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Premature ejaculation treatments

There is now a major set of stories on erectile dysfunction and erectile dysfunction treatments in Bandolier 's Sexual Health pages. Premature ejaculation or climaxing too early was a problem that occurred with 31% of men in the sexual surveys in this Bandolier and in Bandolier 65 . Fourteen percent of men reported this to be a current problem. By any definition, this, like other issues from the sexual surveys, was common. So Bandolier did a quick search to see whether there was a literature on effective treatments.

Premature ejaculation has been defined as persistent or recurrent ejaculation with minimal sexual stimulation before, during, or after intromission and before the patient wishes it. There have been a number of psychological approaches to treatment, though we could not find any papers that defined the effectiveness of these approaches. We may have been looking in the wrong place. But a number of antidepressants have delayed ejaculation as an adverse effect, and these have been tested in randomised trials. Bandolier thought this merited a quick review.

Search


Several searches were done using MEDLINE, PubMed and the Cochrane Library using the terms premature ejaculation and individual drug names. Twenty-one studies appeared to be randomised, controlled trials of use of antidepressants in men with premature ejaculation. Three of them were not controlled studies, and were excluded. Copies of five studies could not be obtained within two months. Full citations for all of these studies are here on the Bandolier Internet site.

Outcomes


The main outcome in all studies was the intravaginal latency time, usually measured by men at home using a bedside stop-clock. Almost all studies included only men with intravaginal latency times of less than one minute, though a few included men with longer times.

Interventions


Various antidepressants were used, at varying doses. Studies divided between those in which men were instructed to take the drugs some time before expected intercourse (usually four to six hours) and those in which drugs were taken daily.

Results


Full details and references are available, tabulated results and citations . Two studies included men without premature ejaculation as controls, and in these the average intravaginal latency time was eight or nine minutes, and was minimally increased by antidepressants.

Antidepressants were variably effective in men with premature ejaculation. The Figure shows the intravaginal latency times for placebo and antidepressants for drugs taken before sexual activity and with daily dosing. Pooling of data and calculation of NNTs was not possible.

Figure: Each point represents the intravaginal latency time for drug or placebo in a single arm of a randomised trial


Adverse effects were those associated with antidepressants. Ejaculatory failure was noted occasionally, though this was reversed when drugs were stopped or dose reduced.

Comment


There are a number of points that need to be emphasised.

  1. This is a preliminary and quick review of the literature. It is less than a full systematic review.
  2. Not all of the published work could be obtained. While it was frustrating that five papers could not be read, their abstracts generally supported the general conclusion that antidepressants were effective. There may be other studies we did not find.
  3. We could find no patient-orientated definition of what was a useful increase in intravaginal latency.
  4. There was little information on what was a normal intravaginal latency, and though mean times for control subjects in two studies suggested eight or nine minutes, there is clearly great variation, both in individuals and in circumstances.
  5. Not all men responded equally. Some men had large increases in intravaginal latency, whilst in others it was minimal [1]. Perhaps about half had increases to over two minutes.
  6. Men included generally had intravaginal latency times of less than one minute, and could be defined as having the most severe problem. How antidepressants would affect men with less moderately impaired intravaginal latency was not investigated. This all being said, many authors comment that the increases in intravaginal latency were clinically significant. Moreover, the treatment appears to be one that is not necessarily for ever. One author [2] reported that in an open continuation after a trial, 67% of patients were able to discontinue treatment after four-weekly trials of staged withdrawals, with a mean latency time of 4.1 minutes.

References:

  1. DS Strassberg et al. Clomipramine in the treatment of rapid (premature) ejaculation. Journal of Sex and Marital Therapy 1999 25: 89-101.
  2. CG McMahon. Treatment of premature ejaculation with sertraline hydrochloride: a single-blind placebo controlled crossover study. Journal of Urology 1998 159: 1935-1938.
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