Male Sexual Dysfunction
Medications to slow down the ejaculatory reflex by increasing serotonergic transmission are commonly used. Ejaculation may be delayed 8-fold by paroxetine (10–40 mg daily) and 4- to 5-fold by clomipramine (12.5–50 mg daily), sertraline (50–200 mg daily) and fluoxetine (20–40 mg daily). On-demand therapy 1–2 hours before sexual activity is generally less effective and may result in bothersome side effects. Most common side effects experienced with these agents include fatigue, nausea, diarrhea, decreased sexual desire and erectile dysfunction. Relapse is likely when medication is discontinued. Combining pharmacologic and behavioural techniques is recommended to prolong benefit and ultimately allow withdrawal of medication.
Evidence supporting the effectiveness of PDE5 inhibitors in the treatment of PE is weak. If tried, it is best to combine PDE5 inhibitors with a medication used in the management of PE (e.g., paroxetine) or target those patients with coincident ED.
Although not generally recommended, intracavernosal therapy in those with severe PE may improve partner satisfaction due to erectile persistence after ejaculation.
Numbing the penile skin with local anesthetic reinforces the man's inability to recognize lower states of sexual arousal and is generally not advised.
The overall objective of the adaptation and sex therapy techniques (± medication) is to enable the man to focus his attention away from the act of intercourse and concentrate instead on his enjoyment of the total sexual experience, including the pleasure he gives to, and receives from, his sexual partner. The more he can become aware of lower states of arousal, coupled with his ability to enjoy them, the less anxious he will be and the slower his response becomes.
- Genitourinary System