Trip Answers

Question answered:05/04/06 Warning! this question is over two years old.

In 2004 Bandolier carried out a review of a systematic review [1]. 

A 2004 guideline, published by the American Urological Association [2], includes the following statement:

“Premature ejaculation can be treated effectively with several serotonin reuptake inhibitors (SRIs) or with topical anesthetics. The optimal treatment choice should be based on both physician judgment and patient preference. (Based on Panel consensus and review of data.)”

We have also looked for randomised controlled trials published since mid-2004.  We will report these briefly below (see reference section for URLs to abstracts, which we recommend you read).  We have not assessed these trials for bias.

Title: On-demand treatment of premature ejaculation with clomipramine and paroxetine: a randomized, double-blind fixed-dose study with stopwatch assessment. [3]
Conclusion: On-demand treatment with 25 mg clomipramine led to a clinical relevant ejaculation delay. In contrast, 20 mg paroxetine had no clinical relevant ejaculation delay in men with lifelong premature ejaculation with an IELT of less than 1 minute. Both drugs exert mostly mild yet annoying non-sexual side effects both at the coitus day and the next day.

Title: Safety and efficacy of citalopram in the treatment of premature ejaculation: a double-blind placebo-controlled, fixed dose, randomized study. [4]
Conclusion: these results indicate that citalopram has significantly better results in terms of IVELT and intercourse satisfaction versus placebo. Further studies with different dosages and treatment regimens are necessary to draw final conclusions on the efficacy of this drug in PE and to prolong the efficacy.

Title: Efficacy of sildenafil citrate (Viagra) in men with premature ejaculation [5]
Conclusion: Although IELT and VTS-ELT were not significantly improved, sildenafil increased confidence, the perception of ejaculatory control, and overall sexual satisfaction, and decreased the refractory time to achieve a second erection after ejaculation in men with PE.

Title: Comparison of efficacy of sildenafil-only, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation. [6]
Conclusion: Sildenafil-only was not superior to placebo or combination treatment. Topical EMLA-cream-only had equal effectiveness to that of sildenafil plus topical EMLA treatment. The use of topical EMLA-cream-only seems to be an effective treatment of premature ejaculation.

References

1) Bandolier. Premature ejaculation treatments reviewed. 2004 (http://www.jr2.ox.ac.uk/bandolier/band128/b128-3.html)
2) Erectile Dysfunction Guideline Update Panel. AUA guideline on the pharmacologic management of premature ejaculation. Linthicum (MD): American Urological Association, Inc.; 2004. (http://www.guideline.gov/summary/summary.aspx?doc_id=4870&nbr=3504&ss=6&xl=999)
3) Waldinger MD et al. On-demand treatment of premature ejaculation with clomipramine and paroxetine: a randomized, double-blind fixed-dose study with stopwatch assessment. r Urol. 2004 Oct;46(4):510-5 (http://www.hubmed.org/display.cgi?uids=15363569)
4) Safarinejad MR et al.  Safety and efficacy of citalopram in the treatment of premature ejaculation: a double-blind placebo-controlled, fixed dose, randomized study.  J Impot Res. 2006 Mar-Apr;18(2):164-9. (http://www.hubmed.org/display.cgi?uids=16107866)
5) McMahon CG et al. Efficacy of sildenafil citrate (Viagra) in men with premature ejaculation. J Sex Med. 2005 May;2(3):368-75 (http://www.hubmed.org/display.cgi?uids=16422868)
6) Atan A et al. Comparison of efficacy of sildenafil-only, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation. Urology. 2006 Feb;67(2):388-91. (http://www.hubmed.org/display.cgi?uids=16461091)
 

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