Don’t take chances in treating premature ejaculation

Unless a scientifically-proven and expert-recommended medication is available, treating premature ejaculation (PE) can become a “trial and error” affair.

PE is the most common male sexual disorder, even more prevalent than erectile dysfunction (ED or impotence)—one in three men suffers from it. Men with PE are unable to control or delay ejaculation after vaginal penetration, resulting in short latency time and decreased sexual satisfaction, as well as personal distress and relationship problems. PE affects adult males regardless of age.

Early studies showed that daily dosing with various antidepressant drugs, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) improved intravaginal ejaculation latency time (IELT), which is the time it takes for a man to ejaculate during vaginal penetration. This is because delayed ejaculation is a recognized side effect of some antidepressants. However, IELT assessment in studies involving antidepressants has been inconsistent. Moreover, published studies in general have small patient populations. Patient-reported outcomes indicate that daily-dosed antidepressants may not be useful for routine treatment of PE as their pharmacokinetic profile is not fit for on-demand dosing. As such, no daily-dosed antidepressants are approved for the treatment of PE.

Anti-ED drugs, such as Viagra and Cialis, are sometimes used to treat PE. Increased blood flow to the penis is required to produce and sustain an erection. In men with ED, an enzyme (phosphodiesterase type 5 or PDE-5) interferes with a key part of the biochemical process that increases penile blood circulation, thereby causing erectile dysfunction. Anti-ED drugs, also known as PDE-5 inhibitors, act by blocking the action of this enzyme.

However, no scientific rationale has been established to support the use of PDE5 inhibitors in the treatment of PE. Published literature on the use of PDE-5 inhibitors in PE employed poor study design with no solid methodology. Such studies did not have a clear-cut PE definition, appropriate endpoints for outcome evaluation of a placebo control arm, and Institutional Review Board approval. Men with PE and ED may be treated with PDE-5 inhibitors to treat the erectile dysfunction. However, PDE-5 inhibitors are neither recommended nor approved for the treatment of PE.

PE-P Talk TRIVIA CONTEST. True or False: Antidepressants are approved for the treatment of premature ejaculation. E-mail your answer to [email protected] and get the chance to win a prize!

Dr. Enrique C. Tenazas is a urologist; president of Central and Eastern Visayas Chapter of the Philippine Urological Association; and chief of the Section of Urology, Chong Hua Hospital and training officer of Department of Urology of the Vicente Sotto Memorial Medical Center. A health information advocacy supported by A. Menarini Philippines, PE-P Talk is a column series that aims to raise awareness on and enhance understanding of premature ejaculation (PE) and its proper diagnosis and treatment. For inquiries, please e-mail [email protected] or visit www.controlPE.ph.