Does the Hypothetical Aetiology Affect the Response to Serotonin Reuptake Inhibitors and Local Anesthetics Therapies in Patients with Primary Premature Ejaculation? A Prospective, Placebo-Controlled, Crossover Study

Introduction: Premature ejaculation (PE), which has a 30% prevalence rate among the population, is one of the most prevalent male sexual dysfunctions. Aim of work: To evaluate the effectiveness of Selective Serotonin Re-uptake Inhibitors (SSRI) and local anesthetics treatments in patients with primary life-long PE induced by tactile stimulation and those induced by non-tactile stimuli. Patients and methods: Fifty patients who were presented to Al-Hussein and Sayed Galal, Al-Azhar University Hospitals, Cairo, Egypt, were enrolled in a prospective, interventional, cross-over study in Dec 2021, randomized into double-blinded groups. The first group involved 25 patients with premature ejaculation not evoked by tactile stimulation, received local anesthesia cream and placebo SSRI for 8 weeks then one week washout, then received local cream as placebo and SSRI for another 8 weeks, While the second group involved 25 patients with premature ejaculation evoked by tactile stimulation, received local cream placebo and SSRI for 8 weeks then one week washout then received local anesthesia cream and placebo SSRI for 8 weeks. Results: There was statistically significant difference as regard Intra-vaginal Ejaculatory Latency Time (IELT) and sex satisfaction score after both phases (P=0.001), with predominant significant improvement after phase two. Conclusion: In non-tactile stimulation-induced premature ejaculation, selective serotonin re-uptake inhibitors (SSRI) are efficient, while local anesthetic creams are effective in tactile stimulation-induced premature ejaculation. More research should be done to compare different SSRI doses and the results of abrupt discontinuation of such treatment.