Guidelines on the treatment methods, approved by the Board of Directors of AUAby PEhomepage.com Editorial Team
Premature ejaculation or PE is a condition in which ejaculation occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners. PE (also known as early ejaculation or rapid ejaculation) is one of the most common male sexual disorders with a prevalence of 21% in men ages 18 to 59 in the
United States. The treatment of PE is based on psychological, behavioral and pharmacologic interventions. Current treatments methods include;
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Decreasing sensory input (reducing local penile sensation)
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Behavior modification therapies
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Use of drug’s side effects (those with serotonin reuptake inhibiting activity).
Guidelines on the treatment methods, approved by the Board of Directors of AUA, have been published in order to
facilitate informed treatment decisions by physicians and the patients to achieve better results. The guidelines recommendations are as follows;
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The diagnosis of PE is based on sexual history alone. A detailed sexual history should be obtained from all patients with ejaculatory complaints.
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In patients with PE and ED (erectile dysfunction), the ED should be treated first.
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Both the patient and their partner should be educated on the risks and benefits of all treatment options prior to any intervention. Patient and partner satisfaction is the primary target outcome for the treatment of PE.
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Premature ejaculation can be treated effectively with several antidepressants such as serotonin reuptake inhibitors (SRIs) or with topical anesthetics. The optimal treatment choice should be based on both physician judgment and patient preference.
Oral medication using antidepressants
These antidepressants include SRIs fluoxetine, paroxetine, and sertraline and clomipramine. Treatment with oral antidepressants should be started at the lowest possible dose that has a reasonable chance of success.
The administration of the drug can be either continuous on a daily basis or situational and is based on the frequency of sexual activity by the patient.
The side effects of using antidepressants for the treatment of PE are similar to those reported in patients being treated for depression but the frequency and severity of the side effect is less when using antidepressants for PE.
Topical anesthetic agents
Topical anesthetic agents may be applied to the penis prior to intercourse to delay ejaculation. Lidocaine/prilocaine creams are examples of topical anesthetic agents. Prolonged application (30-45 min) of the topical anesthetic may cause numbness and reduction in penile sensation. Topical anesthetic is not suitable for patients or their partners who are allergic to it.
Other pharmacologic therapies
intra corporal injection of a vasoactive agent, such as alprostadil, and the administration of sildenafil citrate, therapies effective in the management of ED can also be used to treat PE. Treatment of PE by adrenergic blockade using alfuzosin and terazosin has proven meditatively effective.
The guideline concludes that, though FDA has not approved the usage of antidepressants and topical anesthetic for the treatment of PE, these drugs have shown to be effective and have fewer side effects. Providing support and educating the patient and their partner on the effectiveness, side effects, and acceptance of the therapy and regular review of alternative approaches are essential part of PE therapy.
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