Combination therapy for premature ejaculation: results of a small-scale study

Abstract

Premature ejaculation (PE) has an estimated prevalence of 22% of sexually active men. Treatment options are being drawn towards poles of clinical management, i.e. sole use of an anti-depressant or behavioural therapy. We speculated that a combination approach may offer both an improvement in ejaculatory delay, but also facilitate engagement with behavioural therapies. Our aims were to to compare ejaculatory delay between paroxetine 20mg daily or Premjact Spray™, followed by a behavioural therapy that did not include solitary or mutual masturbation. A randomised trial of pharmacological intervention for two months was followed immediately by a standardised behavioural therapy programme for a further two months. It was found that both paroxetine 20mg and Premjact Spray™ provided a statistically significant delay in ejaculation (measured by stopwatch); combination therapy indicated that ejaculatory delay had been maintained. Self-reported improvement to relationships was established, but did not correlate to the timed ejaculatory delay, i.e. successful treatment did not depend on a time delay, but on a reintroduction of intimacy. We conclude that combination therapy may provide a viable option for clinical management in men with psychogenic PE. Using medication, an initial stabilising effect to a relationship can be established, thus improving the uptake of behavioural therapy resulting in an improvement from baseline ejaculatory latency.

Keywords:

• premature ejaculation
• paroxetine
• Premjact Spray
• behavioural therapy
• clinical management

Acknowledgements

The study was supported by the Barts and the London RAB Charitable Foundation. Premjact Spray was supplied by Pound International, Ltd. We would like to thank the Department of Urology, Barts, and the London NHS Trust for support throughout the trial.