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Current and emerging treatment options for premature ejaculation

Nature Reviews Urology volume 19, pages 659–680 (2022)Cite this article

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Abstract

Premature ejaculation (PE) is a prevalent male sexual dysfunction. Current standard treatment regimens include behavioural therapies, topical anaesthetics, dapoxetine and other selective serotonin reuptake inhibitors (SSRIs). Most of the pharmacotherapeutic options target neurotransmitters (such as serotonin and oxytocin) that have a role in the ejaculation mechanism. However, these treatments are mildly effective and only provide a temporary delay in the ejaculation latency time, and PE recurs when the treatment is stopped. Thus, a treatment for PE is urgently needed and research is ongoing to find the ideal PE therapy. The efficacy and safety of topical anaesthetics and SSRIs in delaying ejaculation have been confirmed in many well-designed controlled trials. Both preclinical and clinical studies on new-generation SSRIs are ongoing. Moreover, promising results came from clinical trials in which the efficacy of on-demand PE therapies targeting neurotransmitters other than serotonin, such as α1-adrenoceptor antagonists and oxytocin antagonists, was assessed. Surgical intervention and neuromodulation have been proposed as potential treatment options for PE; however, current PE guidelines do not recommend these treatments owing to safety concerns.

Key points

  • An increasing number of studies aiming to find an ideal treatment for premature ejaculation are in progress.

  • Currently, most of drug development research for premature ejaculation targets the serotonergic system.

  • Preliminary results of trials with pharmacotherapies targeting other neurotransmitters, such as adrenaline and oxytocin, are promising.

  • Non-pharmacological treatments such as surgical interventions and neuromodulation are gaining popularity; however, additional clinical data are warranted.

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Fig. 1: Neuroanatomical mechanisms of ejaculation.
Fig. 2: Mechanism of action of acute and chronic treatment with selective serotonin reuptake inhibitors.
Fig. 3: Emission phase of ejaculation and mechanism of action of α1 adenoreceptor blockers.
Fig. 4: Central and peripheral effects of oxytocin receptor blockade on ejaculation reflexes of male rats.

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Authors and Affiliations

  1. Department of Urology, Selcuk University School of Medicine, Konya, Turkey

    Murat Gul

  2. Department of Urology, Silopi State Hospital, Sirnak, Turkey

    Kadir Bocu

  3. Department of Urology, Biruni University School of Medicine, Istanbul, Turkey

    Ege Can Serefoglu

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M.G. and K.B. researched data for the article. All authors contributed substantially to discussion of the content. M.G. and K.B. wrote the article. E.C.S. reviewed and edited the manuscript before submission.

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E.C.S. is a consultant for Virility Medical Ltd, Haifa, Israel. M.G. and K.B. declare no competing interests.

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Gul, M., Bocu, K. & Serefoglu, E.C. Current and emerging treatment options for premature ejaculation. Nat Rev Urol 19, 659–680 (2022). https://doi.org/10.1038/s41585-022-00639-5

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