Patient-Reported Outcomes with Sildenafil for Premature Ejaculation

The 154 participants in this retrospective study entered a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex.

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Reliable, appropriately controlled and assessed studies are generally lacking and carefully devised, methodically conducted research is much needed. Sadeghi-Nejad H, and Watson R. Premature ejaculation: Current medical treatment and new directions. Interest in premature ejaculation (PE) has been increasing rapidly among all healthcare professionals. A recent Medline search (January 2008) for articles related to PE, from 1949 to the present, uncovered a total of 589 references of which 160 articles (27%) had been published within the past 2 years.

Information to gather in advance

Much of this recent surge in interest has focused on new and promising medical relief for men who are troubled by this vexing condition. This review, while recognizing the critical importance of an integrated approach to the evaluation and management of PE—coordinating participation on the part of urologists, mental health professionals, endocrinologists, primary care physicians, and other interested healthcare professionals—is directed primarily at providing an update on recent developments in the medical treatment of PE. The definition of PE is still evolving, but the classic triad involved in the definition includes (i) short intravaginal ejaculatory latency time (IELT), (ii) lack of control, and (iii) sexual dissatisfaction [1]. The World Health Organization (WHO) 1994 International Classification of Diseases defines PE as “an inability to delay ejaculation sufficiently to enjoy lovemaking, manifest as either of the following: occurrence of ejaculation before or very soon after the beginning of intercourse (if a time limit is required: before or within 15 seconds of the beginning of intercourse); occurrence of ejaculation in the absence of sufficient erection to make intercourse possible. The problem is not the result of prolonged absence from sexual activity” [1].

the Sildenafil Study Group: Oral sildenafil in the treatment of erectile dysfunction

Furthermore, the WHO definition excludes men whose PE is predominately attributed to (i) alcohol, substance abuse, and/or medications; (ii) a sexual context that has led to very high levels of arousal because of the novelty of partner or situation; and (iii) a low frequency of sexual activity [1]. Others have based their diagnosis on the number of penile thrusts occurring before ejaculation, considering less than 8–15 thrusts as the criterion for PE [2,3]. In 2007, responding to the variability of worldwide definitions and the need for a universal standard, the International Society for Sexual Medicine (ISSM) established an ad hoc committee consisting of 21 internationally recognized experts, to establish a new definition of PE. This latest ISSM definition, based on the recommendations of the most active and respected clinical and basic science experts in the field, characterized PE as follows: “Premature ejaculation is a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and inability to delay ejaculation on all or nearly all vaginal penetrations; and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy” [4]. Based on this new definition, some investigators may question the conclusions of previous studies with potentially inadequate patient selection definitions. Of the 95 participants who completed follow-up, 64% maintained satisfactory ejaculation control at 24 months and 56% did so at 36 months. Surgical procedures that reduce penile sensation have been proposed as treatments for premature ejaculation. These include selective dorsal nerve neurotomy, pulsed radiofrequency ablation or cryoablation of dorsal penile nerves, and hyaluronic acid gelaugmentation of the glans penis. [61, 62] Currently, all those are considered experimental. Before the availability of nonsurgical methods for treating erectile dysfunction, a patient with premature ejaculation who was mistakenly diagnosed with erectile dysfunction might have undergone a penile prosthesis implantation, which would have yielded unsatisfactory results because of the incorrect initial diagnosis. In this scenario, the patient would be able to engage in sexual intercourse, because the penile implant would provide an adequate erection, but he would still climax prematurely.

Currently, penile implants are placed much more rarely, and with the use of nonsurgical treatments for erectile dysfunction, any permanent harm resulting from diagnosing erectile dysfunction rather than premature ejaculation is unlikely. Consultation with a sex therapist, psychologist, or psychiatrist may prove helpful if the primary care physician or urologist cannot provide successful treatment or does not have the time to explore psychological issues and implement behavioral techniques (eg, squeeze-pause). If the primary care physician or urologist is inexperienced or uncomfortable with treating premature ejaculation, early referral to a sex therapist, psychologist, or psychiatrist is indicated. Some physicians are comfortable sildenafil spray implementing pharmacologic therapy but not behavioral therapy. As with any medical condition, the patient should be offered all available treatment options, and the physician should proceed with referral for any option considered to require more specialized help than the physician can provide. For men who may have a severe emotional disturbance underlying the premature ejaculation, referral to a mental health professional is most appropriate. Diagnosis and treatment of the various psychological factors that manifest partly as premature ejaculation are beyond the scope of this discussion. Hossein Sadeghi-Nejad, MD, FACS, and Richard Watson, MD, FACS A B S T R A C TIntroduction.

