https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1743-6109.2010.01782.x

Disorders of Orgasm and Ejaculation in Men

The Neurobiological Approach to Premature Ejaculation

Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: the involvement of the serotonergic system

Seventeen male outpatients with premature ejaculation were randomly assigned to treatment with paroxetine (N = 8) or placebo (N = 9). After a first week dose of 20 mg/day, the paroxetine regimen was increased to 40 mg/day for 5 weeks. Patients and their female partners were interviewed separately. Patients treated with paroxetine had significantly greater clinical improvement than the patients given placebo.

Paroxetine treatment of premature ejaculation: a double-blind, randomized, placebo-controlled study.

The aim of this systematic review and meta-analysis is to evaluate whether the design and methodology of drug-treatment studies of premature ejaculation affect the efficacy outcome differently. Therefore, methodological, design and efficacy data from 79 studies (3034 males), published between 1943 and 2003, are reviewed. A meta-analysis is performed on 43 selective serotonin reuptake inhibitors (SSRIs) and clomipramine studies (1514 males), published between 1973 and 2003; these studies were pooled to provide a summary variance-weighted effect size. The antidepressant-induced percentage increase of the intravaginal ejaculation latency time (IELT) was calculated and examined against various methodological items. A significant difference in efficacy between SSRIs was observed. Using daily treatment, paroxetine appeared more effective than the other SSRIs. Retrospective use of a questionnaire, subjective reports, single-blind and open study designs generate far greater variability of ejaculation time both at baseline and during active drug treatment than real time assessment by stopwatch. In conclusion, at daily treatment, the overall efficacy of paroxetine, clomipramine, sertraline and fluoxetine is comparable, but paroxetine exerts the strongest ejaculation delay. Only eight (18.5%) studies on antidepressant treatment fulfilled all criteria used in evidence-based medicine, for example, randomised, double-blind studies with prospective real time (stopwatch) assessment of the IELT at each intercourse. Single-blind studies, open designs, retrospective reporting, or the use of a questionnaire to assess ejaculation time should be avoided.

Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis.

A double-blind clinical trial was designed to study the effect of clomipramine in 50 patients complaining of rapid ejaculation. Patients were divided into two groups and each group received 2 periods of 6 consecutive weeks' treatment with drug and placebo, so that comparison can be made between drug and placebo within each group and between the two groups. Analysis of collected data showed a significantly higher percentage of satisfactory performances with the drug than with placebo and maintenance of the beneficial effect after the drug was replaced by placebo.

Saad M. Girgis

Papers

A double-blind trial of clomipramine in premature ejaculation.

Testicular Changes in Subfertile Males with Varicocele

Testicular Biopsy in Azoospermia

Aspermia: a survey of 49 cases.

Testicular biopsy in azoospermia. a review of the last ten years' experience of over 800 cases