Ejaculation Problems: Too Fast, Too Slow or Not at All?
Sadeghi-Nejad is a speaker for Pfizer, and is an investigator in a clinical trial sponsored by Plethora Solutions. Lue T, Broderick G. Evaluation and nonsurgical management of erectile dysfunction and premature ejaculation. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds.
- Certain herbal combinations claim to naturally delay ejaculation.
- Clinical trials are essential to confirm the efficacy of PE pills.
- Over-the-counter products should be approached with caution.
- Proper storage of pills ensures potency and safety.
- Monitoring emotional health helps manage PE effectively.
Comparison of efficacy of sildenafilonly, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation.
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However, ICI has been used as a strategy in certain cases to allow men with PE to maintain their erections and continue satisfactory sexual intercourse despite rapid ejaculation. In 1990, Fein reported on a small group (N = 8) of patients with PE who used vasoactive intracavernosal pharmacotherapy (mixture of phentolamine mesylate [1.0 mg/mL] and papaverine hydrochloride [30 mg/mL]) to address their PE [90]. When exploited as a temporary intervention, these artificially induced erections provided patients with confidence and encouragement, while they were awaiting results from more conventional therapies. With dosages ranging from 0.10 to 0.40 mL, the author reported that all eight patients responded successfully to this approach, while three were apparently “cured” of PE. The other five patients in the study continued to use ICIs after the completion of the study.
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An open-label study involving 80 potent men found that the combined use of sildenafil and paroxetine proved more efficacious than either treatment alone [69]. In treating 138 men with a progressive armamentarium of treatments, Chen et al. obtained best results when the use of sildenafil was combined with SSRIs and behavioral counseling. Sildenafil in combination with paroxetine was effective in97%of patients, compared to an improvement for only 47% using paroxetine alone [91]. An alternate approach combines the use of oral agents with the concomitant application of topical solutions. Colpi GM, Fanciullacci libido booster for woman F, Beretta G, Negri L, Zanollo A.
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Evoked sacral potentials in subjects with true premature ejaculation.
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For example, oral fluoxetine, when reinforced by the topical application of lidocaine ointment, effected a “cure” or an improvement in 83.3% of men, compared with 72% of those treated with fluoxetine alone [92]. Combining a psychotherapeutic with a pharmaceutical approach can provide either a stepwise or concurrent integration of psychological and medical interventions [93]. Several investigators have documented the added value of combining psychotherapy with pharmacotherapy in the treatment of ED, utilizing care models that should transfer readily to the integrated multidisciplinary management of PE [33]. Sildenafil has proven helpful as an adjunctive measure in support of a program of SSRI therapy, when combined with psychosexual counseling [91]. Advance in the understanding of PE has been hobbled by a categorical lack of solid studies on which to base clinical decision making.
How do medications for erectile dysfunction relate to premature ejaculation treatment?
As a case in point, an attempt at performing a meta-analysis of all studies, which evaluate the potential for PDE5 inhibitors in the treatment of PE, found that only 2 of 14 studies assessed the patient’s reaction to his problem (“bother score”), and none took into consideration the partner’s distress. Only 1 of the 14 studies met the criteria for an evidence-based, double-blinded, placebo-controlled investigation, using validated outcome assessment tools and including objective physiological measurements [83]. The artificiality involved in studying PE under conditions necessary for objective, physiological measurement conflicts with attempts to understand, evaluate, and treat PE in its natural setting. Findings derived from studies of stopwatch timed, methodically recorded intercourse do not necessarily correlate well with performance under more spontaneous, private, and intimate circumstances. On the brighter side, a most welcome addition to the field is the recent development and validation of a “user-friendly” questionnaire in 2007 to capture the multidimensional nature of PE and lend objectivity to diagnosing this entity [94]. ISSM announces new definition of premature ejaculation. International Society of Sexual Medicine Newsbulletin 2007;24:6. Available at 24.pdf (accessed March 24, 2008).
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Despite these promising leads, it is evident that the recent FDA warning about SSRIs has resulted in a flurry of interest in alternative forms of therapy. Immunohistochemical studies have demonstrated local synthesis of oxytocin and its synthesis-associated protein, neurophysin I, in the epithelial cells of the epididymis [97]. Thus, competing against the SSRI approach, the use of oxytocin compounds as potential therapeutic agents for PE is under investigation [56]. Intervention at other points in the pathophysiologic pathway and topical therapy is also undergoing further testing and improvement [56]. Dietary deficiencies, such as low magnesium intake, may prove to play a limited role [98].
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Interest in medical therapy for PE is surging. New oral agents are now providing important relief for men afflicted with this condition. On the other hand, no agent provides a cure in lifelong PE, and no medical therapy has as yet received FDA and EMEA approval for use sex erection tablet in the treatment of this condition [12]. Studies to date have been relatively few and often limited with respect to the number of patients enrolled and/or the study design [26]. Nevertheless, based on the level of evidence rating of those studies reviewed, both SSRIs and clomipramine have received a grade A recommendation from an expert panel at the Second International Consultation on Sexual Medicine [1]. Jannini EA, Lenzi A.
