SSRI Antidepressants and Their Role in PE

The 1948 Kinsey Report suggested that three-quarters of men ejaculate within two minutes of penetration in over half of their sexual encounters.

Guidelines for Management of Premature Ejaculation

Dapoxetine, a selective serotonin reuptake inhibitor, has been approved for the treatment of premature ejaculation in several countries. [38][39][40] Other SSRIs are used off-label to treat PE, including fluoxetine, paroxetine,[41] sertraline, citalopram, escitalopram and clomipramine. [38] The opioid tramadol, an atypical oral analgesic is also used. [38][42] PDE5 inhibitors appear more effective than placebo and outcomes may be enhanced when combined with SSRIs for premature ejaculation, but the evidence is heterogeneous and of uncertain methodological quality. [43] The full effects of these medications typically emerge after 2-3 weeks, with results indicating about ejaculatory delay of up to 4 times greater than before medication if the medication is combined with psychotherapy.

Tadalafil (Cialis)

[38] Premature ejaculation can return upon discontinuation,[38] and the side effects of these SSRIs can also include anorgasmia, erectile dysfunction, and diminished libido. Topical anesthetics such as lidocaine and benzocaine, commonly known as delay sprays, that are applied to the tip and shaft of the penis have also been developed to essentially numb the intended area. These topical anesthetics are applied 10–15 minutes before sexual activity and have fewer potential side effects as compared to SSRIs. [44] However, this is sometimes disliked due to the reduction of sensation in the penis as well as for the partner (due to the medication rubbing onto the partner if condoms are not used). Two different surgeries, both developed in South Korea, are available to permanently treat premature ejaculation: selective dorsal neurectomy (SDN)[46] and glans penis augmentation using a hyaluronan gel.

The pause-squeeze technique

[47][48] Circumcision has shown no effect on PE. [49] The International Society for Sexual Medicine guidelines do not recommend either surgical treatment due to libido for women the risk of permanent loss of sexual function and insufficient reliable data[49][50][23] and on the basis of violating the medical principle of non-maleficence as the surgery can lead to complications, of which some might not yet be known. [49] The most common complication of surgery is the recurrence of PE, reported to occur in about 10% of surgeries. [49] Other sources consider SDN as a safe and efficient treatment[51] and these surgeries are popular in Asian countries. Premature ejaculation is a prevalent sexual dysfunction in males;[52] however, because of the variability in time required to ejaculate and in partners' desired duration of sex, exact prevalence rates of PE are difficult to determine. Evidence as of 2005[update] supports an average intravaginal ejaculation latency time (IELT) of six and a half minutes in 18- to 30-year-olds.

[18][19] If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about two minutes. [20] Still, it is possible for some men with abnormally low IELTs to be satisfied with their performance and not report a lack of control. [21] Likewise, those with higher IELTs may consider themselves premature ejaculators, and suffer from quality of life issues normally associated with premature ejaculation, and even benefit from non-pharmaceutical treatment. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines premature ejaculation as "A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the person wishes it," with the additional requirements that the condition occurs for a duration longer than 6 months, causes clinically significant distress, and cannot be better explained by relationship distress, another mental disorder, or the use of medications. [2] These factors are identified by talking with the person, not through any diagnostic test.

When to call a professional

In the "Sex in America" surveys (1999 and 2008), University of Chicago researchers found that between adolescence and age 59, approximately 30% of men reported having experienced PE at least once during the previous 12 months, whereas about 10 percent reported erectile dysfunction (ED). [53] In males, although ED is the most prevalent sex problem after age 60, and may be more prevalent than PE overall according to some estimates,[54] premature ejaculation remains a significant issue that, according to the survey, affects 28 percent of men age 65–74, and 22 percent of men age 75–85. [53] Other studies report PE prevalence ranging from 3 percent to 41 percent of men over 18, but the great majority estimate a prevalence of 20 to 30 percent—making PE a very common sex problem. [5][11][52][55][23][56][57][58] There is a common misconception that younger men are more likely to develop premature ejaculation and that its frequency decreases with age. [59][60] Prevalence studies have indicated, however, that rates of PE are relatively constant across age groups.

Medication Options to Reduce Sensitivity and Improve Control

Male mammals ejaculate quickly during intercourse, prompting some biologists to speculate that rapid ejaculation had evolved into genetic makeup of human males to increase their chances of passing their genes. Ejaculatory control issues have been documented for more than 1,500 years. The Kamasutra, the 4th century BCE Indian marriage handbook, declares that "if a male be long-timed, the female loves him the more, but if he be short timed, she is dissatisfied with him. Waldinger summarizes professional perspectives from early in the twentieth century. Sex researcher Alfred Kinsey did not consider rapid ejaculation a problem, but viewed it as a sign of "masculine vigor" that could not always be cured.

