Premature ejaculation
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Understanding and Managing Premature Ejaculation: Insights from Recent Research
Introduction to Premature Ejaculation (PE)
Premature ejaculation (PE) is a prevalent male sexual dysfunction characterized by ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to one or both partners1 3. PE can be classified into two main types: lifelong (primary) and acquired (secondary). Lifelong PE is typically present from the first sexual experience, while acquired PE develops later in life after a period of normal sexual function3.
Neurobiological and Psychological Factors
Serotonergic Neurotransmission
Research indicates that PE is primarily a neurobiological phenomenon, heavily influenced by serotonergic neurotransmission in the central nervous system1 2 6. Disturbances in serotonin (5-HT) receptors, particularly 5-HT1A and 5-HT2C, play a significant role in the regulation of ejaculation1 6. Animal studies and clinical trials have shown that manipulating the serotonergic system can effectively delay ejaculation, supporting the use of selective serotonin reuptake inhibitors (SSRIs) in PE treatment1 6.
Psychological Impact
PE has profound psychological effects, including anxiety, depression, and distress, which can extend to the partner and negatively impact the relationship4 5. Men with PE often experience significant personal distress and may avoid sexual intimacy, further exacerbating the issue4 5.
Diagnostic Criteria and Definitions
The International Society for Sexual Medicine (ISSM) has developed a unified definition for both lifelong and acquired PE, emphasizing short ejaculatory latency, lack of control, and negative personal consequences3. This standardized definition aids in the accurate diagnosis and facilitates more rigorous research and treatment development3 8.
Treatment Options
Pharmacotherapy
SSRIs
SSRIs, such as paroxetine, sertraline, and fluoxetine, are commonly used to treat PE due to their ability to delay ejaculation by increasing serotonin levels1 4 6. Chronic use of SSRIs has shown significant efficacy, although on-demand use is less effective1 4 6. Dapoxetine, a short-acting SSRI, has been specifically approved for on-demand treatment of PE and has demonstrated effectiveness in increasing intravaginal ejaculation latency time (IELT)6 7.
Tramadol and Topical Anesthetics
Tramadol, an opioid analgesic, has also been found to delay ejaculation and is considered a potential alternative to SSRIs with fewer side effects4 7. Topical anesthetics, such as lidocaine-prilocaine spray, provide another on-demand treatment option by reducing penile sensitivity and prolonging IELT7 9.
Behavioral and Psychosexual Therapies
Behavioral therapies, including the "stop-start" and "squeeze" techniques, are often recommended as first-line treatments for PE. These methods focus on improving ejaculatory control through practice and partner involvement9. Psychosexual counseling can address underlying psychological issues and enhance the effectiveness of pharmacotherapy9 10.
Conclusion
Premature ejaculation is a complex condition with both neurobiological and psychological components. Effective management requires a combination of pharmacological treatments, such as SSRIs and topical anesthetics, and behavioral therapies. Continued research and standardized diagnostic criteria are essential for advancing our understanding and treatment of PE, ultimately improving the quality of life for affected individuals and their partners.
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Most relevant research papers on this topic
Premature Ejaculation
Daily treatment with serotonergic antidepressants can effectively delay premature ejaculation, while on-demand use of topical anesthetics and tramadol may also help.
Meta-AnalysisThe neurobiological approach to premature ejaculation.
Premature ejaculation is a neurobiological phenomenon related to central serotonergic neurotransmission and likely influenced by hereditary factors, rather than a psychological disturbance.
Systematic Review
Highly CitedAn evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation.
The unified definition of lifelong and acquired premature ejaculation is a male sexual dysfunction characterized by short ejaculatory latency, reduced control, and negative personal consequences.
Systematic ReviewHighly CitedPremature ejaculation: current medical treatment and new directions (CME).
Medical therapy for premature ejaculation shows promise, but more reliable, controlled studies are needed to confirm efficacy and safety.
Systematic ReviewHighly CitedImpact of premature ejaculation: the psychological, quality of life, and sexual relationship consequences.
Premature ejaculation significantly impacts men and their partners, negatively impacting their quality of life and potentially preventing single men from forming new partner relationships.
Systematic ReviewHighly CitedSerotonin and premature ejaculation: from physiology to patient management.
SSRIs effectively treat premature ejaculation in men, but their mechanism of action and clinical benefits in this condition require further research.
Systematic ReviewHighly CitedNovel Treatment for Premature Ejaculation in the Light of Currently Used Therapies: A Review.
The new dose-metered lidocaine-prilocaine spray (Fortacin) may offer a satisfactory and affordable solution for premature ejaculation, potentially increasing patient acceptance of available monotherapies and becoming an established second-line therapy for severe cases.
Systematic ReviewDefining Premature Ejaculation for Experimental and Clinical Investigations
A common model for defining premature ejaculation groups could guide future research and treatment, improving progress in the field.
Systematic ReviewHighly CitedPremature ejaculation – how to treat?
A holistic approach, including psychotherapy and sex therapy, is the most beneficial for treating premature ejaculation, with dapoxetine as the preferred symptomatic treatment.
Systematic Review
Rigorous JournalManagement Options for Premature Ejaculation and Delayed Ejaculation in Men.
Management options for premature ejaculation and delayed ejaculation in men include psychotherapy, pharmacotherapy, and procedural interventions, but none has been formally approved by the US Food and Drug Administration.
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