What is the most effective treatment for a 23-year-old male patient with premature ejaculation, who reaches orgasm within a few seconds after initiating intercourse and has no prior history of serious illness or medication use?

From the Guidelines

For a 23-year-old male with premature ejaculation (PE) who reaches orgasm within seconds of intercourse and has no medical history or medication use, I recommend a combination approach starting with behavioral techniques, as this approach has been shown to be effective in many young men with lifelong PE, as suggested by the guidelines from the American Urological Association (AUA) and the Society for Male Reproduction and Urology (SMSNA) 1.

Recommended Approach

The patient should try the stop-start technique (pausing sexual activity when approaching climax) and the squeeze technique (applying pressure to the penis head when nearing orgasm). These should be practiced during masturbation first, then with a partner.

• Topical anesthetics like lidocaine sprays (5-10%) applied 10-15 minutes before intercourse can reduce sensitivity.
• If these approaches are insufficient after 4-6 weeks of consistent practice, selective serotonin reuptake inhibitors (SSRIs) like dapoxetine (30-60mg taken 1-3 hours before intercourse) or daily sertraline (50-200mg) can be effective, as they work by increasing serotonin levels, which delays ejaculation, as noted in the AUA/SMSNA guideline 1.

Additional Considerations

• Pelvic floor exercises and mindfulness techniques can provide additional benefit.
• The comprehensive approach addresses both physical and psychological factors contributing to PE, with behavioral techniques serving as first-line treatment due to their safety profile and effectiveness in many young men with lifelong PE.
• It is essential to discuss the risks and benefits of all treatment options with the patient prior to any intervention, as outlined in the AUA guideline on the pharmacologic management of premature ejaculation 1.
• Patient and partner satisfaction is the primary target outcome for the treatment of PE, and treatment should be tailored to the individual's needs and preferences, as suggested by the AUA/SMSNA guideline 1.

From the Research

Treatment Options for Premature Ejaculation

The patient's condition of premature ejaculation can be addressed through various treatment options. The following are some possible approaches:

• Selective Serotonin Reuptake Inhibitors (SSRIs): Studies have shown that SSRIs can be effective in treating premature ejaculation 2, 3. SSRIs such as escitalopram can help improve symptoms of premature ejaculation and increase satisfaction with intercourse.
• Psychotherapy: Cognitive behavioral therapy (CBT) combined with SSRIs has been found to be effective in treating premature ejaculation 4, 5. This approach can help improve perceived control over ejaculation and sexual life satisfaction.
• Behavioral Techniques: Behavioral techniques such as coitus interruptus can be helpful in managing premature ejaculation 5.

Comparison of Treatment Options

The following are some key points to consider when comparing treatment options:

• Efficacy: SSRIs have been shown to be effective in treating premature ejaculation, with a significant improvement in symptoms and satisfaction with intercourse 3.
• Safety: SSRIs are generally well-tolerated, but may have side effects such as increased risk of treatment cessation due to adverse events 3.
• Combination Therapy: CBT combined with SSRIs may be a viable alternative for the treatment of premature ejaculation, with no significant increase in adverse reactions 4.

Recommended Treatment

Based on the available evidence, the most likely treatment to lead to improved sexual functioning for this patient is:

• OD) Escitalopram therapy: Escitalopram is an SSRI that has been shown to be effective in treating premature ejaculation, with a significant improvement in symptoms and satisfaction with intercourse 3.