Which of available selective serotonin reuptake inhibitors (SSRIs) is more effective in treatment of premature ejaculation? A randomized clinical trial

ABSTRACT Purpose: To compare the efficacy and safety of available selective serotonin reuptake inhibitors (SSRIs) in order to find the most effective drug with the least number of side effects in treatment of premature ejaculation (PE). Materials and Methods: This study was a randomized clinical trial. Four hundred and eighty patients with PE in the 4 groups referred to Imam Reza hospital Tehran, Iran from July 2018 to February 2019 were enrolled in the study. The patients received sertraline 50mg, fluoxetine 20mg, paroxetine 20mg and citalopram 20mg, every 12 hours daily. The intravaginal ejaculatory latency time (IELT) before treatment, fourth and eighth weeks after treatment was recorded by the patient's wife with a stopwatch. Results: Mean IELT before, 4 and 8 weeks after treatment in four groups were: sertraline 69.4±54.3, 353.5±190.4, 376.3±143.5; fluoxetine 75.5±64.3, 255.4±168.2, 314.8±190.4; paroxetine 71.5±69.1, 320.7±198.3, 379.9±154.3; citalopram 90.39±79.3, 279.9±192.1, 282.5±171.1 seconds, respectively. The ejaculation time significantly increased in all groups (p <0.05), but there was no significant difference between the groups (P=0.75). Also, there was no significant difference in drugs side effects between groups (p >0.05). The most common side effects were drowsiness and dyspepsia, which were not severe enough to cause discontinuation of the drug. Conclusions: All available SSRIs were effective and usually had no serious complications. In patients who did not respond to any of these drugs, other SSRI drugs could be used as a salvage therapy.

Effect of tadalafil 5mg daily treatment on the ejaculatory times, lower urinary tract symptoms and erectile function in patients with erectile dysfunction

ABSTRACT Objective To investigate the effect of a 5mg daily tadalafil treatment on the ejaculation time, erectile function and lower urinary tract symptoms (LUTS) in patients with erectile dysfunction. Materials and Methods A total of 60 patients diagnosed with erectile dysfunction were retrospectively evaluated using the international index of erectile function questionnaire-5 (IIEF-5), intravaginal ejaculatory latency time (IELT) and international prostate symptoms scores (IPSS). After the patients were treated with 5mg tadalafil once a day for three months, their erection, ejaculation and LUTS were assessed again. The fasting levels of blood glucose, total testosterone, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and total cholesterol were measured. The independent-samples t-test was used to compare the pre- and post-treatment scores of the patients. Results The mean age of the 60 participants was 50.4±7.9 and the mean baseline serum total testosterone, total cholesterol, and fasting blood sugar were 444.6±178.6ng dL-1, 188.7±29.6mg/dL-1,104 (80-360) mg dL-1, respectively. The mean baseline scores were 2.2±1.4 min for IELT, 9.5±3.7 for IIEF-5 and 14.1±4.5 for IPSS. Following the three-month daily 5mg tadalafil treatment, the scores were found to be 3.4±1.9 min, 16.1±4.7, and 10.4±3.8 for IELT, IIEF and IPSS, respectively. When the baseline and post-treatment scores were compared, a statistically significant increase was observed in the IELTs and IIEF-5 values whereas there was a significant decrease in IPSS (p<0.01). Conclusion A daily dose of 5mg tadalafil can be safely used in the treatment of erectile dysfunction and LUTS, that prolongs the ejaculatory latency time.

