Management of premature ejaculation – a comparison of treatment outcome in patients with and without erectile dysfunction

Abstract

This study evaluated the problem of premature ejaculation (PE) in patients treated for erectile dysfunction. The aim was to compare the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the management of primary PE and PE associated with sildenefil treatment. Eighty-seven patients with PE seen over a period of 17 months were recruited into this prospective study. They were categorized into two groups: primary PE (GPI) and PE in sildenefil-treated patients (GPII). All patients recruited into GPII had erectile dysfunction (ED) that was successfully treated with sildenefil citrate for at least a year. Both groups of patients were given sertraline 50 mg 4 h before expected time of sex. The minimum follow-up was 6 months. The ejaculation latency before and after treatment of the two groups were compared. The sexual satisfaction scores of the patients in the two groups were also sought and analysed. Twenty-eight percent of patients with ED who were successfully treated with sildenefil developed PE. Subjects in group GPI were younger and have less comorbid factors than those in group GPII. There was no significant difference in the mean ejaculation latency for both groups (46 vs. 34.6 sec for GPI and GPII, respectively). However, there was highly significant difference in the ejaculation latency between the two groups after treatment with sertraline for 6 months (247.2 vs. 111.6 sec for GPI and GPII, respectively). There was also significant difference in the sexual satisfaction score for group GPI post-treatment, but not for GPII. No significant side-effect of sertraline was reported from patients in both groups. Successful treatment of ED could not assure sexual satisfaction. At least a quarter of sildenefil treated ED patients might develop PE which would continue to frustrate these patients sexually. While selective serotonin re-uptake inhibitors (SSRIs) was effective in the management of primary PE, they were not as effective in patients with sildenefil corrected ED.

Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis

“…Between 1973 and 2003, there have been 35 studies 15,17,23-25,60-79,80,81 on daily treatment with clomipramine, a tricyclic antidepressant, and on SSRIs (Table 2). In the same period, on-demand antidepressant treatment results were reported in eight studies [82][83][84][85][86][87][88][89] (Table 3). The current review consists of 3034 males obtained from 79 studies.…”

“…The review of all drugtreatment studies illustrates an improvement in methodology from initially published case reports and open label studies towards double-blind, placebo-controlled clinical trials. However, unfortunately, for unknown reasons, in recent years, a gradual increase in single-blind and open label studies has appeared to be again acceptable for peer review, particularly for on-demand treatment, 85,86,88,89 in contrast to the criteria of evidence-based medicine. Apart from worries regarding the design issues of clinical trials, one of the major issues of premature ejaculation drug-treatment research remains the outcome measure.…”

Dapoxetine, a novel treatment for premature ejaculation, does not have pharmacokinetic interactions with phosphodiesterase-5 inhibitors

“…Blood sampling and analysis Blood samples (7 ml) for the determination of plasma concentrations of dapoxetine were collected at 0, 0.5, 1, 1.5, 2, 3, 4,6,8,10,12,16,24,48, and 72 h following each of the three treatments. Tadalafil and sildenafil exposure were confirmed through analysis of blood samples taken at 0, 1, 2, 6, 10, and 24 h and at 0, 1, 2, 6, and 24 h after dosing with dapoxetine þ tadalafil and dapoxetine þ sildenafil, respectively.…”

“…8,9 While a few of the studies have evaluated the effectiveness of ED treatments in men with comorbid PE and ED, 10,11 very few have examined the prevalence of these comorbid conditions. A large survey that included 12 134 men from the United States, Germany, and Italy recently found that 7.2% of men met the criteria for both PE and ED.…”

Effect of Eurycoma Longifolia on Sexual Behavior in Sexually Dysfunctional Male: A Systematic Review

“…The cases of PE correlates significantly with ED, about one-third of PE patients may have complaint for ED [11]. Despite having been successfully treated for ED, some patients remained sexually frustrated by PE [12].…”