Efficacy of sertraline hydrochloride in treatment of premature ejaculation: a placebo-controlled study using a validated questionnaire On-demand tramadol hydrochloride use in premature ejaculation treatment. Duloxetine, dual serotonin and norepinephrine reuptake inhibitor, versus paroxetine, selective serotonin reuptake inhibitor, in the treatment for premature ejaculation Treatment benefit of dapoxetine for premature ejaculation: results from a placebo‐controlled phase III trial Efficacy and safety of dapoxetine in men with premature ejaculation and concomitant erectile dysfunction treated with a phosphodiesterase type 5 inhibitor: randomized, placebo-controlled, phase III study. On-demand use of tramadol, sildenafil, paroxetine and local anaesthetics for the management of premature ejaculation: A randomised placebo-controlled clinical trial Safety and Efficacy of Escitalopram in the Treatment of Premature Ejaculation: A Double-Blind, Placebo-Controlled, Fixed-Dose, Randomized Study In vitro measurement of ejaculation latency time (ELT) and the effects of vardenafil on ELT on lifelong premature ejaculators: placebo-controlled, double-blind, cross-over laboratory setting PSD502 improves ejaculatory latency, control and sexual satisfaction when applied topically 5 min before intercourse in men with premature ejaculation: results of a phase III, multicentre, double‐blind, placebo‐controlled study Topical eutectic mixture for premature ejaculation (TEMPE): a novel aerosol‐delivery form of lidocaine‐prilocaine for treating premature ejaculation The efficacy of duloxetine in the treatment of premature ejaculation Comparison Between Tadalafil Plus Paroxetine and Paroxetine Alone in the Treatment of Premature Ejaculation Evaluation of tramadol on demand vs. daily paroxetine as a long-term treatment of lifelong premature ejaculation. The global online sexuality survey (GOSS): The United States of America in 2011 Chapter III--Premature ejaculation among English-speaking male Internet users. Relevance of serum nitric oxide levels and the efficacy of selective serotonin reuptake inhibitors treatment on premature ejaculation: decreased nitric oxide is associated with premature ejaculation Sertraline in the treatment of premature ejaculation: A double-blind placebo controlled study Treatment of premature ejaculation with sertraline hydrochloride: a single-blind placebo controlled crossover study. Dapoxetine for the treatment of premature ejaculation: results from a randomized, double-blind, placebo-controlled phase 3 trial in 22 countries. The Efficacy and Safety of On-demand Tramadol and Paroxetine Use in Treatment of Life Long Premature Ejaculation: A Randomized Double-blind Placebo-controlled Clinical Trial Can sildenafil treat primary premature ejaculation? A prospective clinical study. Topical anaesthetic use for treating premature ejaculation: a double‐blind, randomized, placebo‐controlled study [Comparison between sildenafil plus sertraline and sertraline alone in the treatment of premature ejaculation]. Comparison of the clinical efficacy and safety of the on‐demand use of paroxetine, dapoxetine, sildenafil and combined dapoxetine with sildenafil in treatment of patients with premature ejaculation: A randomised placebo‐controlled clinical trial A randomized double-blind, placebo-controlled multicenter study to evaluate the efficacy and safety of two doses of the tramadol orally disintegrating tablet for the treatment of premature ejaculation within less than 2 minutes. Treatment of premature ejaculation in the Asia-Pacific region: results from a phase III double-blind, parallel-group study of dapoxetine. Combination therapy with selective serotonin reuptake inhibitors and phosphodiesterase‐5 inhibitors in the treatment of premature ejaculation Free nerve ending density on skin extracted by circumcision and its relation to premature ejaculation. Safety and efficacy of vardenafil versus sertraline in the treatment of premature ejaculation: a randomised, prospective and crossover study Comparison between on-demand dosing of dapoxetine alone and dapoxetine plus mirodenafil in patients with lifelong premature ejaculation: prospective, randomized, double-blind, placebo-controlled, multicenter study. Does circumcision have a relationship with ejaculation time? Premature ejaculation evaluated using new diagnostic tools Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: a double-blind, placebo controlled study. Safety and efficacy of tramadol hydrochloride on treatment of premature ejaculation. The efficacy of fluoxetine in the treatment of premature ejaculation: a double-blind placebo controlled study. A randomized, double-blind, placebo-controlled, crossover trial of “on-demand” tramadol for treatment of premature ejaculation Improved ejaculatory latency, control and sexual satisfaction when PSD502 is applied topically in men with premature ejaculation: results of a phase III, double-blind, placebo-controlled study. Tadalafil and Fluoxetine in Premature Ejaculation: Prospective, Randomized, Double-Blind, Placebo-Controlled Study The effects of fluoxetine on several neurophysiological variables in patients with premature ejaculation. Treatment of premature ejaculation with paroxetine hydrochloride as needed: 2 single-blind placebo controlled crossover studies. Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment
Selective serotonin reuptake inhibitors ( SSRIs ) are increasingly used to treat premature ejaculation . We report a large prospect i ve placebo-controlled crossover study of sertraline in premature ejaculation ( PE ) using Arabic Index of Premature Ejaculation ( AIPE ) . One hundred and forty-seven men suffering from PE were enrolled in a r and omized single-blinded crossover study of sertraline hydrochloride and placebo .  Patients were r and omized into group 1 ( n=77 ) and group 2 ( n=70 ) . Both groups received sertraline and placebo interchangeably for 4 weeks . Overall , 127 ( 81 % ) of 157 subjects experienced a significant increase in their AIPE total score after sertraline treatment . Sixty-six ( 66 % ) of 100 patients available for follow-up experienced relapse of PE within 6 months after sertraline withdrawal . The active drug was generally well tolerated . Our relatively large study , using a vali date d question naire ( AIPE ) , confirmed the useful effect of sertraline on PE OBJECTIVES To determine the efficacy of tramadol in premature ejaculation ( PE ) treatment compared with placebo . METHODS A single-blind , placebo-controlled , crossover study was conducted with 60 lifelong ( primary ) patients with PE . The patients were r and omized into 2 groups , each consisting of 30 patients , who took tramadol or placebo on dem and . PE was defined as an intravaginal ejaculation latency time of ≤60 seconds in 90 % of intercourse episodes . The efficacy of the drugs was assessed using the intravaginal ejaculation latency time , ability of ejaculation control , and sexual satisfaction scores after an 8-week treatment period . RESULTS All participants completed the study voluntarily . Two groups were similar in terms of the patient demographics . Increases in the intravaginal ejaculation latency time , ability of ejaculation control , and sexual satisfaction score between the placebo and tramadol groups were compared with the baseline values in both groups . At the end of study period , the tramadol group had significantly ( P<.001 ) greater values for all 3 parameters compared with those in the placebo group . CONCLUSIONS On-dem and use of low-dose tramadol is effective for lifelong PE . Currently , selective seratonin reuptake inhibitors such as dapoxetine , are a more popular treatment option for PE . However , tramadol might be considered an alternative agent for primary PE treatment Abstract Purpose In the current analysis due to the mechanism of effect , we evaluated the treatment benefit of duloxetine 40 mg comparing with paroxetine 20 mg , based on its effects on personal distress and interpersonal difficulty related to ejaculation , perceived control over ejaculation , and satisfaction with sexual intercourse , as well as the patient-reported global impression of change in premature ejaculation ( PE ) and the effect on intravaginal ejaculatory latency times ( IELT ) in men with premature ejaculation . Material s and methods The study included 