Treatment Option For Premature Ejaculation Research Articles

Current and emerging treatment options for premature ejaculation.

Premature ejaculation (PE) is a prevalent male sexual dysfunction. Current standard treatment regimens include behavioural therapies, topical anaesthetics, dapoxetine and other selective serotonin reuptake inhibitors (SSRIs). Most of the pharmacotherapeutic options target neurotransmitters (such as serotonin and oxytocin) that have a role in the ejaculation mechanism. However, these treatments are mildly effective and only provide a temporary delay in the ejaculation latency time, and PE recurs when the treatment is stopped. Thus, a treatment for PE is urgently needed and research is ongoing to find the ideal PE therapy. The efficacy and safety of topical anaesthetics and SSRIs in delaying ejaculation have been confirmed in many well-designed controlled trials. Both preclinical and clinical studies on new-generation SSRIs are ongoing. Moreover, promising results came from clinical trials in which the efficacy of on-demand PE therapies targeting neurotransmitters other than serotonin, such as α1-adrenoceptor antagonists and oxytocin antagonists, was assessed. Surgical intervention and neuromodulation have been proposed as potential treatment options for PE; however, current PE guidelines do not recommend these treatments owing to safety concerns.

Involvement of Histamine H3 Receptor Agonism in Premature Ejaculation Found by Studies in Rats.

Several of the drugs currently available for the treatment of premature ejaculation (PE) (e.g., local anesthetics or antidepressants) are associated with numerous safety concerns and exhibit weak efficacy. To date, no therapeutics for PE have been approved in the United States, highlighting the need to develop novel agents with sufficient efficacy and fewer side effects. In this study, we focused on the histamine H3 receptor (H3R) as a potential target for the treatment of PE and evaluated the effects of imetit (an H3R/H4R agonist), ciproxifan (an H3R antagonist), and JNJ-7777120 (an H4R antagonist) in vivo. Our in vivo electrophysiological experiments revealed that imetit reduced mechanical stimuli-evoked neuronal firing in anesthetized rats. This effect was inhibited by ciproxifan but not by JNJ-7777120. Subsequently, we evaluated the effect of imetit using a copulatory behavior test to assess ejaculation latency (EL) in rats. Imetit prolonged EL, although this effect was inhibited by ciproxifan. These findings indicate that H3R stimulation suppresses mechanical stimuli-evoked neuronal firing in the spinal–penile neurotransmission system, thereby resulting in prolonged EL. To our knowledge, this is the first report to describe the relationship between H3R and PE. Thus, H3R agonists may represent a novel treatment option for PE.

Vibrator-Assisted Start\u2013Stop Exercises Improve Premature Ejaculation Symptoms: A Randomized Controlled Trial

Premature ejaculation (PE) is associated with decreased quality of life, lower confidence and self-esteem, and higher levels of depression, anxiety, and interpersonal difficulties. Here we investigated the effectiveness of vibrator-assisted start–stop exercises for treatment of PE, and whether the treatment effect could be enhanced by an additional psychobehavioral intervention. Fifty participants with a mean age of 41.7 years were included and randomized into two treatment groups and a waiting list control group. Participants were instructed to perform start–stop exercises while stimulating the penis with a purpose-made vibrator, 3 times a week for 6 weeks. Additionally, participants in one of the treatment groups received additional psychoeducation and performed mindfulness meditation-based body scan exercises three times a week. Data were gathered through online questionnaires before and after treatment, as well as 3 and 6 months after treatment. The interventions reduced PE symptoms with large effect sizes (partial η2 = .20 across the three groups, d [95% CI] = 1.05 [.27, 1.82] and 1.07 [.32, 1.82] for treatment groups compared to waiting list control group). The additional psychobehavioral intervention did not further reduce PE symptoms, but did decrease PE-associated negative symptoms such as levels of sexual distress, anxiety, and depression. No side effects were reported. Vibrator-assisted start–stop exercises can be offered as an adequate treatment option for PE.

Management Options for Premature Ejaculation and Delayed Ejaculation in Men.

Many men experience distressing issues regarding the timing of orgasm and ejaculation, such as premature ejaculation (PE) and delayed ejaculation (DE). Despite being highly prevalent, both PE and DE are poorly understood and present a management challenge for sexual medicine specialists. To summarize existing data on the medical management of PE and DE. A comprehensive literature review pertaining to the management of PE and DE was conducted using PubMed and clinicaltrials.gov for data published up until May 2019. Our focus was on double-blind, placebo-controlled trials and meta-analyses of such studies. Peer-reviewed studies on treatment options for PE and DE were critically analyzed for results and methodological rigor. The peer-reviewed data on PE management continue to evolve. Psychotherapy, pharmacotherapy, and procedural interventions have all been associated with some degree of efficacy. A strong evidence base supports the off-label use of selective serotonin reuptake inhibitors and local anesthetics in PE given consistent increases in ejaculation latency time. Education and mental health assessments remain important components of PE management despite a dearth of peer-reviewed data on these interventions. Numerous treatment strategies have been evaluated for DE; limited data support psychotherapy, pharmacotherapy, and/or penile vibratory stimulation as management options. A number of management options for PE or DE exist but none has been formally approved by the US Food and Drug Administration. New and novel treatments would be of great value in managing issues regarding the timing of ejaculation/orgasm. Martin-Tuite P, Shindel AW. Management Options for Premature Ejaculation and Delayed Ejaculation in Men. Sex Med Rev 2020; 8:473-485.

HP-08-006 Penile implantation as treatment option for premature ejaculation: What the patient gets?

To assess effects of penile implantation on intercourse satisfaction (IIEFQ7), overall sexual satisfaction (IIEFQ13), satisfaction with sexual relationships with partner (IIEFQ14) in patients with PE who discontinued local anesthetics (LA), PDE5i and dapoxetine. 37 patients (35-44 years old) with PE who discontinued local anesthetics (LA), PDE5i and dapoxetine due to lack of efficacy or side effects were enrolled. At baseline sexual functions were assessed by means of IIEF. 6 mo after implantation with short form of IIEF (Q7, Q13, Q14). All patients were implanted with malleable ones. Clinical effect was measured by calculating 95% CI of difference of means. t=1,993 for 0,05% and P =72. At baseline all scores were decreased as a result of negative impact of PE on sexual function (Table 1). 6 mo after implantation all of them were clinically significantly improved. Penile implantation clinically significantly improves quality of sexual life in patients with PE and should be considered as treatment option when conservative modalities are discontinued.

316 Systemic Review of Treatment Options for Premature Ejaculation and to Compute a Neuroanatomic Model of a Novel Treatment Methodology

316 Systemic Review of Treatment Options for Premature Ejaculation and to Compute a Neuroanatomic Model of a Novel Treatment Methodology

Advances in understanding and treating premature ejaculation.

Over the past several years, many advances have been made in our understanding of the epidemiology, pathophysiology, and management of premature ejaculation. Newly developed definitions of premature ejaculation are now available, and our perception of the classification, prevalence, aetiological factors, and treatment options for premature ejaculation have evolved. Despite ongoing research, there remains much to be learned about all aspects of this common sexual disorder, in particular effective clinical diagnosis and treatment options.

Male Sexual Dysfunction

Normal male sexual function requires complex interactions among psychological, neurologic, hormonal, and vascular systems. Under the influence of proper stimulation, the acquisition and maintenance of a penile erection occur. Male sexual dysfunction includes erectile dysfunction (ED), impaired libido, and abnormal ejaculation, which occur due to aberrations in normal male sexual response. Estimates suggest a prevalence of approximately 10 to 20% in the adult male population. Thus, sexual dysfunction is a common problem in this country. This chapter focuses on several key, common components of male sexual dysfunction: namely, ED, premature ejaculation (PE), and Peyronie disease (PD). Figures include management algorithms, a graph depicting distribution of intravaginal ejaculation latency time values in a random cohort of men, and a Sexual Health Inventory for Men (SHIM). Tables list medications associated with ED, oral therapies for the treatment of PD, intralesional therapies for PD, indications for surgical correction of PD, recommended questions to establish the diagnosis of PE, treatment options for PE, and causes of delayed ejaculation, anejaculation, and anorgasmia.This chapter contains 5 highly rendered figures, 8 tables, 116 references, 1 teaching slide set, and 5 MCQs.

