From the Guidelines
Premature ejaculation can be effectively treated with daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics as first-line agents of choice. According to the American Urological Association (AUA) and the Society for Male Reproductive and Urology (SMSNA) guideline published in 2022 1, these treatments have been shown to be effective in delaying ejaculation. The guideline recommends daily SSRIs, such as paroxetine 10-40 mg, sertraline 50-200 mg, fluoxetine 20-40 mg, and citalopram 20-40 mg, as well as on-demand clomipramine or dapoxetine, as first-line treatments for premature ejaculation.
Some key points to consider when treating premature ejaculation include:
- Daily treatment with SSRIs has been shown to be more effective than on-demand treatment in delaying ejaculation 1
- Topical penile anesthetics can be used to reduce penile sensitivity and delay ejaculation 1
- Behavioral techniques, such as the stop-start method and the squeeze technique, can also be effective in treating premature ejaculation, although they may not be as effective as pharmaceutical treatments 1
- Patients should be advised to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs, as this may precipitate SSRI withdrawal syndrome 1
It's also important to note that treatment with SSRIs should be avoided in men with a history of bipolar depression due to the risk of mania 1, and caution is suggested in prescribing SSRIs to adolescents with premature ejaculation and to men with premature ejaculation and a co-morbid depressive disorder, particularly when associated with suicidal ideation 1. Overall, the choice of treatment for premature ejaculation should be individualized and based on the patient's specific needs and circumstances.
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 are not directly stated in the provided drug labels. However, the labels do mention SSRIs such as sertraline and paroxetine, which are sometimes used off-label to treat premature ejaculation due to their side effect of delayed ejaculation.
- Sertraline has been reported to cause ejaculation failure (primarily delayed ejaculation) in 14% of male patients.
- Paroxetine has been reported to cause abnormal ejaculation in 13% to 28% of male patients, depending on the condition being treated. It is essential to consult a healthcare professional for proper evaluation and treatment of premature ejaculation, as the use of SSRIs for this condition is off-label and may involve careful consideration of potential benefits and risks 2 3.
From the Research
Treatment Options for Premature Ejaculation
- Behavioral therapies, such as the "squeeze" and "stop-start" techniques, and psychotherapy, have been used to manage premature ejaculation (PE) for many years 4
- Pharmacological treatment options include:
- New pharmacologic drugs, specifically for the treatment of PE, are undergoing evaluation in clinical trials, such as dapoxetine 7, 5
- Integrated pharmacotherapy and cognitive behavioral therapy (CBT) may achieve superior treatment outcomes in some patients 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
Emerging Treatments
- On-demand rapid-acting SSRIs, oxytocin receptor antagonists, or single agents that target multiple receptors may form the foundation of more effective future on-demand medication 5
- New functional-sexological treatment, which improves control over the moment of ejaculation without interrupting sexual activity, has shown significant improvements in duration of intercourse, sexual satisfaction, and sexual functioning 8
Efficacy and Safety
- SSRIs have been demonstrated to be effective and safe in delaying ejaculation, confirming their role as first-line agents for the medical treatment of lifelong and acquired PE 5
- Dapoxetine, off-label SSRI drugs, and topical anesthetics drugs have been shown to be effective and safe in the treatment of PE 5