Comparing Prescription vs. Over-the-Counter Solutions
Topical anaesthetic use for treating premature ejaculation: A double-blind, randomized, placebo-controlled study. Clinical study of SS-cream in patients with lifelong premature ejaculation. Althof S. The psychology of premature ejaculation: Therapies and consequences.
| Side Effect | Medication Type | Incidence Rate | Severity Level | Management Strategies | Notes |
|---|---|---|---|---|---|
| Nausea | SSRIs, topical anesthetics | 10-15% | Mild to Moderate | Dose adjustment, timing | Usually transient |
| Dizziness | SSRIs, topical anesthetics | 8-12% | Mild | Standing slowly, hydration | Common with beginning treatment |
| Headache | SSRIs, topical anesthetics | 5-10% | Mild | Analgesics, time to adjust | Typically diminishes over time |
| Reduced Sensation | Topical anesthetics | 10-20% | Mild | Reduced dose, application timing | Can affect partner satisfaction |
Premature ejaculation: A review of 1130 cases.
Why trust our experts?
Minor but nettlesome side effects have long been a disincentive to chronic use of these medications. Recent experience with the use of tramadol raises the hope that this might prove to be an agent as effective as SSRIs with less worrisome risk of side effects. The recognition of the high prevalence of PE and its significant impact on quality of life will hopefully translate into novel therapies that offer high efficacy and a favorable adverse effect profile for all forms of PE. Until then, blue pillmen it is wise to remember that no oral medication in isolation will entirely replace the need for compassionate patient counseling, coordinating treatment of the genital function aspects of PE with the management of the often highly charged psychosocial and partnership issues attendant to this condition. Corresponding Author: Hossein Sadeghi-Nejad, MD, FACS, UMDNJ New Jersey Medical School—Surgery, Division of Urology, 185 South Orange Ave., MSB G 536, Newark, NJ 07103-2714, USA.
Behavioral techniques
Tel: (973) 972- 4488; Fax: (973) 395-7197 Conflict of Interest: Dr. Sadeghi-Nejad is a speaker for Pfizer, and is an investigator in a clinical trial sponsored by Plethora Solutions. Lue T, Broderick G. Evaluation and nonsurgical management of erectile dysfunction and premature ejaculation. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds.
Intromission time
Comparison of efficacy of sildenafilonly, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation. Colpi GM, Fanciullacci F, Beretta G, Negri L, Zanollo A. Evoked sacral potentials in subjects with true premature ejaculation. ISSM announces fildena super active 150mg new definition of premature ejaculation. International Society of Sexual Medicine Newsbulletin 2007;24:6. Aycock L. The medical management of premature ejaculation.
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The use of phenoxybenzamine treatment in premature ejaculation. Effect of an alpha-blocking agent (phenoxybenzamine) in the management of premature ejaculation. Eaton H. Clomipramine in the treatment of premature ejaculation.
- Dapoxetine is effective when taken 1-3 hours before intercourse.
- Topical anesthetics can reduce sensation but risk partner numbness.
- SSRIs may take several weeks to reach full efficacy for PE.
- Tramadol's use for PE is off-label; consult a doctor before use.
- Combining medication with therapy can optimize outcomes.
- Avoiding excessive alcohol and stress can improve sexual performance.
- Pelvic exercises increase muscle strength and ejaculatory control.
- Psychological support can address anxiety-related PE.
- Devices like constriction rings may be used as mechanical aids.
- Open communication with partner improves treatment success.
- Regular follow-up with healthcare provider is recommended.
- Natural remedies lack solid clinical proof but are popular.
Ejaculation-retarding properties of paroxetine in patients with primary premature ejaculation: A double-blind, randomized, dose-response study. Br J Urol 1997;79:592–5.
Analgesic, Opioid
Berkovitch M, Keresteci AG, Koren G. Efficacy of prilocaine-lidocaine cream in the treatment of premature ejaculation. Morales A. Developmental status of topical therapies for erectile and ejaculatory dysfunction. Optimum usage of prilocaine-lidocaine cream in premature ejaculation. Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: A double-blind, placebo controlled study. Disorders of orgasm and ejaculation in men. J Sex Med 2004;1:58–65. Biri H, Isen K, Sinik Z, Onaran M, Kupeli B, Bozkirli I.
| Drug Name | Approval Year | Primary Use | Recommended Dosage | Prescription Needed | Monitor Required | Typical Side Effects |
|---|---|---|---|---|---|---|
| Dapoxetine | 2009 | Premature ejaculation | 30 mg before sex | Yes | Yes | Nausea, dizziness |
| Paroxetine | Approved for other uses, off-label for PE | 20 mg/day | Yes | Yes | Yes | Fatigue, sexual dysfunction |
| Sertraline | Approved for depression, off-label for PE | 50 mg/day | Yes | Yes | Yes | Insomnia, digestive issues |
Sertraline in the treatment of premature ejaculation: A double-blind placebo controlled study. Sertraline as a treatment for premature ejaculation.
