![]() ![]() We also highlighted specific settings where drugs could be introduced to medical practice. Here, we reviewed how DE is treated pharmacologically. There is a consensus that DE is still a poorly understood disorder with inconsistent practice patterns seen among members of the SMSNA. In a recent survey to evaluate the current opinion and clinical management of DE by members of the Sexual Medicine Society of North America (SMSNA), cabergoline and bupropion were the most commonly selected first line treatments for DE ( 5). ![]() However, no drugs have been approved by regulatory agencies for this indication. These drugs include testosterone, cabergoline, bupropion, amantadine, cyproheptadine, yohimbine, bethanechol, buspirone and others. A variety of drugs are identified for potential use in this condition. Currently, no drug has been approved by FDA for DE. Drug treatment of DE includes many agents with varying degrees of success. Treatment should be etiology specific, and may include patient and their partner psychosexual therapy, drug therapy or integrated treatment. ![]() DE is not easy to treat because it is poorly understood ( 2, 5). Proposed etiological factors include many medical, psychological and lifestyle factors ( 2- 4). DE was shown to be associated with significant reduction in health-related quality of life as well as self-esteem, anxiety, and depression and has been linked to reduced sexual satisfaction and relationship dissatisfaction and discord. Also it may be global, that is, occurring in all sexual scenarios or situational, occurring only in specific sexual scenarios (e.g., with partner but not masturbation, or with one partner but not another). This condition can be lifelong (primary) or acquired (secondary). Of all the male sexual dysfunctions, DE is the least understood, least common and least studied ( 2). In most cases, the diagnosis is made by self-report of the individual. The condition is only a problem if it causes significant distress for the patient or his partner. In DSM-5 definition the condition must persist for a minimum duration of approximately six months with no specific duration of ejaculation latency. The man reports difficulty or inability to ejaculate despite of the presence of adequate sexual stimulation and the desire to ejaculate” ( 1). The term delayed ejaculation (DE) (also called retarded ejaculation, or inhibited ejaculation) has been used to describe “a marked delay in or inability to achieve ejaculation. Various drugs are available to address such problem, however their evidence of efficacy is still limited and their choice needs to be individualized to each specific case. The clinicians need to be aware of the pathogenesis of DE and the pharmacological basis underlying the use of different drugs to extend better care for these patients. It is concluded that successful drug treatment of DE is still in its infancy. Review of literature showed that evidence level 1 (Double blind randomized clinical trial) studies were performed with testosterone, oxytocin, buspirone or bethanechol treatment. Although there are many pharmacological treatment options, the evidence is still limited to small trials, case series or case reports. There are a number of drugs to treat patients with DE including: testosterone, cabergoline, bupropion, amantadine, cyproheptadine, midodrine, imipramine, ephedrine, pseudoephedrine, yohimbine, buspirone, oxytocin, and bethanechol. To achieve the maximum sensitivity of the search strategy and to identify all studies, we combined “delayed ejaculation” as Medical Subject Headings (MeSH) terms or keywords with each of “testosterone” or “cabergoline” or “bupropion” or “amantadine” or “cyproheptadine” or “midodrine” or “imipramine” or “ephedrine” or “pseudoephedrine” or “yohimbine” or “buspirone” or “oxytocin” or “bethanechol” as MeSH terms or keywords. Electronic databases were searched from 1966 to February 2016, including PubMed MEDLINE, EMBASE, EBCSO Academic Search Complete, Cochrane Systematic Reviews Database, and Google Scholar using key words delayed ejaculation, retarded ejaculation, inhibited ejaculation, drugs, treatment, or pharmacology. Here we reviewed how DE is treated pharmacologically. It is often quite concerning to patients and it can affect psychosocial well-being. Delayed ejaculation (DE) is an uncommon and a challenging disorder to treat.
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