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New Concepts in the Diagnosis and Treatment of Premature Ejaculation

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Abstract

Premature ejaculation is the most common male sexual dysfunction. The International Society of Sexual Medicine recently defined premature ejaculation as ejaculation less than about 1 min after penetration, inability to control ejaculation, and resulting negative personal consequences. Evolving treatments target the modulation of the neurobiological causes of the disorder. Current pharmaceuticals focus on aerosolized topical agents, selective serotonin reuptake inhibitors, 5-hydroxytryptamine receptor modulators, and opioid agonists. These emerging medications and the ability to tailor treatments based on genetic information likely will change the paradigm of this disorder and how it will be treated by clinicians.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Jannini E, Lenzi A: Epidemiology of premature ejaculation. Curr Opin Urol 2005, 15:399–403.

    Article  PubMed  Google Scholar 

  2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4: Text Revision. Washington, DC: American Psychiatric Association; 2000.

    Book  Google Scholar 

  3. Laumann EO, Paik A, Rosen RC: Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999, 281:537–544. (Published erratum appears in JAMA 1999, 281:1174.)

    Article  CAS  PubMed  Google Scholar 

  4. Porst H, Montorsi F, Rosen RC, et al.: The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking. Eur Urol 2007, 51:816–824.

    Article  PubMed  Google Scholar 

  5. Symonds T, Roblin D, Hart K, Althof S: How does premature ejaculation impact a man’s life? J Sex Marital Ther 2003, 29:361–370.

    Article  CAS  PubMed  Google Scholar 

  6. Porst H, Vardi Y, Akkus E, et al.: Standards for clinical trials in male sexual dysfunctions. J Sex Med 2010, 7: 414–444.

    Article  CAS  PubMed  Google Scholar 

  7. •• McMahon CG, Althof SE, Waldinger MD, et al.: An evidence-based definition of lifelong premature ejaculation: report of the International Society of Sexual Medicine (ISSM) ad hoc committee for the definition of premature ejaculation. J Sex Med 2008, 5:1590–1606. We feel that this paper will prove to be a landmark in the field of sexual medicine as the first to definitively characterize the disorder as well as provide leadership for the field.

    Article  PubMed  Google Scholar 

  8. Waldinger MD, Berendsen HH, Blok BF, et al.: Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: the involvement of the serotonergic system. Behav Brain Res 1998, 92:111–118.

    Article  CAS  PubMed  Google Scholar 

  9. Coolen LM, Allard J, Truitt WA, McKenna KE: Central regulation of ejaculation. Physiol Behav 2004, 83:203–215.

    CAS  PubMed  Google Scholar 

  10. Giuliano F, Clément P: Physiology of ejaculation: emphasis on serotonergic control. Eur Urol 2005, 48:408–417.

    Article  PubMed  Google Scholar 

  11. Waldinger MD: The neurobiological approach to premature ejaculation. J Urol 2002, 168:2359–2367.

    Article  PubMed  Google Scholar 

  12. Marson L, McKenna KE: A role for 5-hydroxytryptamine in descending inhibition of spinal sexual reflexes. Exp Brain Res 1992, 88:313–320.

    Article  CAS  PubMed  Google Scholar 

  13. Holstege G, Georgiadis JR, Paans AM, et al.: Brain activation during human male ejaculation. J Neurosci 2003, 23:9185–9193.

    CAS  PubMed  Google Scholar 

  14. Giuliano F: 5-Hydroxytryptamine in premature ejaculation: opportunities for therapeutic intervention. Trends Neurosci 2007, 30:79–84.

    Article  CAS  PubMed  Google Scholar 

  15. Semans J: Premature ejaculation: a new approach. South Med J 1956, 49:353–358

    CAS  PubMed  Google Scholar 

  16. Masters WH, Johnson VE: Human Sexual Inadequacy. London: Bantam; 1970:463.

    Google Scholar 

  17. •• Waldinger MD: Premature ejaculation: different pathophysiologies and etiologies determine its treatment. J Sex Marital Ther 2008, 34:1–13. This paper is a major contributor showing us that even though we are moving toward concrete definitions of this disorder, its cause remains complex. The author describes what eventually may be delineated into psychological PE versus organic.

    Article  PubMed  Google Scholar 

  18. Berkovitch M, Keresteci AG, Koren G: Efficacy of prilocaine-lidocaine cream in the treatment of premature ejaculation. J Urol 1995, 154:1360–1361.

