The treatment of premature ejaculation has advantages as an intervention to optimise ocular response and not as the treatment of a malady. Furthermore, it not only improves ejaculatory control and anxiety, but also the quality of life of the patient and his or her partner.
In our centre we use a multimodal approach in which we combine psychosexual therapy with pharmacological treatments, such as desensitising creams and oral treatments.
Medical treatment for premature ejaculation
Local anaesthetics
This is the oldest treatment for premature ejaculation. They increase the arousal threshold by temporarily desensitising the penis and can be found in spray or cream form.
There are studies in the literature that show their ability to significantly increase ejaculatory latency time. Among them we can see:
- Lidocaine cream with prilocaine 2.5%: Apply 15 minutes before intercourse. It is important to wash off before penetration, as it may cause insensitivity to the tissue it contacts.
- Spray of 2.5mg prilocaine + 7.5mg lidocaine: 3 doses of the spray should be administered on the glans penis before intercourse. As an advantage, the glans penis does not need to be washed before penetration.
Selective serotonin reuptake inhibitors.
The most commonly used oral treatment for premature ejaculation is selective serotonin reuptake inhibitors (SSRIs). However, as mentioned above, they must be combined with behavioural therapy to enhance their effect and maintain their results once they are withdrawn.
Currently the most commonly used drug is dapoxetine, a short-lived drug designed specifically for on-demand treatment of premature ejaculation. It is administered at a dose of 30 or 60mg 1-3h before intercourse.
Other drugs with a long half-life such as paroxetine, sertraline, fluoxetine or citalopram can also be used. However, given their characteristics, they require daily dosing.
phosphodiesterase-5 inhibitors
Phosphodiesterase-5 inhibitors (PDE5) have not been shown to be effective in the treatment of premature ejaculation per se and should only be used in combination with erectile dysfunction. There is less evidence of their efficacy in combination with drugs for premature ejaculation, but they can be added if necessary after initiation of IPDE5. On the other hand, in cases of premature ejaculation with correct erectile function, these drugs are not recommended.
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With the right combination of drug treatment and psychosexual therapy it is possible to slow down ejaculation.