Male Sexual Dysfunction

Normal male sexual function requires complex interactions among psychological, neurologic, hormonal, and vascular systems. Under the influence of proper stimulation, the acquisition and maintenance of a penile erection occur. Male sexual dysfunction includes erectile dysfunction (ED), impaired libido, and abnormal ejaculation, which occur due to aberrations in normal male sexual response. Estimates suggest a prevalence of approximately 10 to 20% in the adult male population. Thus, sexual dysfunction is a common problem in this country. This chapter focuses on several key, common components of male sexual dysfunction: namely, ED, premature ejaculation (PE), and Peyronie disease (PD). Figures include management algorithms, a graph depicting distribution of intravaginal ejaculation latency time values in a random cohort of men, and a Sexual Health Inventory for Men (SHIM). Tables list medications associated with ED, oral therapies for the treatment of PD, intralesional therapies for PD, indications for surgical correction of PD, recommended questions to establish the diagnosis of PE, treatment options for PE, and causes of delayed ejaculation, anejaculation, and anorgasmia.This chapter contains 5 highly rendered figures, 8 tables, 116 references, 1 teaching slide set, and 5 MCQs.

Male Sexual Dysfunction

Normal male sexual function requires complex interactions among psychological, neurologic, hormonal, and vascular systems. Under the influence of proper stimulation, the acquisition and maintenance of a penile erection occur. Male sexual dysfunction includes erectile dysfunction (ED), impaired libido, and abnormal ejaculation, which occur due to aberrations in normal male sexual response. Estimates suggest a prevalence of approximately 10 to 20% in the adult male population. Thus, sexual dysfunction is a common problem in this country. This chapter focuses on several key, common components of male sexual dysfunction: namely, ED, premature ejaculation (PE), and Peyronie disease (PD). Figures include management algorithms, a graph depicting distribution of intravaginal ejaculation latency time values in a random cohort of men, and a Sexual Health Inventory for Men (SHIM). Tables list medications associated with ED, oral therapies for the treatment of PD, intralesional therapies for PD, indications for surgical correction of PD, recommended questions to establish the diagnosis of PE, treatment options for PE, and causes of delayed ejaculation, anejaculation, and anorgasmia.This chapter contains 5 highly rendered figures, 8 tables, 116 references, 1 teaching slide set, and 5 MCQs.

Dapoxetine and the treatment of premature ejaculation.

BackgroundPremature ejaculation (PE) is the most common male sexual complaint. Off-label oral selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for the treatment of PE. Dapoxetine is a short-acting SSRI specifically designed for on-demand use. The objective of this communication is to summarize the clinical and physiological evidence regarding the role of the serotonergic pathway and specifically dapoxetine in the treatment of PE.MethodsA PubMed search was conducted on articles reporting data on dapoxetine for the treatment of PE. Articles describing the pathophysiology and treatment options for PE were additionally included for review.ResultsThe etiology of PE is multi-factorial in nature. There are many treatment options for PE such as psychological/behavioral therapy, topical anesthetic agents, phosphodiesterase type 5 (PDE-5) inhibitors, and tramadol hydrochloride. SSRIs play a major role in PE treatment. Animal and clinical studies in addition to its pharmacokinetic document dapoxetine’s clinical efficacy and safety for on-demand treatment of PE.ConclusionsDapoxetine demonstrates clinical efficacy and a favorable side effect profile. Dapoxetine is currently the oral drug of choice for on-demand treatment of PE.

Premature ejaculation: do we have effective therapy?