    Article  CAS  PubMed  Google Scholar 

  19. Busato W, Galindo CC: Topical anaesthetic use for treating premature ejaculation: a double-blind, randomized, placebo-controlled study. BJU Int 2004, 93:1018–1021.

    Article  CAS  PubMed  Google Scholar 

  20. Morales A, Barada J, Wyllie MG: A review of the current status of topical treatments for premature ejaculation. BJU Int 2007, 100:493–501.

    Article  CAS  PubMed  Google Scholar 

  21. Dinsmore WW, Hackett G, Goldmeier D, et al.: Topical eutectic mixture for premature ejaculation (TEMPE): a novel aerosol-delivery form of lidocaine-prilocaine for treating premature ejaculation. BJU Int 2007, 99:369–375.

    Article  CAS  PubMed  Google Scholar 

  22. •• Dinsmore WW, Wyllie MG: PSD502 improves ejaculatory latency, control and sexual satisfaction when applied topically 5 min before intercourse in men with premature ejaculation: results of a phase III, multicentre, double-blind, placebo-controlled study. BJU Int 2009, 103:940–949. PSD502, as described in this article, is currently in phase 3 trials. Once approved, it will be the first FDA-approved medication for the sole purpose of treating PE.

    Article  CAS  PubMed  Google Scholar 

  23. Waldinger MD, Zwinderman AH, Schweitzer DH, Olivier B: Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis. Int J Impot Res 2004, 16:369–381.

    Article  CAS  PubMed  Google Scholar 

  24. Leaker B: A double blind, placebo-controlled, randomized crossover study to investigate the effect of inhaled doses of VR776 on intravaginal ejaculatory latency in patients with premature ejaculation (abstract P-05-048). J Sex Med 2008, 5(Suppl 2):60.

    Google Scholar 

  25. Modi NB, Dresser MJ, Simon M, et al.: Single- and multiple-dose pharmacokinetics of dapoxetine hydrochloride, a novel agent for the treatment of premature ejaculation. J Clin Pharmacol 2006, 46:301–309.

    Article  CAS  PubMed  Google Scholar 

  26. Pryor JL, Althof SE, Steidle C, et al.: Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomized controlled trials. Lancet 2006, 368:929–937.

    Article  CAS  PubMed  Google Scholar 

  27. Uckert S, Bazrafshan S, Sonnenberg JE, Kuczyk MA: Effects of phosphodiesterase inhibitors on the contractile responses of isolated human seminal vesicle tissue to adrenergic stimulation. J Sex Med 2009, 6:408–414.

    Article  PubMed  Google Scholar 

  28. •• Aversa A, Pili M, Francomano D, et al.: Effects of vardenafil administration on intravaginal ejaculatory latency time in men with lifelong premature ejaculation. Int J Impot Res 2009, 21:221–227. This article has adopted a new role for the PDE5Is, demonstrating favorable results in patients with PE.

    Article  CAS  PubMed  Google Scholar 

  29. Safarinejad MR: Once-daily high-dose pindolol for paroxetine-refractory premature ejaculation: a double-blind, placebo-controlled and randomized study. J Clin Psychopharmacol 2008, 28:39–44.

    Article  CAS  PubMed  Google Scholar 

  30. Salem EA, Wilson SK, Bissada NK, et al.: Tramadol HCL has promise in on-demand use to treat premature ejaculation. J Sex Med 2008, 5:188–193.

    CAS  PubMed  Google Scholar 

  31. Alghobary M, El-Bayoumy Y, Mostafa Y, et al.: Evaluation of tramadol on demand vs. daily paroxetine as a long-term treatment of lifelong premature ejaculation. J Sex Med 2010 Mar 30 (Epub ahead of press).

  32. Safarinejad MR, Hosseini SY: Safety and efficacy of tramadol in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. J Clin Psychopharmacol 2006, 26:27–31.

    Article  CAS  PubMed  Google Scholar 

  33. Carmichael MS, Humbert R, Dixen J, et al.: Plasma oxytocin increases in the human sexual response. J Clin Endocrinol Metab 1987, 64:27–31.

    Article  CAS  PubMed  Google Scholar 

  34. Arletti R, Bazzani C, Castelli M, Bertolini A: Oxytocin improves male copulatory performance in rats. Horm Behav 1985, 19:14–20.

