Choice of Pharmacologic Agents

Historically, premature ejaculation (PE) was considered to be an acquired psychosexual phenomenon. Hence, behavioral therapies such as “stop-start” and “squeeze” methods were popular management approaches albeit with limited success. Observation of delayed ejaculation in patients taking selective serotoninergic reuptake inhibitors (SSRI) has contributed to the serendipitous advent of pharmacotherapy using SSRI for PE. Serotonin on the whole exerts an inhibitory effect on ejaculation both at the spinal and supraspinal levels. Many serotonin receptor subtypes have been identified so far, each having different functions. Other neurotransmitters implicated to play a secondary role in ejaculatory process include dopamine, acetylcholine, adrenaline, neuropeptides, oxytocin, gamma aminobutyric acid, and nitric oxide.