The role of local anaesthetics in premature ejaculation

Abstract

E 9 4 3What ' s known on the subject? and What does the study add? It is now accepted that both biological and psychological factors are important in the aetiology of premature ejaculation (PE). Of particular interest is the correlation between ejaculatory latency and penile sensory thresholds. Men with PE appear to have a heightened sensory response to penile stimulation and also generally exhibit other abnormal refl ex pathways within the ejaculatory process, suggesting a link between penile hypersensitivity and PE. Considering these sensory differences, drugs that selectively produce some degree of penile desensitization or act within the afferent-efferent refl ex could delay ejaculatory latency without adversely affecting the sensation of ejaculation.This review evaluates published clinical trial data for local anaesthetics used off-label in PE as well as novel topical agents in development. New analyses of the phase III data are presented for topical eutectic mixture for PE (TEMPE, also known as PSD502, Plethora Solutions Plc., London), a proprietary formulation of lidocaine and prilocaine in a metered-dose aerosol delivery system.

The office management of ejaculatory disorders

“…Daily treatment with long-acting SSRIs increases medication accumulation and consequently increases sexual side effects, such as ED and hypoactive sexual desire (78), as well as the risk of suicidal ideation (79) and SSRI discontinuation syndrome (80). The most common adverse reactions associated with local anesthetics include ED, penile numbness, and vulvovaginal burning sensation in the female partner (81). …”

“…The integrated analysis of data from the five phase III trials demonstrated significant improvements in satisfaction with sexual intercourse, ejaculation-related personal distress and interpersonal difficulty in the female partners of men treated with dapoxetine versus those treated with placebo (68). Although the benefits of PSD502 (a topical anesthetic) for female partners have been demonstrated using the PEP questionnaire (96), topical anesthetics may cause vulvovaginal burning sensation, discomfort or numbness in partners (81,96,97). These potential drawbacks may limit the acceptability of topical anesthetics for the treatment of PE in patients with PE and their partners (98).…”

The characterization, current medications, and promising therapeutics targets for premature ejaculation

“…So far, there has been no consensus on the dosage of medication or the timeframe for application of topical anesthetic agents. Several topical agents have been used including severance-secret (SS) cream, lignocaine spray, lidocaine-prilocaine cream, and dyclonine-alprostadil combination (Choi et al, 1999;Henry & Morales, 2003;Wyllie & Powell, 2012). The theory that men with PE have penile hypersensitivity provides a rationale for using locally effective topical desensitizing agents.…”

Premature ejaculation: definition, epidemiology and treatment

“…Condoms can also be used and are effective, particularly when combined with local anaesthesia. 43 The introduction of selective serotoninreuptake inhibitors (SSRIs) has revolutionised the management of PE. Daily treatment has been shown to be effective once the drug has reached steady state, but benefit may occur earlier.…”