- Dapoxetine's side effects can include nausea, headache, and dizziness.
- Topical anesthetics include lidocaine and prilocaine-based creams or sprays.
- SSRIs like fluoxetine, sertraline, may also be used off-label for PE.
- Opioid medications require careful medical oversight due to dependency potential.
- Behavioral approaches are first-line treatment for many men with PE.
- Regular exercise can improve overall sexual function and control.
- Some innovations include vibration devices to delay ejaculation temporarily.
- Medical tests may be recommended to exclude underlying causes.
- Education about sexual response stages can improve control strategies.
- Sex therapy often involves both partners to address relational issues.
- Medications may take several weeks to show maximum benefit.
- Lifestyle modifications, like reducing alcohol, can also help manage PE.
Athanasios Z, Polyanthi P, George K.
Additional info
Available at 24.pdf (accessed March 24, 2008). Jannini EA, Lenzi A. Ejaculatory disorders: Epidemiology and current approaches to definition, classification and subtyping. Sexual dysfunction in the United States: Prevalence and predictors. The epidemiology of the DSM-III psychosexual dysfunctions.
Key Takeaways
Rapid ejaculation: A review of conceptual, etiological, and treatment issues. Arch Sex Behav 1995;24:447–72. An analysis of selfreported sexual behavior in a sample of normal males. Arch Sex Behav 1984;13:69–83. Incidence and prevalence of the sexual dysfunctions: A critical review of the empirical literature.
Sildenafil (Viagra®) for PE
Arch Sex Behav 1990;19:389–408. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: Prevalence, comorbidities, and professional help-seeking. Eur Urol 2007;51:816–23; discussion 824. Prevalence, characteristics and implications of premature ejaculation/rapid ejaculation. Etiology of ejaculation and pathophysiology of premature ejaculation. The efficacy of duloxetine in the treatment of premature ejaculation. Selective serotonin reuptake inhibitor-induced sexual dysfunction: clinical and research considerations. Utility of selective serotonin reuptake inhibitors in premature ejaculation. Curr Opin Invest Drugs 2004;5:743–7. Safarinejad MR. Safety and efficacy of escitalopram in the treatment of premature ejaculation: A doubleblind, placebo-controlled, fixed-dose, randomized study. Giuliano F, Clement P.
- Dapoxetine is contraindicated with certain medications and health conditions.
- Topical creams should be used sparingly to prevent partner numbness.
- SSRI treatment may cause emotional blunting or decreased libido.
- Tramadol's risk of dependency requires careful medical supervision.
- Mechanical devices can provide temporary ejaculation delay.
- Behavioral training involves specific sex exercises for control.
- Mindfulness and relaxation techniques benefit PE management.
- Proper diagnosis is essential to rule out underlying disorders.
- Incorporate partner feedback to improve treatment results.
- Avoid abrupt discontinuation of prescribed medication.
- Lifestyle modifications can include weight management.
- Ongoing research aims to develop more effective PE treatments.
Serotonin and premature ejaculation: From physiology to patient management. Clomipramine and sexual function in men with premature ejaculation and controls. Giuliano F. 5-Hydroxytryptamine in premature ejaculation: Opportunities for therapeutic intervention. Giuliano F. Interview with Dr Francois Giuliano (by Christine McKillop). New avenues in the pharmacological treatment of premature ejaculation. Relevance of an evidence-based ejaculation time cutoff point for neurobiological research of premature ejaculation. Animal models of premature and retarded ejaculation. Waldinger MD, Schweitzer DH, Olivier B.
| Therapy Type | Description | Typical Duration | Success Rate | Noted Benefits | Noted Drawbacks |
|---|---|---|---|---|---|
| SSRI Medications | Selective serotonin reuptake inhibitors, delay ejaculation | 4-12 weeks | 70% | Long-term control | Possible side effects |
| Behavioral Therapy | Techniques like start-stop and squeeze method | Several sessions | 60-80% | No medication needed | Requires patient commitment |
| Topical Anesthetics | Numbing creams or sprays applied to glans penis | As needed | 65-75% | Fast onset | Reduced sensation, partner sensitivity |
| Pelvic Floor Exercises | Exercises to strengthen pubococcygeus muscles | 6-12 weeks | 50-65% | Improves control | Time-consuming |
On-demand SSRI treatment of premature ejaculation: Pharmacodynamic limitations for relevant ejaculation delay and consequent solutions.
