title: Premature ejaculation: do we have effective therapy?
abstract: BACKGROUND
  Premature ejaculation (PE) is the most common sexual dysfunction, with the majority of PE patients remaining undiagnosed and undertreated. Despite its prevalence, there is a current paucity of data regarding available treatment options and mechanisms. The objective of the current investigation is to review and summarize pertinent literature on therapeutic options for the treatment of PE, including behavioral/psychologic, oral pharmacotherapy, and surgery.
  
  
  METHODS
  A pubmed search was conducted on articles reporting data on available treatment options for PE. Articles describing potential mechanisms of action were additionally included for review. Preference was given towards randomized, controlled trials, when available.
  
  
  RESULTS
  PE remains an underdiagnosed and undertreated disease process, with limited data available regarding potential underlying mechanisms and long-term outcomes of treatment options. Psychological/behavioral therapies, including the stop-start, squeeze, and pelvic floor rehabilitation techniques have demonstrated improvements in short-term series, with decreased efficacy with additional follow-up. Topical therapies, which are commonly utilized result in prolonged intravaginal ejaculatory latency time (IELT) at the expense of potential penile/vaginal Hypothesia. Oral therapies similarly demonstrate improved IELTs with variable side effect profiles and include selective serotonin reuptake inhibitors (daily or on demand), phosphodiesterase-5 inhibitors, alpha-1 adrenergic antagonists, and tramadol. Alternative therapies such as acupuncture have shown benefits in limited studies. Surgery is not commonly performed and is not recommended by available guidelines.
  
  
  CONCLUSIONS
  PE is a common condition, with limited data available regarding its underlying pathophysiology and treatment. Available therapies include topical, oral, behavioral/psychologic modification, or a combination thereof. Additional research is required to assess the optimal treatment strategies and algorithms as well as to better define the mechanisms for PE and its management.
authors.affiliation: 1 Tulane University, School of Medicine, Department of Urology, New Orleans, LA, USA ; 2 Medicana International Hospital, Ankara, Turkey.
authors.forename: Ege Can
authors.initials: EC
authors.lastname: Serefoglu
authors.affiliation: 1 Tulane University, School of Medicine, Department of Urology, New Orleans, LA, USA ; 2 Medicana International Hospital, Ankara, Turkey.
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Saitz
authors.affiliation: 1 Tulane University, School of Medicine, Department of Urology, New Orleans, LA, USA ; 2 Medicana International Hospital, Ankara, Turkey.
authors.forename: Landon
authors.initials: L
authors.lastname: Trost
authors.affiliation: 1 Tulane University, School of Medicine, Department of Urology, New Orleans, LA, USA ; 2 Medicana International Hospital, Ankara, Turkey.
authors.forename: Wayne J G
authors.initials: WJ
authors.lastname: Hellstrom
keywords: Premature ejaculation; sexual dysfunction; treatment
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