Latest news in the treatment of  premature ejaculation

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PSD502, an anesthetic spray for premature ejaculation -

The treatment of premature ejaculation may be about to take a leap forward....or maybe not. This latest treatment sounds a bit like an anesthetic lotion for the penis which was produced in the 1970's but never really caught on. PSD502 is a new compound manufactured for men with premature ejaculation. It consists of an aerosol spray with which the man can spray a numbing or desensitizing lotion onto his penis a few minutes before intercourse to reduce sensitivity to sexual stimulation. The spray contains a mixture of lidocaine and prilocaine, both well known agents in the treatment of premature ejaculation. The results show that men who used the spray lasted up to six times longer during sex than men who had not used the spray - but were they satisfied with their orgasm? It's an important question, since men who have used condoms impregnated with local anesthetic can probably testify to the numbing effect of the local, topically applied anesthetic, but they generally seem to find that while they do not last any longer during sex, the pleasure of their orgasm is greatly reduced.

In this study, the results as presented by Professor Wallace Dinsmore apparently showed that PSD502 was very well received and caused few adverse effects, being well tolerated and accepted by the men who took part in the study.

We all know that many men are affected by premature ejaculation: depending on how you define the intravaginal ejaculatory latency time (IELT) which qualifies as premature ejaculation, as many as seventy five per cent of men have the problem....and every man who comes quickly knows what a problem it can be. Despite this, there is no prescription drug approved by the FDA to treat the condition; and a simple drug solution would obviously make many men's sexual experiences  - not to mention those of their partners - much more enjoyable.

The study into the effectiveness of the new drug was done with the help of 300 men in four European countries. The average time between penetration and ejaculation was increased to one minute in 90% of the men taking part, and to two minutes for 75% of the en taking part in the test. But these seem like very small increases - though some men would undoubtedly have benefited more - and despite the fact that the men's sexual satisfaction rating was correspondingly higher after receiving PSD502, I would be very interested to know what sex with the addition of this anesthetic to my penis actually felt like. My suspicion is that it would not be as rewarding. The men may have reported greater sexual satisfaction in response to the fact that they could maintain vaginal penetration for a period of time without ejaculating - that's bound to be a significant thing for a man who is accustomed to ejaculating almost immediately after penetration. 

So here is the relevant data on quality of orgasm: the number of men who thought they had had a "good" or "very good" orgasm increased from 20% to over 60% with the drug. So, it seems that the men liked it. But the result of a comparatively small scale trial like this do not really reveal much about the practical application of the system in the real world. For one thing, the conditions under which the drug was applied to the penises of the men before intercourse would no doubt have been very strictly controlled.

As far as side effects were concerned, the study obfuscates by reporting that "only" 2.6% of men reported treatment-related adverse events. These included a case of penile numbness.....as opposed, presumably, to reduced sensitivity. Five men experienced mild adverse effects: one man experienced hypoesthesia (reduced sense of touch or sensation, or a partial loss of sensitivity to sensory stimuli), there were two episodes of erythema, (redness of the skin caused by capillary congestion), one report of burning, and two men lost their erections.

PSD502 is a non-ionized combination of lidocaine and prilocaine 2.5 mg in a propellant, designed to be sprayed onto a man's glans only five minutes before sexual intercourse takes place. As a result of its chemical properties the compound penetrates the surface of the penis, thus taking only five minutes before the onset of its action. Maybe the most important aspect of the study is that the drug does not only help the man to last longer - it helps his partner, who may care more about his premature ejaculation than he does.

American Urological Association 104th Annual Scientific Meeting: Abstract 1370: Presented April 28, 2009.

Premature ejaculation may be in the genes

In a study conducted in Holland, just under 100 men with premature ejaculation were recruited alongside 92 men who had never had premature ejaculation. The object was to investigate the variables whish might contribute to premature ejaculation. The men's partners were asked, perhaps slightly bizarrely, to time the period between intromission and ejaculation with a stopwatch. Whether or not this could give a fairly balanced view of the men's performance as lovers is slightly questionable, but that was the way the researchers established their data.

The results revealed that men who had premature ejaculation showed lower levels of serotonin than men who did not, a significant finding in view of the fact that serotonin is responsible for the control - or at least exerts significant influence over - the processes of ejaculation, sexual activity, aggression and appetite. A low level of activity of serotonin means that nerve activity will be lower.

Apparently, the study showed that a particular gene (5-HTTLPR for those with a fanatical interest in detail) which is responsible for levels and activity of serotonin in the brain has three forms in the human body, named LL, SL and SS. The men whose genetic constitution carries the LL version of the gene are primed to ejaculate faster than those who carry the other variants - twice as fast, in fact.

What's revolutionary about this, of course, is the fact that we have mostly seen premature ejaculation as a psychological issue up till now. This strongly contradicts that idea, and suggest that at least part of the problem is physiological. It remains unclear how significant this finding is in terms of practical application: gene therapy specifically to deal with premature ejaculation would seem to be both unethical and unlikely.

October 2008

Finding that Viagra can work for men with erectile dysfunction has prompted interest in the possibility of orally taken drugs for the treatment of premature ejaculation.

Serotonergic antidepressant drugs may cause retarded or delayed ejaculation in men who take them for depressions. Could this be significant in the treatment of premature ejaculation?