80 married male patients diagnosed with lifelong PE . A total of 80 patients were r and omly distributed into two groups of 40 patients each . Group 1 patients received 40 mg duloxetine once a day for a month . Group 2 patients received 20 mg paroxetine once a day for a month . International index of erectile function question naire ( IIEF ) and IELT and PE profile were recorded before and after treatment . Results Comparing the groups ’ mean treatment IELT , there was no difference between groups . The IELT increase from baseline to treatment was 117 % in the duloxetine group ( P < 0.001 ) and 126 % in the paroxetine group ( P < 0.001 ) . There was no statistical difference between two groups in terms of IELT increase ( P > 0.05 ) . Also , there was no statistically significant difference between two groups at baseline IIEF to treatment IIEF scores . All PEP measures improved significantly with duloxetine and paroxetine groups ( P < 0.001 ) . Conclusion We think that duloxetine is safe and effective for the treatment for premature ejaculation To evaluate the overall treatment benefit of dapoxetine for  premature ejaculation ( PE )  , with specific emphasis on improvements in personal distress and interpersonal difficulty related to ejaculation .  Although these factors are key elements of numerous sets of diagnostic criteria for PE , they have rarely been evaluated as outcome measures in clinical trials INTRODUCTION Men with comorbid erectile dysfunction ( ED ) and premature ejaculation ( PE ) may be concomitantly prescribed a phosphodiesterase type 5 ( PDE5 ) inhibitor and dapoxetine . AIM Evaluate efficacy and safety of dapoxetine 30 mg and 60 mg on dem and ( prn ) in men with PE and ED who were being treated with PDE5 inhibitors . METHODS This r and omized , double-blind , placebo-controlled , flexible-dose , multicenter study enrolled men ≥18 years who met diagnostic criteria for PE including intravaginal ejaculatory latency time ( IELT ) of ≤2 minutes in ≥75 % of sexual intercourse episodes ; were on stable regimen of a PDE5 inhibitor ; and had International Index of Erectile Function-erectile function domain score ≥21 . Subjects received placebo , dapoxetine 30 mg , or dapoxetine 60 mg prn ( 1 - 3 hours before intercourse ) for 12 weeks . MAIN OUTCOME MEASURE Stopwatch-measured average IELT , Clinical Global Impression of Change ( CGIC ) in PE , Premature Ejaculation Profile ( PEP ) , and treatment-emergent adverse events ( TEAEs ) . RESULTS Of 495 subjects r and omized , 429 completed the study . Arithmetic mean average IELT significantly increased with dapoxetine vs. placebo at end point ( 5.2 vs. 3.4 minutes ) and weeks 4 , 8 , and 12 ( P ≤ 0.002 for all ) . Men who described their PE at least " better " using the CGIC were significantly greater with dapoxetine vs. placebo at end point ( 56.5 % vs. 35.4 % ) and weeks 4 , 8 , and 12 ( P ≤ 0.001 for all ) . Significantly better outcomes were also reported with dapoxetine vs.  placebo on PEP measures . Incidence of TEAEs was 20.0 % and 29.6 % in placebo- and dapoxetine-treated subjects , respectively ( P = 0.0135 ) . TEAEs led to discontinuation in 1.6 % of subjects in both groups . Most frequent TEAEs were known adverse drug reactions of dapoxetine treatment including nausea ( 9.2 % ) , headache ( 4.4 % ) , diarrhea ( 3.6 % ) , dizziness ( 2.4 % ) , and dizziness postural ( 2.4 % ) . CONCLUSIONS In men with PE and comorbid ED on a stable regimen of PDE5 inhibitor , dapoxetine provided meaningful treatment benefit and was generally well tolerated Abstract Objectives : To compare the clinical efficacy of the on-dem and use of four drugs in the management of patients with premature ejaculation ( PE ) , as the off-label use of selective serotonin-reuptake inhibitors and topical penile anaesthetics is frequently indicated for the management of patients with PE , and tramadol HCl and sildenafil citrate were also tried for managing this disorder , but with recommendations based on weak evidence . Patients and methods : This was a single-centre , single-blind , placebo-controlled clinical trial conducted on 150 patients who had PE for > 1 year . Patients were r and omised equally into five groups .  On-dem and tramadol , sildenafil , paroxetine , local lidocaine gel or placebo was given for patients in groups 1–5 , respectively . During the month before treatment , the intravaginal ejaculation latency time ( IELT ) and sexual satisfaction scores ( on a 0–5-point scale ) were measured and compared to the mean IELT and sexual satisfaction scores recorded during 4 weeks of on-dem and drug administration , with monitoring of any possible side-effects . Results : Tramadol-treated patients had a significantly longer mean ( SD ) IELT , of 351 ( 119 ) s , than the other groups . Local anaesthetic was significantly better than paroxetine in prolonging the IELT , at 278 ( 111 ) vs. 186 ( 65 ) s , respectively . The improvement in sexual satisfaction was significantly better in the sildenafil group , with a mean ( SD ) improvement of 2.9 ( 1 ) points , than in the paroxetine and local anaesthetic groups , at 2.2 ( 0.9 ) and 1.9 ( 0.9 ) points , respectively . Conclusions : The four drugs significantly improved IELT values over placebo . Tramadol was associated with significantly longer IELT values , whilst sildenafil induced significantly better sexual satisfaction than the other drugs . The four drugs had tolerable side-effects Purpose : To evaluate the efficacy and safety of most selective serotonin reuptake inhibitor drug , escitalopram , in delaying ejaculation in patients with premature ejaculation ( PE ) . Material s and Methods : A total of 276 married men ( mean age , 34.4 years ) with PE were r and omly assigned to receive 10 mg of escitalopram ( n = 138 ; Group 1 ) or placebo ( n = 138 ; Group 2 ) for 12 weeks . Pretreatment evaluation included history and physical examination , intravaginal ejaculatory latency time ( IELT ) , International Index of Erectile Function ( IIEF ) , and Meares-Stamey test . The efficacy of 2 treatments was assessed every 2 weeks during treatment , at the end of study , and in 3- and 6-month follow-up after cessation of treatment . Results : At the end of 12-week treatment , the escitalopram group had a 4.9-fold ( 95 % confidence interval [ CI ] , 3.14 - 6.12 ) increase of the geometric mean IELT , whereas after placebo , the geometric mean IELT did not increase significantly ( 1.4-fold increase ; 95 % CI , 0.86 - 1.68 ; P = 0.001 ) . Baseline mean intercourse satisfaction domain values of IIEF 10 and 11 reached to 16 and 10 at 12-week treatment in Groups 1 and 2 , respectively ( P = 0.01 ) . At the end of 6-month follow-up period , the geometric mean IELT in escitalopram and placebo group demonstrated 3.1- ( 95 % CI , 2.16 - 4.4 ) and 1.3-fold ( 95 % CI , 0.78 - 1.62 ) increase , respectively ( P = 0.001 ) . Three- and 6-month intercourse satisfaction domain values of IIEF were 15 and 14 in Groups 1 and 10 and 10 ( P = 0.01 ) in Group 2 , respectively . Mean number of adverse events was 22 for escitalopram and 9 for placebo ( P = 0.04 ) . Conclusions : Oral escitalopram is an effective treatment for PE with long-term benefit for the patient after it is withdrawn . Further studies are required to draw final conclusions on the efficacy of this drug in PE Objective The aim of this study is to measure the ejaculation latency time ( ELT ) and to evaluate the effects of vardenafil on ELT and rigidity parameters of patients with lifelong premature ejaculation ( PE ) in a laboratory setting . Material s and methods Double-blind , placebo-controlled , cross-over laboratory study was performed with 40 males with lifelong PE . As the subject ingested the placebo or vardenafil , real-time penile tumescence and rigidity monitoring began . Audiovisual sexual stimulation ( AVSS ) was performed 45 min later . The patient began vibratory stimulation to the frenular area at 8th minute of AVSS till ejaculation . A button has been placed under the cover where the patient presses to operate the vibrator . ELT was calculated in seconds with a chronometer . Following ejaculation , AVSS was stopped . The test was repeated with second medication in 7–15 days . Results Among 40 patients , the results of 17 could be evaluated . When the patient took placebo and vardenafil , mean ELTs were 62.7 and 189.5 s , respectively . When compared with placebo , vardenafil  improved ELT significantly ( P = 0.04 ) . After the beginning of AVSS , time to first recorded base or tip rigidities was shorter and time to last recorded tip or base rigidities following ejaculation was longer than placebo ; however , these differences were not significant ( P > 0.05 for each ) . Conclusions This laboratory design might be used to evaluate the effects of drugs on patients with ejaculation disorders . In this laboratory setting study , vardenafil exerted a threefold increase in ejaculation delay outside the vagina in patients with lifelong PE To determine the effect of PSD502 applied topically 5 min before intercourse on the Index of Premature Ejaculation ( IPE ) and intravaginal ejaculatory latency time ( IELT ) of men with lifelong premature ejaculation ( PE ) defined according to the International Society of Sexual Medicine ( ISSM ) definition ; secondary objectives were to evaluate the safety and tolerability of PSD502 in patients with PE , and their sexual partners To evaluate , in a phase II study , the efficacy and safety of a topical eutectic mixture for premature ejaculation ( TEMPE ) , a metered‐dose aerosol spray containing a eutectic mixture of lidocaine and prilocaine , as a treatment for PE Abstract Aim : Though premature ejaculation ( PE ) has been overshadowed by current attention given to erectile dysfunction , it is the most widespread form of male sexual dysfunction . Delayed or inhibited ejaculation , a known side effect of selective serotonin reuptake inhibitors ( SSRIs ) , has made SSRIs potentially useful in the treatment of this disorder . In the present study , we examined the efficacy of duloxetine , an SSRI , in the treatment of PE . Method : The study included 20 married patients diagnosed with PE . The patients were r and omly assigned to two groups , duloxetine ( group I ) and placebo ( group II ) , each consisting of 10 patients . The effects on the ejaculatory function were estimated by the intravaginal ejaculation latency time . All patients were evaluated by using clinical global impression-improvement Scale ( CGI-I ) . Results : The increase in the intravaginal ejaculation latency time in the duloxetine group was statistically significant than that of placebo group . Of group I patients , four ( 40 % ) were considered as “ very much improved ” and four ( 40 % ) “ much improved ” by CGI-I and only one of group II patients ( 10 % ) showed “ much improved ” . Conclusion : Duloxetine appears to be superior to placebo in the pharmacological treatment of PE when administered on a chronic basis Background : Several recent studies have investigated the therapeutic role of phosphodiesterase type 5 ( PDE5 ) inhibitors in premature ejaculation ( PE ) used in the treatment of erectile dysfunction . Objectives : In the present research , the efficacy of paroxetine alone and paroxetine plus tadalafil was compared in patients referred because of premature ejaculation . Patients and Methods : This quasi-experimental study was performed on 100 consecutive 17 to 49-year-old potent men with premature ejaculation and without any clear organic disease . All patients had lifelong PE with an intravaginal ejaculation latency time ( IELT ) shorter than 1.5 minutes . Informed consent was obtained from all patients who were r and omly divided into two groups using a computer-generated r and om tabulation list . In group A , patients received 10 mg paroxetine daily , in addition to four hours before planned sexual activity . In group B , 10 mg paroxetine was taken daily , plus 10 mg tadalafil one hour before planned sexual activity . The duration of the intervention was six months and patients were evaluated for IELT three and six months after the beginning of therapy . Results : The mean age of patients in groups A and B were 33 ± 9.6 and 31.2 ± 9.3 years , respectively ( P = 0.368 ) . The mean number of intercourses were 1.08 ± 0.6 and 1.12 ± 0.6 per week in groups A and B , respectively ( P = 0.791 ) . Mean IELT at the 3-month follow up in groups A and B was 4.5 ± 1.5 and 5 ± 2.4 minutes , respectively ( P = 0.285 ) and at the 6-month follow up was 4.8 ± 1 and 5.3 ± 2 minutes , respectively ( P = 0.278 ) . Conclusions : The results of the study show that tadalafil can increase the mean IELT and can be used for treatment of premature ejaculation in combination with paroxetine INTRODUCTION Premature ejaculation ( PE ) is the most common male sexual dysfunction with many lines of treatment that show conflicting results . Paroxetine and tramadol were both reported to be effective in treatment of PE . AIM To investigate the effectiveness of long-term daily paroxetine vs. on-dem and tramadol HCl in treatment of PE . MAIN OUTCOME MEASURES Intravaginal ejaculatory latency time ( IELT ) and Arabic Index of PE ( AIPE ) were used to assess the efficacy of investigated drugs . METHODS Thirty-five cases with lifelong PE were enrolled in this study . Baseline recording of IELT using a stop watch and AIPE was done . Patients were r and omized to take tramadol HCl on-dem and or daily paroxetine . Re assessment was done after 6 and 12 weeks . A wash-out period for 2 weeks was given before cross-over to the other medication . Assessment of the effect of the second medication after 6 and 12 weeks was done . RESULTS Tramadol and paroxetine increased IELT significantly after 6 weeks by seven- and 11-folds , respectively , compared with baseline . After 12 weeks , a decline of IELT to fivefolds was recorded with tramadol whereas further increase of IELT to 22-folds was recorded with paroxetine compared with baseline ( P < 0.05 ) . Tramadol improved AIPE score significantly after 6 weeks but not after 12 weeks vs. baseline , whereas paroxetine increased the AIPE score after 6 and 12 weeks vs. baseline ( P < 0.05 ) . CONCLUSIONS Daily paroxetine is more effective than on-dem and tramadol for treatment of lifelong PE . Tramadol is not recommended as a long-term treatment of lifelong PE INTRODUCTION The Global Online Sexuality Survey ( GOSS ) is a worldwide epidemiologic study of sexuality and sexual disorders . In 2010 , the first report of GOSS came from the Middle East . AIM This report studies the prevalence rate of premature ejaculation ( PE ) in the U.S. as of 2011 - 2012 and evaluates risk factors for PE . METHODS GOSS was r and omly deployed to English-speaking male web surfers in the USA via paid advertising on Facebook ® , comprising 146 questions . MAIN OUTCOME MEASURES Prevalence of PE as per the International Society of Sexual Medicine 's ( ISSM ) definition . RESULTS With a mean age of 52.38 years ± 14.5 , 1,133 participants reported on sexual function . As per the ISSM definition of PE , the prevalence rate of PE in the USA as of 2011 was 6.3 % . This is in contrast to 49.6 % as per the Premature Ejaculation Diagnostic Tool ( PEDT ) , 77.6 % as per unfiltered subjective reports , and 14.4 % as per subjective reporting on more consistent basis . 56.3 % of the latter reported lifelong PE . 63.2 % could be classified as having natural variable PE . Erectile dysfunction is a possible predisposing factor for acquired PE , while genital size concerns may predispose to lifelong PE . Age , irregular coitus , circumcision , and the practice of masturbation did not pose a risk for PE , among other risk factors . Oral treatment for PE was more frequently used and reported to be more effective than local anesthetics , particularly in those with lifelong PE . CONCLUSION Applying the ISSM definition , prevalence of PE is far less than diagnosed by other methods , 6.3 % among Internet users in USA as of the year 2011 . PEDT measures both lifelong and acquired PE , in addition to 35 % men with premature-like ejaculatory dysfunction  , making it inaccurate for isolating lifelong and acquired PE cases The aim of the present study was to determine the relevance of serum nitric oxide levels and the efficacy of selective serotonin reuptake inhibitors ( SSRI ) treatment on  premature ejaculation . Sixty married men ( aged 20–50 ) with lifelong premature ejaculation and forty healthy men ( aged 24–48 ) as control group were included in this study . The patients were evaluated by  intravaginal ejaculation latency time ( IELT ) for premature ejaculation ( PE ) . IELT<1 min is accepted PE . Patients with diabetes