What are the drugs used to treat premature ejaculation?
Prof. Zhang Zhichao: With the development of science, we found that more and more patients with primary premature ejaculation are caused by pentraxin reinnervation metabolism disorder (abnormal regulation), and the treatment is mainly applied to pentraxin reuptake inhibitors (SSRIs), which are drugs that improve neuroenergetics and can prolong ejaculation time.
SSRIs are mainly used to treat depression. So what is the difference in effectiveness in treating premature ejaculation and antidepressants?
Prof. Zhang Zhichao: There is a big difference. In the past, depression was treated with pentazocine reuptake inhibitors, and during the treatment, many doctors found that it had delayed ejaculation. At that time, for premature ejaculation, we suffered from the lack of a specific drug. After this effect was found, we were using it. However, there were several problems.
First, this is a non-indication drug, and there is a question of whether it is legal for clinical use. And that this drug is designed for antidepressant and the time to reach the optimal drug concentration is slow, usually taking 3-6 hours, with time requirements for the arrangement of sexual life.
Secondly, because of the characteristics of antidepressant treatment, the duration of drug effect is relatively long, with a half-life (i.e. 50% of the time for drug metabolism) of more than 24 hours. It is inconvenient for patients who are used for premature ejaculation. For example, couples who want to have sex have to take the medication five or six hours in advance, but after that the mood may change and they don’t want to have intercourse. Another situation is that after sex, the medicine often stays in the body for a long time and cannot be metabolized quickly, which can add many side effects and is very inconvenient.
In recent years there has been an SSRI specifically designed for premature ejaculation, scientifically known as Dapoxetine Hydrochloride. This is now internationally recognized as a very good drug in terms of safety and effectiveness. It overcomes the drawbacks of the antidepressants mentioned above and has indications for premature ejaculation treatment and is legal for clinical use.
This drug is absorbed particularly quickly and reaches an effective concentration very quickly. Usually patients take it between one and three hours before intercourse, and it can reach its effect quickly. This reduces the occurrence of side effects and of course also reduces the occurrence of cumulative use of the drug, which can also create a very good effect if taken again or multiple times.
How long does it take to get results with premature ejaculation medication?
Prof. Zhang Zhichao: From the pharmacokinetic study, generally speaking 70-80 minutes, which means most people take 1.5 hours, have reached the optimal drug concentration. However, due to individual differences, some people may be a little faster and have reached it within 60 minutes; others are slower and may take 100 or 120 minutes. Patients should take the medication and adjust it according to their situation. If the effect of the medication is not too good this time, next time use the medication a little earlier to give more time for the medication to take effect.
How long can sex be prolonged after medication?
Prof. Zhang Zhichao: Generally speaking, it is two to four times longer. There are individual differences here as well, but overall the effectiveness is above 70%. This also means that 30% of the patients may not be effective. We recommend that patients start with one month of treatment, six to eight doses in a month, and if it doesn’t work, it means that this may not work for them.
Are there any adverse reactions to the medication?
Prof. Zhang Zhichao: Some patients have slight nausea, dizziness, and some have diarrhea after taking the drug. However, these adverse reactions are usually very mild and transient, mostly occurring during the first dose, or during the first week of use. As the number of doses increases and the body adapts, these side effects will disappear or diminish.
To avoid these adverse reactions, we recommend that patients drink plenty of water, a large glass of water at a time, when taking the drug early on, for hydrating the drug and reducing adverse reactions. There are no other serious adverse reactions to this drug and the overall safety profile is still good.
Which patients are not suitable for treatment with dapoxetine?
Prof. Zhang Zhichao: There are no absolute contraindications to dapoxetine. However, there is a point where people who are not suitable for sexual life are definitely not suitable for this drug. For example, elderly people who cannot climb two or three floors are not suitable for the drug. Some patients are particularly intolerant to this drug and will have very bad adverse reactions, that also can not force these patients to eat.
If there is no problem with premature ejaculation, can men use this type of medicine to further prolong sex and put the icing on the cake?
Prof. Zhang Zhichao: Not recommended. Why should it be the icing on the cake? The purpose of using medicine is to turn a patient into a normal person, to turn a disease state into a normal state. But we never turn a normal person into a superhero.
Can premature ejaculation medication be taken continuously? What is the best frequency of sexual life during the drug treatment?
Prof. Zhang Zhichao: We suggest to look at the patient’s own characteristics and physical condition after sex. First of all, sexually active men, mostly aged 18-55, can take the medication two to three times a week.
The criteria for judging the frequency of sexual intercourse mainly depends on not feeling fatigue the day after sex, which is appropriate. Some people are more capable, the number of sexual life can be more, some people are less capable, can reduce some times. But try not to repeat the medication within 24 hours. More than 24 hours, you can repeat the use of premature ejaculation medication.
