Pharmacotherapy in the Treatment of Male Sexual Dysfunction

Journal of Sex Research, August, 2000 by David L. Rowland, Arthur L. Burnett

Topical anesthetics. Anesthetizing ointments or creams may be applied directly to the penis to retard ejaculation. The effect is peripheral and local, the goal being to attenuate genital sensory input and thus reduce the likelihood of triggering the ejaculatory reflex. A number of recent investigations suggest creams containing prilocaine-lidocaine or other local anesthetics applied prior to intercourse can delay ejaculation in many men up to several minutes (Berkovitch, Keresteci, & Koren, 1995; Xin, Choi, Lee, & Choi, 1997). This approach, however, is not appropriate for men who ejaculate before vaginal intromission. Furthermore, it necessitates a condom to protect the partner from potential irritating and desensitizing effects of the cream or, alternatively, wiping the cream off prior to intercourse. In addition, the long term efficacy of these ointments is not known. Nevertheless, given the parsimony of this approach (simple, direct, specific, and inexpensive), it warrants consideration as an aid to delaying ejaculation in some men.

Pharmacostimulation of erection. A second approach has employed intracavernosal (penile) injection of papaverine (Fein, 1990), a vasoactive agent that induces erection and has been associated most with the treatment of erectile dysfunction. Few studies have approached the treatment of PE from this angle--the treatment does not delay ejaculation but enables the man with PE to maintain an erection long after ejaculation has occurred. The increased duration of erectile response allows greater enjoyment and satisfaction of coitus by the partner. Intracavernosal injection appears to have limited value in the treatment of PE, although this and other various proerectile oral treatments (yet to be investigated) may provide options for men who have concurrent erectile problems and are concerned primarily with their partner's satisfaction. The prolonged erection may also enable the man with PE to enjoy a second orgasm after an initial one involving short latency.

Oral retardants of ejaculation. The third and most common pharmacological approach to treating PE involves the use of oral medications that interfere with the ejaculatory process, thereby increasing latency. Most of these medications were originally developed for the treatment of mood disorders and emotional problems. Astute clinicians and patients noted that these antidepressant drugs had the side effect of delaying or inhibiting ejaculation (Beaumont, 1973; Yassa, 1982). Even with today's large selection of antidepressants, many of which operate via different pharmacological mechanisms, only a few are reportedly free of this side effect, and this attribution may reflect an incomplete evaluation of the drug rather than a lack of effect on ejaculation. Because the ejaculatory-inhibiting action of antidepressants was considered a side effect to the drugs' intended use, extensive testing to determine the effects of these drugs on PE using large clinical trials has generally not been carried out.