New Insights into Premature Ejaculation Could Lead to Better Diagnosis and Treatment

Two papers published simultaneously in the journal Sexual Medicine and the Journal of Sexual Medicine provide important leads to improve diagnosis and treatment of a much researched condition called premature ejaculation. Premature ejaculation (PE) or rapid ejaculation is the most common sexual dysfunction in men. It is also known as rapid ejaculation, premature climax, or early ejaculation.

Premature ejaculation can cause significant distress to a man and his partner and it is not a condition that has recently been identified, yet, there is ambiguity in the clinical definition of premature ejaculation. This has made it difficult for researchers to try out new and effective drugs and for doctors to effectively identify and treat PE patients.

Although there is no universally accepted definition of PE as yet, for better diagnosis and treatment, researchers have divided PE into four categories, namely:

• Lifelong PE,
• Acquired PE,
• Natural variable PE,
• Premature-like ejaculatory dysfunction.

This categorization, experts feel, will determine the first choice of treatment.

Premature ejaculation treatment

If premature ejaculation happens once in a while, you may not require any treatment. Treatment options include:

• Masturbating one or two hours prior to sexual intercourse to delay ejaculation.

• Avoiding intercourse for a period of time to remove performance pressure and anxiety.

• Using behavioral techniques such as squeeze technique in which the penis is stimulated to the point of ejaculation; then, squeezing the point in the penis where the glans meets the shaft and holding it until the urge to ejaculate passes. This should be followed by releasing the squeeze and continuing with the foreplay. The process can be repeated as necessary.

• Psychological therapy such as consulting a psychologist or psychiatrist to identify emotional disturbance underlying PE or for strategies to reduce performance anxiety.

• Medications - Although the FDA does not specifically approve of any medications for PE, the following drugs can help treat premature ejaculation.

• Antidepressants - SSRI such as Prozac, Zoloft, Paxil; and tricyclic anti-depressants such as Anafranil.

• Phosphodiesterase inhibitors, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). These are used alone or in combination with the SSRIs.

• Topical anesthetic creams containing lidocaine or prilocaine. The cream is wiped off before the intercourse.

An SSRI, dapoxetine, was developed specifically to treat this condition. It may be effective when taken one to three hours before sexual intercourse. Researchers found that it may be effective at the very first dose itself in some men, whereas daily dose may be required in others. Its adverse effects are similar to those of other SSRIs. Dapoxetine (Sustinex) has been approved in a number of countries including India.

Unfortunately, this is the only drug that has been developed successfully till date.

In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines, including assessments and treatment, for patients suffering from lifelong premature ejaculation (PE). The panel recognized the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. In view of that, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for two days in Bangalore, India. 

‘The lack of an evidence-based definition for acquired premature ejaculation promotes errors of classification, resulting in poorly defined study populations and less reliable and harder-to-interpret data that are difficult to generalize to patients,” said Ege Can Serefoglu, MD, FECSM, of the Bagcilar Training & Research Hospital, Istanbul, Turkey. Dr. Serefoglu is one of the experts in the second panel.

The second committee proposed a unified definition of lifelong and acquired premature ejaculation that is characterized by:

• Ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired);

• The inability to delay ejaculation on all or nearly all vaginal penetrations; and

• Negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.

‘The unified definition of lifelong and acquired premature ejaculation will reduce errors of diagnosis and classification by providing the clinician with a discriminating diagnostic tool,’ said Dr. Serefoglu. ‘It should form the basis for both the office diagnosis of premature ejaculation and the design of observational and interventional clinical trials,’ he added.

The committee also conducted and published a study, led by Stanley Althof, PhD, of Case Western Reserve University School of Medicine in West Palm Beach, Florida, to provide clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of premature ejaculation for family practice clinicians and sexual medicine experts.

References:

1. http://0-www.ncbi.nlm.nih.gov.elis.tmu.edu.tw/pubmed/24848686

2. http://www.ncbi.nlm.nih.gov/pubmed/24848686

Source-Medindia