Beta-adrenergic Blocker
Enlivened interest on the part of the pharmaceutical industry would channel a significant increase in funding into this area, which is much in need of improved investigation, awareness promotion, and effective treatment. Despite these promising leads, it is evident that the recent FDA warning about SSRIs has resulted in a flurry of interest in alternative forms of therapy. Immunohistochemical studies have demonstrated local synthesis of oxytocin and its synthesis-associated protein, neurophysin I, in the epithelial cells of the epididymis [97]. Thus, competing against the SSRI approach, the use of oxytocin compounds as potential therapeutic agents for PE is under investigation [56]. Intervention at other points in the pathophysiologic pathway and topical therapy is also undergoing further testing and improvement [56].
Tadalafil (Cialis)
Dietary deficiencies, such as low magnesium intake, may prove to play a limited role [98]. Interest in medical therapy for PE is surging. New oral agents are now providing important relief for men afflicted with this condition. On the other hand, no agent provides a cure in lifelong PE, and no medical therapy has as yet received FDA and EMEA approval for use in the treatment of this condition [12]. Studies to date have been relatively few and often limited with respect to the number of patients enrolled and/or the study design [26].
Information to gather in advance
Nevertheless, based on the level of evidence rating of those studies reviewed, both SSRIs and clomipramine have received a grade A recommendation from an expert panel at the Second International Consultation on Sexual Medicine [1]. Clinical research in this field is hampered by the complexity, variability, and subjectivity of this complaint. The placebo effect is high and reliable, appropriately controlled studies are in the minority. Carefully devised, methodically conducted research is much needed. SSRIs have been the most promising agents to date. J Sex Med 2005;2:121–31. Peripheral and central neurochemical effects of the selective serotonin reuptake inhibitors (SSRIs) in humans and nonhuman primates: Assessing bioeffect and mechanisms of action. Sprouse J, Braselton J, Reynolds L, Clarke T, Rollema H.
Risk factors of premature ejaculation
Penile sensitivity in patients with primary premature ejaculation. Somatosensory evoked potentials in patients with primary premature ejaculation. Guidelines for the diagnosis and management of premature ejaculation. Dinsmore WW, Hackett G, Goldmeier D, Waldinger M, Dean J, Wright P, Callander M, Wylie K, Novak C, Keywood C, Heath P, Wyllie M. Topical eutectic mixture for premature ejaculation (TEMPE): A novel aerosol-delivery form of lidocaine-prilocaine for treating premature ejaculation. Activation of postsynaptic 5-HT(1A) receptors by fluoxetine despite the loss of firingdependent serotonergic input: Electrophysiologicaland neurochemical studies. Sprouse J, Clarke T, Reynolds L, Heym J, Rollema H.
Expected duration
Prevalence of chronic prostatitis in men with premature ejaculation. Effects of a new type of 5-HT receptor agonist on male rat sexual behavior. Pharmacol Biochem Behav 1981; 15:785–92. The role of the 5-HT2 receptor in the regulation of sexual performance of male rats. Waldinger MD, Berendsen HH, Blok BF, Olivier B, Holstege G.
Complications of premature ejaculation
Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: The involvement of the serotonergic system. Behav Brain Res 1998;92:111–8. Effect of SSRI antidepressants on ejaculation: A double-blind, randomized, placebocontrolled study with fluoxetine, fluvoxamine, paroxetine, and sertraline. The selective serotonin re-uptake inhibitors fluvoxamine and paroxetine differ in sexual inhibitory effects after chronic treatment. Waldinger MD, Zwinderman AH, Olivier B.
SSRIs for Premature Ejaculation
SSRIs and ejaculation: A double-blind, randomized, fixeddose study with paroxetine and citalopram. Waldinger MD, Zwinderman AH, Olivier B. Antidepressants and ejaculation: A double-blind, randomized, placebo-controlled, fixed-dose study with paroxetine, sertraline, and nefazodone. Jern P, Santtila P,Witting K, Alanko K, Harlaar N, Johansson A, von der Pahlen B, Varjonen M, Vikstrom N, Algars M, Sandnabba K. Premature and delayed ejaculation: Genetic and environmental effects in a population-based sample of Finnish twins. Comparison of the effects of sertraline and its metabolite desmethylsertraline on blockade of central 5-HT reuptake in vivo. Anderson GM, Barr CS, Lindell S, Durham AC, Shifrovich I, Higley JD. Time course of the effects of the serotonin-selective reuptake inhibitor sertraline on central and peripheral serotonin neurochemistry in the rhesus monkey.