Investigating Available Treatment Optionsby PEhomepage.com Editorial Team
Once a physician has made a diagnosis of premature ejaculation, the treatment process begins. Authors of this study advocate that the primary goal of treatment is “to increase patient and partner satisfaction.” Treatment is most effective when it involves both the male and his partner making an informed decision about next steps in the process.
Behavioral or sex training involves a technique first discussed by Masters and Johnson in the 1970s. The start-stop or squeeze technique requires cooperation of both the male and the female partner. As ejaculation becomes imminent, the male or his partner squeezes the base of the glans penis for a few seconds (2-3). This effort delays ejaculation by inhibiting the response. Over time the ejaculatory response is conditioned to delay without further intervention. Long-term studies of sex therapy for premature ejaculation have not yielded positive results since gains in therapy are not often sustained over time.
Pharmacologic or medication based treatments have centered around using selective serotonin reuptake inhibitors (SSRIs). These medications have long been shown to prolong latency in men suffering from premature ejaculation. Some of the off-label medications used in studies include fluoxetine (Prozac®), sertraline (Zoloft®), and paroxetine (Paxil®). Studies demonstrate that chronic use or higher dosages of these SSRIs tend to be more effective, yet they also cause more side effects. Side effects of these medications include nausea, lowered libido, insomnia or sleepiness, weight gain, and difficulty concentrating.
In order to counteract the side effects and still provide for on-demand dosing, researchers are working with a new medication called dapoxetine
( Priligy ™ ). In large studies with more than 2,000 patients, researchers have established that dapoxetine
( Priligy ™ ) can delay ejaculation for up to 3.32 minutes (vs. 1.75 minutes with placebo) and that 79% of patients who use it report higher sexual satisfaction. The medication has a half-life of 1.2 hours. The most common side effects noted with dapoxetine
( Priligy ™ ) is nausea, dizziness, and diarrhea. The Food and Drug Administration has not yet approved dapoxetine
( Priligy ™ ) for use, although more research is being conducted to demonstrate its safety and effectiveness. If it is approved, dapoxetine
( Priligy ™ ) would be the first medication developed that would treat premature ejaculation on demand instead of requiring chronic dosing.
Topical anesthetics such as lidocaine have been studied to determine if individuals are able to successfully delay ejaculation. In addition, medications such as sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®) have also been studied to determine if they are effective in the treatment of premature ejaculation. Authors note that “none of these latter treatments have been shown to be effective in the treatment of PE [premature ejaculation] in randomized, placebo-controlled studies.” Finally, studies of construction rings used to maintain erection and intracorporal injections of prostaglandin E1 have not been studied sufficiently to determine their effectiveness rate.
More recently, experts have been advocating that couples use a combination of behavioral/sex therapy and pharmacological intervention with medications like SSRIs. This combination approach to treatment is still being evaluated to determine if it is effective in relieve premature ejaculation.
Source: Rosen, Raymond; Kountz, David; and Kuritzky, Louis. “Managing Sexual Problems in Primary Care: Focus on Premature Ejaculation”
University of
Medicine & Dentistry of
New Jersey – Center for Continuing and Outreach Education, September 2005.
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