Should premature ejaculation medication be taken as needed or regularly?
Prof. Zhang Zhichao: Traditional antidepressant treatment is taken daily for three to five days in a row before it takes effect, and it usually takes two to three weeks to achieve the best results. In the case of dapoxetine, taking it one to three hours before intercourse is sufficient, and the frequency of intercourse is different for everyone. It should be taken as needed for individual, different age groups, and different frequency of intercourse, of your own choice.
Will premature ejaculation gradually get better on its own after taking the medication as needed?
Prof. Zhang Zhichao: There will be some degree of improvement. For example, we now classify premature ejaculation according to the duration of the disease into those within six months, those within two years, those between two and five years, and those over five years. From our current research, it may be difficult to cure premature ejaculation, so we call some premature ejaculation lifelong premature ejaculation.
If the duration of premature ejaculation is very short, for example, it occurs within six months, early diagnosis, early treatment, and regular medication, it is possible to achieve a 50%-60% cure. If the duration of the disease is more than five years, it is very difficult to remove the root of the disease. At this time, we have to carry out lifelong maintenance treatment or long-term maintenance treatment.
What are the key indicators to assess the effectiveness of premature ejaculation treatment?
Prof. Zhang Zhichao: First of all, there is a gold standard, namely the ejaculatory latency period (IELT), which is the time from penile insertion into the vagina to ejaculation. The most objective way to measure IELT is to take a stopwatch and record the time from insertion to ejaculation. However, this is difficult to do in general conjugal life, except for clinical research.
Since the difference between the patient’s subjective perceived time and the objective time is relatively large, doctors often advise patients that the number of strokes be used to assess. In other words, to judge the effect of premature ejaculation treatment, you can look at the time or you can count by the number of jerks. If the original premature ejaculation, can only be 30 to 50 times, after the use of drugs can be up to 100 times, then it is effective.
How long can I take the medicine to assess the effect?
Prof. Zhang Zhichao: There is an adaptation period for everything. Before assessing the effectiveness of the drug, first of all, we have to figure out the best time for each person to use the drug, that is, when to use the drug, sexual life can reach a better state. For drugs, the pentraxin receptors in the human body also have an adaptation period, generally more than six times in a row or two weeks after each administration, this receptor can really adapt, this time the drug is in the most stable, the best state. In other words, the drug should be used for at least two weeks before the effect can be evaluated.
When can I stop taking the medication? If I don’t take the medication and I don’t experience premature ejaculation, is it possible to stop the medication?
Prof. Zhang Zhichao: You can try. If the duration of the disease is relatively short and the patient is relatively young, it is entirely possible to stop the medication.
I often tell patients that the treatment of premature ejaculation with medication is equivalent to a training for neurological dysfunction. The medication is used to bring the patient to a normal state and to stimulate the patient to establish a new pattern of ejaculation through a certain frequency of sexual life.
However, discontinuation of the medication must be done under the guidance of a doctor. The dosage needs to be gradually reduced until the medication is discontinued, which is the ideal state. This is because it takes three to six months to establish the conditioned reflex to control ejaculation, or longer for consolidation.
For example, if you consider taking the drug six times as needed, or taking it for a month, as a treatment cycle, then the efficacy should be judged based on each month’s use, and the dosage should be gradually reduced on this basis and eventually discontinued. Otherwise, it is a pity to work hard to treat for a period of time, the effect is good, but after a period of time to revert to the previous.
Does long-term medication have any effect on the body?
Prof. Zhang Zhichao: Long-term use of the drug is also safe. This drug has been on the market for a limited time, and there are some clinical evaluations for cardiovascular and sexual function safety, which are still reliable throughout.
Of course we can also use its counterpart, the SSRIs antidepressants, as a reference. Antidepressants are used in larger doses and for longer periods than those used for premature ejaculation. Antidepressants have been in clinical use for decades, and there have been many safety studies over ten years of them. This is side evidence that the safety of SSRIs drugs is still very good.
Does it have any effect on the fetus if my wife gets pregnant after using premature ejaculation medication?
Prof. Zhang Zhichao: We often come across such a situation that many patients have their loved ones become pregnant while taking medication. I would say two words, firstly congratulations and secondly let nature take its course.
Dapoxetine hydrochloride has not been clearly found to have teratogenic effects. And the antidepressant SSRIs we used to treat premature ejaculation were not found to have teratogenic effects from animal experiments, including clinical reports.
However, in the past, some patients reported that male sperm motility decreased after using antidepressants, which may affect the wife’s ability to conceive. Therefore, we would have to reduce or stop the use of antidepressants when the patient has fertility requirements. But now for dapoxetine hydrochloride, this problem does not exist because of the short half-life.
