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Treatment of Premature Ejaculation
Serotonergic Antidepressants

Several scientific articles and reviews have addressed the use of serotonergic drugs in treating patients with premature ejaculation. Data earlier than 1995 on the use of clomipramine were reviewed by Althof and by Harvey and Balon. These data indicate that clomipramine at doses from 25 to 50 mg is effective in prolonging the intravaginal intercourse to at least two minutes in about 70% of men, compared to a 10% improvement in patients treated with placebo. Further, a study by Segraves et al. suggested that the intake of clomipramine could be limited to the day of intercourse. The minimum time between drug ingestion and maximum ejaculatory control, however, has not yet been fully established.

A prospective, doubleblind, placebo-controlled, cross-over design study examined the effect of 25 mg clomipramine, ingested as needed, 12 to 24 hours before anticipated sexual activity (coitus or masturbation) was evaluated in eight patients with primary premature ejaculation, six with combined premature ejaculation and ED, and eight controls. Significant increase in ejaculatory latency from two to eight minutes was reported by men with primary premature ejaculation but not by the other two groups of patients. Clomipramine inhibited nocturnal penile tumescence in all subjects. Moreover, the mechanism(s) by which clomipramine retards the ejaculatory latency is not totally clear. Clomipramine is a tricyclic antidepressant, which also acts centrally at the 5-HT-2 receptor to inhibit serotonin reuptake and thus promotes serotonin activities. Some studies have suggested, however, that clomipramine increases the sensory threshold for stimuli in the genital area, possibly through the inhibition of the adrenergic receptors in the peripheral sympathetic system. The effect of clomipramine on sexual function is not always consistent, and both spontaneous orgasms and ejaculation and anorgasmia have been reported to occur in some patients. Painful ejaculation is another possible side effect to the intake of clomipramine.

SSRIs, have also been used to treat premature ejaculation. Similar to clomipramine, these agents also have the potential for inducing variable effects on sexual function, including spontaneous orgasms and ejaculation, anorgasmia, or painful ejaculation. Further, the earlier reports on treatment of premature ejaculation with antidepressants have been criticized by Althof for the following reasons:

1. relying on the subject’s selfreport of ejaculatory latency;
2. inconsistent adherence to strict controls, dosages, washout periods, or investigator blindness;
3. lack of long-term follow-up;
4. lack of determination of drug effects on psychosocial or other sexual parameters;
5. lack of distinction between life-long and acquired conditions.

More recent reports have been placebo controlled, and one study measured penile sensory threshold, sacralevoked response, and cortical somatosensory-evoked potential testing to gain insight into the mechanism of drug action. In this study, fluoxetine increased the penile sensory threshold, without changing the amplitude and latencies of sacral-evoked response and cortical somatosensory-evoked potential.

Also you can use Viagra with Priligy in Australia to treat premature ejaculation and make your sexual life brighless. Viagra (sildenafil) is indicated for the treatment of erectile dysfunction, defined as the inability to achieve and maintain penile erection required for successful intercourse.

α-Adrenergic Receptor Blockers

The use of α-adrenergic receptor blockers to delay premature ejaculation is based on the understanding that the sympathetic nervous system is responsible for the peristaltic movement of the seminal fluid through the male genital tract. Shilon et al. administered phenoxybenzamine to nine men with premature ejaculation, seven of whom reported an increase in their ejaculatory latencies. Cavallini reported the effects of treatment with two other α-1-blockers (alphuzosin and terazosine) on premature ejaculation in 91 men who were resistant to psychological therapy. The study was a double-blind, placebo-controlled, cross-over in which each drug and placebo were administered for two months. Approximately 50% of patients and their partners reported improved ejaculatory latencies for both α-blocking agents, as compared to approximately 13% for patients on placebo. Side effects, mainly hypotension and epigastric pain, were experienced by about 5% of patients on active drug. Another side effect of α-receptor blockade reported in the above referenced study with phenoxybenzamine is dry ejaculation (ejaculation without expulsion of the seminal fluid). These preliminary studies suggest that the effectiveness of α-blockers in treating premature ejaculation is close to that seen in treatment of benign prostatic hyperplasia. The final assessment of the role of α-receptor blocking agents in treating premature ejaculation, however, must await the results of large well-controlled trials to examine both efficacy and safety of long-term use.