mellitus , chronic disorders or erectile dysfunction and heavy smokers were excluded . All patients were evaluated with history , physical examination , International Index of Erectile Dysfunction‐5 ( IIEF‐5 ) score and IELT by stopwatch  method . Nitric oxide levels were measured by Griess reaction , and all sample s were frozen at −80 ° C . Patients were r and omly categorised 4 group to receive fluoxetine 20 mg day−1 ( Group 1 ) , paroxetine 20 mg day−1 ( Group 2 ) , sertraline 50 mg day−1 ( Group 3 ) and healthy control ( Group 4 ) for 4 weeks . Baseline and post‐treatment findings were compared between the four groups . At the end of 4 weeks , in fluoxetine , paroxetine , sertraline  groups mean IELT values showed a statistically significant improvement from the baseline values ( P < 0.001 , P < 0.001 , P = 0.03 ; respectively ) . Baseline and 1st month follow‐up mean IIEF scores were 24.5 and 23.05 , 24.70 and 23.60 ( P < 0.05 ) in group 1 and group 3 respectively ; also 23.09 and 23.32 ( P > 0.05 ) in group 2 . Baseline serum NO levels were 31.8 , 30.44 , 30.8 and 42.84 in fluoxetine , paroxetine , sertraline and healthy control groups respectively . NO levels were statistically lower in patients with PE . After treatment of fluoxetine , paroxetine and sertraline , NO levels were increased baseline ( 35.8 , 36.4 , 38.08 ) ( P < 0.05 ) . Our findings indicated that PE is associated with decreased serum NO levels . After the SSRI treatment increased , NO may retard ejaculation presumably by central peripheral mechanism . Further studies are needed to confirm this suggestion and the role of NO in pathophysiology and treatment for premature ejaculation This study investigated the efficacy and the adverse effects of sertraline in the treatment of premature ejaculation ( PE ) . Thirty-seven patients with PE were r and omly assigned to receive either sertraline or a placebo . Of them 22 were given 50 mg of sertraline per day and the other 15 patients were given an identical placebo one per day . After 4 weeks , the latency to ejaculation in the sertraline group was found to be significantly longer than that of the placebo group ( p<0.01 ) . None of the patients discontinued therapy due to adverse effects . These results indicate that  sertraline is an effective therapy for PE PURPOSE The efficacy of sertraline hydrochloride for the treatment of  premature ejaculation  is evaluated . MATERIAL S AND METHODS A total of 37 potent men , 19 to 70 years old ( mean age 41 ) , with premature ejaculation were treated with 50 mg . oral sertraline and placebo in a controlled r and omized single-blind crossover trial . All men were either married or in a stable relationship . None of the patients received any formal psychosexual therapy . Chronic open label treatment with sertraline was continued in 29 patients who had achieved an increase in ejaculatory latency times over pretreatment levels with active drug in the initial crossover study . In an attempt to identify which patients could maintain the improved ejaculatory control after withdrawal of the active drug , serial drug withdrawal was conducted every 4 weeks with drug initiation after a further 2 weeks if improved ejaculatory control was not maintained . RESULTS The mean pretreatment ejaculatory latency time was 0.3 minute ( range 0 to 1 ) . The mean ejaculatory interval after 4 weeks of treatment was 3.2 minutes ( range 1 minute to anejaculation ) with sertraline and 0.5 minute ( range 0 to 1 ) with placebo ( p < 0.001 ) . Intravaginal ejaculation was achieved for the first time in 5 patients with primary premature ejaculation and 2 patients experienced anejaculation . One patient described minor drowsiness and anorexia , and 2 patients described mild , transient gastrointestinal upset . Staged drug withdrawal allowed 20 of the 29 patients ( 67 % ) on chronic open label treatment with sertraline to discontinue the drug after a mean interval of 7.3 months with a mean ejaculatory latency time of 4.1 minutes ( range 1 to 12 ) . CONCLUSIONS Sertraline appears to be a useful agent in the pharmacological treatment of premature ejaculation BACKGROUND Dapoxetine is being developed for the on-dem and treatment of premature ejaculation ( PE ) . Previous clinical trials have demonstrated its safety and efficacy . OBJECTIVE To evaluate the long-term efficacy and safety of dapoxetine in men with PE . DESIGN , SETTING , AND PARTICIPANTS This r and omized , double-blind , parallel-group , placebo-controlled , phase 3 trial , conducted in 22 countries , enrolled men ( N=1162 ) > or = 18 yr of age who met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition , text revision criteria for PE for > or = 6 mo , with an intravaginal ejaculatory latency time ( IELT ) < or = 2 min in > or = 75 % of intercourse episodes at baseline . INTERVENTION Dapoxetine 30 mg or dapoxetine 60 mg or placebo on dem and ( 1 - 3 h before intercourse ) for 24 wk . MEASUREMENTS Stopwatch-measured IELT , Premature Ejaculation Profile ( PEP ) , Clinical Global Impression ( CGI ) of change , adverse events ( AEs ) . RESULTS AND LIMITATIONS The study was completed by 618 men .  Mean average IELT increased from 0.9 min at baseline ( all groups ) to 1.9 min , 3.2 min , and 3.5 min with placebo and dapoxetine 30 mg and dapoxetine 60 mg , respectively , at study end point ; geometric mean IELT increased from 0.7 min at baseline to 1.1 min , 1.8 min , and 2.3 min , respectively , at study end point . All PEP measures and IELTs improved significantly with dapoxetine versus placebo at week 12 and week 24 ( p<0.001 for all ) . The most common AEs were nausea , dizziness , diarrhea , and headache . AEs led to discontinuation in 1.3 % , 3.9 % , and 8.2 % of subjects with placebo and dapoxetine 30 mg and dapoxetine 60 mg , respectively . Limitations of this study included the exclusion of men who were not in long-term monogamous relationships . CONCLUSIONS Dapoxetine significantly improved all aspects of PE and was generally well tolerated in this broad population Background : Several medical therapies have been proposed for the treatment of  premature ejaculation ( PE ) .  Paroxetine and tramadol were both reported to be effective in treatment of PE . In this study , the therapeutic effects of tramadol , paroxetine and placebo were compared in treatment of primary PE . Methods : In this r and omized , double-blind , placebo-controlled clinical trial , 150 patients were divided into 3 groups . One group was treated with tramadol 50 mg ondem and , the other group took paroxetine 20 mg on-dem and and the third group was treated with placebo . Before starting treatment and after 12 weeks , patients were asked to measure their average intravaginal ejaculation latency time ( IELT ) and fill the PEP ( Premature Ejaculation Profile ) question naire . Results : At the end of the 12th week , the mean IELT and average of PEP scores improved in all 3 groups . The increase in tramadol group was significantly higher than the paroxetine and placebo groups ( p<0.0001 ) . There were no significant differences in terms of side effects between the 3 groups . Conclusion : The results showed that despite an increase in mean IELT and PEP scores in all 3 groups , the rate of improvement in tramadol group was significantly more than the others . Thus , tramadol may be considered as an appropriate alternative therapeutic option for lifelong PE BACKGROUND Recently , sildenafil has been demonstrated to be effective in treating  premature ejaculation ( PE ) .  However , these studies ignored female factors and could not exclude the probability of drug interaction when combined with paroxetine . Therefore , the aim of this study was to evaluate the efficacy and safety of sildenafil alone in the treatment of primary PE , taking female factors into consideration . METHODS One hundred and eighty potent men with primary PE were r and omly divided into three groups and followed up for 6 months . Group A were treated with 50 mg sildenafil as needed , group B with 20 mg paroxetine daily and group C with squeeze technique daily .  