Premature ejaculation (PE) is a frequent male sexual complaint.This occurrence does
not automatically imply the existence of a male sexual disorder. The current DSM definition of PE has a low positive predictive value with a high associated risk
for false-positive diagnoses of PE. A new classification in four well-defined PE syndromes
has recently been proposed for the pending DSM-V. According to this new classification there are different pathophysiologies and treatments
of PE, dependent on the underlying PE syndrome. Some types are particularly neurobiologically
or medically determined and need drug treatment; other types, which are mainly psychologically
determined, need psychotherapy or both drug treatment and psychotherapy. A meta-analysis
of all selective serotonin reuptake inhibitors (SSRIs) and clomipramine studies, which
were performed according to current standards of evidence-based medicine, demonstrated
a similar efficacy for the daily treatment with the serotonergic antidepressants paroxetine
hemihydrate, clomipramine, sertraline, and fluoxetine, with paroxetine hemihydrate
exerting the strongest effect on ejaculation. On-demand treatment with SSRIs generally
exerts much less ejaculation delay than daily SSRI treatment. Other on-demand treatment
options are the topical use of anesthetics, tramadol, and phosphodiesterase type 5
inhibitors. Caution is needed with tramadol with regard to its potential addictive
properties. There is insufficient evidence for the ejaculation delaying effects of
phosphodiesterase type 5 inhibitors and intracavernous injection of vasoactive drugs.
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