• Sildenafil's role in PE is still under research.
• Off-label use requires informed consent.
• Behavioral techniques are first-line in many cases.
• The impact of psychological health on PE should not be ignored.
• Educating patients on realistic expectations is important.
• Sometimes, medication just masks underlying issues.
• Regular sexual activity can decrease PE severity.
• Consulting a urologist is recommended for persistent PE.
• Combining medication with therapy often improves outcomes.
• Delaying ejaculation involves both physical and mental strategies.
• Support and understanding enhance treatment adherence.

Premature ejaculation (PE) is the most common form of male sexual dysfunction. Until very recently, scientific investigation of PE has been hampered by a lack of standardized definitions and objective, validated questionnaires. Small numbers of randomized controlled studies evaluating various treatment options have also added to the challenges facing the clinicians who manage PE. This article provides a summary of some of the more relevant the peer-reviewed literature pertaining to the medical therapy of premature ejaculation. A retrospective review of peer reviewed publications relevant to the field of premature ejaculation and related medical therapies.

• Sildenafil enhances blood flow but doesn't directly delay ejaculation.
• PE is often linked with heightened genital sensitivity.
• Timed use of sildenafil may improve sexual confidence.
• Medication dose should be carefully managed.
• PDE5 inhibitors may have a role in PE enhancement.
• Regular sexual activity can help reduce PE symptoms.
• Psycho-sexual therapy addresses underlying issues.
• Identifying triggers can help manage PE episodes.
• Drugs are part of a comprehensive PE management plan.
• Pharmacotherapy may require adjustment over time.
• Always follow medical advice regarding medication use.

Review of safety and efficacy of various medical therapies for premature ejaculation. Selective serotonin release inhibitors have been the most promising agents to date. The on-demand “PRN” use of these agents is more convenient, but its efficacy is less well established. Chronic use of this class of medications has been associated with minor, but bothersome side effects.

More recently, concern over the risk of an increased suicide rate in young men upon initiation of SSRIs has dampened enthusiasm. Recent experience with the use of Tramadol raises the hope that this might prove to be an sildenafil citrates agent as effective as SSRIs with less worrisome risk of side-effects. New trials on novel formulations of topical solutions are currently underway in the United States. Interest in medical therapy for PE is rapidly increasing and reflected in a disproportionate number of publications in this field in the past few years. Clinical research in this field is hampered by the complexity, variability among different men and cultures, and subjectivity of PE.

• Misusing sildenafil for PE can cause serious health risks.
• The drug's primary purpose is erectile dysfunction.
• Off-label use for PE should be supervised by a doctor.
• Performance anxiety often exacerbates PE.
• Proper medication adherence improves results.
• Natural remedies lack strong scientific support.
• Combining drugs without guidance is dangerous.
• Behavioral adjustments can sometimes eliminate PE.
• It is vital to address both physical and psychological aspects.
• Clinical trials explore sildenafil's role in PE management.
• Open communication with a healthcare professional is key.

Reliable, appropriately controlled and assessed studies are generally lacking and carefully devised, methodically conducted research is much needed. Sadeghi-Nejad H, and Watson R. Premature ejaculation: Current medical treatment and new directions. Interest in premature ejaculation (PE) has been increasing rapidly among all healthcare professionals.

Author information

Other related definitions include primary or lifelong PE—presence sildenafil for women of the problem from the onset of initial sexual activity; acquired or late onset PE—indicates that the problem has developed after an initial time of unimpaired ejaculatory function; and situational (vs. global) PE—indicates PE that is limited to specific partner or situation, while the patient enjoys satisfactory intercourse in other contexts [5]. The National Health and Social Life Survey, a probability sample study of sexual behavior in men and women aged 18–59 years, reported a prevalence of 21% among men in the United States [6]. Nathan [7] analyzed the findings of 22 general population sex surveys, and estimated the prevalence of PE to be 35%. Most estimates from other general population prevalence studies fall between 22% and 38%, with ranges from 4% to 39% [8–10].

