Abstract and Introduction
Abstract
Introduction: Premature 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.
Methods: A 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.
Results: PE 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.
Conclusions: PE 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.
Introduction
Ejaculatory dysfunction (EjD), erectile dysfunction (ED) and premature ejaculation (PE) are the three main subtypes of male sexual dysfunction. It has been more than a century since the initial report regarding PE was published, but the definition, classification, prevalence and effective treatment options for PE are still under debate. Although PE is classically accepted to be the most common sexual dysfunction, the number of PE patients who seek treatment for this condition is low. Hence, almost 75% of urologists in the U.S. reported seeing less than one PE patient per week, and 41.4% of European urology residents denied treating any PE patients. Lack of exposure to patients with PE during urology residency training results in a lack of knowledge regarding the principal clinical guidelines for the treatment of PE. This highlights a need for increased awareness and education of available, effective management options.
Historically, treatments for PE were limited to psychological and behavioral therapies; however, more recent reports include pharmacotherapy as a common first-line treatment (Table 1). To date, the U.S. Food and Drug Administration (FDA) has not approved any medications for the primary treatment of PE. As such, any medical treatments are currently administered off-label, and patients must therefore be counseled as to the risks and benefits of therapy. Treatments must additionally be individualized according to the type of PE complaint, as well as patient and partner preferences (Figure 1).
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Figure 1.
Algorithm for the management of premature ejaculation