Treatment of Premature Ejaculation with Sertraline Hydrochloride

International Journal of Impotence Research (1998) 10, 181±184 ß 1998 Stockton Press All rights reserved 0955-9930/98 $12.00 http://www.stockton-press.co.uk/ijir Treatment of premature ejaculation with sertraline hydrochloride CG McMahon St. Luke's Hospital Complex, Sydney, Australia Purpose: To evaluate the ef®cacy of sertraline hydrochloride in the drug treatment of premature ejaculation (P.E.). Materials and Method: Forty-six normally potent men, aged 22 to 63 years (mean 42 years) with premature ejaculation were treated with oral sertraline in a dose ranging study. All men were either married or in a stable relationship. The mean ejaculatory interval was 1 minute (range 0± 5 min). All men were started on Sertraline 25 mg daily and were increased to 50 mg after 3 weeks and 100 mg after a further 3 weeks. None of the men received any formal psychosexual therapy. Results: With a dose of 25 mg, the mean ejaculatory interval increased to 7.6 min (range 0±20 min). With a dose of 50 mg, the mean ejaculatory interval increased to 13.1 min (range 7 min± anejaculation) with 4 men experiencing anejaculation. With a dose of 100 mg, the mean ejaculatory interval increased to 16.4 min (range 7 min±anejaculation), 10 men experiencing anejaculation. With a dose of 25 mg, 1 man described transient dizziness. With a dose of 50 mg, 1 man described some drowsiness and anorexia and 1 man experienced minor dyspepsia. With a dose of 100 mg, 2 men described erectile dysfunction and reduced libido, 2 men described transient drowsiness and anorexia, 2 men experienced minor dyspepsia and 2 men described feelings of anxiety. Conclusion: Sertraline appears to be a useful agent in the pharmacological treatment of premature ejaculation. Keywords: premature ejaculation; sertraline; selective serotonin re-uptake inhibitors Introduction Although the `cornerstone' of treatment is short term directive sex therapy, premature ejaculation may also be treated pharmacologically with a variety Premature ejaculation (PE) is the most common of different medications. These medications either male sexual disorder, affecting perhaps as many as act centrally or locally to retard the psychoneurolo- 75% of men at some stage in their sexual lives. The gical control of ejaculation and subsequent orgasm. Diagnostic and Statistical Manual of Psychiatry It is well established that major tranquillisers such (DSM-IV) de®nes premature ejaculation as `ejacula- as the phenothiazine, thioridazine, will retard tion that occurs before the individual wishes ejaculation signi®cantly and will, in a signi®cant because of recurrent and persistent lack of reason- percentage of men result in failure to ejaculate.2 able voluntary control of ejaculation and orgasm Although these agents can be used to treat PE their during sexual activity ...'.1 ef®cacy is unfortunately counteracted by the high Premature ejaculation is invariably psychogenic incidence of adverse side effects including drowsi- and can be due to performance anxiety, fear or ness, tardive dyskinesia and other extrapyramidal psychological trauma. Men with premature ejacula- adverse effects. The antidepressant clomipramine is tion progress very rapidly from excitement to often associated with delayed or absent ejaculation orgasm which is often experienced as minimally with an incidence of up to 94%3,4 and has been pleasurable. They appear to have a hypersensitive reported as useful in the treatment of PE.5,6 ejaculatory re¯ex. The fact that anxiety plays a role The selective serotonin re-uptake inhibitors in this process however, is attested by the frequent (SSRIs) are primarily indicated in the treatment of situational nature of the problem and the almost depression and are often associated with a variety of universal experience of good ejaculatory control sexual adverse reactions including delayed ejacula- during solitary masturbation. tion. The side effect pro®le differs between different SSRIs, ¯uoxetine tending to effect ejaculation, orgasm and sexual desire, all of which are restored slowly after withdrawal of the drug, whereas sertra- Received 15 May 1997; revised=accepted 28 December 1997 line and paroxetine tend to affect ejaculation more. Treatment of premature ejaculation CG McMahon 182 This paper reports the results of a prospective Results open label dose ranging study of the ef®cacy of sertraline hydrochloride (Zoloft1, P®zer) in treatment of PE. The mean age of the 46 men studied was 42 y (range 22±63 y). The mean pre-treatment ejaculatory latency time was 1.0 min with a range of ejaculation occurring from during foreplay or at intromission to 5 min after intromission. The pre-treatment fre- Materials and methods quency of intercourse was 0.6 times=week. Thirty- six men (78%) had primary premature ejaculation, the remaining 10 men (22%) describing secondary Forty-six normally potent men, aged 22±63 y (mean