IntroductionPremature ejaculation (PE) is the most common sexual dysfunction, with the majority of PE patients remaining undiagnosed and undertreated. Despite its prevalence, there is a current paucity of data regarding available treatment options and mechanisms. The objective of the current investigation is to review and summarize pertinent literature on therapeutic options for the treatment of PE, including behavioral/psychologic, oral pharmacotherapy, and surgery.MethodsA pubmed search was conducted on articles reporting data on available treatment options for PE. Articles describing potential mechanisms of action were additionally included for review. Preference was given towards randomized, controlled trials, when available.ResultsPE remains an underdiagnosed and undertreated disease process, with limited data available regarding potential underlying mechanisms and long-term outcomes of treatment options. Psychological/behavioral therapies, including the stop-start, squeeze, and pelvic floor rehabilitation techniques have demonstrated improvements in short-term series, with decreased efficacy with additional follow-up. Topical therapies, which are commonly utilized result in prolonged intravaginal ejaculatory latency time (IELT) at the expense of potential penile/vaginal Hypothesia. Oral therapies similarly demonstrate improved IELTs with variable side effect profiles and include selective serotonin reuptake inhibitors (daily or on demand), phosphodiesterase-5 inhibitors, alpha-1 adrenergic antagonists, and tramadol. Alternative therapies such as acupuncture have shown benefits in limited studies. Surgery is not commonly performed and is not recommended by available guidelines.ConclusionsPE is a common condition, with limited data available regarding its underlying pathophysiology and treatment. Available therapies include topical, oral, behavioral/psychologic modification, or a combination thereof. Additional research is required to assess the optimal treatment strategies and algorithms as well as to better define the mechanisms for PE and its management.

Silodosin and its potential for treating premature ejaculation: A preliminary report

Premature ejaculation is a common sexual problem, as is erectile dysfunction. We evaluated silodosin, a highly selective α1A-adrenoceptor antagonist, as a new treatment option for premature ejaculation. α1-Adrenoceptor antagonists are widely used for lower urinary tract symptoms, and clinical studies on silodosin have shown excellent clinical efficacy for lower urinary tract symptoms. However, compared with other α1-adrenoceptor antagonists, silodosin appeared to suppress ejaculation in a relatively higher percent of trial participants. This suppression of ejaculation by silodosin suggested its potential for treating premature ejaculation. Consequently, we evaluated the feasibility of off-label silodosin as a new treatment option for premature ejaculation. Eight patients suffering premature ejaculation were treated with silodosin. Silodosin (4 mg) was given 2 h before sexual intercourse. Intravaginal ejaculatory latency time, premature ejaculation profile item, clinical global impression change in premature ejaculation and systemic adverse events were recorded. Intravaginal ejaculatory latency time was significantly prolonged (from 3.4 min to 10.1 min, P = 0.003). All patients answered better (much better) or slightly better for their own premature ejaculation problem compared with pretreatment condition in the clinical global impression change. Premature ejaculation profile also significantly improved. Two (25%), three (37.5%) and seven patients (87.5%) experienced anejaculation, reduced semen volume and discomfort during orgasm, respectively. However, these problems were not of major concern for the participants. No systemic adverse effects were reported. The current results support the possible use of silodosin as a new treatment option for premature ejaculation, and suggest that a placebo controlled study assessing its clinical usefulness would be worthwhile.

An Overview of Pharmacotherapy in Premature Ejaculation

With increasing interest and clinical research in male sexual disorders, it has become clear that not only psychological but also organic, neurobiological, and genetic factors may play an important role in premature ejaculation (PE). This article provides an overview of the different treatment options both for lifelong (primary, "congenital") and acquired (secondary) PE. Review of the literature. Currently used treatment options for PE. Treatments reviewed include psychological/behavioral/sexual counseling therapy, topical anesthetics, dapoxetine, and other selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and phosphodiesterase-5 (PDE-5) inhibitors. Before starting any therapy for PE, correct diagnosis has to be made considering the patient's reported intravaginal ejaculatory latency time (IELT) and the duration and type of PE. Concomitant erectile dysfunction (ED) should be either ruled out or proven by appropriate means. In uncomplicated cases of PE with stable partnerships, medical treatment represents the first-choice option with a high likelihood of success. Dapoxetine, where available, or other SSRIs provide suitable therapeutic options with a good risk/benefit profile for patients. In complicated ("difficult-to-treat") PE patients, a combination of medication and sexual counseling should be considered the first treatment option. Combination therapies of PDE-5 inhibitors and PE-related medications should be offered to patients suffering from comorbid PE and ED, with ED treatment starting first. In those patients with severe PE-IELTs of <30-60 seconds or anteportal ejaculation-combination therapy of topical and oral medications can be offered and may considerably increase IELT, compared with either monotherapy.

