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Egyptian Rheumatology and Rehabilitation
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Treatment of premature ejaculation: a new combined approach

Egyptian Rheumatology and Rehabilitation volume 42, pages 39–44 (2015)Cite this article

Abstract

Background

Selective serotonin reuptake inhibitors (SSRIs) are utilized to treat premature ejaculation (PE). However, their effect is moderate, with no universally adopted schedule. A possible role for pelvic floor dysfunction in the pathogenesis of PE was reported previously.

Objective

The aim of this study was to compare the efficacy of combined sertraline and pelvic floor rehabilitation with either line in patients with an unsatisfactory response to SSRIs.

Design, setting, and participants

From June 2009 to December 2012, 74 PE patients with an unsatisfactory response to sertraline 50 mg were enrolled and subjected to pelvic floor rehabilitation as an alternative therapy, and then a combination of both was tested on the same group.

Outcome measurements and statistical analysis

Relationships with outcome were analyzed using the Student t-test, Pearson’s correlation, and linear regression.

Results and limitations

The baseline intravaginal ejaculatory latency time (IELT) was 20–110 s (mean ± SD = 56.35 ± 21.67). With sertraline 50 mg therapy alone, IELT reached 90–180 s (mean ± SD = 121.69 ± 21.76, P = 0.0001). Of them, 44 (59.46%) patients failed to exceed an IELT of 120 s. With pelvic floor rehabilitation alone, IELT reached 90–270 s (mean ± SD = 174.73 ± 45.79, P = 0.0001). Of them, 13 (17.56%) patients failed to exceed an IELT of 120 s. Using a combination therapy of both, IELT reached 180–420 s (mean ± SD = 297.57 ± 59.19, P = 0.0001). This response was significantly higher than the baseline IELT and that of either lines alone (P = 0.0001, for all tests).

Conclusion

Pelvic floor rehabilitation is an important addition when treating PE, particularly in patients with pelvic floor dysfunction. We recommend this combination in patients with an unsatisfactory response to SSRIs.

Patient summary

Causes of PE differ considerably. In this paper, we compared the outcomes of two single treatment lines together with a combination of both. The combination therapy was more effective than either line alone.

References

  1. Hellstrom WJ. Update on treatments for premature ejaculation. Int J Clin Pract 2011; 65:16–26.

    Article  CAS  Google Scholar 

  2. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281:537–544.

    Article  CAS  Google Scholar 

  3. Dunn KM, Croft PR, Hackett GI. Sexual problems: a study of the prevalence and need for health care in the general population. Fam Pract 1998; 15:519–524.

    Article  CAS  Google Scholar 

  4. Reading AE, Wiest WM. An analysis of self-reported sexual behavior in a sample of normal males. Arch Sex Behav 1984; 13:69–83.

    Article  CAS  Google Scholar 

  5. Rowland D, Perelman M, Althof S, Barada J, McCullough A, Bull S, et al. Self-reported premature ejaculation and aspects of sexual functioning and satisfaction. J Sex Med 2004; 1:225–232.

    Article  Google Scholar 

  6. Simons JS, Carey MP. Prevalence of sexual dysfunctions: results from a decade of research. Arch Sex Behav 2001; 30:177–219.

    Article  CAS  Google Scholar 

  7. Aschka C, Himmel W, Ittner E, Kochen MM Sexual problems of male patients in family practice. J Fam Pract 2001; 50:773–778.

    CAS  PubMed  Google Scholar 

  8. 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 

  9. Buvat J, Tesfaye F, Rothman M, Rivas AD, Giuliano F. Dapoxetine for the treatment of premature ejaculation: results from a randomized, double-blind, placebo-controlled phase 3 trial in 22 countries. Eur Urol 2009; 55:957–967.

    Article  CAS  Google Scholar 

  10. Xin ZC, Zhu YC, Yuan YM, Cui WS, Jin Z, Li WR, Liu T Current therapeutic strategies for premature ejaculation and future perspectives. Asian J Androl 2011; 13:550–557.

    Article  Google Scholar 

  11. Wang WF, Chang L, Minhas S, Ralph DJ Selective serotonin reuptake inhibitors in the treatment of premature ejaculation. Chin Med J (Engl) 2007; 120:1000–1006.

