The effects of three phosphodiesterase type 5 inhibitors on ejaculation latency time in lifelong premature ejaculators

For a while now many psychosexual physicians have found PDE5 inhibitors of use in treating not only erectile dysfunction but men with premature ejaculation (PE) too.  There are more studies evaluating their use in treating this frustrating and difficult condition.

 

In this study, the three PDE5 inhibitors sildenafil, vardenafil and tadalafil, were used on men with long standing PE in a double blind laboratory setting to evaluate their effects.

80 men with lifelong premature ejaculation, defined by ejaculation within a minute of achieving an erection, were randomised into four groups of 20 men.  They had all abstained from sexual activity for 3 days before the study.  All had normal erectile function as measured by the index of erectile function domain score.

The subjects attended the laboratory where they were randomised to receive either placebo, vardenafil 10mg, sildenafil 50mg or tadalafil 20mg.  Each was placed in a silent room away from the observer.  Real-time penile rigidity and tumescence was monitored.  The men read newspapers with no sexual content for 1.5 hours.  Then audiovisual sexual stimulation began with a video. This was started by the observer who was in another room.  After 8 minutes of the video the subjects began stimulation to the frenular area of the penis using a standardised vibratory device.  The time taken to ejaculation was recorded by the observer to obtain an ejaculation latency time (ELT) in seconds.

Results were obtained for 16 men in the placebo, sildenafil and tadalafil groups and 15 in the vardenafil group.  Six men couldn’t achieve an erection, five ejaculated before vibratory stimulation, one couldn’t ejaculate and one suffered technical problems. 

ELT for placebo was 48.5 seconds compared to 53.5 s for sildenafil, 70.0 s for tadalafil and 82.5 s for vardenafil.  The ELT was significantly increased in the vardenafil group (P=0.019).  Penile rigidity was only significantly improved in the sildenafil group but none had erectile problems prior to the study. 

In this study, vardenafil increased the ELT but sildenafil improved erection quality.  The lack of significant response with tadalafil may surprise many as this is often the drug of choice for men with PE.  However, this study was small and conducted in a laboratory setting.  One of the advantages of tadalafil is the longer time of action allowing improved spontaneity.  Many men with premature ejaculation lack confidence, and the context in which the sexual activity is occurring is significant.  It is one thing to last longer under quiet, private and controlled laboratory conditions but quite another thing to last when there is another person with you when performance anxiety can creep in.  Tadalafil may help reduce this anxiety by allowing a more natural response to sexual stimulation that doesn’t require interruption to take medication.

More studies are required to evaluate properly the role of PDE5 inhibitors in the treatment of premature ejaculation and their use in addition or in the place of better known treatments like SSRI’s but this RCT adds to the increasing evidence that PDE5 inhibitors can help men with lifelong ejaculation problems.

Gokce A, Halis F, Demirtas et al. The effects of three phosphdiesterase type 5 inhibitors on ejaculation latency time in lifelong premature ejaculators: a double-blind laboratory setting study. BJU International 2011; 107: 1274-1277.

 

Filed under: Doctors Notes, View AllPosted at 21:56

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