    Article  CAS  PubMed  Google Scholar 

  35. Gupta J, Russell R, Wayman C, et al.: Oxytocin-induced contraction within rat and rabbit ejaculatory tissues are mediated by vasopressin V1A receptors and not oxytocin receptors. Br J Pharmacol 2008, 155:118–126.

    Article  CAS  PubMed  Google Scholar 

  36. Ahlenius S, Larsson K: Specific involvement of 5-HT1A receptors in mediation of male rat ejaculatory behavior. Neurochem Res 1997, 22:1065–1070.

    Article  CAS  PubMed  Google Scholar 

  37. Ahlenius S, Larsson K: Evidence for an involvement of 5-HT1B receptors in the inhibition of male rat ejaculatory behavior produced by 5-HTP. Psychopharmacology (Berl) 1998, 137:374–382.

    Article  CAS  Google Scholar 

  38. Fernández-Guasti A, Escalante AL, Ahlenius S, et al.: Stimulation of 5-HT1A and 5-HT1B receptors in brain regions and its effects on male rat sexual behaviour. Eur J Pharmacol 1992, 210:121–129.

    Article  PubMed  Google Scholar 

  39. Safarinejad MR: Analysis of association between the 5-HTTLPR and STin2 polymorphisms in the serotonin-transporter gene and clinical response to a selective serotonin reuptake inhibitor (sertraline) in patients with premature ejaculation. BJU Int 2010, 105:73–78.

    Article  CAS  PubMed  Google Scholar 

  40. Looney C, Thor KB, Ricca D, Marson L: Differential effects of simultaneous or sequential administration of Paroxetine and WAY-100,635 on ejaculatory behavior. Pharmacol Biochem Behav 2005, 82:427–433.

    Article  CAS  PubMed  Google Scholar 

  41. Schapiro B: Premature Ejaculation: A review of 1130 cases. J Urol 1943, 50:374–379.

    Google Scholar 

  42. Janssen PK, Bakker SC, Réthelyi J, et al.: Serotonin transporter promoter region (5-HTTLPR) polymorphism is associated with the intravaginal ejaculation latency time in Dutch men with lifelong premature ejaculation. J Sex Med 2009, 6:276–284.

    Article  CAS  PubMed  Google Scholar 

  43. Collins S, Upshaw J, Rutchik S, et al.: Effects of circumcision on male sexual function: debunking a myth? J Urol 2002, 167:2111–2112.

    Article  CAS  PubMed  Google Scholar 

  44. Kim D, Pang MG: The effect of male circumcision on sexuality. BJU Int 2007, 99:619–622.

    Article  PubMed  Google Scholar 

  45. Senkul T, Iserl C, Karademir BK, et al.: Circumcision in adults: effect on sexual function. Urology 2004, 63:155–158.

    Article  PubMed  Google Scholar 

  46. O’Hara K, O’Hara J: The effect of male circumcision on the sexual enjoyment of the female partner. BJU Int 1999, 83(Suppl 1):79–84.

    PubMed  Google Scholar 

  47. Gallo L, Perdonà S, Gallo A: The role of short frenulum and the effects of frenulectomy on premature ejaculation. J Sex Med 2010, 7:1269–1276.

    Article  PubMed  Google Scholar 

  48. Kim JJ, Kwak TI, Jeon BG, et al.: Effects of glans penis augmentation using hyaluronic acid gel for premature ejaculation. Int J Impot Res 2004, 16:547–551.

    Article  CAS  PubMed  Google Scholar 

  49. Shi WG, Wang XJ, Liang XQ, et al.: Selective resection of the branches of the two dorsal penile nerves for primary premature ejaculation [in Chinese]. Zhonghua Nan Ke Xue 2008, 14:436–438.

    PubMed  Google Scholar 

  50. Basal S, Goktas S, Ergin A, et al.: A novel treatment modality in patients with premature ejaculation resistant to conventional methods: the neuromodulation of dorsal penile nerves by pulsed radiofrequency. J Androl 2010, 31:126–130.

    Article  PubMed  Google Scholar 

  51. Salonia A, Maga T, Colombo R, et al.: A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation. J Urol 2002, 168:2486–2489.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Wayne J. G. Hellstrom.

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Keel, C.E., Dorsey, P.J., Acker, W. et al. New Concepts in the Diagnosis and Treatment of Premature Ejaculation. Curr Urol Rep 11, 414–420 (2010). https://doi.org/10.1007/s11934-010-0144-2

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