Correlation between ejaculatory and erectile dysfunction

The wide variability in the reported ranges is mirrored in the variability and lack of standardized definitions for PE. A number of studies have raised the point that in spite of the high prevalence rates, PE is the disorder for which patients are least likely to seek professional assistance, raising the distinct possibility that the problem may be more prevalent than currently estimated [8,10]. More recently, the PE Prevalence and Attitudes (PEPA) internetbased survey of 12,133 men aged 18–70 in the United States, Germany, and Italy reported a prevalence of 22.7% [11]. It is noteworthy that only 9% of the men in this survey had consulted a physician, and more than 90% reported little or no improvement after they sought treatment, leading to a general lack of satisfaction with the results. It has also been suggested that the prevalence of PE may vary between racial groups; one recent survey of 1,320 men found that PE was more prevalently admitted among Hispanic men, highlighting the importance of further investigation of ethnic and cultural variances in PE worldwide [12].

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The recurrent emerging pattern appears to be that PE is a largely underdiagnosed condition. The etiology of PE has been traditionally divided between “psychogenic” and “biogenic” factors. Psychogenic causes include anxiety, an unpleasant introductory or early sexual experience, infrequent sexual intercourse, poor ejaculatory control techniques, and evolutionary as well as psychodynamic factors. A recent Medline search (January 2008) for articles related to PE, from 1949 to the present, uncovered a total of 589 references of which 160 articles (27%) had been published within the past 2 years.

Much of this recent surge in interest has focused on new and promising medical relief for men who are troubled by this vexing condition. This review, while recognizing the critical importance of an integrated approach to the evaluation and management of PE—coordinating participation on the part of urologists, mental health professionals, endocrinologists, primary care physicians, and other interested healthcare professionals—is directed primarily at providing an update on recent developments in the medical treatment of PE. The definition of PE is still evolving, but the classic triad involved in the definition includes (i) short intravaginal ejaculatory latency time (IELT), (ii) lack of control, and (iii) sexual dissatisfaction [1]. The World Health Organization (WHO) 1994 International Classification of Diseases defines PE as “an inability to delay ejaculation sufficiently to enjoy lovemaking, manifest as either of the following: occurrence of ejaculation before or very soon after the beginning of intercourse (if a time limit is required: before or within 15 seconds of the beginning of intercourse); occurrence of ejaculation in the absence of sufficient erection to make intercourse possible. The problem is not the result of prolonged absence from sexual activity” [1].

• Premature ejaculation is classified as lifelong or acquired.
• Lifelong PE begins from the first sexual experience.
• Acquired PE develops after a period of normal function.
• Sensory sensitivity might influence PE severity.
• Partner communication can improve PE management.
• Pelvic floor exercises may help control ejaculation.
• Squeeze techniques can delay climax.
• Pharmacological options include SSRIs, dapoxetine.
• Biofeedback therapy is an emerging PE treatment.
• Erectile dysfunction and PE can coexist.
• Proper diagnosis ensures effective treatment.

Furthermore, the WHO definition excludes men whose PE is predominately attributed to (i) alcohol, substance abuse, and/or medications; (ii) a sexual context that has led to very high levels of arousal because of the novelty of partner or situation; and (iii) a low frequency of sexual activity [1]. Others have based their diagnosis on the number of penile thrusts occurring before ejaculation, considering less than 8–15 thrusts as the criterion for PE [2,3]. In 2007, responding to the variability of worldwide definitions and the need for a universal standard, the International Society for Sexual Medicine (ISSM) established an ad hoc committee consisting of 21 internationally recognized experts, to establish a new definition of PE. This latest ISSM definition, based on the recommendations of the most active and respected clinical and basic science experts in the field, characterized PE as follows: “Premature ejaculation is a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and inability to delay ejaculation on all or nearly all vaginal penetrations; and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy” [4]. Based on this new definition, some investigators may question the conclusions of previous studies with potentially inadequate patient selection definitions. Other related definitions include primary or lifelong PE—presence sildenafil for women of the problem from the onset of initial sexual activity; acquired or late onset PE—indicates that the problem has developed after an initial time of unimpaired ejaculatory function; and situational (vs. global) PE—indicates PE that is limited to specific partner or situation, while the patient enjoys satisfactory intercourse in other contexts [5]. The National Health and Social Life Survey, a probability sample study of sexual behavior in men and women aged 18–59 years, reported a prevalence of 21% among men in the United States [6]. Nathan [7] analyzed the findings of 22 general population sex surveys, and estimated the prevalence of PE to be 35%. Most estimates from other general population prevalence studies fall between 22% and 38%, with ranges from 4% to 39% [8–10]. The wide variability in the reported ranges is mirrored in the variability and lack of standardized definitions for PE.

