Selective Serotonin-Reuptake Inhibitors in the Treatment of Premature Ejaculation

Amanda J Moreland and Eugene H Makela

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OBJECTIVE: To review the use of selective serotonin-reuptake inhibitors (SSRIs) in the treatment of premature ejaculation.

DATA SOURCES: Articles were retrieved through a MEDLINE search (1966–January 2004). Search terms used to identify articles
included serotonin uptake inhibitors, premature ejaculation, rapid ejaculation, and sexual behavior, as well as the generic names of
currently available SSRIs: fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, and escitalopram. The literature search was limited
to articles published in the English language containing human subjects.

STUDY SELECTION AND DATA EXTRACTION: Articles obtained through the literature search were evaluated, and randomized
controlled trials were included in this review. Information from noncontrolled trials or case reports was considered for inclusion if it
contributed to the completeness of this review and if it was the highest level of evidence available.

DATA SYNTHESIS: Premature ejaculation is a commonly reported sexual difficulty. Delayed ejaculation is a widely reported sexual
adverse effect of SSRIs. In some men exhibiting premature ejaculation, the ability of the SSRIs to delay ejaculation has been therapeutic.
Trials evaluating the ejaculation-delaying ability of SSRIs demonstrated that paroxetine, fluoxetine, sertraline, and citalopram produce a
statistically significant increase in the ejaculation latency time compared with placebo.

CONCLUSIONS: Taking advantage of the ejaculation-delaying effects of SSRIs increases the treatment options available to prescribers
and patients. Convenience and minimal adverse effect profile make these agents an alternative to previously used behavior modalities
and older pharmacologic agents. Although some questions still surround the details of their use, SSRIs have the potential to improve
the quality of life for men with premature ejaculation and their partners.

Key Words: selective serotonin-reuptake inhibitors: citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, premature ejaculation

Published Online, June 7, 2005. www.theannals.com, DOI 10.1345/aph.1E069

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-05-024-H01