Clinical Question

Are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) safe and effective for the treatment of premature ejaculation in adult men?

Evidence-Based Answer

SSRIs and SNRIs increase the ejaculatory latency time (mean difference [MD] = 3.09 minutes; 95% CI, 1.94 to 4.25 minutes) and improve the satisfaction of the experience (relative risk [RR] = 1.63; 95% CI, 1.42 to 1.87) compared with placebo. However, adverse effects cause a substantial number of men to stop treatment (RR = 3.80; 95% CI, 2.61 to 5.51).¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

According to the International Society for Sexual Medicine, premature ejaculation is a sexual dysfunction characterized by penile ejaculation that always or nearly always occurs before or within one minute of sexual penetration.² It is either present from the patient's first sexual encounter (lifelong premature ejaculation) or a bothersome decrease in ejaculatory latency (secondary or acquired), often to three minutes or less. Causes of acquired premature ejaculation include sexual performance anxiety, psychological and relationship problems, erectile dysfunction, and use of or withdrawal from medications or recreational drugs. Rarely, hyperthyroidism or prostatitis can contribute to premature ejaculation. In lifelong and acquired premature ejaculation, there is an inability to delay ejaculation during all or nearly all instances of sexual penetration, leading to personal distress or avoidance of sexual intimacy.^1,3,4