Levosulpiride in premature ejaculation

Premature ejaculation is one of the most common sexual disorders. A large number of treatment options have been used so far for the treatment of this dysfunction and still a large number of experts are doing research in this field. Here we have tried to research on the beneficial effects of levosulpiride in the treatment of PE. Eighty-eight patients form different areas of Hazara division suffering from PE were chosen. Sixty-four patients were given levosulpiride and the remaining 24 patients were given Placebo. Out of 64 patients who have been given levosulpiride, 30 patients showed very good improvement, 14 patients showed some improvement, 14 patients showed little and 06 patients showed no improvement. levosulpiride have very good beneficial effects in the treatment of PE

Efficacy of paroxitine for the management of premature ejaculation

Premature ejaculation is a common male sexual disorder and has been managed by psychosexual counseling, topical anesthetics and pharmacological treatments. We evaluated the efficacy of paroxetine, a potent and highly selective serotonin reuptake inhibitor, antidepressant in patients with premature ejaculation. This comparative study was carried out in the Department of Urology, Nishtar Hospital, Multan for 3 months. A total of 100 patients complaining of premature ejaculation were selected and randomly grouped-A and B. Patients in group-A received 20 mg paroxetine [n-50] and in group-B placebo for 3 first weeks regularly then on demand for 3 months. Pretreatment evaluation included history, physical examination, intra-vaginal ejaculation latency time and satisfaction with sexual intercourse. Efficacy of 2 treatments was assessed at 3 weeks and 3 months at study end point where patient reported impression of change was recorded. Trial was completed by 39 patients in each group [78%], Analysis revealed a difference in WELT increase in 2 groups. In group-A IVELT increased after paroxetine from 1 mm 10 sec to 4 min 17 sec at 3 weeks and 4 mm 6 sec at 3 months while in placebo group IVELT increase from 1 mm 1 sec at beginning to 1 min 15 sec at 3 weeks and 1 min 8 sec at c months [2 tail sig .000]. Regarding patient reported impression of change there was 2 category improvement in 56.4% patients in paroxetine group while 12.8% in placebo group. Paroxetine has significantly better results in terms of IVELT and intercourse satisfaction. Further studies are required to draw final conclusions on the efficacy of this drug in PE

Effect of sildenafil (Viagra®) on the genital reflexes of paradoxical sleep-deprived male rats

Since there is evidence that paradoxical sleep deprivation (PSD) elicits penile erection (PE) and ejaculation (EJ), and that the erectile response of rats is mediated by nitric oxide, the present study sought to extend the latter finding by assessing the effects of sildenafil on the genital reflexes of male Wistar rats subjected to PSD. We also determined the influence of sildenafil on hormone concentrations. In the first experiment, sildenafil at doses ranging from 0.08 to 0.32 mg/kg was administered intraperitoneally to rats that had been deprived of sleep for 4 days and to home cage controls (N = 8-10/group). The frequency of PE and EJ was measured for 60 min. PSD alone induced PE in 50 percent of the animals; however, a single injection of sildenafil did not significantly increase the percentage of rats displaying PE compared to PSD-saline or to home cage groups. PSD alone also induced spontaneous EJ, but this response was not potentiated by sildenafil in the dose range tested. Testosterone concentrations were significantly lower in PSD rats (137 ± 22 ng/dL) than in controls (365 ± 38 ng/dL), whereas progesterone (0.9 ± 0.1 vs 5.4 ± 1 ng/mL) and plasma dopamine (103.4 ± 30 vs 262.6 ± 77 pg/mL) increased. These changes did not occur after sildenafil treatment. The data show that although sildenafil did not alter the frequency of genital reflexes, it antagonized hormonal (testosterone and progesterone) and plasma dopamine changes induced by PSD. The stimulation of the genital reflexes by sildenafil did not result in potentiating effects in PSD rats.

Bethanecol chloride for treatment of clomipramine-induced orgasmic dysfunction in males

OBJETIVO: Investigar se o uso do cloridato de betanecol é uma alternativa útil no manejo clínco da disfunção orgásmica induzida pela clomipramina, relatada por até 96 % dos usuários do sexo masculino. MÉTODOS: Foram estudados 12 pacientes do sexo masculino em remissão completa de transtorno de pânico porém com queixas de disfunção orgásmica grave secundária ao uso da clomipramina. Os pacientes foram aleatoriamente distribuídos ao tratamento com cloridrato de betanecol (20 mg quando necessário) ou placebo em um estudo duplo cego "crossover" de dois períodos. RESULTADOS: Foi observado um benefício claro no período de uso da droga ativa. Não foram observados efeito placebo ou "carry-over" nos pacientes inicialmete alocados ao medicamento ativo. CONCLUSÕES: Os resultados deste estudo sugerem que o cloridato de betanecol, usado em doses únicas, 45 minutos antes da relação sexual, pode ser útil em pacientes do sexo masculino apresentado disfunção orgásmica secundária ao uso da clomipramina.

