Latest Treatments for Premature Ejaculation
Premature ejaculation (PE) is a condition where a man ejaculates earlier than desired during sexual activity. This issue, which is often distressing for those affected, has led to the exploration of various innovative pharmacological treatments. Below, we outline several promising options that require further research and validation:
Cligosiban
Cligosiban is an oral medication that acts as an antagonist to oxytocin receptors. Currently under development for the treatment of premature ejaculation, a study published in 2019 in the Journal of Sexual Medicine indicates that cligosiban may effectively manage PE in men, albeit with some potential side effects.
Dapoxetine
Dapoxetine is recognized as the first drug specifically designed to treat premature ejaculation. It belongs to the class of short-acting selective serotonin reuptake inhibitors (SSRIs) and is considered a cornerstone in the pharmacological management of PE. Dapoxetine works by inhibiting the neural pathways responsible for ejaculation that originate in higher centers in the body. A study examining the effects of paroxetine on intravaginal ejaculatory latency time revealed a moderate effectiveness in extending this duration.
A 2017 study published in the Journal of Sexual Medicine reported that many men discontinued dapoxetine usage due to its high cost and the requirement for ongoing treatment to achieve satisfactory results during sexual activity. Notable side effects of dapoxetine include diarrhea, nausea, headaches, and dizziness.
Modafinil
Modafinil is primarily prescribed for narcolepsy; however, a 2016 study in the Journal of Men’s Health presented limited evidence suggesting that modafinil may aid in treating long-term premature ejaculation. Nevertheless, its effects appeared minimal and transient, warranting further investigation to confirm its efficacy.
Silodosin
Silodosin is predominantly utilized for managing benign prostatic hyperplasia (BPH). It alleviates lower urinary tract symptoms and is a highly selective alpha-1 adrenergic receptor antagonist found in seminal vesicles, thus contributing to the management of PE. A study published in 2016 in The Central European Journal of Urology highlighted that silodosin is a safe and well-tolerated alternative to dapoxetine for individuals experiencing premature ejaculation. Side effects typically include anejaculation and retrograde ejaculation.
Traditional Treatments for Premature Ejaculation
Several time-tested treatments exist for managing premature ejaculation in men. Individuals may need to try various therapies before identifying the most effective options. Common approaches include topical anesthetics, pharmacological treatments, behavioral therapy, and medical counseling. A combination of pharmacotherapy and behavioral therapy often yields the best results.
Behavioral Techniques
Several behavioral strategies may alleviate premature ejaculation, including:
- Kegel Exercises: These exercises enhance the strength of the pelvic floor muscles, potentially mitigating premature ejaculation. It is recommended to perform these exercises three times daily by contracting or tightening the pelvic muscles for 10 seconds in 10 consecutive repetitions, ideally when the bladder is empty. The pelvic muscles targeted are the same ones used to halt urination mid-stream.
- Condom Use: Condoms can diminish penile sensitivity, either by increasing their thickness to reduce sensation or by incorporating topical anesthetics like lidocaine or benzocaine.
- Temporary Abstinence: Healthcare providers may advise couples to temporarily abstain from intercourse, opting for other forms of sexual intimacy in order to reduce the psychological pressure associated with premature ejaculation. Additionally, self-stimulation that involves the partner prior to intercourse, approximately one to two hours ahead, can help delay ejaculation during sexual activity.
Pharmacological Treatments
The following are traditional pharmacological treatments employed for premature ejaculation:
- Topical Anesthetics: Topical anesthetics, such as creams and sprays, can minimize sensation in the penis, thereby delaying ejaculation. These are typically applied 10-15 minutes before sexual activity. Examples include:
- Lidocaine
- Benzocaine
- Prilocaine
- Oral Medications: A variety of medications have historically been utilized for premature ejaculation, and combinations may be employed or used individually. It is important to note that these drugs are not specifically approved by the FDA for this condition. Examples include:
- Phosphodiesterase-5 inhibitors, commonly used for erectile dysfunction, may help with PE as well, including:
- Vardenafil
- Tadalafil
- Sildenafil
- Antidepressants: Certain antidepressants may indirectly reduce premature ejaculation. Prolonged latency to orgasm is a side effect of several SSRIs, such as fluoxetine, escitalopram, sertraline, and paroxetine. If these medications prove ineffective, clomipramine, a tricyclic antidepressant, may be prescribed.
- Tramadol: This prescription pain reliever could delay ejaculation as a side effect in some cases.
- Phosphodiesterase-5 inhibitors, commonly used for erectile dysfunction, may help with PE as well, including: