What’s the best drug treatment for premature ejaculation?

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What’s the best drug treatment for premature ejaculation?

J Fam Pract. 2008 March;57(3):192-194

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References

1. Althof SE. Prevalence, characteristics and implications of premature ejaculation/rapid ejaculation. J Urol 2006;175(3 pt 1):842-848.

2. Ahlenius S, Larsson K, Svensson L, et al. Effects of a new type of 5-HT receptor agonist on male rat sexual behavior. Pharmacol Biochem Behav 1981;15:785-792.

3. Waldinger MD, Berendsen HH, Blok BF, Olivier B, Holstege G. Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: the involvement of the serotonergic system. Behav Brain Res 1998;92:111-118.

4. Waldinger MD, Olivier B. Utility of selective serotonin reuptake inhibitors in premature ejaculation. Curr Opin Investig Drugs 2004;5:743-747.

5. Waldinger MD, Hengeveld MW, Zwinderman AH. Paroxetine treatment of premature ejaculation: a double-blind, randomized, placebo-controlled study. Am J Psychiatry 1994;151:1377-1379.

6. Waldinger MD, Zwinderman AH, Schweitzer DH, Olivier B. Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis. Int J Impot Res 2004;16:369-381.

7. Busato W, Galindo CC. Topical anaesthetic use for treating premature ejaculation: a double-blind, randomized, placebo-controlled study. BJU Int 2004;93:1018-1021.

8. Atan A, Basar MM, Tuncel A, Ferhat M, Agras K, Tekdogan U. Comparison of efficacy of sildenafil-only, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation. Urology 2006;67:388-391.

9. Atikeler MK, Gecit I, Senol FA. Optimum usage of prilocaine-lidocaine cream in premature ejaculation. Andrologia 2002;34:356-359.

10. McMahon CG, McMahon CN, Leow LJ, Winestock CG. Efficacy of type-5 phosphodiesterase inhibitors in the drug treatment of premature ejaculation: a systematic review. BJU Int 2006;98:259-272.

11. McMahon CG, Stuckey BG, Andersen M, et al. Efficacy of sildenafil citrate (Viagra) in men with premature ejaculation. J Sex Med 2005;2:368-375.

12. Li X, Zhang SX, Cheng HM, Zhang WD. Clinical study of sildenafil in the treatment of premature ejaculation complicated by erectile dysfunction [in Chinese]. Zhonghua Nan Ke Xue 2003;9:266-269.

13. Montague DK, Jarow J, Broderick GA, et al. AUA Erectile Dysfunction Guideline Update Panel. AUA guideline on the pharmacologic management of premature ejaculation. J Urol 2004;172:290-294.

14. Richardson D, Goldmeier D, Green J, Lamba H, Harris , JR. BASHH Special Interest Group for Sexual Dysfunction. Recommendations for the management of premature ejaculation: BASHH Special Interest Group for Sexual Dysfunction. Int J STD AIDS 2006;17:1-6.

Another RCT⁸ (N=84) compared EMLA cream applied 15 minutes prior to intercourse, sildenafil 50 mg orally 45 minutes prior to intercourse, EMLA cream plus sildenafil, and placebo. In the sildenafil-plus-EMLA group, 32% of the patients reported “improvement” and 54% reported “cure,” which was defined as ejaculation delayed until the patient wished it. In the EMLA-only group, 27% of the patients reported “improvement” and 50% reported “cure.” This was a statistically significant difference when compared with the placebo and sildenafil-only groups (number needed to treat [NNT]=3). There was no significant difference in reports of “improvement” or “cure” between the placebo and sildenafil-only groups.

One small RCT⁹ (N=24) compared placebo with the application of EMLA cream 20, 30, and 45 minutes prior to sexual intercourse. Improvement was seen in IELT in the 20- and 30-minute group, but penile numbness and erection loss increased in the 30- and 45-minute group.

PDE5 inhibitors: No convincing evidence

A review¹⁰ of 14 clinical trials concluded that there is no convincing evidence for PDE5 inhibitors in the treatment of men with lifelong premature ejaculation and normal erectile function. One RCT¹¹ found no increase in IELT from baseline in men taking sildenafil when compared with placebo, although patients reported overall sexual satisfaction and confidence based on a questionnaire.

However, a study by Li et al¹² treated 45 men with premature ejaculation and comorbid erectile dysfunction with sildenafil. Eighty-nine percent reported improved erectile function, and 60% reported decreased severity of premature ejaculation.

FAST TRACK

There is no good evidence that PDE5 inhibitors treat premature ejaculation effectively

Recommendations from others

The American Urological Association¹³ recommends antidepressants as first-line systemic therapy for premature ejaculation, specifically the SSRIs fluoxetine, paroxetine, sertraline, and the tricyclic clomipramine. Topical EMLA cream is also recommended, but the reduction of penile sensation may limit the acceptability of this treatment option.

The British Association for Sexual Health and HIV Special Interest Group for Sexual Dysfunction¹⁴ also recommends SSRIs and clomipramine as they have the strongest evidence for their efficacy. The group emphasizes the importance of combining behavioral and pharmacologic therapies as the management approach should be tailored to the individual patient.

Acknowledgments

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government.

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