Pharmacological management of premature ejaculation

Premature ejaculation is the most common male sexual complaint, affecting approximately 23% of all men. All definitions of premature ejaculation incorporate three main qualifications: a short time interval between penetration and ejaculation, little or no control over ejaculation, and interpersonal or relationship distress. There are two primary pharmacological interventions for premature ejaculation: antidepressants and local anaesthetics, although phosphodiesterase type 5 inhibitors, intracavernosal injections, and opiates have also been used. The selection of treatment is dependent on accurate assessment (to exclude prostate infection), the context of the patient's sexual relationship, and the patient's choice. For many, a combination approach of pharmacology and behavioural intervention will be needed. In this article, treatment choices are considered and recommendations made for the clinical management of premature ejaculation.