Sildenafil's Influence on Sexual Confidence and Relationship Satisfaction

Topical anaesthetic use for treating premature ejaculation: A double-blind, randomized, placebo-controlled study. Clinical study of SS-cream in patients with lifelong premature ejaculation.

Other Therapy

The epidemiology of the DSM-III psychosexual dysfunctions. Rapid ejaculation: A review of conceptual, etiological, and treatment issues. Arch Sex Behav 1995;24:447–72. An analysis of selfreported sexual behavior in a sample of normal males. Arch Sex Behav 1984;13:69–83.

Sexual dysfunction in primary medical careprevalence, characteristics and detection by the general practitioner

Incidence and prevalence of the sexual dysfunctions: A critical review of the empirical literature. Arch Sex Behav 1990;19:389–408. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: Prevalence, comorbidities, and professional help-seeking. Eur Urol 2007;51:816–23; discussion 824. Prevalence, characteristics and implications of premature ejaculation/rapid ejaculation. Althof S. The psychology of premature ejaculation: Therapies and consequences. Premature ejaculation: A review of 1130 cases. Aycock L. The medical management of premature ejaculation.

The use of phenoxybenzamine treatment in premature ejaculation. Effect of an alpha-blocking agent (phenoxybenzamine) in the management of premature ejaculation. Eaton H. Clomipramine in the treatment of premature ejaculation. Ejaculation-retarding properties of paroxetine in patients with primary premature ejaculation: A double-blind, randomized, dose-response study.

Research Design

SSRIs and ejaculation: A double-blind, randomized, fixeddose study with paroxetine and citalopram. Waldinger MD, Zwinderman AH, Olivier B. Antidepressants and ejaculation: A double-blind, randomized, placebo-controlled, fixed-dose study with paroxetine, sertraline, and nefazodone. Jern P, Santtila P,Witting K, Alanko K, Harlaar N, Johansson A, von der Pahlen B, Varjonen M, Vikstrom N, Algars M, Sandnabba K. Premature and delayed ejaculation: Genetic and environmental effects in a population-based sample of Finnish twins.

Medical Subject Headings (MeSH) Keywords

Penile sensitivity in patients with primary premature ejaculation. Somatosensory evoked potentials in patients with primary premature ejaculation. Guidelines for the diagnosis and management of premature ejaculation. Dinsmore WW, Hackett G, Goldmeier D, Waldinger M, Dean J, Wright P, Callander M, Wylie K, Novak C, Keywood C, Heath P, Wyllie M. Topical eutectic mixture for premature ejaculation (TEMPE): A novel aerosol-delivery form of lidocaine-prilocaine for treating premature ejaculation. Br J Urol 1997;79:592–5. Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: A double-blind, placebo controlled study. J Sex Med 2004;1:58–65. Biri H, Isen K, Sinik Z, sildenafil citrate tablets for female Onaran M, Kupeli B, Bozkirli I. Sertraline in the treatment of premature ejaculation: A double-blind placebo controlled study. Sertraline as a treatment for premature ejaculation. Athanasios Z, Polyanthi P, George K. The efficacy of duloxetine in the treatment of premature ejaculation. Selective serotonin reuptake inhibitor-induced sexual dysfunction: clinical and research considerations. Utility of selective serotonin reuptake inhibitors in premature ejaculation.

• Erectile function and PE may influence each other.
• Sildenafil can improve erectile rigidity, indirectly helping PE.
• Psychological factors often underpin PE.
• A detailed sexual history is essential for diagnosis.
• PE is a common condition, not a reflection of masculinity.
• Non-pharmacological methods include start-stop techniques.
• Partner cooperation enhances treatment outcomes.
• Some men experience placebo effects from medications.
• Regular follow-up is necessary to assess progress.
• Emotional well-being is linked to sexual health.
• Combining therapy modalities can provide best results.

Curr Opin Invest Drugs 2004;5:743–7.