Intravaginal ejaculatory latency time ( IELT ) , PE grade , intercourse satisfactory score ( ISS ) , frequency of intercourse , and adverse effects of drugs were recorded before treatment , and 3 and 6 months after treatment . RESULTS Compared with pretreatment , the three groups had significant differences in all the parameters after 3 or 6 months treatment , except the frequency of intercourse in Group C ( all P = 0.00 ) . However , there were no significant differences between 3 and 6 months . Compared with paroxetine and squeeze technique , after 3 or 6 months , sildenafil had significant differences in all the parameters ( all P = 0.00 ) . After 6 months , 1.7 % , 18.3 % and 36.7 % patients in groups A , B and C , respectively , withdrew from the study and 86.7 % , 60.0 % and 45.0 % patients , respectively , wanted to be treated further with the original administration , and this was statistically significant ( both P = 0.00 ) . CONCLUSION Sildenafil is very effective and safe to treat PE , and has much higher efficacy than paroxetine and squeeze technique To assess the use of a topical anaesthetic mixture to improve  premature ejaculation ( PE )  , for which penile hypersensitivity might be a cause OBJECTIVE To compare the efficacy and safety of sildenafil plus sertraline with those of sertraline alone in the treatment of premature ejaculation ( PE ) . METHODS Seventy-two patients with PE but without any obvious organic cause were enrolled in this study . They were r and omly divided into Groups A and B of equal number . Group A received 50 mg sertraline daily 4 to 6 hours before planned sexual activity for 12 weeks , and Group B were given 50 mg sertraline daily plus 50 mg sildenafil as needed , 1 hour before planned sexual activity , for 12 weeks . Before and after the treatment , the mean intravaginal ejaculation latency time , the intercourse satisfaction , the mean number of coituses per week and the drug-related side effects were evaluated . RESULTS The mean intravaginal ejaculatory latency time was ( 0.59 + /- 0.12 ) , ( 3.9 + /- 0.15 ) minutes ( P < 0.001 ) at baseline and post-treatment in Group A , and ( 0.56 + /- 0.11 ) , ( 5.6 + /- 0.12 ) minutes ( P < 0.001 ) in Group B , improved in both of the 2 groups , but more significantly in Group B ( P < 0.05 ) . Before and after the treatment , the mean intercourse satisfaction domain values of the IIEF were ( 8.9 + /- 1.2 ) , ( 10.8 + /- 1.1 ) ( P < 0.05 ) and ( 8.8 + /- 1.1 ) , ( 13.8 + /- 1.3 ) ( P < 0.001 ) in Groups A and B , respectively , significantly greater in Group B than in Group A ( P < 0.05 ) after the treatment ; the mean numbers of coituses per week in Groups A and B were ( 0.9 + /- 0.2 ) , ( 1.9 + /- 0.3 ) ( P < 0.05 ) and ( 1.0 + /- 0.2 ) , ( 2.7 + /- 0.2 ) ( P < 0.001 ) respectively , significantly larger in Group B ( P<0.05 ) after the treatment . As for the side effects , there was a higher rate of headaches ( P < 0.01 ) and flushing episodes ( P < 0.001 ) in Group B than in Group A. CONCLUSION Sertraline combined with sildenafil can produce significantly better results than sertraline alone in patients with premature ejaculation .  However , the combined treatment is associated with a slight increase in the drug-related side effects The aim of the study was to compare the clinical efficacy and safety of the on‐dem and use of paroxetine , dapoxetine , sildenafil and combined dapoxetine with sildenafil in treatment of patients with premature ejaculation ( PE ) . In a single‐blind placebo‐controlled clinical study , 150 PE patients without erectile dysfunction ( ED ) were included during the period of March 2015 to May 2016 . Patients were r and omly divided into five groups ( 30 patients each ) . On dem and placebo , paroxetine ( 30 mg ) , dapoxetine ( 30 mg ) , sildenafil citrate ( 50 mg ) and combined dapoxetine ( 30 mg ) with sildenafil citrate ( 50 mg ) were given for patients for 6 weeks in each group respectively . All patients were instructed to record intravaginal ejaculatory latency time ( IELT ) and evaluated with Premature Ejaculation Diagnostic Tool ( PEDT ) and the patient satisfaction score before and after treatment . The mean of IELT , satisfaction score and PEDT in all groups was significantly improved after treatment ( p value = .001 ) . Combined dapoxetine with sildenafil group had the best values of IELT , satisfaction scores and PEDT in comparison with other treatment groups ( p value < .001 ) . The combined dapoxetine with sildenafil therapy could significantly improve  PE patients without ED as compared to paroxetine alone or dapoxetine alone or sildenafil alone with tolerated adverse effects BACKGROUND  Premature ejaculation ( PE ) is a widely observed male sexual dysfunction with a major impact on quality of life for many men and their sexual partners . OBJECTIVE To assess the safety of tramadol orally disintegrating tablet ( ODT ) ( Zertane ) and its efficacy in prolonging intravaginal ejaculation latency time ( IELT ) and improving Premature Ejaculation Profile ( PEP ) scores . DESIGN , SETTING , AND PARTICIPANTS We conducted an integrated analysis of two identical 12-wk r and omized double-blind , placebo-controlled phase 3 trials across 62 sites in Europe . Healthy men 18 - 65 yr of age with a history of lifelong PE according to the Diagnostic and Statistical Manual of Mental Disorders , 4th Edition , Text Revision , and an IELT ≤ 120 s were included . There were 604 intent-to-treat subjects included in the analysis . INTERVENTION Subjects were r and omized to receive 1:1:1 placebo ( n=200 ) , 62 mg tramadol ODT ( n=206 ) , or 89 mg tramadol ODT ( n=198 ) . MEASUREMENTS We measured overall change and fold increase in median IELT and the mean change in all four measures of the PEP . Differences across treatment groups were analyzed using Wilcoxon rank-sum tests , analysis of variance , and chi-square analyses . RESULTS AND LIMITATIONS Tramadol ODT result ed in significant increases in median IELT compared with placebo ; increases were 0.6 min ( 1.6 fold ) , 1.2 min ( 2.4 fold ) , and 1.5 min ( 2.5 fold ) for placebo , 62 mg tramadol ODT , and 89 mg tramadol ODT , respectively ( p<0.001 for all comparisons ) . Men saw significantly greater improvement in all four measures of the PEP in both doses compared with placebo ( p<0.05 for all comparisons ) . Tramadol ODT was well tolerated ; study discontinuation occurred in 0 % , 1.0 % , and 1.6 % of subjects in placebo , 62 mg , and 89 mg tramadol ODT groups , respectively . Limitations include study inclusion for men with IELT up to 120 s. CONCLUSIONS On-dem and 62 mg tramadol ODT is an effective treatment for PE in a low and safe therapeutic dose and provides a new option for managing mild to severe PE INTRODUCTION Dapoxetine is a short-acting selective serotonin reuptake inhibitor that was recently approved for the on-dem and treatment of  premature ejaculation ( PE ) . AIM To evaluate the efficacy and safety of dapoxetine 30 mg and 60 mg on dem and ( prn ) in men with PE from the Asia-Pacific region . METHODS This r and omized , double-blind , parallel-group ,  placebo-controlled trial enrolled men who were 18 years or older ; in a monogamous , heterosexual relationship for at least 6 months ; met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition , text revision , criteria for PE for at least 6 months ; and had an intravaginal ejaculatory latency time ( IELT ) of 2 minutes or less in at least 75 % of sexual intercourse episodes . Subjects received placebo , dapoxetine 30 mg , or dapoxetine 60 mg prn ( 1 - 3 hours before intercourse ) for 12 weeks . MAIN OUTCOME MEASURES Stopwatch-measured Average IELT , the Premature Ejaculation Profile ( PEP ) , Clinical Global Impression ( CGI ) of change in PE , treatment-emergent adverse events ( TEAEs ) . RESULTS Of the 1,067 subjects r and omized , 858 completed the study .  