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Medical treatment of PME

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This week, I will explore the use of medical therapy or a pill to fix Premature Ejaculation (PME). Lots of couples are primarily interested in “performance and pleasure”, not in relationships. I say couples, because the woman is equally likely to complain of her man coming quickly and not being satisfied, and the man being dissatisfied at not performing his “work” properly. Lots of men therefore resort to medications.{{more}} Before I give a patient medication, I do a thorough interview and examination to make sure that he has no infections in the urinary passage including the prostate and I treat these. I also try to help him to get treatment for psychologic issues like recreational drugs of abuse including alcoholism. Finally, I treat impotence. You’d be surprised how many men actually suffer from PME due to impotence. In other words, some men actually do have impotence, but because he cannot get it up properly, it causes anxiety such that when it does come up, he comes quickly. Hence, I treat his impotence first and this usually resolves his PME. Studies have also shown that treatment of men who suffer from impotence with Viagra also helps them to stay up longer. I mentioned this in my previous discussion on the treatment of impotence.

The treatment of premature ejaculation with medication actually occurred “by accident” as a lot of men taking medication for mood problems like anxiety and depression actually found that they took longer to “come”. These medications called SSRIs or the medical term “selective serotonin reuptake inhibitors” include medications like Prozac, Paxil or Zoloft. They are used at a lower dose than is used to treat their primary diseases anxiety or depression. These are what is called “off label” use. That is the FDA of the US has not licensed these medications for the treatment of PME, but medical professionals use them as they are proven to work with minimal side effects. It is usually just a matter of time before they are licensed for such, because studies have been done and are being reviewed and presented to the FDA for approval. As I said, Paxil, Prozac and Zoloft are used in the treatment of anxiety, phobias and mild clinical depression. The good thing about using these medications for PME is that they usually work at 1¼4 to 1¼2 the normal dose used to treat anxiety. At these lower doses, they have fewer side effects and can be use as a “day only” dose i.e. only on the day when they are needed. In other words, the man does not need to take the tablet every day, only on the day when he plans to make love or have sex. This can be as early as 4-6 hours before intercourse. This means possibly once or twice a week for some men. The benefit of this is that he does not have to worry about taking a tablet every day and worry about the side effects of stopping long term treatment (withdrawal side effects).

The obvious drawback is that you are not curing the problem, but for people in transient or unstable relationships, these tablets are ideal. Obviously, when you stop taking the tablets, the problem recurs in most persons, but interestingly, some couples are helped permanently, as these pills can be used to tide the relationship over the initial anxiety period after starting a relationship. Some men are not helped immediately by the day only dose, but may need to take the low dose pill every day for at least 3 weeks before they notice a prolongation of the erection. Fortunately, this is not common.

The side effects of SSRIs include dizziness, drowsiness, dry mouth, blurred vision and skin rashes, but as I said, these are rare at the doses used to treat. Interestedly, these medications can cause impotence and loss of desire if taken at the higher dose and for prolonged periods.

The other class of medications used to treat premature ejaculations is called the TCADs or tricyclic antidepressants. These were the original antidepression medications and include medications such as amitriptylline and clomipramine. The latter named medication is also called Anafranil. It was and continues to be the premiere medication used to treat PME. The dose is as mentioned only about 1¼4 of the normal dose so side effects are minimal. The main side effect is drowsiness, especially when combined with alcohol. Therefore men are cautioned against using the medication and operating heavy machinery. Again, like the SSRIs Anafranil can be taken only on the day when you need to use it and as soon as 2-6 hours before intercourse. The main side effects of both types of medication occur if these medications are taken for a long period of time at the higher dose and the withdrawal side effects then become a problem. The withdrawal side effects occur when the person stops using the tablets after taking them daily for a long time (at least 6 weeks). These side effects include nausea, vomiting, agitation, dizziness, headache, anxiety and difficulty sleeping.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: [email protected]