Tadalafil (Cialis®) for PE

[66] The belief that it should be considered a disease rather than a normal variation, has also been disputed by some modern researchers. [2] The DSM-5 allows for specifiers whether the condition is lifelong or acquired, applying in general or only to certain situations, and severity based on the time under one minute, however these subtypes have been criticised as lacking validity due to insufficient evidence. The 2007 ICD-10 defined PE as ejaculating without control, and within around 15 seconds. Several treatments have been tested for treating premature ejaculation. A combination of medication and non-medication treatments is often the most effective method. Many men attempt to treat themselves for premature ejaculation by trying to distract themselves, such as by trying to focus their attention away from the sexual stimulation. There is little evidence to indicate that it is effective and it tends to detract from the sexual fulfillment of both partners.

Frequently asked questions

The 1948 Kinsey Report suggested that three-quarters of men ejaculate within two minutes of penetration in over half of their sexual encounters. Evidence as of 2005[update] supports an average intravaginal ejaculation latency time (IELT) of six and a half minutes in 18- to 30-year-olds. [18][19] If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about two minutes. [20] Still, it is possible for some men with abnormally low IELTs to be satisfied with their performance and not report a lack of control. [21] Likewise, those with higher IELTs may consider themselves premature ejaculators, and suffer from quality of life issues normally associated with premature ejaculation, and even benefit from non-pharmaceutical treatment.

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The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines premature ejaculation as "A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the person wishes it," with the additional requirements that the condition occurs for a duration longer than 6 months, causes clinically significant distress, and cannot be better explained by relationship distress, another mental disorder, or the use of medications. [2] These factors are identified by talking with the person, not through any diagnostic test. [2] The DSM-5 allows for specifiers whether the condition is lifelong or acquired, applying in general or only to certain situations, and severity based on the time under one minute, however these subtypes have been criticised as lacking validity due to insufficient evidence. The 2007 ICD-10 defined PE as ejaculating without control, and within around 15 seconds. Several treatments have been tested for treating premature ejaculation.

Paroxetine (Paxil, Pexeva)

A combination of medication and non-medication treatments is often the most effective method. Many men attempt to treat themselves for premature ejaculation by trying to distract themselves, such as by trying to focus their attention away from the sexual stimulation. There is little evidence to indicate that it is effective and it tends to detract from the sexual fulfillment of both partners. Other self-treatments include thrusting more slowly, withdrawing the penis altogether, purposefully ejaculating before sexual intercourse, and using more than one condom. Some men report these to have been helpful. Other self-treatments include thrusting more slowly, withdrawing the penis altogether, purposefully ejaculating before sexual intercourse, and using more than one condom.

Some men report these to have been helpful. Several techniques have been developed and applied by sex therapists, including Kegel exercises (to strengthen the muscles of the pelvic floor) and Masters and Johnson's "stop-start technique" (to desensitize the male's responses) and "squeeze technique" (to reduce excessive arousal). To treat premature ejaculation, Masters and Johnson developed the "squeeze technique", based on the Semans technique developed by James Semans in 1956. [25] Men were instructed to pay close attention to their arousal pattern and learn to recognize how they felt shortly before their "point of no return", the moment ejaculation felt imminent and inevitable. Sensing it, they were to signal their partner, who squeezed the head of the penis between thumb and index finger, suppressing the ejaculatory reflex and allowing the male to last longer.

Why trust our experts?