References (14)

In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Comparison of efficacy of sildenafilonly, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation. Colpi GM, Fanciullacci F, Beretta G, Negri L, Zanollo A. Evoked sacral potentials in subjects with true premature ejaculation. ISSM announces new definition of premature ejaculation.

RETRACTED ARTICLE: The effects of sildenafil citrate on intrauterine growth restriction: a systematic review and meta-analysis

International Society of Sexual Medicine Newsbulletin 2007;24:6. Available at 24.pdf (accessed March 24, 2008). Jannini EA, Lenzi A. Ejaculatory disorders: Epidemiology and current approaches to definition, classification and subtyping. Sexual dysfunction in the United States: Prevalence and predictors. Safarinejad MR. Safety and efficacy of escitalopram in the treatment of premature ejaculation: A doubleblind, placebo-controlled, fixed-dose, randomized study. Giuliano F, Clement P. Serotonin and premature ejaculation: From physiology to patient management. Clomipramine and sexual function in men with premature ejaculation and controls. Giuliano F. 5-Hydroxytryptamine in premature ejaculation: Opportunities for therapeutic intervention. Giuliano F. Interview with Dr Francois Giuliano (by Christine McKillop). New avenues in the pharmacological treatment of premature ejaculation.

Relevance of an evidence-based ejaculation time cutoff point for neurobiological research of premature ejaculation. Animal models of premature and retarded ejaculation. Waldinger MD, Schweitzer DH, Olivier B.

Alternative medicine

Prevalence of chronic prostatitis in men with premature ejaculation. Effects of a new type of 5-HT receptor agonist on male rat sexual behavior. Pharmacol Biochem Behav 1981; 15:785–92. The role of the 5-HT2 receptor in the regulation of sexual performance of male rats. Waldinger MD, Berendsen HH, Blok BF, Olivier B, Holstege G.

Disorders of orgasm and ejaculation in men

Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: The involvement of the serotonergic system. Behav Brain Res 1998;92:111–8. Effect of SSRI antidepressants on ejaculation: A double-blind, randomized, placebocontrolled study with fluoxetine, fluvoxamine, paroxetine, and sertraline. The selective serotonin re-uptake inhibitors fluvoxamine and paroxetine differ in sexual inhibitory effects after chronic treatment. Waldinger MD, Zwinderman sildenafil tablets lp 100 mg AH, Olivier B. On-demand SSRI treatment of premature ejaculation: Pharmacodynamic limitations for relevant ejaculation delay and consequent solutions. J Sex Med 2005;2:121–31. Peripheral and central neurochemical effects of the selective serotonin reuptake inhibitors (SSRIs) in humans and nonhuman primates: Assessing bioeffect and mechanisms of action. Sprouse J, Braselton J, Reynolds L, Clarke T, Rollema H.

Activation of postsynaptic sildenafil citrate 200mg price 5-HT(1A) receptors by fluoxetine despite the loss of firingdependent serotonergic input: Electrophysiologicaland neurochemical studies. Sprouse J, Clarke T, Reynolds L, Heym J, Rollema H. Comparison of the effects of sertraline and its metabolite desmethylsertraline on blockade of central 5-HT reuptake in vivo. Anderson GM, Barr CS, Lindell S, Durham AC, Shifrovich I, Higley JD. Time course of the effects of the serotonin-selective reuptake inhibitor sertraline on central and peripheral serotonin neurochemistry in the rhesus monkey.

About the Author

SSRIs have been the most promising agents to date. Minor but nettlesome side effects have long been a disincentive to chronic use of these medications. Recent experience with the use of tramadol raises the hope that this might prove to be an agent as effective as SSRIs with less worrisome risk of side effects. The recognition of the high prevalence of PE and its significant impact on quality of life will hopefully translate into novel therapies that offer high efficacy and a favorable adverse effect profile for all forms of PE. Until then, it is wise to remember that no oral medication in isolation will entirely replace the need for compassionate patient counseling, coordinating treatment of the genital function aspects of PE with the management of the often highly charged psychosocial and partnership issues attendant to this condition.

