Treatment of Premature Ejaculation

Pharmacologic Treatment

The American Urological Association recommends SSRIs like sertraline (50-200 mg daily) as first-line treatment for premature ejaculation, with daily dosing superior to on-demand use 1, 2
Paroxetine (20 mg daily) demonstrates the strongest ejaculation delay among SSRIs 3, 2
Topical anesthetics (lidocaine/prilocaine cream applied 20-30 minutes before intercourse) are moderately effective alternatives 1, 3

Approximately 40% of patients refuse or discontinue SSRI treatment within 12 months due to concerns about taking antidepressants, side effects, or cost 1, 2
The American Urological Association advises against abrupt SSRI discontinuation as this can precipitate withdrawal syndrome; always taper 1, 2
Patients should be screened for concurrent erectile dysfunction, as some acquired premature ejaculation may be secondary to ED and should be treated according to AUA ED guidelines 1, 2