SSRIs, oxytocin receptor antagonists, or single agents that target multiple receptors, which may form the foundation of more effective future on-demand medication 5, 7
Pharmacological Treatments
Pharmacological treatments for PE target the multiple neurotransmitters and receptors involved in the control of ejaculation, including:
- Serotonin
- Dopamine
- Oxytocin
- Norepinephrine
- Gamma amino-butyric acid (GABA)
- Nitric oxide (NO) 5 Daily dosing of SSRIs is likely to be associated with superior fold increases in intravaginal ejaculation latency time compared with on-demand SSRIs 5.
Combination Therapy
Combination therapy integrating sex therapy and sexual pharmaceuticals is frequently the best treatment approach for PE, as it addresses both psychosocial and physiologic factors 8. This approach can result in prolonged ejaculatory latency, improved treatment satisfaction, and superior long-term outcome.
Emerging Treatments
Research is ongoing to find the ideal PE therapy, with promising results from clinical trials on new-generation SSRIs, on-demand PE therapies targeting neurotransmitters other than serotonin, such as α1-adrenoceptor antagonists and oxytocin antagonists 5, 7. However, current PE guidelines do not recommend surgical intervention and neuromodulation due to safety concerns 7.