Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation by Abdel-Hamid et al

Abstract

The authors state that`premature ejaculation (PE) like psychogenic erectile dysfunction is a performance anxiety related problem'. This may well be so. Certainly the levels of anxiety measured on the Hamilton anxiety ratings have been shown to be higher in patients with primary PE compared to secondary PE. 1 However, this anxiety in primary PE may be secondary to the patients having a chronic sexual problem. Other workers feel primary PE may be controlled by biogenic factors, 2 which may well have their basis in dysfunctional 5HT receptors in the central and peripheral nervous systems. 3,4 Although PDE5 receptors have been found in the cerebellum of rats 5 and PDE7 receptors in the caudate nucleus of humans, 6 we ®nd it implausible on a theoretical level that sildena®l has a direct effect on latency times. It is tautological to state, as they say, that`ejaculation latency time is dependent on erection time' Ð intravaginal latency time is terminated by ejaculation, so that these times (in men without erectile dysfunction) are almost always the same.We are also concerned that the EDITS 7 was used to measure sexual satisfaction. The EDITS was constructed and validated for use in erectile dysfunction Ð it is therefore inappropriate to use it for assessment of sexual satisfaction associated with PE.The most plausible reason for the prolonged intravaginal latency time in patients on sildena®l, we feel, is that this drug enables patients to respond to small amounts of sexual desire soon after an initial episode of intercourse. It is well known that a second or third coitus within a short space of time results in prolonged ejaculatory latency time. 8 We feel this explanation should have been put forward as the most plausible cause of the prolonged ejaculatory latency time for patients on sildena®l. References

Paroxetine in the treatment of premature ejaculation: a systematic review and meta-analysis

“…Where reported, side effects related to paroxetine included: headache, fatigue, nausea, dizziness, sleep disturbances, yawning, dry mouth, sweating, and constipation. The pooled relative risk of 3 RCTs [17, 22, 24] was 1.23 [RR (random effect) 95% Cl, 0.38 to 4.04; p = 0.73], which indicated no difference between the paroxetine and placebo groups in terms of adverse events (Fig. 4).…”

“…Paroxetine vs. PDE5Is: Five RCTs compared the safety and efficacy of paroxetine with those of tramadol [15, 20, 23, 24, 26]. Because 2 RCTs lacked relevant standard deviations [23, 24],3 other pooled RCTs [15, 20, 26] showed that paroxetine had similar effects to PDE5Is,with between-group difference in IELT of − 0.59 [95% [Cl], − 1.45 to 0.26; p = 0.17]. While there was a high level of heterogeneity (I 2 = 88%) (Fig.…”

“…The relative risk of side effects between two groups pooled from 3 RCTs [24, 26] was 1.14 [RR (random effect) 95% Cl, 0.76 to 1.73; p = 0.52], as shown in Fig. 4.…”

“…Paroxetine vs. sertraline: Six studies [19, 24, 27–30] investigated IELT and the side effects with paroxetine vs. sertraline. In 4 pooled RCTs [19, 27–29], treatment with paroxetine was more effective than sertraline, but the difference was not statistically significant [MD, 0.19; 95% Cl, − 0.14 to 0.52; p = 0.26] (Fig.…”

Premature Ejaculation: Current Medical Treatment and New Directions (CME)

“…PDE5 inhibitors may exert a secondary benefit for patients with PE when they (i) allow for a sustained penile erection, even after ejaculation; (ii) facilitate a second intercourse after the initial ejaculation, which is often less prone to PE; and/or (iii) help the patient to overcome performance anxiety, which often exacerbates PE [83,89]. However, it is deemed unlikely that PDE5 inhibitors have a significant role in the treatment of PE—with the exception of men with acquired PE secondary to ED [1].…”