The squeeze technique worked, but many couples found it cumbersome. From the 1970s to the 1990s, sex therapists refined the Masters and Johnson approach, largely abandoning the squeeze technique and focused on a simpler and more effective technique called the "stop-start" technique. During intercourse, as the male gets the sensation of approaching climax, both partners stop moving and remain still until the male's feelings of ejaculatory inevitability subside, at which point, they are free to resume active intercourse. The functional-sexological approach to treating premature ejaculation, as developed by François de Carufel & Gilles Trudel, offers a novel method focusing on sexual function ed tablets improvement without interrupting sexual activity. This treatment, distinct from traditional behavioral techniques like the squeeze and stop-start methods, has demonstrated significant improvements in the duration of intercourse, sexual satisfaction, and overall sexual function. A pivotal study by De Carufel & Trudel (2006) showcases the effectiveness of this approach. [33] Moreover, the Cochrane review on psychosocial interventions for premature ejaculation recognizes the De Carufel study as having a low risk of bias, highlighting its methodological robustness among psychosocial intervention studies. [34] This acknowledgment points to the functional-sexological treatment as a promising avenue for individuals and couples grappling with premature ejaculation, suggesting a shift towards more contemporary and empirically supported treatments in the field. [35] Access to functional-sexological therapy can be limited due to a shortage of qualified professionals. A study published in the Journal of Sex & Marital Therapy found that many individuals experience difficulties in seeking treatment for sexual concerns, largely due to a lack of awareness about available services and the scarcity of trained sex therapists, making these services appear inaccessible to those in need. Pharmacological treatments for premature ejaculation, particularly selective serotonin reuptake inhibitors, topical anesthetics, and tramadol, increase intravaginal ejaculatory latency time compared with placebo; adverse events are common and overall evidence quality is limited by methodological heterogeneity and risk of bias. Dapoxetine, a selective serotonin reuptake inhibitor, has been approved for the treatment of premature ejaculation in several countries.

• Dapoxetine is contraindicated with certain medications and health conditions.
• Topical creams should be used sparingly to prevent partner numbness.
• SSRI treatment may cause emotional blunting or decreased libido.
• Tramadol's risk of dependency requires careful medical supervision.
• Mechanical devices can provide temporary ejaculation delay.
• Behavioral training involves specific sex exercises for control.
• Mindfulness and relaxation techniques benefit PE management.
• Proper diagnosis is essential to rule out underlying disorders.
• Incorporate partner feedback to improve treatment results.
• Avoid abrupt discontinuation of prescribed medication.
• Lifestyle modifications can include weight management.
• Ongoing research aims to develop more effective PE treatments.

[38][39][40] Other SSRIs are used off-label to treat PE, including fluoxetine, paroxetine,[41] sertraline, citalopram, escitalopram and clomipramine. [38] The opioid tramadol, an atypical oral analgesic is also used. [38][42] PDE5 inhibitors appear more effective than placebo and outcomes may be enhanced when combined with SSRIs for premature ejaculation, but the evidence is heterogeneous and of uncertain methodological quality. [43] The full effects of these medications typically emerge after 2-3 weeks, with results indicating about ejaculatory delay of up to 4 times greater than before medication if the medication is combined with psychotherapy. [38] Premature ejaculation can return upon discontinuation,[38] and the side effects of these SSRIs can also include anorgasmia, erectile dysfunction, and diminished libido.

• Topical anesthetic creams temporarily desensitize the penis to delay ejaculation.
• SSRI medications like paroxetine are prescribed off-label for premature ejaculation.
• Dapoxetine is a short-acting SSRI specifically approved for PE treatment.
• Tramadol, an opioid, can help delay ejaculation but carries dependency risks.
• Topical sprays offer quick, localized numbing effects to control ejaculation timing.
• PDE5 inhibitors like sildenafil may improve performance in men with PE and ED.
• Behavioral therapies include the stop-start and squeeze techniques to extend duration.
• Kegel exercises strengthen pelvic muscles, potentially delaying ejaculation.
• Counseling and sex therapy can address psychological causes of PE.
• Combining medication with behavioral techniques enhances treatment effectiveness.
• Herbal supplements lack robust clinical evidence but are used by some for PE.
• Consultation with a healthcare provider is essential to tailor appropriate therapy.

Topical anesthetics such as lidocaine and benzocaine, commonly known as delay sprays, that are applied to the tip and shaft of the penis have also been developed to essentially numb the intended area. These topical anesthetics are applied 10–15 minutes before sexual activity and have fewer potential side effects as compared to SSRIs. [44] However, this is sometimes disliked due to the reduction of sensation in the penis as well as for the partner (due to the medication rubbing onto the partner if condoms are not used). Two different surgeries, both developed in South Korea, are available to permanently treat premature ejaculation: selective dorsal neurectomy (SDN)[46] and glans penis augmentation using a hyaluronan gel. [47][48] Circumcision has shown no effect on PE. [49] The International Society for Sexual Medicine guidelines do not recommend either surgical treatment due to libido for women the risk of permanent loss of sexual function and insufficient reliable data[49][50][23] and on the basis of violating the medical principle of non-maleficence as the surgery can lead to complications, of which some might not yet be known.

[49] The most common complication of surgery is the recurrence of PE, reported to occur in about 10% of surgeries. [49] Other sources consider SDN as a safe and efficient treatment[51] and these surgeries are popular in Asian countries.

