A review of the current status of topical treatments for premature ejaculation

Abstract

The three mini‐reviews this month cover several areas of interest, including premature ejaculation, urological malignancies after renal transplantation and the much‐vexed issue of the relevance of prostate size to prostate disease. Each of these should help to keep the readers up‐to‐date with each of these important topics. We examine the progress that has been made towards the development of topical treatments for premature ejaculation (PE). Although generally regarded as one of the most common male sexual problems, the lack of approved pharmacological agents for PE means that treatment options are limited to behavioural therapy, where available, and the use of drugs ‘off‐label’. There are various theories on the aetiology of PE, but it seems likely that both biological and psychological factors are important. One theory, that men with PE might have a heightened sensory response to penile stimulation, provides the rationale for using topical therapy; reducing the sensitivity of the glans penis with topical desensitizing agents (e.g. local anaesthetics) might improve ejaculatory latency without adversely affecting the sensation of ejaculation. Off‐label topical treatments are now relatively widely used, despite limited supportive efficacy data. There are also new topical treatments in various stages of development, designed specifically for use in PE. Treatments reviewed include TEMPE spray, containing a eutectic mixture of the topical anaesthetics lidocaine and prilocaine, and several creams, including one containing natural products (SS‐cream), and preliminary results from another containing the local anaesthetic dylonine, with alprostadil (prostaglandin E1). Despite wide variations in the methods of clinical trials, it is possible to conclude that all placebo‐controlled studies of topical treatments have reported a significant increase in intravaginal ejaculatory latency time compared to baseline and placebo. Topical treatments for PE are appealing in that they can be applied as needed and only minimal systemic effects are likely. However, without well‐controlled drug delivery there is the theoretical possibility of penile hypoaesthesia and/or transvaginal contamination. Unlike the cream formulations, the TEMPE spray has a well‐controlled delivery system, making it easy to administer locally, and it appears to be well tolerated in early clinical trials. It appears that topical treatments might be able to satisfy many of the requirements of an ideal treatment for PE, and certainly have the potential for use as a first‐line treatment.

A Novel Treatment Modality in Patients With Premature Ejaculation Resistant to Conventional Methods: The Neuromodulation of Dorsal Penile Nerves by Pulsed Radiofrequency

“…Biological and psychological factors are important in the etiology of PE (Morales et al, 2007). Patients with primary PE have penile hypersensitivity, which provides further evidence for an organic basis of PE (Xin et al, 1996).…”

“…The hypothesis is that reducing the sensitivity of the glans penis with topical desensitizing agents (eg, local anesthetics) would delay ejaculatory latency without adversely affecting the sensation of ejaculation. However, in applying a local anesthetic to the penis, there is, of course, the theoretical possibility of penile hypoesthesia, transvaginal contamination, and female genital anesthesia (Morales et al, 2007).…”

Safety and efficacy of tramadol hydrochloride on treatment of premature ejaculation

“…26 There are multiple reports in the literature on the use of a variety of drugs in the treatment of PE. These drugs facilitate ejaculation through either a central dopaminergic or anti-serotoninergic mechanism of action.…”

Current therapeutic strategies for premature ejaculation and future perspectives

“…Although manufacturers claim that the spray had the ability to delay ejaculation, reliable data from clinical trials are absent; therefore, its efficacy and safety cannot be assessed. 75 …”

“…In addition, eight of 11 patients and seven of 11 partners reported their sexual satisfaction after the spray as 'better' or 'much better', respectively. 75 In a phase II placebo-controlled trial recently published, 86 54 patients using topical eutectic mixture for PE prolonged their IELT from a mean baseline of 1.0 to 4.9 min. Only three cases (12%) experienced hypoaesthesia (numbness in the penis) and four experienced ED; none interrupted treatment as a result.…”