Treatment for Premature Ejaculation 

Daily treatment with between 20 and 50 mg of clomipramine appears to be effective in controlling premature ejaculation - at least to the extent that a number of studies have confirmed this.

Treatment with SSRIs

Paroxetine was first shown to have a strong ejaculation-delaying-effect in 1994, at dosages of between 20 and 40 mg per day. Unfortunately, despite the claimed effectiveness, the drug companies have not applied to the American FDA for approval for the use of the drugs in this context. This may be because the drugs can in fact have a major effect on sexual potency, and the drug companies do not wish this fact to be highlighted.

However, when the published studies which are of a sufficiently high standard on this matter are reviewed, the order of effectiveness of these drugs is as follows:

Highest (most effective) - Paroxetine (20-40 mg)
Clomipramine (10-50 mg)
Sertraline         (50-100 mg)
Lowest (least effective) - Fluoxetine  (20-40 mg)

Ejaculation delay apparently begins a few days after first taking these drugs, but becomes most marked after a period of between one and three weeks. The effect of delaying ejaculation is usually permanent, but it may sometimes diminish after a year.

It should be noted that the mechanism by which these drugs delay ejaculation is still unclear. Furthermore, there are a number of more-or-less unpleasant side-effects, which include fatigue, yawning, mild nausea, loose bowels, sweating and so forth: these are claimed to diminish with time, and to have mostly disappeared by three weeks into the treatment regime. It is also claimed that loss of libido and erectile function are rarely reported by users of these drugs who seek to extend their sexual performance and staying power. (This is not the case with men who take them for depression.)

One unfortunate effect is priapism: that is to say, getting an erection which lasts for hours. If this happens to you, please seek urgent medical attention - any erection which lasts over three hours can cause serious damage to the penis and its erectile mechanism.

On demand drug premature ejaculation treatment is obviously the desirable objective, in that the drugs can be taken some time before intercourse and ejaculation will later be delayed. There has been surprisingly little research in this area, but the results are not promising. Those drugs investigated include topical anesthetics, clomipramine, SSRIs, Dapoxetine, and compounds like Viagra.

Topical Anesthetics

Use of local anesthetics such as lidocaine in the form of a cream, liquid gel or spray to be applied to the penis is a method still used even today, although it can cause adverse and unwanted side-effects such as complete anesthesia or a numb vagina. Such anesthesia of the penis may produce difficulties with erection. These anesthetics supposedly delay ejaculation by decreasing the sensitivity of the glans. The numb vagina may be avoided by using a condom.

Clomipramine

There is a suggestion that use of 20-40mg clomipramine 3 to 5 hours before sex can delay ejaculation - unfortunately, the side-effect is nausea, which might be somewhat deleterious to the romance of the occasion.

SSRIs

Few studies of on-demand treatment with SSRls have been reported. A review of the few studies that have been conducted suggest that on-demand use of SSRIs do not have a significant impact on ejaculation after 3-5 hours. There is another aspect to this too: the spontaneity of sex is adversely affected when a drug has to be take several hours before sex (though those taking Viagra for erectile problems may not agree that it is much of a disadvantage!)

Dapoxetine

The SSRI Dapoxetine has been developed for on-demand treatment of premature ejaculation but it has never been approved for the purpose. clinical study. Dapoxetine gets into the bloodstream quickly but it does not actually produce much of a delay in the time between penetration and intercourse - only a minute or two.

Tramodol

Tramadol is a centrally acting analgesic agent that combines opioid receptor activation and inhibits uptake of serotonin and noradrenalin. It can produce a delay in ejaculation, but it has unpleasant side-effects in 28% of men including nausea and vomiting.

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