Phosphodiesterase type 5 inhibitors (PDE5 inhibitors)
Clinical research in this field is hampered by the complexity, variability, and subjectivity of this complaint. The placebo effect is high and reliable, appropriately controlled studies are in the minority. Carefully devised, methodically conducted research is much needed. SSRIs have been the most promising agents to date. Minor but nettlesome side effects have long been a disincentive to chronic use of these medications. Ejaculatory disorders: Epidemiology and current approaches to definition, classification and subtyping. Sexual dysfunction in the United States: Prevalence and predictors.
- Delay pills might reduce sensation, extending intercourse time.
- The safety profile of herbal pills is less documented than pharma drugs.
- Patients should monitor for side effects and inform their doctor.
- Psychological factors like anxiety can be addressed alongside pills.
- Proper dosage and timing are key to maximizing benefits.
The epidemiology of the DSM-III psychosexual dysfunctions. Rapid ejaculation: A review of conceptual, etiological, and treatment issues. Arch Sex Behav 1995;24:447–72.
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A permanent cure for PE remains a distant goal. In the interim, ideal medical treatment for PE would entail the development of a medication that is effective on a rapid-acting, “on-demand” basis, without impairing the spontaneity and intimacy of the relationship. Sexual side effects (e.g., vardenafil hcl 10mg diminished libido and ED), as well as generalized side effects (e.g., nausea, insomnia, and headache), would be avoided. Novel topical therapies in the form of aerosol (i.e., TEMPE, Plethora Solutions; London, UK) and short-acting SSRI compounds that target the serotonergic system are currently undergoing clinical trials in the United States. Alza/Johnson & Johnson is soliciting an FDA approval for dapoxetine.
Premature ejaculation (PE), or now, as it is often referred, rapid ejaculation (RE), is a common medical condition that is tough to define and affects up to 30 percent of men.
Pfizer and Bristol-Myers Squibb also have patented agents under development [56]. Although specific data about these compounds are not available at the time of this writing, the Pfizer medication (UK 390957, Pfizer Inc., New York,NY, USA) has been described as a rapid-acting serotonin modulator, i.e., a short-acting SSRI [95]. The Bristol-Myers Squibb drug, BMS-505130, is a potent and selective SSRI with a short half-life with potential advantages in the treatment ofPEbecause of the relatively rapid fall in plasma concentrations [96]. Should these effective, short-acting, “ondemand” agents receive FDA and European Medicines Agency (EMEA) approval for this indication, they could dramatically alter the treatment landscape [12]. Enlivened interest on the part of the pharmaceutical industry would channel a significant increase in funding into this area, which is much in need of improved investigation, awareness promotion, and effective treatment. An analysis of selfreported sexual behavior in a sample of normal males. Arch Sex Behav 1984;13:69–83. Incidence and prevalence of the sexual dysfunctions: A critical review of the empirical literature. Arch Sex Behav 1990;19:389–408. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: Prevalence, comorbidities, and professional help-seeking.
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Recent experience with the use of tramadol raises the hope that this might prove to be an agent as effective as SSRIs with less worrisome risk of side effects. The recognition of the high prevalence of PE and its significant impact on quality of life will hopefully translate into novel therapies that offer high efficacy and a favorable adverse effect profile for all forms of PE. Until then, it is wise to remember that no oral medication in isolation will entirely replace the need for compassionate patient counseling, coordinating treatment of the genital function aspects of PE with the management of the often highly charged psychosocial and partnership issues attendant to this condition. Corresponding Author: Hossein Sadeghi-Nejad, MD, FACS, UMDNJ New Jersey Medical School—Surgery, Division of Urology, 185 South Orange Ave., MSB G 536, Newark, NJ 07103-2714, USA. Tel: (973) 972- 4488; Fax: (973) 395-7197 Conflict of Interest: Dr. Eur Urol 2007;51:816–23; discussion 824.
| Pill Type | Common Side Effects | Serious Risks | Population Caution | Duration of Side Effects |
|---|---|---|---|---|
| Local Anesthetics | Numbness, irritation | Allergic reactions | Men with allergies to anesthetics | Few hours to a day |
| Prescription Medications | Dizziness, nausea | Serotonin syndrome, depression | Men on SSRIs or antidepressants | Few hours to days |
| Natural Supplements | Gastrointestinal discomfort, headaches | No significant risks | Pregnant or nursing women | Varies |
Prevalence, characteristics and implications of premature ejaculation/rapid ejaculation. Etiology of ejaculation and pathophysiology of premature ejaculation. Prevalence of chronic prostatitis in men with premature ejaculation. Effects of a new type of 5-HT receptor agonist on male rat sexual behavior.
- Topical gels can numb nerves and delay ejaculation temporarily.
- Oral pills like dapoxetine are prescription medications for PE.
- Herbal supplements claim to improve stamina and control.
- SSRIs often prescribed off-label to help delay climax.
- Some lifestyle changes, like stress reduction, may improve symptoms.
Pharmacol Biochem Behav 1981; 15:785–92.
- Some medications are designed specifically for premature ejaculation.
- Using pills without medical advice risks adverse effects.
- Combining pills with behavioral techniques can yield better results.
- Natural pills often lack scientific evidence for efficacy.
- Regular follow-up with a healthcare provider is crucial.
The role of the 5-HT2 receptor in the regulation of sexual performance of male rats. Waldinger MD, Berendsen HH, Blok BF, Olivier B, Holstege G. Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: The involvement of the serotonergic system.