FEW men dare to speak its name. But as the first drug specifically designed to treat premature ejaculation proves successful in clinical trials, some critics are questioning whether such treatments are necessary at all.
Jon Pryor at the University of Minnesota, Minneapolis, and colleagues tested the effectiveness of a selective serotonin reuptake inhibitor (SSRI) called dapoxetine on nearly 2000 men with moderate or severe premature ejaculation (PE). Before the trial, these men lasted less than 1 minute after penetration before ejaculating.
After 12 weeks of treatment, the time to ejaculation was 1.8 minutes for men given placebo, 2.8 minutes for those on30 milligrams of dapoxetine and 3.3 minutes for the 60 milligram dose. All doses were taken 1 to 3 hours before intercourse (The Lancet, vol 368, p 929).
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鈥淭he time to ejaculation increased to 3.3 minutes. Partners benefited through improved satisfaction with intercourse鈥�
鈥淒apoxetine also improved patients鈥� perceptions of control over ejaculation, satisfaction with sexual intercourse and overall impression of change in condition,鈥� says Pryor. 鈥淧artners benefited through improved satisfaction with sexual intercourse.鈥�
However, Marcel Waldinger, a neuropsychiatrist at Leyenburg Hospital in The Hague, the Netherlands, says other SSRIs are already being used to treat the condition and are more effective. He is also concerned that pharmaceutical companies may be trying to 鈥減athologise鈥� a condition that does not need treating in this way. Last year, Waldinger compared the time taken to ejaculate among the general population of the Netherlands, the UK, US, Spain and Turkey. On average, men lasted for 5.4 minutes, though in Turkey the average time was 3.7 minutes.
鈥淐linicians should be careful that pharmaceutical companies do not try to pathologise and medicalise men who sometimes only suffer from a rapid ejaculation, as this belongs to normal sexual performance,鈥� Waldinger says.
Pryor describes PE as the most common form of male sexual dysfunction, affecting between 21 and 33 per cent of men at some point in their lives. Lifelong PE is probably much rarer, Waldinger says, affecting only 1 to 5 per cent of men. They are the only ones who should consider taking drugs for the condition, he says.
The US Food and Drug Administration last year declined to grant a licence for dapoxetine to treat PE, but did not give a reason. Pryor says his study proves the drug is effective and safe, although some participants suffered side effects including nausea, diarrhoea, headaches and dizziness. Dapoxetine is made by ALZA, a subsidiary of Johnson & Johnson.
