Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Effects of paroxetine on intravaginal ejaculatory latency time in Egyptian patients with lifelong premature ejaculation as a function of serotonin transporter polymorphism


Premature ejaculation (PE) is a common ejaculatory complaint. The estimated rates among Turkish men reached 20%, although the severest type of PE (lifelong PE) usually does not exceed 2.3%. This could be seen in line with two survey studies involving five nations. They revealed that 2.5% of men had an intravaginal ejaculation latency time of <1 min and 6% of <2 min. Rapid ejaculation may be treated pharmacologically with a variety of different medications that act either centrally or locally to delay ejaculation and subsequent orgasm. Antidepressants, particularly members of the selective serotonin reuptake inhibitor class, retard ejaculation significantly. Recently, it was postulated that men with lifelong PE might result from a combination of polymorphisms of the serotonergic transporter and receptors, and other neurotransmitters and/or receptors. Our findings augment the significant effect of paroxetine in delaying ejaculation in the responders (P<0.001). Meanwhile, the findings do not suggest a positive association between such response and serotonin transporter gene promoter polymorphism.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1


  1. 1

    McMahon CG, Althof SE, Waldinger MD, Porst H, Dean J, Sharlip ID et al. An evidence-based definition of lifelong premature ejaculation: report of the International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the definition of premature ejaculation. J Sex Med 2008; 5: 1590–1606.

    Article  Google Scholar 

  2. 2

    Serefoglu EC, Yaman O, Cayan S, Asci R, Orhan I, Usta MF et al. Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes: results from the Turkish Society of Andrology Sexual Health Survey. J Sex Med 2011; 8: 540–548.

    Article  Google Scholar 

  3. 3

    Althof S, Abdo C, Dean J, Hackett G, McCabe M, McMahon CG et al. International Society for Sexual Medicine’s Guidelines for the diagnosis and treatment of premature ejaculation. J Sex Med 2010; 7: 2947–2969.

    Article  Google Scholar 

  4. 4

    Waldinger M, Quinn P, Dilleen M, Mundayat R, Schweitzer D, Boolell M . A multinational population survey of intravaginal ejaculation latency time. J Sex Med 2005; 2: 292–297.

    Google Scholar 

  5. 5

    Waldinger M, McIntosh J, Schweitzer DH . A five-nation survey to assess the distribution of the intravaginal ejaculatory latency time among the general male population. J Sex Med 2009; 6: 2888–2895.

    Article  Google Scholar 

  6. 6

    Serefoglu EC, Cimen HI, Atmaca AF, Balbay MD . The distribution of patients who seek treatment for the complaint of ejaculating prematurely according to the four premature ejaculation syndromes. J Sex Med 2009; 7: 810–815.

    Article  Google Scholar 

  7. 7

    Zhang X, Gao J, Liu J, Xia L, Yang J, Hoa Z et al. Distribution and factors associated with four premature ejaculation syndromes in outpatients complaining of ejaculating prematurely. J Sex Med 2013; 10: 1603–1611.

    Article  Google Scholar 

  8. 8

    Waldinger MD, Rietschel M, Nothen MM, Hengeveld MW, Olivier B . Familial occurrence of primary premature ejaculation. Psychiatr Genet 1998; 8: 37–40.

    CAS  Article  Google Scholar 

  9. 9

    Chan JS, Olivier B, de Jong TR, Snoeren EM, Kooijman E, van Hasselt FN et al. Translational research into sexual disorders: pharmacology and genomics. Eur J Pharmacol 2008; 585: 426–435.

    CAS  Article  Google Scholar 

  10. 10

    Jern P, Santtila P, Johansson A, Varjonen M, Witting K, von der Pahlen B et al. Evidence for a genetic etiology to ejaculatory dysfunction. Int J Impot Res 2009; 21: 62–67.

    CAS  Article  Google Scholar 

  11. 11

    Janssen PK, van Schaik R, Zwinderman AH, Olivier B, Waldinger MD . The 5-HT1A receptor C (1019) G polymorphism influences the intravaginal ejaculation latency time in Dutch Caucasian men with lifelong premature ejaculation. Pharmacol Biochem Behav 2014; 121: 184–188.

    CAS  Article  Google Scholar 

  12. 12

    Lesch KP, Bengel D, Heils A, Sabol SZ, Greenberg BD, Petri S et al. Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region. Science 1996; 274: 1527–1531.

    CAS  Article  Google Scholar 

  13. 13

    Heils A, Teufel A, Petri S, Stober G, Riederer P, Bengel D et al. Allelic variation of human serotonin transporter gene expression. J Neurochem 1996; 66: 2621–2624.

    CAS  Article  Google Scholar 

  14. 14

    Lesch KP . Gene-environment interaction and the genetics of depression. J Psychiatry Neurosci 2004; 29: 174–184.

    PubMed  PubMed Central  Google Scholar 

  15. 15

    Smits KM, Smits LJM, Schouten JSAG, Stelma FF, Nelemans P, Prins MH . Influence of SERTPR and Stin2 in the serotonin transporter gene on the effect of selective serotonin reuptake inhibitors in depression: a systematic review. Mol Psychiatry 2004; 9: 433–441.

    CAS  Article  Google Scholar 

  16. 16

    Little KY, McLaughlin DP, Zhang L, McFinton PR, Dalack GW, Cook EH Jr et al. Brain dopamine transporter messenger RNA and binding sites in cocaine users: a postmortem study. Arch Gen Psychiatry 1998; 55: 793–799.

    CAS  Article  Google Scholar 

  17. 17

    Murphy GM Jr, Hollander SB, Rodrigues HE, Kremer C, Schatzberg AF . Effects of the serotonin transporter gene promoter polymorphism on mirtazapine and paroxetine efficacy and adverse events in geriatric major depression. Arch Gen Psychiatry 2004; 61: 1163–1169.

