The Controversial Role of Phosphodiesterase Type 5 Inhibitors in the Treatment of Premature Ejaculation

Abstract

Introduction It is controversial whether or not the most frequent male sexual dysfunctions, premature ejaculation (PE) and erectile dysfunction (ED), share pathogenetic mechanisms and treatments. Methods Three scientists (C.McM., J.C., and A.A.), together with the Controversy's Editor (E.A.J.), with expertise in the area of medical treatment of PE, present different perspectives on the use of phosphodiesterase type 5 inhibitors (PDE5is) in PE. The psychological point of view is discussed by an expert in sexology (M.P.). Main Outcome Measure Outcome measures used are expert opinions supported by the critical review of the currently available literature. Results This Controversy examines the role of nitric oxide (NO) as a neurotransmitter involved in the central and peripheral control of ejaculation, the adherence of methodology to the contemporary consensus of ideal PE drug trial design, the impact of methodology on treatment outcomes, and the role of PDE5i drugs (sildenafil, tadalafil, and vardenafil) in the treatment of PE. Conclusions While it is evident that PDE5is are the first choice in patients with comorbid ED and PE (where one may be secondary to the other), well-designed studies on the possible use of PDE5is in PE patients without ED are still limited. The issue will be less controversial when further evidence on the role of NO and PDE5 in the mechanism of ejaculation is available.

Everything you ever wanted to know about phosphodiesterase 5 inhibitors and the heart (but never dared ask): How do they work?

“…Vardenafil was introduced with two indications: ED and premature ejaculation that was improved even in the absence of ED [17]. Initially produced as a film-coated tablet, it was then also distributed as an orodispersible tablet, with a 1.21-1.44-fold higher bioavailability [13].…”

Seminal vesicles and diabetic neuropathy: ultrasound evaluation after prolonged treatment with a selective phosphodiesterase‐5 inhibitor

“…Moreover, there are some data on the effects of PDE5i administration on sperm parameters (Hellstrom et al, 2008;Pomara et al, 2007). Finally, some authors have debated the usefulness of these molecules for the treatment of premature ejaculation (Gökçe et al, 2011;Jannini et al, 2011). On the contrary there are no data on the ultrasound characteristics of the SV after treatment with PDE5i in infertile diabetic patients with neuropathy, or changes on sperm parameters.…”

Impact of erectile function and age in men with lower urinary tract symptoms on ejaculatory dysfunction and premature ejaculation

“…15,16 Although the prescription of PDE5 inhibitors for PE is still controversial, PDE5 inhibitors are regarded as the first choice for patients with comorbid ED and PE. 27 Subjects with ED may either require higher levels of manual stimulation to achieve an erection or may intentionally 'rush' intercourse to prevent early detumescence of a partial erection, resulting in ejaculation with a brief latency. This may be compounded by the presence of high levels of performance anxiety related to their ED, which only serves to worsen their prematurity.…”