premature ejaculation with previous acceptable 42 y) suffering from PE were enrolled in a prospec- ejaculatory control. Of the 36 men with primary tive dose ranging study to assess the ef®cacy and premature ejaculation, 6 men (17%) had severe tolerance of sertraline hydrochloride (Zoloft1) in the primary premature ejaculation and had never management of PE. All of the study group were achieved intravaginal ejaculation. heterosexual, had no other sexual disorders and In treatment phase 1 (25 mg sertraline=d), the were either married or in a stable relationship. mean ejaculatory latency time of the 46 enrolled Premature ejaculation was regarded as ejaculation men was 7.6 min (range 0±20 min). In treatment that occurred earlier than either the man or his phase 2 (50 mg sertraline=d) the mean ejaculatory partner wished. As no attempt was made to enrol latency time of the 46 enrolled men was 13.1 min men using accepted average ejaculatory latency time (range 7 min anejaculation). Four men were unable intervals, several men had ejaculatory latency inter- to ejaculate after prolonged intercourse with 50 mg vals that would be regarded as acceptable by normal sertraline=d and declined to enrol in treatment standards. Men with erectile dysfunction, reduced phase 3. In treatment phase 3 (100 mg sertraline=d) sexual desire, inhibited male orgasm, chronic the mean ejaculatory latency time of the 42 men psychiatric or physical illness, alcohol or substance enrolled was 16.4 min (range 7 min anejaculation). abuse and the use of psychotropic medication were Ten men were unable to ejaculate after prolonged excluded from the trial. Men were asked not to use intercourse with 100 mg sertraline=d (Table 1). The condoms, topical penile anaesthetic creams or mean pre-treatment ejaculatory latency time of the sprays. None of the men received any formal 14 men who experienced anejaculation was 1.9 min psychosexual counselling. (range 0±5 min). The study comprised three consecutive treatment The mean frequency of intercourse after three phases each separated by a three week washout weeks of treatment was 1.6 times=week in treatment period. In treatment phase I, men received 25 mg phase 1 (25 mg sertraline=d), 2.1 times=week in sertraline daily for three weeks. Following comple- treatment phase 2 (50 mg sertraline=d) and 2.2 tion of phase 1 and the subsequent drug washout times=week in treatment phase 3 (100 mg period, men were enrolled in treatment phase 2 and sertraline=d). The mean frequency of intercourse received 50 mg sertraline daily for a further three after three weeks of treatment was signi®cantly weeks. Following completion of phase 2 and the superior to the pre-treatment mean frequency with subsequent drug washout period, men were enrolled all doses of sertraline (p < 0.001). There was no in treatment phase 3 and received 100 mg sertraline statistical difference between the mean frequency of daily for the ®nal three weeks. intercourse with differing doses of sertraline. Men were supplied with an ejaculation diary and Intravaginal ejaculation was achieved for the ®rst were asked to record their frequency of coitus, time in each of the cohort of six men with severe quality of erection and orgasm, and to measure and primary premature ejaculation who had never record their ejaculatory latency time using a stop- achieved intravaginal ejaculation. Intravaginal ejac- watch. Men were required to attempt coitus on at ulation occurred in four of the six men with 25 mg least two occasions each week. Results were ana- sertraline=d and in all men with 50 mg and 100 mg lysed using standard statistical methods. sertraline=d. The mean age of this group of six men Table 1 Results of dose ranging study of sertraline hydrochloride (25, 50 and 100 mg) in the treatment of premature ejaculation Mean ejaculatory interval Ejaculatory interval range Dose (min) (min) Men with anejaculation Frequency of intercourse Pre-treatment 1.0 0±5 Ð 0.6 25 mg 7.6 0±20 0 1.6 50 mg 13.1 7±anejac. 4 2.1 100 mg 16.4 7±anejac. 10 2.2 Treatment of premature ejaculation CG McMahon 183 was 26.9 years (range 23±32 years). All men in this logical control of ejaculation and subsequent or- cohort were either married or were involved in a gasm. Animal studies have shown that the central long term stable relationship. One man in this cohort neurotransmitter serotonin has an inhibitory effect developed anejaculation with 100 mg sertraline=d. on sexual function, while dopamine is generally Sertraline was, in general, well tolerated. Most stimulatory.7 Sexual effects can occur through any side effects were minor and none prompted with- shift in this serotonin-dopamine balance by an drawal from the study, apart from the anejaculation increase or decrease in either or both neurotrans- experienced by four and 10 men in treatment phase mitter. The serotonin re-uptake inhibitors (SSRI) 2 and 3 respectively.

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