HisandHerHealth: Information About Sexuality, Prostate, Incontinence

"Premaute Ejaculation Sildrenadil (the ingredient of Viagra) plus Sertraline (Sertraline HCl is a selective serotonin reuptake inhibitor (SSRI) Zoloft) vs.Sertraline alone and Sildenafil alone."

The paper was presented by: Antonio Fernandez Lozano, Eduard Ruiz Castane, Sabadell Barcelona, Spain

Introduction and Objective: Prevalence on premature ejaculation is not well known, nevertheless an increasing number of patients demand in our Urology offices a treatment for their sexual disorder. Many men are reluctant to psychological therapy for different reasons (cultural, social, economic). Regardless of the cause, the fact is that there is a large group of patients requiring treatment for a condition that deprives them of pleasant sexual relations. The intention of this study is to compare in three groups of patients the efficacy of pharmacological treatment.

Methods: 129 patients free of erectile dysfunction were studied and followed for one year in three groups with: physical examination, IIEF and evaluation of ejaculatory latency time. GroupI: 51 pts. mean age 32 (range 20-59), complaining of P.E. (38 lifelong, 13 acquired), were treated with Sertraline 50 mg/day for two months and as needed following. GroupII: 48 pts. mean age 45 (range 32-60), complaining of P.E.(20 lifelong, 28 acquired),were treated with Sertraline 50mg a day for two months and as needed following plus Sildenafil 25-100 mg one hour before sexual intercourse. Group III: 30 pts. mean age 39 (range 27-61), complaining of P.E. (27 lifelong, 3 acquired), were treated with Sildenafil 50 mg one hour before they had sexual intercourse.

Results: B the drugs were well tolerated. Group I: drowsiness and gastrointestinal upset 3/51, an ejaculation 2/51, and 6/51 did not follow the study. GroupII: 3/48 gastrointestinal upset, 4/48 headaches, 4/48 flushes, and 3/48 did not follow the study. Group III: 2/30 gastrointestinal upset, 5/30 flushes, 6/30 did not follow the study. The mean ejaculatory latency time in Group I (29/51) increased from 0.50 min. to a mean 4.6 min., while in GroupII (30/48) from a baseline of 1 min. to a mean of 5.5 min., and in GroupIII only 12/30 declared an improvement on the mean ejaculatory latency time from 0.50 min. to a mean of 6.2 min. The patients with stable partner were asked to grade their sexual life from 0 to 5 (5 excellent). This parameter also increased in the three groups from 0.5 to 3 in GroupI, from 0.7 to 4.1 in GroupII and from 1 to 3.3 in Group III.

Conclusions: Delayed ejaculation is one of the most common side effects of a wide number of antidepressant agents. Though the mechanism underlying a Sildenafil induced delay in ejaculation is unknown, it seems evident that in combination with Sertraline improves the latency ejaculatory time and sexual satisfaction mainly in older patients with a lifelong pattern of P.E. (April 2003)

"TOPICAL APPLICATION OF ALPROSTADIL CREAM IN COMBINATION WITH A LOCAL ANESTHETIC FOR THE TREATMENT OF PREMATURE EJACULATION (PE)"

Shumin Deng, Xiaonian Ma, Beijing, China; Ruidong Wang, Qingdao, China; Joseph Mo, James L Yeager, Ming Q Lu*, Robbinsville, NJ

Introduction and Objective: The neurological aspects of ejaculation involve two reflex mechanisms. The first reflex is initiated by stimulation of the genital receptors. The second (ejaculatory) reflex is transmitted from the nerves surrounding the urethra to the ejaculatory center (S2-4) and eventually causes ejaculation. This study was designed to examine the efficacy and safety of a topical alprostadil (300 mcg)/lidocaine (2.5%) cream for treating PE by interrupting the second ejaculatory reflex via the local relaxation of smooth muscle and inhibitory effects through neurological reflexes.

Methods: Fifty-one PE patients (mean age 37.7 years and PE duration of 4.5 years) were recruited in a multi-center, single-blind, 3-month duration study. Eight patients were enrolled in the (0.3% w/w) alprostadil cream group and 43 patients were enrolled in the alprostadil cream with 2.5% lidocaine group. In the first 2 weeks, the PE baseline ejaculatory latency time (ELT) were collected (>2 times). All of the patients were given a minimum of 4 doses of cream. The patients were instructed to administer the cream topically, to the tip of the penis 5 to 20 min before sexual intercourse. The primary efficacy variable was ELT, as measured using a stopwatch. The degree of satisfaction of both patient and partner were recorded. The clinical efficacy was assessed by the doctors based on patient diary.

Results: The mean ELT (± SE) at baseline and post-dosing in the alprostadil treatment group were 1.03 ± 0.19 and 1.39 ± 0.39 min, respectively (p>0.05). Only one patient, after administration of the cream, had a mean ELT over 2 min. No satisfaction was reported from either the patients or their partners. In the alprostadil/lidocaine cream treatment group, the mean (± SE) ELT at baseline and post-dosing were 0.89 ± 0.08 and 3.12 ± 0.36 min, with a net increase of 2.23 ± 0.36 minutes (p<0.001). The ELT in 53.5% (23/43) of all patients increased to > 2 min. The sexual satisfaction of the patients and their partners were 72.1% (31/43) and 67.4% (29/43). The clinical efficacy was 72.1% as assessed by the doctors. All reported adverse events were mild and transient local engorgement pain or warmth.

Conclusions: The results suggest that a topical alprostadil/lidocaine cream (2.5% lidocaine), utilized for the treatment of PE is safe and effective. The medication was well tolerated by patient and partner.