Alternative Treatments for Premature Ejaculation: A Review of Pharmacological Strategies

Abstract

Introduction and Purpose:
Premature ejaculation (PE) is a common male sexual disorder with a complex etiology involving psychological, neurobiological, and physiological factors. PE is defined as ejaculation occurring earlier than desired, often causing distress. Its etiology is multifactorial and not fully understood. Current standard treatments such as Selective Serotonin Reuptake Inhibitors (SSRIs) and lidocaine-prilocaine creams are helpful but limited, prompting interest in alternatives.
This review presents alternative pharmacological treatments for PE, excluding SSRIs and topical anesthetics, along with their side effects and benefits.

Material and Methods:
This narrative review evaluated pharmacological treatments for PE, excluding SSRIs and topical agents. Literature was searched in databases like PubMed and ScienceDirect for English-language studies published between 2000 and 2025. Selected studies focused on agents such as tramadol, clomipramine, levosulpiride, phosphodiesterase type 5 inhibitors, and α₁-adrenoreceptor antagonists. Inclusion criteria comprised clinical trials, meta-analyses, observational studies, and systematic reviews. Studies focusing solely on SSRIs, local treatments, or non-pharmacological methods were excluded.

Results:
Agents like PDE5 inhibitors, tramadol, silodosin, levosulpiride, and clomipramine showed significant improvements in intravaginal ejaculatory latency time (IELT), patient satisfaction, and outcomes, with acceptable side effect profiles.

Conclusions:
PE treatment should be tailored to individual needs. PDE5Is, α₁-adrenoreceptor antagonists, tramadol, levosulpiride, and clomipramine have shown promising results; however, due to the limitations of current studies, further research is necessary to confirm their efficacy and clarify their clinical roles.