Penile vibratory threshold changes with various doses of SS-cream in patients with primary premature ejaculation

SS-cream made with extracts from natural products is a topical agent for treating premature ejaculation (PE). In order to elucidate the penile vibratory threshold changes and clinical effects of various doses of SS-cream, 53 patients with primary PE were investigated in a double-blind randomized placebo-controlled study. The mean age was 37.3 +/- 6.4 years and mean ejaculatory latency was 1.37 +/- 0.52 minutes. Neither the patients nor their sexual partners were satisfied with their sexual lives. Vibratory threshold at the glans penis, penile shaft, scrotum and index finger were measured using a biothesiometer twice during the screening period and three times one hour after the application of respective creams (SS-cream 0.05, 0.10. 0.15, 0.20 gm and placebo 0.10 gm) on the glans penis according to the order of the allocation table in a randomized fashion. The efficacy of SS-cream was defined as when the vibration threshold increased by more than 4 microns compared to the value tested during the screening period. The vibratory thresholds at the glans penis increased significantly in a dose-dependent manner after the application of various doses (0.05, 0.10, 0.15, 0.20 gm) of SS-cream (p < 0.001), and the efficacy of SS-cream on the penile vibration threshold increased according to the increased dosage (penile shaft: 48.4, 51.6, 54.8, 64.5%, glans penis: 58.1, 67.7, 77.4, 83.9%, respectively). With these results, we concluded that SS-cream increased the penile sensory threshold dose dependently, and therefore it is clinically effective for treating the heightened penile sensory response in patients with PE.

Efficacy of a topical agent SS-cream in the treatment of premature ejaculation: preliminary clinical studies

SS-cream is a topical agent for treating premature ejaculation (PE) which is made with extracts from 9 natural products. We evaluated the efficacy of SS-cream in the treatment of PE. An open pilot study was performed in 186 patients with PE. The mean ejaculatory latency from intromission to ejaculation was 1.5 minutes. Sixty-four of the 186 patients (34.4%) were combined with mild erectile dysfunction in whom penile rigidity was not sufficient to be satisfied in sexual activity. Patients were instructed to apply 0.1 gm. of SS-cream on the glans penis 1 hour before sexual contact and to wash out the cream before sexual intromission. Patients were asked to complete a report form including ejaculatory latency, the degree of satisfaction in the sexual lives of both themselves and their partners, and any adverse effects after each application. One hundred and sixty-six out of 186 patients (89.2%) reported they were satisfied with the application of the SS-cream and the mean ejaculatory latency was significantly prolonged to 10.89 +/- 5.60 minutes. The mean ejaculatory latency was 9.85 +/- 3.58 minutes in 52 out of 64 patients (81.2%) with mild erectile dysfunction. There was no significant difference in the changes of ejaculatory latencies between patients with pure PE and patients with mild erectile dysfunction. Twenty patients (10.8%) claimed to have no changes of ejaculatory latencies after the application of SS-cream. Adverse effects were noted in 11 patients (5.9%), which were mild local irritation symptoms in 7 patients, and delayed ejaculation of more than 30 minutes in 4 patients, the symptoms subsided spontaneously within 4 hours. These results indicate SS-cream is effective in the treatment of PE and also PE combined with mild erectile dysfunction with a few side effects. Further studies on the action mechanisms of SS-cream and a double blind placebo-controlled trial are needed.

