Pharmacotherapy for premature ejaculation

Abstract

Introduction: Four premature ejaculation (PE) subtypes are distinguished on the basis of the duration of the intravaginal ejaculation latency time (IELT), its course in life, and frequency of complaints. Since the 1930s oral drug treatment and local anesthetics have been used to treat PE. Apart from dapoxetine, all currently available drugs to treat PE (SSRIs, clomipramine, and local anesthetics) are off-label. Not only men with lifelong and acquired PE, but also men with normal IELT values may want to postpone their ejaculation time.

Areas covered: The guideline of the International Society for Sexual Medicine for the treatment of PE has provided evidence-based recommendations for the pharmacotherapy of lifelong and acquired PE. Selective serotonin reuptake inhibitors (SSRIs) delay ejaculation by interfering with the serotonin (5-HT) neurotransmission system in the central nervous system. Attention is given not only to the well-known but also to the recently published, very rare side effects of SSRIs.

Expert opinion: Men with normal IELT values who want to postpone ejaculation do not need “drugs for the treatment of PE” but “ejaculation delaying drugs.” Pharmacological research of these ejaculation-delaying drugs ought to be investigated in men with normal IELT values, such as in men with subjective PE, variable PE, and in male volunteers.

Keywords:

• clomipramine
• dapoxetine
• local anesthetics
• post selective serotonin reuptake inhibitors sexual dysfunction
• premature ejaculation
• selective serotonin reuptake inhibitors
• serotonin

Declaration of interest

MD Waldinger is a member of the Advisory Boards of Emotional Brain B.V., Menarini Netherlands and Pounds Int. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Notes on contributors

Marcel D Waldinger

Affiliation

Marcel D Waldinger^1,2 MD, PhD

¹Drexler University College of Medicine, Department of Pharmacology and Physiology, Philadelphia, USA

²Practice for Psychiatry and Neurosexology, Amstelveen, The NetherlandsTel: [phone], E-mail: [email protected]