Premature ejaculation has always been seen as a learned behavior or conditioned response cause by rushed early sexual experiences, the conditioning heightened by anxiety. Anxiety promotes the release of adrenalin, and this makes the smooth muscle of the penis contract (a possible cause of secondary erectile dysfunction). Treatment strategies developed by psychologists and sex therapists ranged from  psychoanalysis to Masters & Johnson's "squeeze" technique. But although these techniques work at the time, after three years, as few as one fourth of the men who gained longer IELT (intravaginal ejaculatory latency times) are found to have maintained those gains.

Premature ejaculation produces lower self-esteem and general self-confidence in men, as well as sexual and overall relationship difficulties which are less marked for men who are capable of making love for longer before ejaculating. So it is a significant problem, as you can see from the definition: Premature ejaculation is ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners.

Diagnosis

Men who have premature ejaculation are defined by a time between intromission and ejaculation as being of less than two minutes and where there is distress caused by this short period of lovemaking. From the man's point of view, this means he has reduced control over ejaculation; he is dissatisfied with intercourse, and he or his partner are distressed about it.

In one study in men over 18 years of age data analysis showed that the most significant things associated with a formal diagnosis of premature ejaculation are: control (or lack thereof) over ejaculation, personal distress, and IELT less than 2 minutes. Since many men do not apparently mind that they can make love for so short a length of time, the added factor of "distress" is need: substantial overlap exists between men with premature ejaculation and those without when IELT alone is used alone as a defining feature of the condition.

When men are asked to estimate how long they are capable of making love for, they are found to overestimate the time somewhat: men with PE think they can make love for two minutes, when the actual average is 1.8 minutes - men without PE estimate their capacity at 9 minutes when they can actually make love for 7.3 minutes. By these criteria, premature ejaculation is present in at least 35% of males over 18 years of age. It's also not surprising to find that  premature ejaculation is the most common male sexual dysfunction with erectile dysfunction and decreased libido close behind. Men with premature ejaculation are obviously much less happy about the quality of their sexual relationship, their sex life, and the quality of their relationship with their partner.

Topical Treatment

Despite the rave reviews produced for PSD 502, the application of chemicals to the penis can be messy, indiscreet, and does rather depend on the ma's partner going along with the treatment. In addition, there are problems of  anorgasmia, inability to ejaculate, and penile numbness (not to mention vaginal numbness). However, oral treatment with Viagra can be helpful when premature ejaculation develops after mild erectile dysfunction, probably because it reduces the anxiety about not getting an erection.

Pharmacologic Treatment

Selective serotonin reuptake inhibitors (SSRIs) have been used unofficially for some time to delay ejaculation. Because these usages are unofficial, and the drugs are not licensed for these uses, the research which would demonstrate the optimum dose has been lacking. we do know that constant use is more successful than on-demand use - a rather dramatic way of controlling rapid ejaculation, and perhaps not one that many men would be willing to take. Ongoing use of SSRIs is linked to dry mouth, nervousness, headache, drowsiness, gastrointestinal upset, diarrhea and restlessness.

So an ideal drug for premature ejaculation would be discreet, preferably oral; work rapidly, be eliminated rapidly, not accumulate in the body, and be well tolerate with few side-effects. There is no such drug at present!

Dapoxetine

Dapoxetine hydrochloride has been developed for the treatment of premature ejaculation; it is a powerful inhibitor of serotonin reuptake and is a serotonin transporter inhibitor. Animal experiments have shown that intravenous dapoxetine in varying doses has the capacity to reduce the emission and expulsion phases of ejaculation directly proportional to the dosage. Dapoxetine works - at least in rats - by increasing the pudendal motor neuron (nerve cell) reflex latency period.

Just over 1700 men tried varying doses of dapoxetine (0, 30 mg and 60 mg) taken between 1 and 3 hours before sexual intercourse. On follow-up, the men revealed increased satisfaction with sexual intercourse, increased control of what was previously premature ejaculation, and reduced symptom severity. What's more, dapoxetine was shown to work equally well in acquired and lifelong premature ejaculation. Men who had the shortest time between penetration and ejaculation (thirty seconds or less) showed more or less a 7 fold increase in the length of time for which they could make love. Those who previously lasted between 1 and 2 minutes could now last for three times as long. Sadly, the most common side-effect is nausea.

Those with an interest in promoting Dapoxetine have shown that it is not accumulated in the body to a significant extent, and that it is rapidly eliminated. But it is a fairly major stretch to imagine this heavy duty pharmaceutical as a licensed treatment for premature ejaculation, and indeed the drug hs so far not gained FDA approval.

Educational Need

The majority of men who consider they have premature ejaculation also have significant worry about the problem with 58% saying they are frustrated about ejaculating too soon. according to other research, most doctors seem to think that premature ejaculation causes only minor or no distress to men who have it (a trifle odd, since presumably a lot of doctors have it and know how it affects them). About a tenth of all men have spoken to a doctor about premature ejaculation - a massive 85% said there was little or no improvement after consultation. in this, as in so many other ways, doctors are letting their patients down - even if the only recommendation they can make is for sexual therapy.

http://cme.medscape.com/viewarticle/520278

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