Treatment can be most challenging since males do not always feel comfortable discussing sexual matters generally or revealing intimate details. Assessment of the males relationship and personal history as well as the participating, maintaining, or contextual factors that contribute to rapid ejaculation is helpful if the goal of treatment is not simply ejaculatory control but rather sexual enhancement. Yet, it is one of the most prevalent complaints of men (and most significantly the partners). There are a number of behavioral interventions for delaying ejaculation during sexual intimacy, however, pharmacological treatment has become increasingly popular over the past decade. Defining the problem of rapid ejaculation continues to be one of the biggest challenges, and who gets to decide if it is a genuine disorder? The therapist or physician? The partner? Or the male with the distress of the condition?
The SSRIs Paxil, Zoloft, Prozac, and the tricyclic antidepressant clomipramine (Anafranil) as classes of medications are believed to have a similar mechanism of action have been successfully utilize to treat rapid ejaculation. The dose range for each SSRI agent is: Paxil 20 to 40 mg, clomipramine 10 – 50 mg, Zoloft 50 – 100 mg; and Prozac 20 to 40 mg. Effects of the medication are observed within the first week and tend to improve during the course of treatment. Side effects from these agents could include fatigue, nausea, G.I. distress, and at times excessive sweating. These side effects need to be monitored and tend to diminish over time. It is important to note that these agents should not be abruptly terminated as a serotonin withdrawal syndrome occurs perhaps 60% of SS are high – treated patients following abrupt sensation of drug intake. Onset of the syndrome is usually within a few days and purses perhaps 3 to 4 weeks. There are six core set of somatic signs and symptoms represented by the mnemonic “FINISH” (Muzina, 2010):
- Flulike symptoms (fatigue, lethargy, myalgias, chills, headache)
- Insomnia (sleep disturbance, vivid dreams)
- Nausea (gastrointestinal symptoms, vomiting, diarrhea)
- Imbalance (dizziness, vertigo, ataxia)
- Sensory disturbance (sensation of electric shock in the arms, legs, or head)
- Hyperarousal (anxiety, agitation)
All the somatic and psychological phenomena are reduced over time and disappear when the SSRIs are reintroduced. It is important to note that titration of all antidepressants being discontinued is recommended.