Mean Average IELT increased from approximately 1.1 minutes at baseline ( across groups ) to 2.4 , 3.9 , and 4.2 minutes with placebo , dapoxetine 30 mg , and dapoxetine 60 mg , respectively , and geometric mean Average IELT increased from approximately 0.9 minutes at baseline ( across groups ) to 1.8 , 2.7 , and 3.1 minutes , respectively ( fold-increases of 2.0 , 2.8 , and 3.3 , respectively ) . All PEP measures and the CGI of change were significantly improved with dapoxetine vs. placebo at study endpoint ( P < or = 0.005 for all ) . The most common TEAEs with dapoxetine included nausea , dizziness , somnolence , headache , vomiting , diarrhea , and nasopharyngitis ; TEAEs led to discontinuation in 0.3 % , 1.7 % , and 5.1 % of subjects with placebo , dapoxetine 30 mg , and dapoxetine 60 mg , respectively . CONCLUSIONS Dapoxetine treatment significantly prolonged IELT and improved PEP measures and was generally well tolerated in men with PE in the Asia-Pacific region We aim ed to evaluate the effectiveness of paroxetine and tadalafil combination in the treatment of  premature ejaculation ( PE ) . A total of 150 primary (lifelong)PE patients were r and omly distributed into three groups of 50 patients each . Group 1 received 20 mg paroxetine every day for 1 month , Group 2 received 20 mg tadalafil on dem and 2 h before intercourse , and Group 3 received paroxetine and tadalafil on dem and 2 h before intercourse . Intravaginal ejaculatory latency times ( IELT ) scores were evaluated at baseline , at the end of the first month of therapy and 1 month after discontinuation of the treatment , while International Index of Erectile Function ( IIEF ) question naire scores were evaluated both prior to and after the treatment . At the end of the first month of therapy , IELT scores were compared with the basal values and statistically significant changes were detected ( 60.6 ± 30.2–117.3 ± 67.3 , 68.5 ± 21.4–110.2 ± 37.3 , 71.56 ± 40.23–175.2 ± 60.2)(P < 0.01 ) . IELT scores after discontinuation of treatment were found to be close to the baseline IELT scores ( P > 0.05 ) . IIEF scores were evaluated both prior to and after the treatment , and no statistically significant difference was detected ( P > 0.05 ) . It is concluded that utilisation of selective serotonin reuptake inhibitors ( SSRI ) and phosphodiesterase‐5 inhibitors ( PDE5i ) combination before intercourse seems to provide significantly longer ejaculatory latency times as compared with SSRI alone for a long time in patients with PE Many studies have shown that skin tissue extracted by circumcision can cause differences in sexual function , especially at the time of ejaculation . Sensitivity changes in penile skin and sexual satisfaction deriving from circumcision starting from premature ejaculation ( PE ) are discussed . Furthermore , most of these studies rely on question naires . Extracted free nerve endings ( FNE ) on the foreskin , which can detect temperature , mechanical stimuli ( touch , pressure , stretch ) or pain ( nociception ) , have not been research ed . Our aim is to determine FNEs in foreskin and the affects on sexual function , especially PE . This prospect i ve study was done on adults who voluntarily applied to be circumcised between September 2010 and October 2011 . The ejaculation latency times ( ELT ) before circumcision have been assessed , and a PE diagnostic tool ( PEDT ) form was filled out by the urologist according to the answers given by the volunteers . The proximal and distal ends of the foreskin were marked before circumcision , and the extracted foreskin was sent to the pathology department to determine FNEs . Twenty volunteers ( average age 21.25 ± 0.44 years ) were included in the study .  The average ELT was 103.55 ± 68.39 seconds , and the average PE score was 4.35 ± 3.13 . Proximal , middle , and distal tip nerve densities were compared . Proximal and distal ( P = .003 ) and proximal and middle ( P = .011 ) segments differed from each other , whereas middle and distal were similar ( P = .119 ) . There were not any correlations between PEDT scores and total nerve endings number ( r = .018 , P = .942 ) . Also there were not any correlations between mean ELT and PEDT scores ( r = .054 , P = .822 ) . The tissue extracted by circumcision has intensive FNEs , yet FNE intensity has no relation to PE We investigated safety and efficacy of vardenafil and sertraline in  premature ejaculation ( PE ) . Seventy‐two men grade d their primary PE on a scale of 0–8 ( 0 = almost never , 8 = almost always ) . Intravaginal ejaculatory latency time ( IELT ) was measured . Patients were included if they scored their PE as 4 or greater and their IELTs were less than 1.30 min . After 6 weeks of behavioural psychosexual therapy , 49 patients still had a PE of 4 or greater and an IELT less than 1.30 min and they were r and omised : 6 weeks vardenafil ( 10 mg ) or sertraline ( 50 mg ) . After a wash‐out phase for 1 week , medication was changed in a cross‐over design . Initially , all 72 men with PE  received behavioural therapy .  Twenty‐three men were satisfied with treatment and excluded . The remaining 49 men grade d their PE as 5.94 ± 1.6 and IELT was 0.59 min and patients were r and omised . Four men discontinued the study  . Vardenafil  improved PE grading : 2.7 ± 2.1 ( P < 0.01 ) and IELT increased to 5.01 ± 3.69 ( P < 0.001 ) . PE grading improved 1.92 ± 1.32 , ( P < 0.01 ) and IELT 3.12 ± 1.89 ( P < 0.001 ) with sertraline . It is concluded that vardenafil and sertraline are useful agents in the pharmacological treatment of PE INTRODUCTION There is partial evidence to support the use of phophodiesterase-5 inhibitor ( PDE5-I ) for the treatment of  premature ejaculation ( PE ) . AIM We compared on-dem and dosing of dapoxetine alone and combined with mirodenafil in subjects with lifelong PE and without erectile dysfunction ( ED ) . METHODS Our prospect i ve , r and omized , double-blind , placebo-controlled , multicenter trial enrolled 118 subjects with lifelong PE without ED . PE was diagnosed using Diagnostic and Statistical Manual of Mental Disorders , fourth edition , text revision . Patients were divided into two groups : dapoxetine 30 mg plus placebo ( group A , n=56 ) and dapoxetine 30 mg plus mirodenafil 50 mg ( group B , n=62 ) . MAIN OUTCOME MEASURES During 12 weeks , intravaginal ejaculatory latency time ( IELT ) and the time from foreplay to beginning intercourse ( FTIT ) with a stopwatch , and Premature Ejaculation Profile ( PEP ) were measured . Overall sexual act time ( OSAT ; sum of FTIT and IELT ) was calculated . Any treatment-emergent adverse events ( TEAEs ) were also recorded . RESULTS Over 12 weeks , IELT , OSAT , and PEP index score significantly improved in group B compared with group A ( increased geometric mean IELT in group A and B=3.6 and 6.1 minutes , P=0.026 ; increased geometric mean OSAT in group A and B=5.5 and 9.9 minutes , P=0.012 ; increased median PEP index score in group A and B=1.0 and 1.3 , P=0.046 ) . However , there was no significant difference between two groups with respect to improvement of FTIT ( P=0.147 ) . TEAEs did not differ between groups ( all P>0.05 ) , and there was no serious adverse event in any subjects . CONCLUSIONS Low dose of dapoxetine combined with mirodenafil showed better results in terms of IELT , OSAT , and PEP index score , and similar TEAEs , compared with that of dapoxetine only . Our results support the suggestion that the PDE5-Is have a potential role in the treatment of PE without ED The aim of the study is to investigate whether there is an effect of adult circumcision on ejaculation parameters and to research the relationship between intravaginal ejaculation latency time ( IELT ) and premature ejaculation diagnostic tool ( PEDT ) . Adults who underwent voluntary circumcision between September 2010 and November 2011 were enrolled in this prospect i ve study . The IELT before and 3 months following circumcision was recorded . Also , PEDT was filled out before and 3 months after circumcision . During statistical evaluation , the comparison of situations before and after circumcision was made using IELT averages and PEDT total scores . Furthermore , the correlation between changes in IELT and PEDT has also been evaluated . A total of 30 volunteers ( mean age 21.25±0.44 ) were enrolled in the study . The volunteers ’ mean and median IELT before were 104.36±66.21 and 88 ( 26–307 ) seconds , whereas mean and median IELT after circumcision were 123.56±54.44 and 107.5 ( 67–300 ) seconds , respectively . The increase after circumcision was statistically significant ( P=0.001 ) . The mean and median PEDT score were 4.26±2.91 and 3 ( 1–12 ) before , and 2.63±1.82 and 2 ( 0–7 ) after circumcision . Improvement was statistically significant ( P<0.0001 ) . No correlation could be found between ejaculation time and PEDT scores . Circumcision during adulthood does not adversely affect ejaculatory function ; it may slightly improve . However , it could not be interpreted as a justification for circumcision in men with premature ejaculation ( PE ) PURPOSE We compared the efficacy and safety of fluoxetine , sertraline , clomipramine and placebo for the oral pharmacotherapy of premature ejaculation . MATERIAL S AND METHODS The study included 36 men ( mean age 44 years ) who had intravaginal ejaculation latency of less than 2 minutes . Patients took each of 3 drugs and the placebo consecutively during a 4-week period per each agent . Efficacy and side effects data were obtained by a self-reported patient question naire that rated intravaginal ejaculation latency , sexual satisfaction of patient and partner , and possible side effects . RESULTS After 4 weeks of treatment with placebo , fluoxetine , sertraline and clomipramine the mean intravaginal ejaculation latency time was significantly increased from 46 seconds to 2.27 minutes , 2.30 minutes , 4.27 minutes and 5.75 minutes , respectively ( all p < 0.01 ) . However , treatment with clomipramine or sertraline caused a greater increase in mean intravaginal ejaculation latency time than fluoxetine or placebo ( p < 0.01 ) . Patient sexual satisfaction rate after treatment with clomipramine was significantly higher ( p < 0.05 ) than with sertraline , fluoxetine or placebo .  