Therapeutic target
- Improvement of the symptomatology
Therapy recommendations
- Psychotherapy or behavioral therapy should be performed in any case before the use of medication
- For symptomatic therapy, the following groups of agents are used:
- Antihypotensives (drugs used to treat hypotensive circulatory disorders); 30 min before ejaculation; for retrograde ejaculation.
- Antidepressants: SSRI (selective serotonin reuptake inhibitor); take several hours before coitus, taking as needed.
- Local anesthetics/drugs used for local anesthesia (anesthetic creams and sprays; coated condoms); may also decrease partner sensation
- Phosphodiesterase-5 inhibitors; taken as needed.
- See also under “Other therapy.”
Antidepressants
Antidepressants are drugs such as amitriptyline or venlafaxine that are used to treat depression. Amitriptyline is one of the tricyclic antidepressants. These medications have a mood-lifting effect. Venlafaxine is one of the Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRI) and has an antidepressant effect without being sedating (drowsy) at the same time. The most common side effect of this medication is nausea. In ejaculatio praecox, antidepressants are used to prolong the time during intercourse until ejaculation.
Selective serotonin reuptake inhibitors
Selective serotonin reuptake inhibitors are drugs that are among the first-line medications for depression. Among the most important representatives of this group are the agents citalopram and fluoxetine. They appear to have the same effect as the tricyclic antidepressants, but with better tolerability. The most frequent side effects concern the gastrointestinal tract with loss of appetite and nausea. Furthermore, they lead to sleep disturbances and sexual dysfunction. However, the most feared is serotonin syndrome, which can lead to convulsions and disturbances of consciousness. For ejaculatio praecox, the substances fluoxetine, sertraline, paroxetine and dapoxetine are mainly used.
Tricyclic antidepressants
Tricyclic antidepressants are among the classic medications used in the treatment of depression. They include amitriptyline and desipramine. All of the active ingredients in the groups are mood elevating. Thus, according to further effect types can be divided into depressant and activating drugs. Side effects include mainly weight gain, orthostatic hypotension, and sexual dysfunction. For ejaculatio praecox, the drug clomipramine is used.
Phosphodiesterase inhibitors
Phosphodiesterase inhibitors refers to a group of drugs that result in vasodilation (widening of blood vessels). Several subgroups are distinguished, with group V and its active ingredients sildenafil and vardenafil being used for ejaculatio praecox. Side effects include blood pressure attacks, visual disturbances, and the risk of cardiovascular disorders.
Local anesthetics
Local anesthetics are medications administered to eliminate pain in a limited area of the body. They are usually given before minor surgical procedures. Lidocaine or prilocaine are the most commonly used for ejaculatio praecox. Local anesthetics are applied to the penis and delay arousal.
