Overcoming Challenges, Side Effects, and Limitationsby PEhomepage.com Editorial Team
Premature ejaculation (PE) remains one of the most common male sexual dysfunctions, although diagnosing the condition remains limited by available definitions and men who are willing to admit suffering from PE. The definition has evolved over the years from one that focused strictly on partner satisfaction (Masters and Johnson, 1970) to a myriad of proposed ideas that include sexual satisfaction and intravaginal ejaculation latency time (IELT). All available definitions refuse to provide a specific “normal” time for IELT, leaving men and their female partners to define what is comfortable and satisfactory for them.
PE impacts men, their female companions, and the quality of their sexual relationship. For many men, it is too embarrassing to discuss and physicians do not routinely screen for it during regular visits. Men often have decreased sexual confidence, lower self-esteem, and eventually PE impacts their relationships in negative ways.
Many people erroneously feel that PE can be treated strictly through psychological intervention and that medical alternatives are unavailable. Behavioral techniques designed to treat PE have failed to show lasting recovery rates. Evidence exists to show a physiologic component that can be treated through medication. Some studies indicate that this physiologic component is based in the central nervous system and can be treated with selective serotonin reuptake inhibitors (SSRIs), similar to those used in treating depression and other mood-related disorders.
When assessing the effectiveness of SSRI’s, studies take into account the increase in IELT, while balancing it against the side effects of the medication. Side effects can include dry mouth, nausea, drowsiness, decreased libido, impotence, delayed orgasm, and tolerance. When considering dosage schedules, several studies have examined whether or not one dose taken weekly is more effective than a smaller dose taken daily. Other studies have examined medication taken on-demand (PRN). For example, one study reported that paroxetine increased IELT to a greater degree if patients took 20 mg daily for 2 weeks, followed by 4 weeks of PRN dosing compared to patients who only took 20 mg PRN. Some researchers favor using a PRN dosing schedule, although admittedly, antidepressants were not designed to be taken PRN. Patient compliance becomes an issue when considering medication taken over a prolonged period of time, especially when results can be delayed up to six weeks.
Topical anesthetics, such as lidocaine and prilocaine, generally benefit men in the short-term and have undesirable side effects that are not conducive to long-term usage. While penile sensitivity is decreased when these anesthetics are applied to the penis, female partners have reported numbing of the vaginal area. In addition, topical anesthetics need to be applied as much as 20 to 30 minutes prior to sexual intercourse and the penis is still covered by a condom in order to minimize female discomfort and exposure to the anesthetic. Spontaneity is decreased and is often cited as a reason why this treatment approach is less favorable than others available today.
Some men with IELTs of less than 1 minute have tested erectile dysfunction medication – sildenafil – and reported success. One study used sildenafil in conjunction with paroxetine to demonstrate if the dual dosing provided better results. The study showed that men who took 10 mg paroxetine daily for 21 days and then used 20 mg paroxetine and 50 mg sildenafil one hour before intercourse experienced greater results than men who took paroxetine only – 10 mg for 2 1days and 20 mg three to four hours prior to intercourse. Headache and flushing were the most common side effects reported with this medication combination. Another study examined the sildenafil/paroxetine combination with psychological and behavioral counseling and found that 56 of 58 patients demonstrated significant improvement. This last study provides interesting clues into combining both medical and psychological treatment options for Premature Ejaculation.
While there are promising treatment options, there are still limitations associated with them. Medications available on the market are not specifically approved for use in treating PE. In addition, patient compliance is an issue when considering SSRIs, since the medications may need to be taken over the course of several weeks in order to obtain optimal results. Topical anesthetics generally provide too many drawbacks for long-term usage. Treatment options need to include both physiological and psychological components that are comfortable for men and their sexual partners.
Source: Mulhall, John P. “Current and Future Pharmacotherapeutic Strategies in Treatment of Premature Ejaculation.”
Urology, 2006, p. 9.
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