The effects of SS-cream and its individual components on rabbit corpus cavernosal muscles

SS-cream (Severance Secret cream) is made up of extracts from 9 natural products for treating premature ejaculation (PE). SS-cream has been proved to be effective in the treatment of PE in pilot clinical studies. It has also been found to have a potentiating effect of their erectile capacity in some patients. Therefore, we investigated the pharmacological actions of SS-cream and the extracts of its individual components in rabbit corpus cavernosal smooth muscle to realize the effect of SS-cream on penile erection. Extracts of Bufonis Venenum induced a dose-related contraction of rabbit corpus cavernosal muscle, which was significantly inhibited by phentolamine. Extracts of Caryophylli Flos induced a dose-related relaxation in the muscle strips precontracted with phenylephrine (5 x 10(-6)M; PHE). Caryophylli Flos caused a dose-dependent inhibition of the PHE induced contraction and also inhibited the contractility of Bufonis Venenum. Other extracts, when used individually or in a mixture, induced a dose-related relaxation in the precontracted muscle strips with PHE. SS-cream began to exert a relaxing effect at the concentration of 0.05 mg/ml in the muscle strips precontracted muscle strips with PHE (5 x 10(-6)M); causing dose-dependent relaxation with a maximal effect at 0.2 mg/ml. The relaxation effect of SS-cream was partially inhibited by endothelial disruption and by pretreatment with methylene blue, pyrogallol, atropine, and indomethacin, although they were not statistically significant. The results show that SS-cream has a relaxing effect on cavernosal smooth muscle. And it is partly related with enhancing the NO/cyclic GMP pathway although the relaxation mechanism in detail remains to be elucidated. Therefore, SS-cream may be effective for future treatment of mild erectile dysfunction, in addition to its role for premature ejaculation.

Sensory evoked potential and effect of SS-cream in premature ejaculation

The cause of premature ejaculation (PE) has been thought to be psychological in the majority of patients but we investigated penile hypersensitivity for an organic basis of PE. For another organic basis of PE, we have suggested hyperexcitability of the ejaculation center. SS-cream is a topical agent containing 9 oriental herbs for treating PE. Clinically SS-cream has been effective in the treatment of PE. Therefore, in order to implicate the organic basis of PE and realize the effect of SS-cream on PE, we investigated the somatosensory evoked potential (SEP) in patients with PE(16 cases) and the effects of SS-cream on SEP for treating PE. The latencies and amplitudes of the evoked responses were measured by two different places in stimuli, one was on the penile shaft with ring electrode and the other on the glans penis with a surface electrode. The latency of SEP stimulated at the glans penis was significantly longer than that stimulated at the penile shaft (p 0.05). The amplitudes of the evoked responses stimulated at the glans penis were significantly higher than those stimulated at penile shaft (p< 0.05). And both these amplitudes were significantly reduced with the application of SS-cream (p< 0.05). With these result, we can suggest that the patients with PE have glans penile hyperexcitability and it provides further implications for an organic basis of PE, SEP stimulated at the glans penis can be a very useful method to evaluate PE, along with SEP stimulated a penile shaft and SS-cream prolongs the sensory conduction and reduces the penile hyperexcitability of the patient with PE.

Experiencia en el tratamiento de la eyaculación precoz con alta bloqueadores asociados a terapia conductual / Experience in the treatment of premature eyaculation with alpha blockers associated with behavioral therapy

Se tratan 54 pacientes que padecen de eyaculación precoz o incontinencia eyaculatoria con fenoxibenzamina. Se administró por vía oral la droga a 40 pacientes en dosis de 10 mg diarios por un tiempo que fluctuó entre 5 y 7 semanas. A 14 pacientes se le administró placebo en la misma forma. Se obtuvo éxito en 80% (32/40) de los tratados con fenoxibenzamida y en 57,2% (8/14) de los que recibieron placebo. El resultado se considera promisorio, dado que el 58% de los tratados con droga acusaron efectos excelentes y buenos mientras que el placebo produjo sólo un 21,5% de resultados buenos y ninguno excelente. En los casos que fracasaron el tratamiento se prolongóm por cuatro semanas, indicándoseles además, la autoterapia de Lopicolo. Se logró así un 100% de rendimiento con fenoxibenzamina y un 78,5% con placebo, diferencia que es estadísticamente significativa (p < 0.01)