    Article  CAS  Google Scholar 

  12. La Pera G. Awareness of the role of the pelvic floor muscles in controlling the ejaculatory reflex: preliminary results. Arch Ital Urol Androl 2012; 84:74–78.

    PubMed  Google Scholar 

  13. La Pera G, Nicastro A. A new treatment for premature ejaculation: the rehabilitation of the pelvic floor. J Sex Marital Ther 1996; 22:22–26.

    Article  Google Scholar 

  14. Pastore AL, Palleschi G, Leto A, Pacini L, Iori F, Leonardo C, Carbone A A prospective randomized study to compare pelvic floor rehabilitation and dapoxetine for treatment of lifelong premature ejaculation. Int J Androl 2012; 35:528–533.

    Article  CAS  Google Scholar 

  15. Piediferro G, Colpi EM, Castiglioni F, Scroppo FI Premature ejaculation. 3. Therapy. Arch Ital Urol Androl 2004; 76:192–198.

    PubMed  Google Scholar 

  16. Giuliano F, WJ Hellstrom. The pharmacological treatment of premature ejaculation. BJU Int 2008; 102:668–675.

    Article  CAS  Google Scholar 

  17. Porst H, Montorsi F, Rosen RC, Gaynor L, Grupe S, Alexander J The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking. Eur Urol 2007; 51:816–823; discussion 824.

    Article  Google Scholar 

  18. Rosen RC. Prevalence and risk factors of sexual dysfunction in men and women. Curr Psychiatry Rep 2000; 2:189–195.

    Article  CAS  Google Scholar 

  19. Giuliano F, Patrick DL, Porst H, La Pera G, Kokoszka A, Merchant S, et al. 3004 Study Group Premature ejaculation: results from a five-country European observational study. Eur Urol 2008; 53:1048–1057.

    Article  Google Scholar 

  20. Patrick DL, Althof SE, Pryor JL, Rosen R, Rowland DL, Ho KF, et al. Premature ejaculation: an observational study of men and their partners. J Sex Med 2005; 2:358–367.

    Article  Google Scholar 

  21. Rowland DL, Patrick DL, Rothman M, Gagnon DD The psychological burden of premature ejaculation. J Urol 2007; 177:1065–1070.

    Article  Google Scholar 

  22. Morales A, Barada J, Wyllie MG. A review of the current status of topical treatments for premature ejaculation. BJU Int 2007; 100:493–501.

    Article  CAS  Google Scholar 

  23. Waldinger MD. Recent advances in the classification, neurobiology and treatment of premature ejaculation. Adv Psychosom Med 2008; 29:50–69.

    Article  Google Scholar 

  24. Steggall MJ, A Pryce. Premature ejaculation: defining sex in the absence of context. J Men Health Gender 2006; 3:25–32.

    Article  Google Scholar 

  25. Tuncel A, et al. Efficacy of clomipramine, sertraline and terazosin treatments in premature ejaculation. Turk J Med Sci 2008; 38:59–64.

    CAS  Google Scholar 

  26. McMahon CG. Treatment of premature ejaculation with sertraline hydrochloride: a single-blind placebo controlled crossover study. J Urol 1998; 159:1935–1938.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Assiut University Hospital, 71516, Assiut, Egypt

    Adel Kurkar, Sherif M. Abulsorour MD, Ahmed M. Eltaher, Ahmed S. Safwat, Mohammed M. Gadelmoula, Ahmed A. Elderwy & Mahmoud M. Shalaby

  2. Department of Rheumatology and Rehabilitation, Assiut University Hospital, Assiut, Egypt

    Rania M. Gamal & Abeer M. Ghandour

Authors
  1. Adel Kurkar
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  2. Sherif M. Abulsorour MD
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  3. Rania M. Gamal
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  4. Ahmed M. Eltaher
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  5. Ahmed S. Safwat
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  6. Mohammed M. Gadelmoula
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  7. Ahmed A. Elderwy
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  8. Mahmoud M. Shalaby
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  9. Abeer M. Ghandour
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Corresponding author

Correspondence to Sherif M. Abulsorour MD.

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Kurkar, A., Abulsorour, S.M., Gamal, R.M. et al. Treatment of premature ejaculation: a new combined approach. Egypt Rheumatol Rehabil 42, 39–44 (2015). https://doi.org/10.4103/1110-161X.155649

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  • DOI: https://doi.org/10.4103/1110-161X.155649

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