Premature ejaculation is a prevalent sexual dysfunction in males;[52] however, because of the variability in time required to ejaculate and in partners' desired duration of sex, exact prevalence rates of PE are difficult to determine. In the "Sex in America" surveys (1999 and 2008), University of Chicago researchers found that between adolescence and age 59, approximately 30% of men reported having experienced PE at least once during the previous 12 months, whereas about 10 percent reported erectile dysfunction (ED). [53] In males, although ED is the most prevalent sex problem after age 60, and may be more prevalent than PE overall according to some estimates,[54] premature ejaculation remains a significant issue that, according to the survey, affects 28 percent of men age 65–74, and 22 percent of men age 75–85. [53] Other studies report PE prevalence ranging from 3 percent to 41 percent of men over 18, but the great majority estimate a prevalence of 20 to 30 percent—making PE a very common sex problem. [5][11][52][55][23][56][57][58] There is a common misconception that younger men are more likely to develop premature ejaculation and that its frequency decreases with age. [59][60] Prevalence studies have indicated, however, that rates of PE are relatively constant across age groups. Male mammals ejaculate quickly during intercourse, prompting some biologists to speculate that rapid ejaculation had evolved into genetic makeup of human males to increase their chances of passing their genes. Ejaculatory control issues have been documented for more than 1,500 years. The Kamasutra, the 4th century BCE Indian marriage handbook, declares that "if a male be long-timed, the female loves him the more, but if he be short timed, she is dissatisfied with him. Waldinger summarizes professional perspectives from early in the twentieth century. Sex researcher Alfred Kinsey did not consider rapid ejaculation a problem, but viewed it as a sign of "masculine vigor" that could not always be cured. [66] The belief that it should be considered a disease rather than a normal variation, has also been disputed by some modern researchers.

Cited sources

Several techniques have been developed and applied by sex therapists, including Kegel exercises (to strengthen the muscles of the pelvic floor) and Masters and Johnson's "stop-start technique" (to desensitize the male's responses) and "squeeze technique" (to reduce excessive arousal). To treat premature ejaculation, Masters and Johnson developed the "squeeze technique", based on the Semans technique developed by James Semans in 1956. [25] Men were instructed to pay close attention to their arousal pattern and learn to recognize how they felt shortly before their "point of no return", the moment ejaculation felt imminent and inevitable. Sensing it, they were to signal their partner, who squeezed the head of the penis between thumb and index finger, suppressing the ejaculatory reflex and allowing the male to last longer. The squeeze technique worked, but many couples found it cumbersome.

Surgical treatments

From the 1970s to the 1990s, sex therapists refined the Masters and Johnson approach, largely abandoning the squeeze technique and focused on a simpler and more effective technique called the "stop-start" technique. During intercourse, as the male gets the sensation of approaching climax, both partners stop moving and remain still until the male's feelings of ejaculatory inevitability subside, at which point, they are free to resume active intercourse. The functional-sexological approach to treating premature ejaculation, as developed by François de Carufel & Gilles Trudel, offers a novel method focusing on sexual function ed tablets improvement without interrupting sexual activity. This treatment, distinct from traditional behavioral techniques like the squeeze and stop-start methods, has demonstrated significant improvements in the duration of intercourse, sexual satisfaction, and overall sexual function. A pivotal study by De Carufel & Trudel (2006) showcases the effectiveness of this approach.

Premature ejaculation (PE), or now, as it is often referred, rapid ejaculation (RE), is a common medical condition that is tough to define and affects up to 30 percent of men.

[33] Moreover, the Cochrane review on psychosocial interventions for premature ejaculation recognizes the De Carufel study as having a low risk of bias, highlighting its methodological robustness among psychosocial intervention studies. [34] This acknowledgment points to the functional-sexological treatment as a promising avenue for individuals and couples grappling with premature ejaculation, suggesting a shift towards more contemporary and empirically supported treatments in the field. [35] Access to functional-sexological therapy can be limited due to a shortage of qualified professionals. A study published in the Journal of Sex & Marital Therapy found that many individuals experience difficulties in seeking treatment for sexual concerns, largely due to a lack of awareness about available services and the scarcity of trained sex therapists, making these services appear inaccessible to those in need. Pharmacological treatments for premature ejaculation, particularly selective serotonin reuptake inhibitors, topical anesthetics, and tramadol, increase intravaginal ejaculatory latency time compared with placebo; adverse events are common and overall evidence quality is limited by methodological heterogeneity and risk of bias.