Treatment of premature ejaculation

Abstract

a b s t r a c tPremature ejaculation (PE) is the most common male sexual disorder, and it may have a profound negative impact on a man and his partner's lives. Different organizations and societies have no consensus on the definition and classifications of PE. However, most organizations and societies include in their definitions the intravaginal ejaculation latency time (IELT), the control of ejaculation, and the distress or impact of interpersonal difficulties. Evaluation procedures have been standardized in clinical studies by the development of an objective measurement of IELT (using a stopwatch) and by the introduction of patient-reported outcome (PRO) questionnaires on ejaculation control and sexual satisfaction. The identification of four different patterns of PEdlifelong, acquired, normal variant, and premature-like ejaculatory dysfunctiondis critical because of different underlying pathogeneses and consequently different management approaches. The optimal treatment for PE should be individualized, based on a patient's symptoms, expectations, and underlying variant causes. Most lifelong PE patients need pharmacotherapy (possibly in combination with psychosexual counseling) as a first-line treatment because of the underlying neurobiological etiology and the impact of PE on the couple's relationship. The management of acquired PE is etiologically specific and may include pharmacotherapy for erectile function management in men with comorbid erectile dysfunction (ED). Men with natural variable PE complain of early ejaculation in situational or coincidental conditions; the ejaculation is inconsistent and occurs irregularly. Psychoeducation and reassurance are indicated for men with this type of PE. Psychotherapy or sex counseling is the first choice of treatment for men with premature-like ejaculatory dysfunction. All pharmacotherapies such as long-term selective serotonin reuptake inhibitors (SSRIs) or on-demand topical anesthetics are off-label indications, The benefits of pharmacotherapy toward improving ejaculation times should be weighed against their safety profiles. The development of the short-acting selective serotonin reuptake inhibitor (SSRI) dapoxetine hydrochloride (30 mg and 60 mg) for oral ondemand use opened a new era of PE treatment. Other potential pharmacotherapies such as tramadol, lidocaine/prilocaine spray, and phosphodiesterase inhibitors are still under development. Their safety and efficacy profiles should be further evaluated and supported by additional clinical studies.

Assessing satisfaction in men with premature ejaculation after dapoxetine treatment in real-world practice

“…The mean of initial prescription was 1.5 ± 0.7 packs (3 tablets/pack), and the refill rate of dapoxetine at 2nd visit was 73.9% (105/142). A total of 712 packs of dapoxetine were purchased during this study, with an average of 2.5 ± 2.5 packs per person. The mean follow‐up duration was 2.3 ± 2.1 months (0–9).…”

“…The diagnosis and classification of PE followed the guidelines of the ISSM (1). Based on the SHIM score, the severity of ED was classified as: severe ED (1-7), moderate ED (8)(9)(10)(11), mild-to-moderate ED (12)(13)(14)(15)(16), mild ED (17)(18)(19)(20)(21), and no ED (22)(23)(24)(25).…”

“…It is important to diagnose the underlying primary cause of PE and any associated comorbidities, such as hyperthyroidism and prostatitis , because they should be treated first or at the same time as PE . Psychological/behavioural therapy and several types of pharmacotherapy, such as topical anaesthetic agents, long‐acting selective serontonin reuptake inhibitors (SSRIs), phosphodiesterase type 5 (PDE5) inhibitors, the tricyclic antidepressant clomipramine, and the opioid analgesic tramadol, have been reported to treat PE with varying degrees of success, but these are all off‐labelled uses for PE treatment .…”

The comparison of on-demand caffeine consumption with squeezing technique on treating patients with premature ejaculation; a randomized clinical trial

“…Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, clomipramine, and dapoxetine, have proved effective on PE; however, not many studies have demonstrated their long-term effects leading to long-lasting sexual dysfunction such as anorgasmia and erectile dysfunction [9,11]. On the other hand, SSRIs are normally used by patients with depression and other psychological disorders, meaning that SSRIs can result in stigma and lower compliance [10].…”

Premature ejaculation in couples using contraceptive withdrawal and associations with characteristics of its use: A cross‐sectional study

“…The pathology of PE has different anatomical, physiological and psychological components (Martin, Nolen, Podolnick, & Wang, 2017; McMahon, Jannini, Serefoglu, & Hellstrom, 2016). Because of these different pathogeneses and thus different management approaches, PE can be classified into four types: lifelong, acquired, normal variant and PE dysfunction (Hsu, Huang, & Huang, 2013). Many patients suffering from PE generally complain about psychological concerns, anxiety and depression along with dissatisfaction with sexual intercourse (Patrick et al., 2005; Serefoglu et al., 2014).…”