Pharmacologic Treatment of Rapid Ejaculation: Levels of Evidence-Based Review

Rapid (premature) ejaculation (RE) is defined as persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before it is wished by the man or his partner. RE is the most frequently encountered sexual complaint of men and couples. Estimates suggest that as many as one third of all sexually active men suffer from RE. RE has been treated with various modalities. These include behavioral therapy, topical applications, oral pharmacotherapy and intracavernosal vasoactive drug injection. The success rates of these modalities are variable, however, to date an approved treatment does not exist. In this article, we review the evidence surrounding the pharmacological management of RE. The search included (i) a MEDLINE search from 1980 through August 2005 limited to Englishlanguage medical literature; (ii) relevant abstracts from 2003, 2004, and 2005; and (iii) a pipeline search for therapeutics in development. The review does not include behavioral therapy. The distinct feature of this review is that the level of evidence supporting each treatment will be discussed in details. Results showed that there is consistent evidence which supports the daily use of paroxetine, clomipramine, sertraline and fluoxetine for the treatment of RE. There is no strong evidence suggesting the use of these previous drugs on an as-needed basis. There is strong evidence to suggest the use of dapoxetine on an as-needed in RE. Available evidence indicates that topical anesthetic agents such as prilocaine-lidocaine and SS-cream appears to be effective in treatment of RE. There is no strong evidence to suggest that PDEI5 could prolong IELT in RE when used on-demand. In conclusion, based on literature data, although some drugs may be effective in treatment of RE, more extended multi-center prospective double-blind, placebo-controlled stopwatch studies on the benefits of SSRIs, SNRIs and PDEI5 in RE are required.