    CAS  Article  Google Scholar 

  18. 18

    Hariri AR, Brown SM . Images in neuroscience: serotonin. Am J Psychiatry 2006; 163: 12.

    Article  Google Scholar 

  19. 19

    Durham LK, Webb SM, Milos PM, Clary CM, Seymour AB . The serotonin transporter polymorphism, 5HTTLPR, is associated with a faster response time to sertraline in an elderly population with major depressive disorder. Psychopharmacology (Berl) 2004; 174: 525–529.

    CAS  Article  Google Scholar 

  20. 20

    Serretti A, Kato M, De Ronchi D, Knoshita T . Meta-analysis of serotonin transporter gene promoter polymorphism (5-HTTLPR) association with selective serotonin reuptake inhibitor efficacy in depressed patients. Mol Psychiatry 2007; 12: 247–257.

    CAS  Article  Google Scholar 

  21. 21

    Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH . Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data. J Sex Med 2005; 2: 498–507.

    Article  Google Scholar 

  22. 22

    Shamloul R, Ghanem H, Abou-zeid A . Validity of the Arabic version of the sexual health inventory for men among Egyptians. Int J Impot Res 2004; 16: 452–455.

    CAS  Article  Google Scholar 

  23. 23

    Gong ZY, Tang TL, Cui S, Wang JZ, Deng XZ . Oral paroxetine for premature ejaculation: a randomized controlled study. Zhonghua Nan Ke Xue 2011; 17: 923–925.

    PubMed  Google Scholar 

  24. 24

    Waldinger MD, Zwinderman AH, Schweitzer DH, Olivier B . Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis. Int J Impot Res 2004; 16: 369–381.

    CAS  Article  Google Scholar 

  25. 25

    Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G et al2014 An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. Sex Med 2014; 2: 41–59.

    Article  Google Scholar 

  26. 26

    Bleich S, Bönsch D, Rauh J, Bayerlein K, Fiszer R, Frieling H et al. Association of the long allele of the 5-HTTLPR polymorphism with compulsive craving in alcohol dependence. Alcohol 2007; 42: 509–512.

    CAS  Article  Google Scholar 

  27. 27

    Ozbek E, Tasci AI, Tugcu V, Ilbey YO, Simsek A, Ozcan L et al. Possible association of the 5-HTTLPR serotonin transporter promoter gene polymorphism with premature ejaculation in a Turkish population. Asian J Androl 2009; 11: 351–355.

    CAS  Article  Google Scholar 

  28. 28

    Safarinejad MR . Polymorphisms of the serotonin transporter gene and their relation to premature ejaculation in individuals from Iran. J Urol 2009; 182: 2983, author reply 2983-4.

    Article  Google Scholar 

  29. 29

    Zhu L, Mi Y, You X, Wu S, Shao H, Dai F et al. A meta-analysis of the effects of the 5-hydroxytryptamine transporter gene-linked promoter region polymorphism on susceptibility to lifelong premature ejaculation. PLoS One 2013; 8: e54994.

    CAS  Article  Google Scholar 

  30. 30

    Janssen PK, Bakker SC, Réthelyi J, Zwinderman AH, Touw DJ, Olivier B et al. Serotonin transporter promoter region (5-HTTLPR) polymorphism is associated with the intravaginal ejaculation latency time in Dutchmen with lifelong premature ejaculation. J Sex Med 2009; 6: 276–284.

    CAS  Article  Google Scholar 

  31. 31

    Hu X, Oroszi G, Chun J, Smith TL, Goldman D, Schuckit MA . An expanded evaluation of the relationship of four alleles to the level of response to alcohol and the alcoholism risk. Alcohol Clin Exp Res 2005; 29: 8–16.

    CAS  Article  Google Scholar 

  32. 32

    Lipsky RH, Hu XZ, Goldman D . Additional functional variation at the SLC6 A4 gene. Am J Med Genet B Neuropsychiatr Genet 2009; 150: 153.

    Article  Google Scholar 

  33. 33

    Kuzelova H, Ptacek R, Macek M . The serotonin transporter gene (5-HTT) variant and psychiatric disorders: review of current literature. Neuro Endocrinol Lett 2010; 31: 4–10.

    CAS  PubMed  Google Scholar 

  34. 34

    Janssen PK, Zwinderman AH, Olivier B, Waldinger MD . Serotonin transporter promoter region (5-HTTLPR) polymorphism is not associated with paroxetine-induced ejaculation delay in Dutch men with lifelong premature ejaculation. Korean J Urol 2014; 55: 129–133.

    Article  Google Scholar 

  35. 35

    Ozbek E, Otunctemur A, Simsek A, Polat EC, Ozcan L, Köse O et al. Genetic polymorphism in the serotonin transporter gene-linked polymorphic region and response to serotonin reuptake inhibitors in patients with premature ejaculation. Clinics 2014; 69: 710–713.

    Article  Google Scholar 

  36. 36

    Griffiths AJF, Gelbart WM, Miller JH, Lewontin RC . Modern Genetic Analysis: Integrating Genes and Genomes 2nd edn. W. H. Freeman and Co: New York, 2002.

    Google Scholar 

Download references


We thank the EVA pharmaceutical company that provided us with paroxetine and placebo for the patients.

Author information



Corresponding author

Correspondence to S F GamalEl Din.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on International Journal of Impotence Research website

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Salem, A., Kamel, I., Rashed, L. et al. Effects of paroxetine on intravaginal ejaculatory latency time in Egyptian patients with lifelong premature ejaculation as a function of serotonin transporter polymorphism. Int J Impot Res 29, 7–11 (2017).

Download citation

Further reading


Quick links