Progresses in pharmaceutical and surgical management of premature ejaculation

Abstract

Objective:Premature ejaculation (PE) is regarded as one of the most common male sexual dysfunctions. This review introduced several pharmaceutical and surgical methods for the management of PE. The definition, etiology, behavioral, and psychological therapy of PE were also discussed.Data sources:“Premature,” “ejaculation,” or “sexual dysfuction” were used as the medical subject headings (MeSH) to obtain relevant articles before June 2019 on Pubmed, Google Scholar and CNKI. Most articles used were written in English and several Chinese articles were also cited.Study selection:Full-text articles of retrospective/prospective/randomized controlled trials were analyzed. Animal experiments and letters were excluded.Results:There are four PE sub-types: lifelong PE, acquired PE, natural variable PE, and subjective PE. Behavioral therapy, psychotherapy, medication, topical anesthetics, and surgery are currently used for the treatment of PE. However, all the above treatments have limitations. Therefore, novel ways should be investigated to more efficiently control PE.Conclusions:The pharmaceutical therapy that is currently being used in clinical practice for the management of PE is still the main choice globally due to its good efficacy. Surgery may be a choice for patients who are resistant to medication. However, it should be performed cautiously.

The network meta‐analysis of “on‐demand” and “daily” use of paroxetine in treating men with premature ejaculation from randomized controlled trials

“…In our study, both daily and on-demand paroxetine significantly improved the IELT in patients with PE, with better results with increasing dose; 20 mg paroxetine daily may have a better ability to improve the IELT than 20 mg paroxetine on-demand (3.14 min vs. 1.5 min). After receiving SSRIs for 1 to 2 weeks, serotonin neurotransmission is increased and changes in specific serotonin receptors will occur in the central nervous system, which is the central pathway leading to PE (Hu et al, 2019).…”

“…The pharmaceutical development and surgical approaches for PE have achieved several breakthroughs in recent years (Hu et al, 2019). Pharmacotherapy mainly includes selective serotonin reuptake inhibitors (SSRIs) (sertraline, fluoxetine, dapoxetine and paroxetine), phosphodiesterase type 5 inhibitors (PDEI5) (tadalafil or sildenafil) and other drugs (tramadol) (Moudi & Kasaeeyan, 2016).…”

Efficacy and safety assessment of glandular augmentation with hyaluronic acid for premature ejaculation

“…Amongst all accessible modalities for PE, pharmacological interventions using antidepressants and local anaesthetics remain the mainstream strategy. Despite good amelioration, recurrence after withdrawal and systemic adverse effects of antidepressants are inevitable and sometimes unacceptable for patients (Hu et al, 2019). Topical anaesthetics can cause disturbing side effects such as local irritation, penile hypoesthesia and transvaginal contamination (Morales et al, 2007).…”

Effects of One-Shot Hyaluronic Acid Injection in Lifelong Premature Ejaculation: A Pilot Study

“…Therefore, many therapies could be applied, including behavioral therapy, topical anesthetics, antidepressants, such as serotonin re-uptake inhibitors and tricyclic antidepressants, phosphodiesterase-5 inhibitors, and opiate analgesics, such as tramadol [3]. However, the recurrence after withdrawal and the local and systemic adverse effects resulting from the pharmacological treatments, are sometimes unacceptable for patients [4,5]. In addition to pharmacotherapies, procedures can be used to reduce glans hypersensitivity and improve the intravaginal ejaculation latency time (IELT), such as the selective dorsal neurectomy and the hyaluronic acid injection into the glans penis [6].…”