More About The Medical Research On A Cure For Premature Ejaculation
The elusive medical cure for premature ejaculationAn analysis of the use of SSRIs as a treatment for premature ejaculation over 60 years was published in 2004. Although this relied on intra-vaginal-ejaculatory latency time (IELT) and not on the accounts of men experiencing premature ejaculation, there are some obvious conclusions: For daily treatment, paroxetine was most efficient, with an average increase of 8.8 times in IELT, closely followed by sertraline (4.1 fold increase) and fluoxetine (3.9 fold increase). A placebo only increased IELT by 1.4 times. Citalopram is a newer drug, with as yet unproven results in treating premature ejaculation. One form of citalopram (escitalopram) has shown a high preference for serotonin transporters compared to noradrenalin and dopamine transporters. In one randomized, double-blind, placebo-controlled, research study, escitalopram resulted in a 4.9 fold increase in average IELT. Both citalopram and escitalopram produced an increased level of satisfaction with sexual intercourse and an increase in the frequency of sex. When administered daily, it takes about 2 or 3 weeks before the effects become noticeable in delaying ejaculation - although some men find the drug affects their ejaculatory latency in as little as 5 or 7 days after the onset of treatment. One interesting effect is that some men do not respond to the treatment - and even when they do, the effects of it may reduce over time. The reason for this is not known. The on-demand administration of SSRIs for premature ejaculation is somewhat controversial, and the data that results from such studies as have been done is confused: this means it is difficult to conclude exactly what effects a particular medication may have in the treatment of premature ejaculation. However, as you might expect, daily treatment tends to produce more results than on-demand treatment. Paroxetine seems to be the medication which has most impact in treating premature ejaculation in this fashion, though well designed studies have yet to be conducted. Dapoxetine, a new SSRI, has offered more hope in the on-demand treatment of premature ejaculation. Unlike conventional SSRIs, maximum concentrations of the pharmacologically active substance are achieved about one hour after a 30-mg oral dose. Two randomized, placebo controlled studies of over 2000 men with premature ejaculation revealed that dapoxetine increased not only IELT, but also a man's perception of the level of his control over the timing of his ejaculation, and most especially his and his partner's satisfaction with sexual intercourse. The IELT increase amounted to 2.8 times and 3.3 times for the 30 mg and 60 mg groups, and only 1.8 times for placebo. The effectiveness of the drug is less than for daily SSRI administration, but even so it is convenient and fast acting. The FDA has not granted a license for the drug in the treatment of premature ejaculation. Another study looked at patient preferences for premature ejaculation treatment. It compared men's responses to anesthetic ointment with on-demand and continuous use of SSRI's. Perhaps rather surprisingly, a large majority of men preferred continuous treatment: the numbers wanting on-demand SSRIs and anesthetic ointment were rather low. And in fact this did not change even when the men were told about possible side-effects. However, the problem is that the men were only offered a variety of SSRI which needs to be taken several hours before intercourse - hardly a recipe for successful spontaneous sex. In other words, the study is pretty useless about interpreting men's intentions around premature ejaculation treatment. Tramadol is a reportedly effective, centrally acting analgesic with two different mechanisms of action: a weak p-opioid effect, and an inhibition of noradrenaline and serotonin reuptake, which apparently activates descending monoaminergic inhibitory pathways. While the drug can be taken an hour or so before intercourse, and a 50 mg dose is highly effective in extending the time for which men can thrust (increasing the IELT by 13 fold), this dosage does have some rather marked side-effects: 28% of men experience nausea, vomiting and dizziness, which may mean it is not a suitable treatment for premature ejaculation. With a lower dosage of 25 mg, men experienced a 6.3 fold increase in IELT compared to a 1.7 fold increase in a placebo group. In this case, about 13% of the men reported adverse side-effects including dyspepsia and mild somnolence. Viagra has also been investigated as a possible treatment in cases of premature ejaculation: chiefly because many men with premature ejaculation also have erectile dysfunction. However, the results of these studies have been encouraging, showing that Viagra can produce a 15 fold increase in IELT when taken 3 - 5 hours before intercourse. Furthermore, the use of Viagra also increased sexual satisfaction markedly; unfortunately, about 18% of men who tried this drug reported headaches and facial flushing, which are known side-effects of Viagra. Another piece of research compared how effective Viagra was in extending IELT and reducing premature ejaculation with (1) a daily SSRI (paroxetine) and (2) the squeeze technique in men who were experiencing premature ejaculation. The research also investigated how satisfied the men were with sexual intercourse. After six months' treatment, the investigators found a 5.7 fold, a 2.5 fold, and a 4.4 fold increase in IELT in men treated with Viagra, the squeeze technique and the SSRI paroxetine respectively. The greatest increase in sexual satisfaction was reported in the men who received treatment for premature ejaculation with Viagra. Once again, the most noticeable side-effects were nasal congestion, flushing, and headaches. However, when Viagra is used on men who are actually not suffering from erectile dysfunction, the results of the research become much more confused. Studies show that there is no difference in improvement in premature ejaculation among men able to get an erection between those given Viagra and those given a placebo. However, the men who received Viagra did report much greater sexual satisfaction, and also said they had greater control over their ejaculation and greater ejaculatory confidence. It may well be that the benefit of the Viagra centers on providing an enhanced erection after ejaculation has occurred. Other treatment options for premature ejaculation include alpha-adrenoceptor antagonists, which are used to improve obstructive urinary symptoms. There has been limited work on animals in this field, so the evidence on human sexual behavior is unclear, although one clinical study appeared to show some improvement in about half of men with premature ejaculation who were resistant to psychotherapy. There are, of course, other treatment options under investigation. The best treatment for premature ejaculation would be an on-demand treatment which worked well with minimum side-effects, had a short delay before it became effective, and allowed spontaneous sexual activity. Obviously one approach to this is to rely on a drug based approach. A combination of 5-HTIA receptor blockers and SSRI seems to produce a very significant increase in IELT, though the potential adverse side-effects of the combination have not yet been evaluated. Another approach is to use a combination of behavior therapy and physiological therapies. Premature ejaculation is condition with many aspects, and may represent a physiological response which is compounded by psychological and interpersonal issues. It may well be, therefore, that combination therapy is the way forward. Of course, since premature ejaculation is a self reported condition, the diagnosis is mainly based on perception, and none of the guidelines suggest a formal diagnostic testing, there are problems inherent in all stages of any investigations into the problem. The first stage is to confirm that three elements of the diagnosis are present: short time before ejaculation, lack of control over ejaculation, and emotional distress for both partners. Therapy needs to be tailored for the individual man, so that all treatments for premature ejaculation are considered and each treatment option reviewed. For many men with premature ejaculation, collaboration between doctor and sex therapist has a significant impact on treatment success rates. Premature ejaculation, based upon the Asian Journal of Andrology, 2008 Jan; 10: 102-109 Effect of PE on a man and woman's sex life What is an ejaculation - the physiology of ejaculation
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