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Hossein Sadeghi-Nejad, MD, FACS, and Richard Watson, MD, FACS A B S T R A C TIntroduction. Premature ejaculation (PE) is the most common form of male sexual dysfunction. Until very recently, scientific investigation of PE has been hampered by a lack of standardized definitions and objective, validated questionnaires. Small numbers of randomized controlled studies evaluating various treatment options have also added to the challenges facing the clinicians who manage PE. This article provides a summary of some of the more relevant the peer-reviewed literature pertaining to the medical therapy of premature ejaculation.

The pathophysiology of acquired premature ejaculation

A retrospective review of peer reviewed publications relevant to the field of premature ejaculation and related medical therapies. Review of safety and efficacy of various medical therapies for premature ejaculation. Selective serotonin release inhibitors have been the most promising agents to date. The on-demand “PRN” use of these agents is more convenient, but its efficacy is less well established. Chronic use of this class of medications has been associated with minor, but bothersome side effects.

Clinical study of SS-cream in patients with lifelong premature ejaculation

More recently, concern over the risk of an increased suicide rate in young men upon initiation of SSRIs has dampened enthusiasm. Recent experience with the use of Tramadol raises the hope that this might prove to be an sildenafil citrates agent as effective as SSRIs with less worrisome risk of side-effects. New trials on novel formulations of topical solutions are currently underway in the United States. Interest in medical therapy for PE is rapidly increasing and reflected in a disproportionate number of publications in this field in the past few years. Clinical research in this field is hampered by the complexity, variability among different men and cultures, and subjectivity of PE. A number of studies have raised the point that in spite of the high prevalence rates, PE is the disorder for which patients are least likely to seek professional assistance, raising the distinct possibility that the problem may be more prevalent than currently estimated [8,10]. More recently, the PE Prevalence and Attitudes (PEPA) internetbased survey of 12,133 men aged 18–70 in the United States, Germany, and Italy reported a prevalence of 22.7% [11].

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The 154 participants in this retrospective study entered a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex. Of the 95 participants who completed follow-up, 64% maintained satisfactory ejaculation control at 24 months and 56% did so at 36 months. Surgical procedures that reduce penile sensation have been proposed as treatments for premature ejaculation. These include selective dorsal nerve neurotomy, pulsed radiofrequency ablation or cryoablation of dorsal penile nerves, and hyaluronic acid gelaugmentation of the glans penis.

More Information

[61, 62] Currently, all those are considered experimental. Before the availability of nonsurgical methods for treating erectile dysfunction, a patient with premature ejaculation who was mistakenly diagnosed with erectile dysfunction might have undergone a penile prosthesis implantation, which would have yielded unsatisfactory results because of the incorrect initial diagnosis. In this scenario, the patient would be able to engage in sexual intercourse, because the penile implant would provide an adequate erection, but he would still climax prematurely. Currently, penile implants are placed much more rarely, and with the use of nonsurgical treatments for erectile dysfunction, any permanent harm resulting from diagnosing erectile dysfunction rather than premature ejaculation is unlikely. Consultation with a sex therapist, psychologist, or psychiatrist may prove helpful if the primary care physician or urologist cannot provide successful treatment or does not have the time to explore psychological issues and implement behavioral techniques (eg, squeeze-pause).

Efficacy of sildenafil citrate (viagra) in men with premature ejaculation

If the primary care physician or urologist is inexperienced or uncomfortable with treating premature ejaculation, early referral to a sex therapist, psychologist, or psychiatrist is indicated. Some physicians are comfortable sildenafil spray implementing pharmacologic therapy but not behavioral therapy. As with any medical condition, the patient should be offered all available treatment options, and the physician should proceed with referral for any option considered to require more specialized help than the physician can provide. For men who may have a severe emotional disturbance underlying the premature ejaculation, referral to a mental health professional is most appropriate. Diagnosis and treatment of the various psychological factors that manifest partly as premature ejaculation are beyond the scope of this discussion. It is noteworthy that only 9% of the men in this survey had consulted a physician, and more than 90% reported little or no improvement after they sought treatment, leading to a general lack of satisfaction with the results. It has also been suggested that the prevalence of PE may vary between racial groups; one recent survey of 1,320 men found that PE was more prevalently admitted among Hispanic men, highlighting the importance of further investigation of ethnic and cultural variances in PE worldwide [12]. The recurrent emerging pattern appears to be that PE is a largely underdiagnosed condition. The etiology of PE has been traditionally divided between “psychogenic” and “biogenic” factors. Psychogenic causes include anxiety, an unpleasant introductory or early sexual experience, infrequent sexual intercourse, poor ejaculatory control techniques, and evolutionary as well as psychodynamic factors.