Editorial Comment from Dr Amano to Relationship between plasma melatonin levels and the efficacy of selective serotonin reuptake inhibitors treatment on premature ejaculation.

Abstract

Premature ejaculation (PE) is a very common male sexual dysfunction. Recently (February 2014), an update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of PE became available on the International Society of Sexual Medicine website.1 One of the most promising treatments for PE is selective serotonin reuptake inhibitors (SSRI). The present study reported a relationship between plasma melatonin levels and the efficacy of SSRI in PE patients.2 It is very interesting, and the findings that the mean plasma melatonin levels in men with PE were significantly lower than that in healthy controls are important. Although the reasons for low plasma melatonin levels in men with PE are not clear, to elevate serum melatonin levels seems to be one of the effective methods for PE treatment. I would like to know more about the following two issues that affect serum melatonin levels. (1) In the present study, PE patients were treated with three SSRI (paroxetine, fluoxetine and sertraline). There is another short-acting SSRI especially for PE, dapoxetine. Do serum melatonin levels elevate with dapoxetine administration? (2) How about administration of a melatonin supplement, and/or melatonin MT1 and MT2 receptor agonist (ramelteon) for PE treatment? Intravaginal ejaculation latency times measured by stopwatch are a useful and objective parameter to evaluate PE. However, stopwatch measurements of intravaginal ejaculation latency times are bothersome and disruptive to sexual pleasure. Recent reports showed that self-estimation by the patient and their partner of ejaculatory latency should be used to determine intravaginal ejaculation latency times in clinical practice.3 It is much easier to evaluate PE by self-estimation, and we can investigate clinical PE conditions and efficacy of treatments for PE more smooth and widely. Therefore, further investigations of PE, including the two aforementioned issues, are expected in the near future. It is significant that this paper suggested serum melatonin levels as an alternative PE treatment strategy. None declared.