Update on treatments for premature ejaculation

Current and upcoming treatment options for premature ejaculation (PE) are of global clinical interest. In 2008, the International Society for Sexual Medicine published an evidence-based definition for PE. While there are no US Food and Drug Administration-approved therapies for PE, the American Urological Association 2004 guidelines state the serotonergic antidepressants paroxetine, sertraline, fluoxetine and clomipramine and the topical lidocaine-prilocaine cream are effective treatment options. However, there are limitations associated with their use, which may be overcome by PE-specific therapies currently in development. Two agents that are in advanced stages of clinical development include: (i) dapoxetine, an on-demand short-acting selective serotonin reuptake inhibitor, and (ii) PSD502, a metered-dose aerosol containing lidocaine and prilocaine, also for on-demand treatment. Another on-demand agent in development is tramadol, a weak opioid that is currently approved for treating pain. Coupled with efficient diagnosis, it is hoped that these newer agents will improve the quality of life for patients who suffer from PE.

ORIGINAL RESEARCH—EJACULATORY DISORDERS: Yoga in Premature Ejaculation: A Comparative Trial with Fluoxetine

ABSTRACT Introduction Yoga is a popular form of complementary and alternative treatment. It is practiced both in developing and developed countries. Use of yoga for various bodily ailments is recommended in ancient ayvurvedic (ayus =life, veda =knowledge) texts and is being increasingly investigated scientifically. Many patients and yoga protagonists claim that it is useful in sexual disorders. We are interested in knowing if it works for patients with premature ejaculation (PE) and in comparing its efficacy with fluoxetine, a known treatment option for PE. Aim To know if yoga could be tried as a treatment option in PE and to compare it with fluoxetine. Methods A total of 68 patients (38 yoga group; 30 fluoxetine group) attending the outpatient department of psychiatry of a tertiary care hospital were enrolled in the present study. Both subjective and objective assessment tools were administered to evaluate the efficacy of the yoga and fluoxetine in PE. Three patients dropped out of the study citing their inability to cope up with the yoga schedule as the reason. Main Outcome Measure Intravaginal ejaculatory latencies in yoga group and fluoxetine control groups. Results We found that all 38 patients (25–65.7%=good, 13–34.2%=fair) belonging to yoga and 25 out of 30 of the fluoxetine group (82.3%) had statistically significant improvement in PE. Conclusions Yoga appears to be a feasible, safe, effective and acceptable nonpharmacological option for PE. More studies involving larger patients could be carried out to establish its utility in this condition.

The Premature Ejaculation Prevalence and Attitudes (PEPA) Survey: Prevalence, Comorbidities, and Professional Help-Seeking

ObjectivesThis study evaluated the associated comorbidities and patient satisfaction with treatment options for premature ejaculation (PE), a common sexual dysfunction. MethodsA comprehensive, Internet-based survey (the PE Prevalence and Attitudes [PEPA] survey) was conducted among men ages 18–70 in the United States, Germany, and Italy (n=12,133). Men were classified as having PE based on self-report of low or absent control over ejaculation, resulting in distress for them or their sexual partner or both. ResultsThe prevalence of PE was 22.7% (24.0% in the United States, 20.3% in Germany, and 20.0% in Italy) and did not vary significantly with age among men over age 24 yr. Men with PE were more likely to self-report other sexual dysfunctions (e.g., anorgasmia, low libido, erectile dysfunction) and psychological disturbances (e.g., depression, anxiety, excessive stress) than men without PE (p<0.05 for all). Men with PE were most aware of (>70%) and most likely to have used (>50%) special positions during sex, interrupted stimulation, masturbation, and having intercourse more often than usual to manage their PE. Only 9.0% of men with PE reported having consulted a physician for the condition; 81.9% had to initiate the conversation about PE and 91.5% reported little or no improvement as a result of seeking treatment. ConclusionPE is a highly prevalent sexual problem, with significant sexual and psychological comorbidities. Most men with PE do not seek assistance from their physician, and most of those who do are not satisfied with the results.