What do men with premature ejaculation prefer: daily or on-demand drug treatment?

Abstract

Since the 1930s various drugs have been used to treat premature ejaculation (PE). Currently, there are two major strategies to treat PE. First, daily treatment (selective serotonin reuptake inhibitors (SSRIs), and clomipramine). Second, on-demand treatment (anesthetic creams, SSRIs, clomipramine, tramadol, PDE-5 inhibitors). According to a meta-analysis of all drug treatment studies, published between 1943 and 2003, daily treatment with 20 mg paroxetine exerts the strongest ejaculation delay, compared to other serotonergic drugs. In contrast, on-demand use of SSRIs, including the new SSRI dapoxetine, exerts only a minimal ejaculation delay. Both daily and on-demand use of SSRIs may give rise to drug-induced side effects, like nausea, fatigue and yawning. Advantages of daily SSRI treatment are 1) the disappearance of side effects after 2-3 weeks of treatment and 2) it does not interfere with the spontaneity of having sex; at each moment of the day ejaculation will be delayed. Disadvantages of on-demand treatment is the likely hood of experiencing side effects at the moment of making love and its negative interference with the spontaneity of having sex. One always has to wait 1-6 hours before ejaculation delay occurs. Despite these disadvantages, pharmaceutical companies are promoting on-demand drugs for the treatment of PE. However, until recently there have been no specific studies investigating which strategy of drug treatment is preferred by men with PE. In 2007, Waldinger et al published the first study of this kind. In this observational questionnaire survey, preferences of different treatment strategies were queried before and after standard efficacy and safety information. The population consisted of a consecutive group of 88 men with lifelong PE who decided for themselves to be seen for rapid ejaculation. The age was 37±11years (mean± SD), range 18-64 years. None of these men was ever treated for PE and 21% used medication that did not affect sexual performance. Of them, 71 (81%) preferred a drug for daily use, 14(16%) a drug on-demand, while three men preferred topical anesthetic cream. Those men who initially preferred daily treatment did not change their view after standard information about efficacy and side effects, while 9 of 17 men who initially preferred on-demand drug treatment had switched their preferences to daily oral drug usage. The most frequently reported argument to prefer daily drug treatment was that this strategy would have the least effects toward the spontaneity of having sex. It was concluded that opposed to agents which must be taken 4-6 hours prior to coitus and with the methods used, this group of Dutch men with lifelong PE favor uninterrupted daily drug treatment to delay ejaculation mainly because daily treatment guarantees no interference with the spontaneity of having sex.