From the Guidelines
Treatment for premature ejaculation should prioritize a combination of behavioral techniques and medications, with daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics as first-line agents of choice, as recommended by the most recent guidelines 1. The most effective approach often involves a combination of these methods, as combining behavioral and pharmacological approaches may be more effective than either modality alone 1. Behavioral techniques such as the stop-start technique and the squeeze technique can help build control over ejaculation. Topical anesthetics like lidocaine sprays or creams can reduce penile sensitivity when applied 10-15 minutes before intercourse. Medications including SSRIs like paroxetine (10-40mg daily) or sertraline (50-200mg daily) can delay ejaculation by increasing serotonin levels, with paroxetine exerting the strongest ejaculation delay, increasing ejaculatory latency time (ELT) a mean of 8.8-fold over baseline 1. It's also important to consider the potential side effects and interactions of these medications, such as serotonin syndrome, and to advise patients to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs to prevent SSRI withdrawal syndrome 1. Psychological counseling can address underlying anxiety or relationship issues contributing to the condition, and most men respond well to treatment, though finding the right approach may require trying different options under medical supervision.
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
Treatment options for premature ejaculation include:
- Selective serotonin reuptake inhibitors (SSRIs): Such as sertraline and paroxetine, which can cause delayed ejaculation as a side effect.
- Off-label use of SSRIs: May be prescribed to treat premature ejaculation, as they can help delay ejaculation.
2 and 3 provide evidence of the use of SSRIs in treating premature ejaculation, although they do not directly address the treatment of this condition.
From the Research
Treatment Options for Premature Ejaculation
The treatment options for premature ejaculation can be categorized into several approaches, including behavioral therapies, pharmacological treatments, and other interventions.
- Behavioral Therapies: These include techniques such as the squeeze method, stop-and-start technique, sensate focus, and pelvic floor rehabilitation 4, 5. Studies have shown that these methods can be effective in improving ejaculatory latency and sexual satisfaction 4, 5.
- Pharmacological Treatments: Various medications have been used to treat premature ejaculation, including selective serotonin reuptake inhibitors (SSRIs), topical anesthetics, and phosphodiesterase-5 inhibitors 6, 7, 8. SSRIs have been shown to be effective in delaying ejaculation, but they can have sexual side effects and may not be suitable for all patients 6, 7, 8.
- Topical Anesthetics: These can be used to reduce the sensitivity of the glans penis and have been shown to be effective in treating premature ejaculation due to hypersensitivity 6, 8.
- Physiotherapy: Pelvic floor muscle physiotherapy may be beneficial for patients with premature ejaculation associated with pelvic floor dysfunction 8.
- Psycho-Sexual Therapy: This approach may be useful in improving results, particularly in the long term, and can be used in combination with other therapies 8, 5.
- Surgical Intervention and Neuromodulation: These have been proposed as potential treatment options, but current guidelines do not recommend them due to safety concerns 6.
Comparison of Treatment Options
Studies have compared the effectiveness of different treatment options for premature ejaculation. For example, a study found that a new functional-sexological treatment was as effective as behavioral therapy in improving ejaculatory latency and sexual satisfaction 4. Another study found that SSRIs were effective in delaying ejaculation, but had limited efficacy and were associated with sexual side effects 7. A systematic review of behavioral therapies found that they could improve intravaginal ejaculatory latency time (IELT) and other outcomes, but the evidence was limited and further studies were needed 5.