Can premature ejaculation medication create dependence?
Prof. Zhang Zhichao: This is something that has to be distinguished from where the dependence comes from. This exists not only in male premature ejaculation treatment, but also in other treatments.
For example, people used to worry about the dependence of antihypertensive drugs and hypoglycemic drugs, worrying whether they would not be able to stop taking them and whether their condition would get worse the more they used them. But now most people have accepted that “can’t stop” is not because the disease is getting worse, not because of dependence, but because some diseases are inherently incurable, and the current medical treatment can only effectively control its development and improve the quality of life.
This is also the case for premature ejaculation. For a few patients who are relatively young, or whose premature ejaculation occurs in a relatively short period of time, it is possible to cure it with medication; for most patients, premature ejaculation cannot be cured at present, but it can be effectively controlled. It is not that medication forms a dependency, but this disease cannot be truly cured.
Can premature ejaculation medication be combined with topical medication?
Prof. Zhang Zhichao: There is no such contraindication, it is not absolutely not possible, but clinicians rarely use them in this way.
For example, some patients may use epileptics, some use SSRIs, some use alpha-blockers, and some use opioid analgesics such as tramadol. Each person has individual differences and each doctor will have his or her own clinical medication habits.
However, dapoxetine hydrochloride is the only drug with indications for premature ejaculation treatment among the western drugs currently used in China. Some of the surface anesthetic sprays available abroad also have indications. All other drugs are prescribed for non-indications. It is a little bit better in terms of legality and safety to have indications for medication. If there is no indication, we have done a good job of explaining and if the patient can accept it, it is also possible to use.
Can I use dapoxetine in combination with antidepressants?
Prof. Zhang Zhichao: The current study does not recommend the combination of these two types of drugs. Because both antidepressants and dapoxetine hydrochloride are SSRIs with the same mechanism of action, antidepressant patients are already using these drugs, and if they want to treat premature ejaculation, patients don’t need that much and stay in the body for that long.
It is possible to treat premature ejaculation by increasing some doses or adjusting the usage of some drugs on the basis of a single dose of antidepressants.
Do patients treated with medication need to combine with psychological adjustment to treat premature ejaculation?
Prof. Zhang Zhichao: Yes. Medication is the fundamental guarantee, psychological guidance and couple education are the very fundamental part of premature ejaculation treatment and the first step to start premature ejaculation treatment.
What does psychological adjustment include? What are the therapeutic effects?
Prof. Zhang Zhichao: We believe that psychological counseling and couple education for premature ejaculation patients is a particularly important part of the process. Because the premature ejaculation patients we see have some personality characteristics, they are introverted, sensitive, and most damagingly, pessimistic in character.
Most men may not perform well in sex at first because they are inexperienced and unaccustomed to it. Most of them can adapt to it after a period of time and reach normal. The majority of them can be adapted to normal after a period of time. A part of people who do not adapt for a long time will develop premature ejaculation. If this part of the population has a pessimistic personality, then every time they have sex they will worry about whether they are still not performing well, whether they can get better, whether they are still that bad. This kind of worry is called “operational anxiety” or “anticipatory anxiety”. Over time, it will form a conditioned reflex, once bitten by a snake, ten years to fear the well. We need to help this part of the patient personality analysis, to help them try to adapt, overcome this mood.
Couple education is also important. Sometimes, premature ejaculation has a lot to do with the wife. Some lesbians are conservative, afraid of pain, unable to let go and squirming, which are factors that cause or aggravate premature ejaculation in men. When we come across such a situation, we also need to analyze it and unburden women’s minds so that the couple can achieve a harmonious situation.
For women there is another reason, such as some women have a strong personality, now called feminine. When men perform badly because of nervousness and lack of experience, unpleasant or reproachful women may also cause or aggravate premature ejaculation in men. That is why it is important to conduct personality analysis and emotional analysis between couples to point out problems and solve them.
There is also behavioral therapy, which was more popular in the past, such as in the 1950s and 1960s, but is now used less and less. We just use it as a supplement to medication, including the moving stop method and glans squeeze therapy. It is important to follow the cycle.
We prefer to combine medication, including psychological detoxification for treatment.
Does behavioral therapy cause genital damage?
Prof. Zhang Zhichao: It is safe to use reasonably. The first reason why behavior therapy is not used much now is that it is difficult to operate itself and needs professional psychotherapists to guide and help couples to train; secondly, although it has certain efficacy, it is often short-term and easy to relapse after treatment. In general, unless the irregular operation may cause damage to men, we have not seen too many reports of damage.