Treatment for Premature EjaculationDrug treatment for premature ejaculation
|
||
Premature ejaculation is a common male sexual problem controlled by disturbances of serotonergic neurotransmission and some serotonin receptors, and, to a lesser degree, oxytocinergic neurotransmission in the central nervous system.The current definition of premature ejaculation is of limited use, and a proposal has been put forward to categorize premature ejaculation into four more clearly defined syndromes, which will be more useful when considering the results of research into the effects of various drugs on premature ejaculation. A meta-analysis of this research has shown that daily treatment with the antidepressants paroxetine, sertraline, clomipramine, and fluoxetine, have similar impact on time to ejaculation. It's also been shown that so-called "on-demand" treatment does not generally have the same impact on delaying ejaculation as daily treatment, although some studies using the SSRI dapoxetine have in fact shown a weak effect in delaying ejaculation about one or two hours after taking the drug. Premature Ejaculation DefinedWhen men ejaculate very quickly, many experts currently believe the problem may be due to either anxiety or a neurobiological pathology. this leaves open the question of what exactly constitutes premature ejaculation; the major problem in finding a consensus in definition is that premature ejaculation is a very variable condition, affecting some men for all their lives from their first sexual encounter onwards, while it affects others only occasionally. This has led to the suggestion that men who have had life-long premature ejaculation and who ejaculate very quickly - say within a minute of penetration - should be given medication to deal with the condition. Lifelong premature ejaculation has the following characteristics: Ejaculation occurs too soon every time a man makes love, and with every partner he has This premature ejaculation occurs from the first time a man has sex and continues thereafter The man ejaculates within two minutes of penetration or even before he has attempted to penetrate his partner The speed of a man's ejaculation does not slow down as he gets older; indeed, it may even speed up. The current thinking around lifelong premature ejaculation like this is that drug treatment may be effective. Acquired premature ejaculation is defined in a different way: A man has had normal sexual experiences before he develops premature ejaculation. The onset of this condition may be gradual or sudden. It may be linked to other physical or emotional conditions such as relationship problems, urological dysfunction, erectile dysfunction and so on. There's a tendency to over-classify among some researchers, and in my opinion that is exemplified in the following categories of premature ejaculation which have been proposed: Natural variable premature ejaculation - this is, as you might expect, a variation in a man's natural sexual performance, such as might occur with a new partner or with higher than normal anxiety. It's supposedly characterized by: an ejaculation time of less than one and a half minutes, a reduced ability to control ejaculation, and inconsistent and irregular ejaculations. In essence, this is in large part a confidence issue, and men who have it are not candidates for treatment with drugs. Premature ejaculatory dysfunction - this is a man who complains of coming too soon, yet whose ejaculatory function is in fact almost normal (upwards of three minutes, and sometimes much longer, up to twenty minutes, perhaps). In other words, the problem is all in the man's imagination - he performs well in bed, but he refuses to accept this fact, and underestimates how long he is able to thrust before he ejaculates. Drug Treatment for Premature EjaculationIt's important that studies into the effectiveness of drugs as a treatment for premature ejaculation are properly controlled, with adequate studies and well-defined baselines. When those conditions are met, one can assess whether or not any particular pharmacological agent is effective in increasing the time between penetration and ejaculation. The most commonly prescribed agents currently in use are selective serotonin re-uptake inhibitors, the tricyclic anti-depressant called clomipramine, and anesthetic agents to be applied to the penis. Obviously these drugs may be given when sex is anticipated or as a daily regime. Daily treatment with clomipramine Daily treatment with between 20 and 50 mg of clomipramine appears to be effective in controlling premature ejaculation - at least to the extent that a number of studies have confirmed this. Treatment with SSRIs Paroxetine was first shown to have a strong ejaculation-delaying-effect in 1994, at dosages of between 20 and 40 mg per day. Unfortunately, despite the claimed effectiveness, the drug companies have not applied to the American FDA for approval for the use of the drugs in this context. This may be because the drugs can in fact have a major effect on sexual potency, and the drug companies do not wish this fact to be highlighted. However, when the published studies which are of a sufficiently high standard on this matter are reviewed, the order of effectiveness of these drugs is as follows: Highest (most
effective) - Paroxetine (20-40 mg) Ejaculation delay apparently begins a few days after first taking these drugs, but becomes most marked after a period of between one and three weeks. The effect of delaying ejaculation is usually permanent, but it may sometimes diminish after a year. It should be noted that the mechanism by which these drugs delay ejaculation is still unclear. Furthermore, there are a number of more-or-less unpleasant side-effects, which include fatigue, yawning, mild nausea, loose bowels, sweating and so forth: these are claimed to diminish with time, and to have mostly disappeared by three weeks into the treatment regime. It is also claimed that loss of libido and erectile function are rarely reported by users of these drugs who seek to extend their sexual performance and staying power. (This is not the case with men who take them for depression.) One unfortunate effect is priapism: that is to say, getting an erection which lasts for hours. If this happens to you, please seek urgent medical attention - any erection which lasts over three hours can cause serious damage to the penis and its erectile mechanism. On demand drug treatment for premature ejaculation is obviously the desirable objective, in that the drugs can be taken some time before intercourse and ejaculation will later be delayed. There has been surprisingly little research in this area, but the results are not promising. Those drugs investigated include topical anesthetics, clomipramine, SSRIs, dapoxetine, and compounds like Viagra. Topical Anesthetics Clomipramine SSRIs The SSRI dapoxetine has been developed for on-demand treatment of premature ejaculation but it has never been approved for the purpose. clinical study. Dapoxetine gets into the bloodstream quickly but it does not actually produce much of a delay in the time between penetration and intercourse - only a minute or two. Tramodol Drug treatment for premature ejaculation Effect of premature ejaculation on a man and woman's sex life Premature ejaculation - and your relationship What is an ejaculation - the physiology of ejaculation The medical view of premature ejaculation Drugs and premature ejaculation Other pages on this website about the treatment of premature ejaculation The effective treatment of premature ejaculation Treatments not requiring drugs
|
|
|