Partner sexual satisfaction rate was also higher with clomipramine than with sertraline or fluoxetine but no statistical difference was found . The incidence of side effects with clomipramine was significantly higher ( p < 0.05 ) compared to that of fluoxetine , sertraline and placebo , while no significant difference among sertraline , fluoxetine and placebo was noted . CONCLUSIONS In men with premature ejaculation clomipramine was the most useful drug in terms of efficacy . Treatment with sertraline was nearly as effective and had a lower incidence of side effects Premature ejaculation ( PE ) is the most common sexual disorder . It affects 20%-30 % of adult men ; the aetiology of this condition has not yet been eluci date d. The aim of this study is to evaluate the efficacy , safety , tolerability , undesirable effects and improved satisfaction with sexual intercourse with tramadol hydrochloride at different dosages for the treatment of PE . A total of 300 patients who presented with lifelong ( primary ) PE were included in this study . The study was performed for 28 weeks , in which placebo ( starch tablet ) was given for 4 weeks , and active ingredient ( tramadol hydrochloride ) was administered at different therapeutic dosages for 24 weeks . Patients were divided into three equal groups , each consisting of 100 patients . The first group ( A ) was given tramadol hydrochloride capsule 25 mg . The second group ( B ) was given tramadol hydrochloride capsule 50 mg . The third group ( C ) was given tramadol hydrochloride capsule 100 mg . All of the 300 participants included completed the study voluntarily . The age of the patients varied from 25 to 50 years . After the treatment period , the recorded data were collected for each group and analysed . The results showed a highly significant increase in the mean intravaginal ejaculatory latency time ( IELT ) in all groups compared to baseline data ( P<0.0001 ) . We concluded that using tramadol hydrochloride at different doses on dem and for the treatment of PE is effective , safe and tolerable , with minimal undesirable effects , and approval for this indication should be sought PURPOSE The efficacy of the selective serotonin re-uptake inhibitor fluoxetine in the treatment of premature ejaculation was examined . MATERIAL S AND METHODS The study comprised 17 patients with premature ejaculation who presented to the urology clinic of our medical school . In this double-blind study the patients were r and omized into treatment groups receiving 20 mg . fluoxetine daily for 1 week and 40 mg . daily afterward ( group 1 ) or 1 capsule placebo daily for 1 week and 2 capsules daily afterward ( group 2 ) . The groups were evaluated according to the latent period of intravaginal ejaculation . RESULTS The latent period of intravaginal ejaculation in group 1 was significantly longer than that in group 2 . Nausea , headache and insomnia were reported side effects . CONCLUSIONS Fluoxetine may be regarded as a safe and effective alternative in the treatment of premature ejaculation Objectives : The objective of this study is to assess the dose-related effects of tramadol on a group of patients with premature ejaculation ( PE ) . Subjects and Methods : During the period of months between June 2010 and July 2012 , 180 PE patients presented to outpatient clinic of our hospital . Patients were r and omized in a 1:1:1 fashion to receive different sequences of the three medications : placebo , 50 mg of tramadol and 100 mg of tramadol . Every patient received 10 doses of each medication for 2 months . Intra-vaginal ejaculatory latency time ( IELT ) was recorded in seconds initially and for each arm . Successful treatment of PE is defined if IELT exceeded 120 s. Side-effects of medications were reported . Results : Of patients enrolled , 125 ( 69.4 % ) continued the study . Patients ′ age range was 20 - 55 years with PE complaint of 1 to 10 years duration .  Mean IELT was 72 at presentation , 82 for placebo , 150 for tramadol 50 mg , and 272 for tramadol 100 mg ( P < 0.001 for all comparisons ) . PE was successfully treated in only 2.4 % of patients with placebo , in contrast to 53.6 % and 85.6 % with 50 and 100 mg tramadol , respectively ( P < 0.001 for all comparisons ) . On multivariate logistic regression analysis , baseline IELT was the only predictor of successful treatment of PE with both tramadol 50 mg ( odds ratio [ OR ] : 1.05 , 95 % confidence interval [ CI ] : 1.03 - 1.07 , P < 0.001 ) and tramadol 100 mg ( OR : 1.07 , 95 % CI : 1.04 - 1.11 , P < 0.001 ) . Postmicturition dribble annoyed 12.8 % of those who received 50 mg tramadol and 33.6 % of those who received 100 mg tramadol ( P < 0.001 ) . Weak scanty ejaculation was the main complaint in 7.2 % versus 21.6 % of those using 50 and 100 mg tramadol , respectively ( P = 0.002 ) . Two patients discontinued tramadol 100 mg due to side-effects . Conclusion : Tramadol hydrochloride exhibits a significant dose-related efficacy and side-effects over placebo for treatment of PE INTRODUCTION PSD502 is a novel aerosolized , lidocaine-prilocaine , spray being developed for the treatment of lifelong premature ejaculation . The clinical profile of PSD502 is described in one of two double-blind , placebo-controlled , phase III studies . AIM To determine the effect of PSD502 on the Index of Premature Ejaculation ( IPE ) and intravaginal ejaculatory latency ( IELT ) of men with lifelong PE . METHODS Men with lifelong PE who documented an IELT ≤ 1 minute with two or more of the first three sexual encounters during a 4-week baseline period were r and omized to receive double-blind treatment with PSD502 or placebo for 3 months . Patients completed IPE and Premature Ejaculation Profile question naires at entry and monthly visits , and recorded stop-watch timed IELT during each encounter . Safety was assessed by collecting adverse event data and st and ard safety measures . MAIN OUTCOME MEASURES Stopwatch timed IELT recordings and a patient-reported outcome question naire the IPE were used in this study to determine the effect of PSD502 applied topically 5 minutes before intercourse . RESULTS Two hundred fifty-six men with PE were r and omized from 38 centers in the U.S. , Canada , and Pol and .  