Premature ejaculation (PE) is also referred to as rapid or early ejaculation and has: a brief ejaculatory latency with loss of control and psychological distress in the patient and/or partner.
Management depends upon the etiology, but the mainstays of therapy include tablets, topical anesthetics, and psychotherapy when psychogenic and/or relationship factors are present
1. I consider SSRIs to be first-line treatment. Such drugs are prescribed by Urologists often and include salts like Paroxetine, Sertraline, Fluoxetine, Citalopram. One should not confuse them to be drugs only for depression and should follow the advise of the Urologist and not a non medical person or the chemist in this regard. The full effect of these drugs is typically not seen until after two to three weeks of therapy, and symptoms return if treatment is stopped. So another word of caution is that this treatment requires patience .
If SSRIs are ineffective or not tolerated, I would consider other drugs
2. An additional SSRI, Dapoxetine, also appears to be effective; Dapoxetine is taken on-demand one to three hours before intercourse.
3. PDE inhibitors like Viagra may also be effective for the treatment of PE, but only in men with PE and co-existing Erectile Dysfunction
4. Topical Anesthetics are also more effective than placebo. Local anesthetic sprays have been reported to improve premature ejaculation when applied topically to the glans penis five minutes before intercourse. Most of them are available over the counter without a doctor prescription.
5. Behavioral and Psychological Therapies are effective in some men. These interventions are designed to achieve a number of goals: improve self-confidence and communication in the relationship, and ultimately, increase the ejaculation latency.
Combined pharmacologic and behavioral treatment appears to be more effective than medicines alone. I would suggest this approach in men with PE who have a clear psychosocial precipitant or in those with individual or couple issues that could impact the success of pharmacotherapy alone.