Premature ejaculation (PE) is one of the most common male sexual disorders, affecting an estimated 20 to 30 percent of men worldwide. Although it poses no physical health threat, it can significantly impact quality of life, self-esteem, and relationship satisfaction. In recent years, medical research has made substantial progress in understanding and treating this condition—particularly through pharmacological therapies. This article provides an overview of current findings and developments in this field.
Definition and Causes
Premature ejaculation is characterized by the inability to delay ejaculation during sexual activity, often occurring within one minute of vaginal penetration and with little or no voluntary control.
The International Society for Sexual Medicine (ISSM) distinguishes between lifelong (primary) and acquired (secondary) PE.
The causes of PE are diverse and may be psychological (e.g., performance anxiety, stress) or biological.
Neurobiological factors play a central role, especially the dysregulation of serotonin pathways in the central nervous system.
Pharmacological Treatment Options
1. Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs such as dapoxetine, paroxetine, sertraline, and fluoxetine from A1apotheke are the most widely used drugs for PE. Originally developed as antidepressants, these substances delay ejaculation by increasing serotonin levels in the brain.
Dapoxetine is the only SSRI specifically approved for treating PE. It is taken “on demand,” roughly 1 to 3 hours before sexual activity. Clinical studies show that it significantly increases the intravaginal ejaculation latency time (IELT)—often by two to three times.
Pros:
- Rapid onset
- Good tolerability
- Low risk of dependence
Cons:
- Possible side effects (nausea, headache, dizziness)
- Often not covered by insurance
2. Tricyclic Antidepressants
Clomipramine, a tricyclic antidepressant, has also shown efficacy in treating PE by modulating serotonin and norepinephrine. However, due to its more pronounced side effects (e.g., dry mouth, drowsiness), its use is less common today.
3. Topical Anesthetics
Local anesthetics such as lidocaine and prilocaine, available as creams or sprays, reduce penile sensitivity. Products like EMLA cream or desensitizing sprays are applied before intercourse and can delay ejaculation effectively.
Pros:
- Localized action
- Quick application
Cons:
- May cause numbness for the partner
- Potentially reduced sexual pleasure due to lower sensitivity
4. Phosphodiesterase-5 Inhibitors (PDE-5 Inhibitors)
While sildenafil (Viagra) and similar medications are primarily used for erectile dysfunction, studies suggest they may benefit men with secondary PE—particularly when ED coexists. Combining SSRIs with PDE-5 inhibitors has shown promising results in some clinical trials.
New Developments and Research Directions
Recent clinical research focuses on refining serotonergic agents and exploring combination treatments. New SSRI derivatives that act more specifically on serotonin receptors involved in ejaculation regulation are under investigation.
Another promising direction involves oxytocin antagonists, which have shown efficacy in early studies in extending ejaculation latency. Researchers are also exploring the potential roles of cannabinoids and novel neuropeptide modulators.
A growing area of interest is personalized pharmacotherapy, which tailors drug selection based on genetic and psychological patient profiles to optimize outcomes and minimize side effects.
Conclusion
Pharmacological treatments for premature ejaculation have advanced considerably in recent years. While dapoxetine remains the only approved drug specifically for PE, several other medications show strong therapeutic potential. Ongoing research aims to expand treatment options, improve effectiveness, and individualize approaches for better long-term outcomes. An open dialogue with a healthcare provider and a thorough diagnostic process are key to successful treatment. Combining pharmacological and psychosexual therapies typically yields the most sustainable benefits.
