5-Hydroxytryptamine in premature ejaculation: opportunities for therapeutic intervention.
Ejaculation, although mediated by a spinal ejaculation generator, is subject to descending supraspinal modulation from several brain regions. 5-Hydroxytryptamine (5-HT or serotonin) is involved in ejaculatory control, with its ejaculation-retarding effects likely to be attributable to activation of 5-HT1B and 5-HT2C receptors, both spinally and supraspinally. By contrast, stimulation of 5-HT1A receptors precipitates ejaculation. Selective serotonin reuptake inhibitors (SSRIs), which are used for treatment of psychiatric disorders, can delay ejaculation in humans and are widely used 'off-label' for treatment of premature ejaculation. SSRIs require 1-2 weeks' chronic dosing to be effective, similar to their use for treatment of depression. However, a new short-acting SSRI is effective 'on demand' and might represent the first of a new generation of therapies targeted to premature ejaculation.
Giuliano
François
F
AP-HP, Neuro-Uro-Andrology Unit, Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, 104 Bd Raymond Poincaré, 92380 Garches, France. giuliano@cyber-sante.org
D000818:Animals; D003863:Depression / Q000188:drug therapy; D004542:Ejaculation / Q000187:drug effects; D006801:Humans; D044282:Receptor, Serotonin, 5-HT1A / Q000378:metabolism; D011985:Receptors, Serotonin / Q000378:metabolism; D012701:Serotonin / Q000378:metabolism*; D012702:Serotonin Antagonists / Q000494:pharmacology; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy / Q000503:physiopathology*
D044282:Receptor, Serotonin, 5-HT1A; D011985:Receptors, Serotonin; D012701:Serotonin; D012702:Serotonin Antagonists; D017367:Selective Serotonin Reuptake Inhibitors