S W Kim1, J S Paick. 1. Department of Urology, Seoul National University College of Medicine, Korea.
Abstract
OBJECTIVES: Pharmacotherapy using selective serotonin reuptake inhibitors (SSRIs) for men with primary premature ejaculation is promising. In particular, the strategy of taking a pill "as needed" may offer an attractive option. To investigate the possibility of self-therapy for the treatment of premature ejaculation, we compared the efficacy of sertraline taken as needed with that of continuous medication. METHODS: Since 1996, we have treated 24 men with sertraline on an as needed basis for primary premature ejaculation. Sertraline was chosen from among the SSRIs because a large dose need not be divided and because peak plasma levels occur 4 to 8 hours after oral administration, making 5 PM a suitable time for administration (by which time a man may know whether sexual intercourse is likely to occur later that evening). Each patient was started on 50 mg daily for 2 weeks, and the dose was then adjusted to 50 or 100 mg on the day of intercourse only (PRN). RESULTS: After 6 weeks, 18 men were still taking medication, and 6 had dropped out. Among the 18, the mean ejaculation latency was 23 +/- 19 seconds before treatment, 5.9 +/- 4.2 minutes after 2 weeks of 50 mg daily, 5.1 +/- 3.8 minutes after 2 weeks of 50 or 100 mg PRN, and 4.5 +/- 2.7 minutes after 4 weeks of 50 or 100 mg PRN. Mean sexual satisfaction scores (5, extremely satisfied; 0, extremely unsatisfied) for men were 0.8 +/- 0.8 before treatment, 3.8 +/- 1.2 after 2 weeks of 50 mg daily, 3.4 +/- 1.0 after 2 weeks of 50 or 100 mg PRN, and 3.2 +/- 0.7 after 4 weeks of 50 or 100 mg PRN. For their partners, mean sexual satisfaction scores were 1.1 +/- 0.7 before treatment, 3.2 +/- 1.6 after 2 weeks of 50 mg daily, 3.1 +/- 1.4 after 2 weeks of 50 or 100 mg PRN, and 3.3 +/- 1.2 after 4 weeks of 50 or 100 mg PRN. Side effects were intermittent excessive delay of ejaculation in 1 patient, fatigue in 2, and numbness in 1. CONCLUSIONS: If our results are supported by additional long-term clinical studies, self-therapy with sertraline taken PRN at 5 PM for the treatment of premature ejaculation could be as attractive as self-injection therapy for the treatment of erectile dysfunction.
OBJECTIVES: Pharmacotherapy using selective serotonin reuptake inhibitors (SSRIs) for men with primary premature ejaculation is promising. In particular, the strategy of taking a pill "as needed" may offer an attractive option. To investigate the possibility of self-therapy for the treatment of premature ejaculation, we compared the efficacy of sertraline taken as needed with that of continuous medication. METHODS: Since 1996, we have treated 24 men with sertraline on an as needed basis for primary premature ejaculation. Sertraline was chosen from among the SSRIs because a large dose need not be divided and because peak plasma levels occur 4 to 8 hours after oral administration, making 5 PM a suitable time for administration (by which time a man may know whether sexual intercourse is likely to occur later that evening). Each patient was started on 50 mg daily for 2 weeks, and the dose was then adjusted to 50 or 100 mg on the day of intercourse only (PRN). RESULTS: After 6 weeks, 18 men were still taking medication, and 6 had dropped out. Among the 18, the mean ejaculation latency was 23 +/- 19 seconds before treatment, 5.9 +/- 4.2 minutes after 2 weeks of 50 mg daily, 5.1 +/- 3.8 minutes after 2 weeks of 50 or 100 mg PRN, and 4.5 +/- 2.7 minutes after 4 weeks of 50 or 100 mg PRN. Mean sexual satisfaction scores (5, extremely satisfied; 0, extremely unsatisfied) for men were 0.8 +/- 0.8 before treatment, 3.8 +/- 1.2 after 2 weeks of 50 mg daily, 3.4 +/- 1.0 after 2 weeks of 50 or 100 mg PRN, and 3.2 +/- 0.7 after 4 weeks of 50 or 100 mg PRN. For their partners, mean sexual satisfaction scores were 1.1 +/- 0.7 before treatment, 3.2 +/- 1.6 after 2 weeks of 50 mg daily, 3.1 +/- 1.4 after 2 weeks of 50 or 100 mg PRN, and 3.3 +/- 1.2 after 4 weeks of 50 or 100 mg PRN. Side effects were intermittent excessive delay of ejaculation in 1 patient, fatigue in 2, and numbness in 1. CONCLUSIONS: If our results are supported by additional long-term clinical studies, self-therapy with sertraline taken PRN at 5 PM for the treatment of premature ejaculation could be as attractive as self-injection therapy for the treatment of erectile dysfunction.