While there are several forms of sexual dysfunction, one of the most common is premature ejaculation (PE).
Some believe that it affects 21-31% of men ages 18-59 in the
United States today.
The American Urological Association (AUA) recently developed guidelines for the treatment of this disorder.
While the exact reason that some men experience PE is unknown, there are several options for treatment.
These may include decreasing sensory input, behavior modification therapy, or pharmacological intervention.
This article focuses on the AUA’s recommendations regarding drug therapies.
After reviewing many articles and analysis, the AUA made several recommendations:
The diagnosis of PE should be made based on the patient’s sexual history.
A full history including input from the partner is critical to proper diagnosis.
Proper diagnosis is necessary before finding an effective treatment plan.
If a patient has both PE and erectile dysfunction (ED), the ED should be treated first.
In patients suffering from both
ED and PE, studies have shown that PE may improve when ED is effectively treated.
It is important that the physician work closely with the patient and their partner.
Sexual satisfaction is the most important outcome in treating this dysfunction.
Men need to be assured first that this is a common and treatable condition.
And while none of the pharmacological treatments options presented are approved by the FDA for this specific purpose, there are two viable treatment options.
PE can be treated with serotonin selective reuptake inhibitors (SSRIs) or what is commonly referred to as antidepressants.
Several of them may be effective such as fluoxetine, paroxetine and sertraline and the tricyclic antidepressant clomipramine.
While the physician can prescribe them to be taken as needed before sexual activity, their effectiveness was enhanced when taken on a regular basis.
The choice of which dosing is best may be determined by the patient’s level of sexual activity.
There are some possible side affects.
Early evidence suggests that any adverse affects from taking SRIs are similar to those reported by patients who take these drugs for the treatment of depression.
The kind and frequency of the effects is acceptable to most people.
They may include things like nausea, dry mouth, dizziness, and a reduced libido.
Overall, it was determined that the benefits of this type of therapy outweighed any of the potential side affects.
Another method of combating PE is the use of topical anesthetic agents.
Topical anesthetics can be applied to the penis prior to intercourse and will delay ejaculation.
They can be used with or without a condom, without changing the effectiveness of the treatment.
Lidocaine or pilocaine cream (2.5 g) can be applied for 20-30 minutes prior to intercourse to be effective.
However there are some downsides to the treatment.
Some report that the loss of sensation during sex is unacceptable, and the partner can experience a loss of sensation post intercourse.
Some even report a loss of erection due to the numbing, making this treatment ineffective in their cases.
There are no significant medical side effects reported, however.
Topical anesthetics are not a good idea for men or their partners who have an allergy to any component of the product.
Future research is still underway. There are other pharmacological therapies that have been investigated but the panel did not feel that there was enough information to support any other treatments as reliable.
Unfortunately, there is still a lack of consistent and reliable data and research in the area of PE, which makes determining best practices difficult at best.
The conclusion of the guidelines was that using oral antidepressants and topical anesthetics can be effective in delaying ejaculation.
However, the FDA has not approved these therapies for use in patients who suffer from PE.
Source:
Montague D.K. et al. AUA guideline on the pharmacologic management of premature ejaculation.
The Journal of Urology, 2004.
