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Dapoxetine 60 mg significantly improves the mean intravaginal ejaculation latency time ielt compared to that of dapoxetine 30 mg in men with lifelong pe, but there is no difference in men with acquired pe.

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The stop-start technique has since been popularized by Kaplan in 1983In this technique the man is asked to pause during sexual stimulationjust prior to impending ejaculationThis pause allows the patient to acclimatize to the sensation and to condition himself to increased ejaculatory controlThis technique helps the patient to heighten his awareness of sexual sensationsUnfortunatelymany others have found that any initial success achieved by behavioral therapy was not maintained at 3-year follow-upSharlip 2005Non-pharmacological treatment options for PE are provided in Figure 1

PE may be treated with sex therapymedicationsor a combination of these approachesDapoxetinea selective serotonin reuptake inhibitorSSRIis the only oral medication developed to treat PEIt is approved in 60 countries.

Recentlyin a well-designed studySalonia et al2002compared paroxetine alone with paroxetine and sildenafil as an oral therapy for men reporting PEIn the combination groupparoxetine was given as 10 mg once daily for 20 daysfollowed by 20 mg as needed and sildenafil 50 mg 1 hour before sexual activityThis study demonstrated that the combination of paroxetine and sildenafil obtained better results in regards to IELT and intercourse satisfaction than paroxetine aloneThe combination treatment was associated with a mild increase in drug-related adverse eventssuch as headache20nausea15and flushing15Despite the higher incidence of adverse effects associated with the combined therapymost patients90were willing to continue this treatment on an as-needed basis.

The involvement of central serotonergic neurotransmission in ejaculation has been investigated in a number of animal studiesThe drug stimuli of the SSRIs fluoxetine and paroxetine most closely resemble 5-HT 2C receptor activationBerendsen and Broekkamp 1994The activation of both 5-HT 2A and 5-HT 2C receptors by 2,5-dimethoxy-4-iodophenyl-2-aminopropane increases ejaculatory latencyForeman et al 1989while the selective 5-HT 2A receptor agonist 2,5-dimethoxy-4-methylamphetamine does not exhibit this effectAhlenius et al 1981On the other handselective activation of 5-HT 1A receptors by 8-hydroxy-2di-n-ropylaminotetra-linshortens the ejaculatory latency time and reduces the number of intromissions preceding ejaculation in animalsAhlenius et al 1981SSRIs block the 5-HT transportersboth in the presynaptic membrane and the cell-bodyAs a consequenceserotonin levels increase outside the cell-body and in the synapsesWaldinger 2005Due to increased serotonin levels by SSRIs5-HT 1A autoreceptors at the surface of the cell-body and 5-HT 1B autoreceptors in the presynaptic membrane become activatedWaldinger et al 1998a2005bThe initial activation of both somatodendritic 5-HT 1A auto-receptors and the presynaptic 5-HT 1B autoreceptors results in an inhibition of 5-HT release into the synaptic cleftConsequentlyafter acute SSRI administrationserotonin concentrations in the synapse generally diminishbut may be active due to the blockage of the 5-HT transporters causing some slight stimulation of all postsynaptic 5-HT receptorsWaldinger et al 1998a2005bHoweverafter chronic SSRI administrationthe 5-HT 1A and 5-HT 1B autoreceptors become desensitizedresulting in a diminished inhibitory action of these receptors to 5-HT releaseConsequentlyserotonin is again released into the synapse.

PE may be treated with sex therapymedicationsor a combination of these approachesDapoxetinea selective serotonin reuptake inhibitorSSRIis the only oral medication developed to treat PEIt is approved in 60 countries.

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