The Ideal Premature Ejaculation Treatment: Examining Current Treatment Options by PEhomepage.com Editorial Team
Stanely E. Althof notes that not only is premature ejaculation (PE) the most common male sexual dysfunction, it is also “incompletely understood.” Developing a treatment for the condition is hindered by the lack of a consistent definition for physicians to use in making a diagnosis. While most studies performed after the 1990s agree that there are both physiological and psychological components to PE, treatment options lag behind as the field struggles to determine exactly what PE is and how best to help individuals who are affected.
Althof’s review of the current literature and examines current interventions in order to provide an overview of possible options. During his review, he also elucidates the ideal treatment for PE sufferers. Pharmacological treatments, or drug therapy, has focused on three areas: antidepressant medications, topical anesthetics, and PDE-5 inhibitors commonly used for the treatment of Erectile Dysfunction (ED). He also discusses psychological and behavioral therapy that researchers have used in the past with limited success.
Antidepressant therapy has been examined by researchers, focusing primarily on selective serotonin reuptake inhibitors (SSRIs). These medications began to be of interest to researchers studying PE since a common side effect of these medications is delayed ejaculation. There are drawbacks to using antidepressant medications, including the fact that these medications are FDA approved for the treatment of depression only. There is also growing concern that SSRIs may be associated with increases in impulsive actions and suicidal behavior. Often the person who takes antidepressant therapy has to take them several weeks before experiencing the full benefit, a clear drawback for the person with PE since these medications cannot be taken on demand.. Also, when taking an antidepressant long-term, the user will likely need to decrease the dosage over a period of time in order to stop taking it without withdrawal symptoms. Studies using antidepressants for PE treatment have been small and “inconsistent in the methods used to define the condition and measure outcomes,” according to Althof.
Topical anesthetic medications have been examined by several studies, using the theory that penile hypersensitivity is a dominant cause of PE. In these studies, the individual uses a cream, ointment, or spray locally containing a medication like lidocaine. Using topical medications requires the man to either use a condom or to wash off the medication prior to intercourse to avoid vaginal numbness during sexual intercourse. Some sexual therapists argue that these medications are often messy and decrease the natural spontaneity of the moment,. Some promise has been seen using a herbal remedy, SS-cream, developed in
Korea. The herbal remedy is not approved for use in the
U.S. by the FDA.
Another medication that some researchers have used is PDE-5 inhibitors. Studies have examined whether these drugs (like Viagra, Levitra and Cialis) can be used either alone or in combination with SSRIs and improve ejaculation times. One study showed that intravaginal ejaculation latency time (IELT), the time between vaginal insertion and ejaculation, improves after taking PDE-5 inhibitors after 3 and 6 months of treatment. Still, the studies looking at PDE5Is as treatments for PE are small and inconclusive.
Even before drug therapy was used, therapists used a combination of counseling and behavioral therapy in order to treat PE. These interventions often call for high commitment on the part of the patient and his partner in order to be effective. There are various methods that limit arousal or teach men to focus on relaxation techniques in order to better control his ejaculation. Studies using the stop-start or squeeze techniques often show marked improvement; however, if the patient does not stay focused on the therapy, these gains are often lost within a relatively short period of time. Men have even resorted to self-treatment, such as wearing multiple condoms or distractions, or masturbation prior to sex increase ejaculation times. These self-help techniques rarely work and may limit spontaneity of the moment and rarely work for extended periods of time.
Instead, Althof proposes that researchers focus on a new type of medication, one that would cure PE instead of treating the symptoms. It would also be approved for use for Premature Ejaculation instead of increased IELT.. This medication would work rapidly after ingestion, can be taken as needed, and have minimal side effects. There is some interest in developing medications like those that Althof proposes, but these medications are still in the early development stages. .
Source: Althof, Stanley E. “Prevalence, Characteristics and Implications of Premature Ejaculation/Rapid Ejaculation.”
The Journal of Urology, (175), March 2004, p. 842-848.
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