Premature ejaculation (PE) is a common male sexual dysfunction with a prevalence of 20-30%. phosphodiesterase peak inhibitor type 5 (PDE5i), a first-line drug for the treatment of erectile dysfunction (ED), has been investigated in recent years and found to affect ejaculatory function possibly through central and peripheral actions. Possible mechanisms are: reduction of central sympathetic efference, diastole of smooth muscles of the vas deferens, seminal vesicles, prostate and urethra, induction of peripheral nociceptive deficits, prolongation of erection duration, increase in self-confidence as well as sensation of ejaculatory control and overall sexual satisfaction, and shortening of the post-ejaculatory climactic period. Shen Heqing, Department of Urology, Xiangcheng People’s Hospital, Suzhou, China
◆Sildenafil alone for PE
Sildenafil has the best effect in prolonging IELT. In the treatment of primary PE, IELT, premature ejaculation grading, sexual satisfaction score (ISS) and number of intercourse were significantly improved in the sildenafil group. Sildenafil was beneficial in increasing patient confidence, improving the feeling of ejaculation control, overall sexual satisfaction and reducing the duration of penile erection after ejaculation.
◆Sildenafil combined with selective 5hydroxytryptamine reuptake inhibitors (SSRIs) for PE
The combination of sildenafil and paroxetine supplemented with psycho-behavioral therapy is more satisfactory for patients with PE who have failed with other treatments. Sildenafil combined with fluoxetine for PE resulted in significantly higher IELT and sexual satisfaction in the treatment group (p<0.05). Sildenafil combined with paroxetine for PE was significantly better than paroxetine alone for improvement in international index of erectile function (iief), ielt, and number of sexual intercourse per week (p<0.05), but there was also a slight increase in adverse effects with the combination. Therefore, combined with the above studies, sildenafil combined with SSRIs can be effective in the treatment of PE, but at the same time, the adverse effects of the combination therapy were also increased.
◆Sildenafil combined with local anesthetics for PE
The combination of sildenafil and bupivacaine syrup improved more significantly (P<0.05) than bupivacaine syrup alone in PE index, IELT, and frequency of spousal satisfaction. Combined application of compounded lidocaine cream and low-dose sildenafil may be an effective method for the treatment of PE. Comparing the efficacy of placebo, sildenafil, sildenafil combined with local anesthetics, and local anesthetics in the treatment of pe, it was found that the cure or improvement rates of the placebo and sildenafil groups were 40% and 55%, and the cure or improvement rate of the combined drug for pe was up to 86.4%, and the cure or improvement rate of local anesthetics alone was 77.3%, so it was concluded that sildenafil alone was not superior to the use of placebo or combined treatment, while the efficacy of combination therapy was comparable to that of local anesthetics alone. There is still controversy regarding the combination of sildenafil with local anesthetics for PE.
Sildenafil in combination with behavioral therapy for PE
The treatment of PE with sildenafil combined with behavioral therapy prolonged the IELT of patients and significantly improved the satisfaction of sexual life of both spouses. The efficacy of sildenafil combined with behavioral therapy was superior to that of behavioral therapy alone in treating patients with PE.
● Vardenafil alone for PE
Vardenafil was used in PE patients for whom behavioral psychotherapy was ineffective, and it was found that the PE score and IELT were significantly improved after treatment (p<0.01). Vardenafil treatment of primary PE improved patient ielt, extra-vaginal ejaculation time, post-ejaculatory withdrawal period and patient confidence and sexual satisfaction. Comparing the effects of placebo, sildenafil, tadalafil and vardenafil on ielt in patients with primary pe, the resultant ielt was 48.5 s in the placebo group, 53.5 s in the sildenafil group, 70.0 s in the tadalafil group and 82.5 s in the vardenafil group. median ielt was significantly longer in patients in the vardenafil group compared with the placebo group (p=0.019). In the post-ejaculatory period of inactivity, the last recorded time to penile root erection was significantly longer in the vardenafil and sildenafil groups than in the placebo group, suggesting that pde5i appears to prolong elt, which suggests that PDE5i may have some beneficial effects in patients with primary PE.
● Vardenafil combined with SSRIs for PE
Vardenafil combined with sertraline for the treatment of PE was found to be more effective than single-agent treatment, however, adverse events were increased. The combination of vardenafil and sertraline was effective in improving IELT. sustained low-dose vardenafil combined with trazodone and behavioral psychotherapy for PE resulted in improved IELT and couple’s satisfaction with sexual life.
▲Tadalafil alone for PE
After low-dose (5 mg) tadalafil treatment for PE, it was found that PE symptoms gradually improved over time in the first three weeks in the treatment group, with no further improvement at week 4 (P>0.05). Low-dose tadalafil treatment for simple PE improved penile hardness, prolonged the duration of penile erection and maintained intercourse for longer.
▲Tadalafil combined with SSRIs for PE
Tadalafil combined with fluoxetine for the treatment of primary PE showed a significant increase in IELT after treatment. It was concluded that treatment of primary PE with tadalafil plus fluoxetine significantly prolonged IELT relative to placebo, tadalafil or fluoxetine alone.
▲Tadalafil in combination with other therapies for PE
Tadalafil combined with behavioral therapy for PE is safe and reliable and excellent in terms of male and female life satisfaction, but the long-term effects need further observation. Oral low-dose tadalafil combined with tamsulosin for secondary PE resulted in a mean prolongation of IELT of 3.78 min in patients after treatment, and improvement in both patient and spousal satisfaction with intercourse.
PDE5i, as a first-line drug for ED, reaped good results for the treatment of ED and its safety was widely certified. The review found that PDE5i alone or in combination with other therapies achieved more satisfactory results in the treatment of PE, therefore, PDE5i can be tried in the treatment of PE when the current treatment of PE is still dominated by SSRI and local anesthetics.