Central regulation of ejaculation and the therapeutic role of serotonergic agents in premature ejaculation.

Premature ejaculation (PE) is characterized by a short ejaculatory latency time, poor control over ejaculation and a negative impact on quality of life. The process of ejaculation is under central control, and serotonin (5-HT) is a key mediator; therefore, SSRIs and tricyclic antidepressants, including paroxetine, sertraline and clomipramine, are commonly used with chronic daily dosing in the treatment of PE. Dapoxetine, a short-acting SSRI that acts supraspinally to inhibit ejaculation, has been approved in several European countries for on-demand treatment of PE. With a range of centrally acting treatment options, treatment should be tailored to meet the needs and preferences of individual patients.