Principles of treatment: It is important to fully understand the patient’s expectations and to thoroughly assess the therapeutic measures before treatment.
For patients with insignificant consequences of PE, psychosexual counseling and catharsis are sufficient.
In the presence of ED and prostatitis, treatment should be given first.
Behavioral therapy has its value and is suitable for those with significant side effects from taking medication. It is not recommended as first-line treatment for primary PE because it is time-consuming and requires close partner cooperation; long-term implementation is difficult; and long-term efficacy is uncertain.
For primary PE, pharmacological treatment is preferred. Dapoxetine is the only approved PE-specific drug in many countries (excluding the United States). Others are non-approved specific drugs, such as selective pentazocine reuptake inhibitors (SSRIs), tricyclic chlorpromazine, and topical topical anesthetics, all of which are effective for PE.
Psycho-behavioral therapy: Behavioral therapy mainly includes Semans’ “move-stop” method and Masers-Johnson’s (see Note 1 for introduction) “squeeze and pinch” method.
1. “Move-stop” method: The partner helps to stimulate the penis, and the patient signals to stop when he feels the urge to ejaculate, and then starts again when the urge disappears.
2. “Squeeze and pinch” method: Before the patient ejaculates, the partner squeezes the glans with his or her hand.
All of the above methods usually require 3 cycles before completing orgasm.
3.Masturbation before intercourse: There are young men who use it. The mechanism is a decrease in penile sensitivity after ejaculation by the masturbation method and a prolongation of the ejaculatory latency after the non-return period.
If psychological factors are present, treat accordingly.
Overall the short-term success rate of psycho-behavioral treatment is 50-60%. Double-blind randomized crossover studies have shown its long-term effectiveness to be uncertain. The efficacy is not as good as, for example, clomipramine, sertraline , paroxetine and sildenafil.
Behavioral psychotherapy combined with drugs is of greater value.
Dapoxetine (December 2008)
Dapoxetine is a powerful short-acting SSRI, and is the only drug approved for exclusive use in many countries (excluding the United States). It has accumulated data on 6,081 cases.
It is characterized by temporary oral administration on demand, rapid absorption, peak time (time from drug absorption to maximum plasma concentration) of only 1.3 hours, and rapid clearance, with 95% clearance in 24 hours (with few after-effects).
Studies have shown that dapoxetine 30 mg, 60 mg was administered 1-2 hours before intercourse. Patients with LELT << span="">30 seconds improved 3.4-fold and 4.3-fold post-treatment; ejaculatory self-control and distress improved, and sexual satisfaction increased. Side effects such as nausea, diarrhea, headache, and drowsiness occurred in 4% and 10% of the two dose groups, respectively.
However, when combined with PDE5 inhibitors, there was an increase in the occurrence of vertigo prodromal symptoms compared to the two drugs alone. Therefore, blood pressure and heart rate should be measured without abnormalities before applying this drug. However, clinical phase III trials have shown that the combination is well tolerated and safe in most patients. The incidence of upright hypotensive syncope (vasovagal reflex) was low (1.6%, see the citation for translation).
Selective pentothal reuptake inhibitors (SSRIs) and chlorpromazine (tricyclic antidepressants)
In Mata analysis, SSRIs increased intravaginal ejaculation latency by 2.6-13.2 times. Paroxetine was superior to fluoxetine, clomipramine, and sertraline. Sertraline was superior to fluoxetine. Clomipramine is similar to fluoxetine and sertraline in efficacy. Dosages were 20-40 mg of paroxetine, 25-200 mg of sertraline, 10-60 mg of fluoxetine, and 25-50 mg of clomipramine.
There was no significant dose potency correlation. Delayed ejaculation may occur a few days after initiation of the drug and is evident after 2 weeks.6 to 12 months may occur with reduced efficacy. Common side effects include fatigue, drowsiness, yawning, nausea, vomiting, dry mouth, diarrhea, and excessive sweating, which are usually mild and resolve after 2 to 3 weeks. Decreased libido, orgasm, ejaculation, and erectile dysfunction have also been reported. Caution: Use with caution when PE patients are under 18 years of age or have coexisting depression. This is because of the theoretical risk of increased suicidal ideation. For long-term daily medication users, avoid sudden discontinuation or rapid dose reduction in order to prevent withdrawal syndrome.
IV. Local topical anesthetics
The longest history of drug use. Can reduce penile glans sensitivity, delay ejaculation treatment, and does not affect ejaculation satisfaction.
1, lidocaine/procaine cream: A randomized, double-blind, placebo-controlled trial, lidocaine/procaine cream increased IELT9 (1 min in the placebo group and 6.7 min in the treatment group). In another randomized, double-blind, controlled trial, lidocaine/procaine cream, the IELT was increased from 1.49 to 8.45 min. 5% lidocaine/procaine cream is appropriate for use 20 -30 min before intercourse. If the drug is applied topically for more than 30-45 minutes, erection may be hindered by a numbing sensation in the penis. It is recommended to use a condom after the medication to avoid the anesthetic entering the vaginal wall of the partner and affecting his sensitivity. If the condom is to be removed for sex, the glans anesthetic needs to be removed first. It is contraindicated in patients or partners who are allergic to any component of the anesthetic.
2. Lidocaine (7.5 mg) + proparacaine (2.5 mg) (TEMPE, aerosol formulation): applied 5 minutes prior to sexual intercourse. Compared with the placebo group, LEIT increased from 0.58 to 3.17 minutes and ejaculation time was delayed 3.3-fold (p < 0.01)< span="">
V. Tramadol
Mechanism is a central analgesic, opioid receptor binding activator and reuptake inhibitor of pentraxin and norepinephrine. It has a half-life of 5-7 hours when administered orally. 50-100 mg doses are administered 3-4 times daily. June 2009 The FDA issued a warning about the potential for addiction and respiratory distress. A large sample study (translation: 604 cases in 3 groups including Bar, USA) applied placebo, tramadol containing tablets (orally disintegrating tablet (ODT) 62, 89mg for 12 weeks.
The results confirmed the safety and efficacy of tramadol. In patients with primary PE and IELT <2 minutes, the IELTs were 0.6 minutes (1.6 times), 1.2 minutes (2.4 times), and 1.5 minutes (2.5 times) for the three groups, respectively. The efficacy was dose-independent and well tolerated at 12 weeks. The overall efficacy was moderate and similar to that of dapoxetine. Long-term data are still needed to assess its value.
Phosphodiesterase 5 inhibitors PDE5 inhibitors: There is only one well-designed, randomized, double-blind controlled study. The results showed no prolongation of IELT after drug administration, but patients had improved self-confidence, control and overall satisfaction, reduced anxiety, and a shorter time to re-erection reflex after ejaculation. Medication use may have led to better erections, relieved anxiety, and may have resulted in a higher arousal threshold, thus benefiting the treatment of PE. Several studies have confirmed that sildenafil combined with either SSSI or behavioral therapy is more effective than alone, and there is limited information on other phosphodiesterases5 such as tadalafil and vardenafil.