The geometric mean IELT over the 3-month treatment period increased from a baseline of 0.56 minute and 0.53 minute in the PSD502 and placebo group respectively to 2.60 and 0.80 minute . There were significantly greater increases in the scores for the IPE domains of ejaculatory control , sexual satisfaction and distress in the PSD502 group than in the placebo group , with a mean 5.0 point difference between treatments in change from baseline in the IPE domain for ejaculatory control , 4.6 point difference in change from baseline in the IPE domain for sexual satisfaction , and a 2.5 point difference in change from baseline in the IPE domain for distress . This was supported by improvements in all secondary endpoints . CONCLUSION In this study , PSD502 applied topically to the glans penis 5 minutes before intercourse showed significantly improved ejaculatory latency , ejaculatory control , sexual satisfaction and distress and was shown to be well tolerated by patients and partners Introduction : Premature ejaculation ( PE ) is a common male sexual disorder . An ideal , reliable and effective treatment is desired by many men and couples affected by this condition . Aim : Evaluate if the association of a phosphodiesterase-5 inhibitor , tadalafil , and a selective serotonin reuptake inhibitor , fluoxetine , can prolong the intravaginal ejaculatory latency time ( IELT ) in men with lifelong premature ejaculation . Methods : Sixty patients with lifelong premature ejaculation and without erectile dysfunction ( ED ) with IELT less than 90 s were enrolled in the protocol and r and omized into 4 groups to use a combination of medications : ( 1 ) tadalafil 20 mg plus fluoxetine 90 mg , ( 2 ) fluoxetine 90 mg plus placebo , ( 3 ) tadalafil 20 mg plus placebo , and ( 4 ) two different placebo capsules ( control ) . Before starting the medications , each man timed his IELT with a stopwatch , and likewise during the treatment period . Fluoxetine 90 mg or placebo was taken once a week plus tadalafil 20 mg or placebo within a 36-hour frame of intended sexual intercourse with a steady partner . Patients were prospect ively followed for 12 weeks . One-way ANOVA was used for statistical comparisons of IELT results in each group . Results : Mean IELT before starting treatment was 51.3 ± 23 s. Withone-way ANOVA , a statistically significant difference in post-treatment IELT was seen with combination treatment compared to placebo ( p < 0.001 ) . There were increases in IELT from baseline in patients using fluoxetine plus tadalafil ( 49.57 ± 25.87 to 336.13 ± 224.77 ) ( p < 0.001 ) , fluoxetine ( 56.55 ± 18.55 to 233.62 ± 105.08 ) ( p < 0.001 ) and tadalafil ( 49.26 ± 19.43 to 186.53 ± 159.05 ) ( p = 0.001 ) . The increases in each group were statistically significant compared to the placebo ( 49.86 ± 19.43 to 67.82 ± 46.18 ) ( p = 0.042 ) . Conclusion : Fluoxetine plus tadalafil significantly increased the IELT from baseline in men with lifelong premature ejaculation when compared to placebo , tadalafil or fluoxetine PURPOSE Fluoxetine , a selective serotonin re-uptake inhibitor , has been shown to increase the intravaginal latency of patients with premature ejaculation . We demonstrated the effects of fluoxetine on intravaginal latency , penile sensory threshold , and variables of sacral evoked response and cortical somatosensorial evoked potential in patients with premature ejaculation . MATERIAL S AND METHODS Of 48 patients 40 who presented to our clinic with premature ejaculation met the study criteria , gave written or oral consent , and were divided r and omly in a double-blind fashion into 2 groups of 20 patients . The study group received 20 mg . fluoxetine daily and the control group received placebo for 1 month . The patients were evaluated during visits before and after treatment for intravaginal latency , penile sensory threshold values , and the variables of sacral evoked response and cortical somatosensory evoked potential tests . RESULTS Patient ages , intravaginal latencies , penile sensory threshold values , and amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential tests in both groups were not significantly different at the beginning of treatment ( p > 0.05 ) . At the end of treatment intravaginal latencies and penile sensory threshold values were increased in the study group compared to before treatment and the control group ( p < 0.05 ) . No change was observed in either group for the amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential tests ( p > 0.05 ) . CONCLUSIONS These findings suggest that fluoxetine is effective treatment for premature ejaculation probably due to its effect of increasing the penile sensory threshold , without changing the amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential PURPOSE We evaluate the efficacy of paroxetine hydrochloride as needed for the treatment of premature ejaculation . MATERIAL S AND METHOD Study 1 comprised 26 potent men with a mean age of 39.5 years with premature ejaculation who were r and omized to receive 20 mg . oral paroxetine ( group A ) or placebo ( group B ) as needed 3 to 4 hours before planned intercourse in a controlled single-blind crossover trial . Study 2 comprised 42 potent men with a mean age of 40.5 years with premature ejaculation who were r and omized to receive 10 mg . paroxetine daily for 3 weeks and then 20 mg . paroxetine as needed ( group C ) for 4 weeks or placebo daily for 3 weeks and then placebo as needed ( group D ) for 4 weeks . RESULTS Mean pretreatment ejaculatory latency time was 0.3 minute for study 1 . At 4 weeks mean ejaculatory latency time was 3.2 minutes in the paroxetine as needed and 0.45 in the placebo as needed phase for group A ( p < 0.001 ) , and 0.6 in the placebo as needed and 3.5 in the paroxetine as needed phase for group B ( p < 0.001 ) . There were no adverse effects with paroxetine or placebo in study 1 . Mean pretreatment ejaculatory latency time was 0.5 minute for study 2 . At 3 weeks mean ejaculatory latency time was 4.3 minutes in the paroxetine daily and 5.8 in the paroxetine as needed phase , and 0.9 in the placebo daily and 0.6 in the placebo as needed phase for group C ( p < 0.001 ) . At 3 weeks mean ejaculatory latency time was 0.8 minutes in the placebo daily and 1.1 in the placebo as needed phase , and 3.3 in the paroxetine daily and 6.1 in the paroxetine as needed phase for group D ( p < 0.001 ) . Adverse effects in 7 of 42 men ( 17 % ) given paroxetine daily included an ejaculation in 3 , anorexia in 1 , gastrointestinal upset in 3 and reduced libido in 2 . Mean ejaculatory latency time was greater in the paroxetine as needed phase of study 2 than that of study 1 ( p < 0.05 ) , suggesting that ejaculatory control achieved with paroxetine as needed is significantly better if patients are initially treated with the drug daily . CONCLUSIONS Paroxetine appears to be superior to placebo in the pharmacological treatment of premature ejaculation when administered on a chronic or as needed basis Purpose Ejaculatory dysfunction is the most common side effect related to surgical treatment of benign prostatic obstruction ( BPO ) . Nowadays , modified surgical techniques and non-ablative techniques have emerged with the aim of preserving ante grade ejaculation . Our objective was to conduce a systematic review of the literature regarding efficacy on ejaculatory preservation of modified endoscopic surgical techniques , and mini-invasive non-ablatives techniques for BPO management . Methods A systematic review of the literature was carried out on the PubMed data base using the following MESH terms : “ Prostatic Hyperplasia/surgery ” and “ Ejaculation ” , in combination with the following keywords : “ ejaculation preservation ” , “ photoselective vaporization of the prostate ” , “ photoselective vapo-enucleation of the prostate ” , “ holmium laser enucleation of the prostate ” , “ thulium laser ” , “ prostatic artery embolization ” , “ urolift ” , “ rezum ” , and “ aquablation ” . Results The ejaculation preservation rate of modified-TURP ranged from 66 to 91 % . The ejaculation preservation rate of  modified-prostate photo-vaporization  ranged from 87 to 96 % . The only high level of evidence studies available compared prostatic urethral lift ( PUL ) and aquablation versus regular TURP in prospect i ve r and omized-controlled trials . The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34 % , respectively . Conclusions Non-ablative therapies and modified endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions
Pooled evidence suggested that topical anaesthetic creams ( TAs ) , tramadol , selective serotonin reuptake inhibitors ( SSRIs ) , and phosphodiesterase type 5 inhibitors ( PDE5is ) are more effective at prolonging IELT comparing with placebo .
Conclusions We recommend the initial use of dapoxetine 30 mg OD for PE because it has been tested in largest and better design ed clinical trials rather than it is more effective than the other drugs studied .
TAs and tramadol 50 mg OD can be used as a viable alternative to oral treatment with SSRIs .
PDE5is combined with SSRIs are more effective than SSRIs monotherapy but are also associated with more side effects .
Purpose The purpose of the study was to conduct a systematic evaluation of the different general prescribed drugs for  premature ejaculation ( PE ) .