Pelvic floor exercises

Corresponding Author: Hossein Sadeghi-Nejad, MD, FACS, UMDNJ New Jersey Medical School—Surgery, Division of Urology, 185 South Orange Ave., MSB G 536, Newark, NJ 07103-2714, USA. Tel: (973) 972- 4488; Fax: (973) 395-7197 Conflict of Interest: Dr. Sadeghi-Nejad is a speaker for Pfizer, and is an investigator in a clinical trial sponsored by Plethora Solutions. Lue T, Broderick G. Evaluation and nonsurgical management of erectile dysfunction and premature ejaculation. Waldinger MD, Zwinderman AH, Olivier B. On-demand treatment of premature ejaculation with clomipramine and paroxetine: A randomized, double-blind fixed-dose study with stopwatch assessment. Eur Urol 2004;46:510–5; discussion 516. Modi NB, Dresser MJ, Simon M, Lin D, Desai D, Gupta S.

• Premature ejaculation can cause relationship issues.
• Education about sexual response helps reduce PE anxiety.
• Patience and communication improve sexual satisfaction.
• Biofeedback and behavioral therapy target PE.
• Some herbal supplements claim to help PE, but evidence is limited.
• Using sildenafil without medical guidance is risky.
• Emotional intimacy can reduce PE-related anxiety.
• Sleep quality impacts sexual performance and PE.
• PE treatment success varies among individuals.
• Peer support groups can provide helpful insights.
• Consistent treatment increases the likelihood of success.

Single- and multiple-dose pharmacokinetics of dapoxetine hydrochloride, a novel agent for the treatment of premature ejaculation. Pryor JL, Althof SE, Steidle C, Rosen RC, Hellstrom WJ, Shabsigh R, Miloslavsky M, Kell S. Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: An integrated analysis of two double-blind, randomised controlled trials.

• Premature ejaculation is classified as lifelong or acquired.
• Lifelong PE begins from the first sexual experience.
• Acquired PE develops after a period of normal function.
• Sensory sensitivity might influence PE severity.
• Partner communication can improve PE management.
• Pelvic floor exercises may help control ejaculation.
• Squeeze techniques can delay climax.
• Pharmacological options include SSRIs, dapoxetine.
• Biofeedback therapy is an emerging PE treatment.
• Erectile dysfunction and PE can coexist.
• Proper diagnosis ensures effective treatment.

McMahon CG, Touma K. Treatment of premature ejaculation with paroxetine hydrochloride as needed: 2 single-blind placebo controlled crossover studies. Salonia A, Maga T, Colombo R, Scattoni V, Briganti A, Cestari A, Guazzoni G, Rigatti P, Montorsi F. A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation. FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. Available at NEW01624.html (accessed March 24, 2008). Rosen RC, Casey R, Levine SB, Mudumbi R, Tesfaye F, Hasmonay R. Treatment of premature ejaculation (PE) with dapoxetine (DPX) is not associated with suicidality. Healy D, Whitaker C.

MeSH terms

Berkovitch M, Keresteci AG, Koren G. Efficacy of prilocaine-lidocaine cream in the treatment of premature ejaculation. Morales A. Developmental status of topical therapies for erectile and ejaculatory dysfunction. Optimum usage of prilocaine-lidocaine cream in premature ejaculation. Antidepressants and suicide: Risk-benefit conundrums. Girgis SM, El-Haggar S, El-Hermouzy S. A double-blind trial of clomipramine in premature ejaculation. Clomipramine as a treatment for rapid ejaculation: A double-blind crossover trial of fifteen couples. Effective daily treatment with clomipramine in men with premature ejaculation when 25 mg (as required) is ineffective. Maier U, Koinig G. Andrological findings in young patients under long-term antidepressive therapy with clomipramine. Mousavizadeh K, Ghafourifar P, Sadeghi-Nejad H. Calcium channel blocking activity of thioridazine, clomipramine and fluoxetine in isolated rat vas deferens: A relative potency measurement study.