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Expulsion refers to the forcible antegrade propulsion of semen through the urethral meatuswhich is caused by contractions of the periurethral and pelvic floor muscles and concurrent relaxation of the external urethral sphincter and urogenital diaphragmThe sympathetic nervous system controls both emission and bladder neck closureand acts through alpha adrenergic receptorsThe neural signals that lead to ejaculation originate from afferent-sensory stimuli in the glans penis and genitaliaThese stimuli are transmitted by means of the pudendal nerve to higher centers in the brainWitt and Grantmyre 1993

Doses and adverse effects of selective and nonselective serotonin reuptake inhibitors for treatment of PE.

Dapoxetine is a safe and effective treatment for premature ejaculationPEbut it has a high discontinuation rateaccording to new research.

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Past studies have revealed high discontinuation rates among men taking dapoxetine for PEeven though trials have shown effectivenessThe current study reported on discontinuation rates and reasons during a 2-year period.

This communication will focus on the prevalenceetiologypathophysiologyand the current treatment options for PEMore specificallya novel selective serotonin reuptake inhibitorSSRIdapoxetinewill be evaluated for its pharmacokineticsefficacyand safety record in light of available preclinical and clinical data.

Expulsion refers to the forcible antegrade propulsion of semen through the urethral meatuswhich is caused by contractions of the periurethral and pelvic floor muscles and concurrent relaxation of the external urethral sphincter and urogenital diaphragmThe sympathetic nervous system controls both emission and bladder neck closureand acts through alpha adrenergic receptorsThe neural signals that lead to ejaculation originate from afferent-sensory stimuli in the glans penis and genitaliaThese stimuli are transmitted by means of the pudendal nerve to higher centers in the brainWitt and Grantmyre 1993

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One hundred eighty-two men with an average age of 38 years participated in the studyAll of the men were seeking treatment for PE at the same medical center in South KoreaThey began taking 30 mg of dapoxetine one to three hours before intercourseIf 30 mg were not effectivethe dose was increased to 60 mgAt 13612and 24-month follow-up periodsthe men were evaluatedIf they had stopped taking dapoxetinethey discussed the reasons why.

Male rat studies have demonstrated that the neurotransmitter serotonin and two 5-HT receptors are involved in the ejaculatory processAhlenius et al 1981Foreman et al 1989Activation of 5-HT 2C receptors delays ejaculationwhereas activation of 5-HT 1A receptors accelerates ejaculatory latencyAhlenius et al 1981Based on these animal studiesWaldinger et al1998ahypothesized that lifelong PE is a neurobiological phenomenon related to decreased central serotonergic neurotransmissioncaused by a disruption in the functional balance of 5-HT receptor subtypesincreased sensitivity of 5-HT 1A receptors with decreased sensitivity of 5-HT 2C receptorsHencethey suggest that treatment for PE should aim at 5-HT 2C receptor stimulation and/or 5-HT 1A receptor inhibitionWaldinger et al 2005b

There are three basic mechanisms involved in normal ante-grade ejaculationemissionexpulsionand orgasmand each of these components possesses separate neural pathwaysEjaculatory dysfunction can result from disruption of any point in this cascade of eventsSeveral recent studies have clarified some aspects of the physiology of ejaculationEmissionwhich begins with closure of the bladder neck to prevent retrograde flow of seminal fluid and sperm into the bladderrefers to the deposition of seminal fluid and sperm from the distal epididymisvas deferensseminal vesiclesand prostate into the posterior urethraWitt and Grantmyre 1993

One hundred eighty-two men with an average age of 38 years participated in the studyAll of the men were seeking treatment for PE at the same medical center in South KoreaThey began taking 30 mg of dapoxetine one to three hours before intercourseIf 30 mg were not effectivethe dose was increased to 60 mgAt 13612and 24-month follow-up periodsthe men were evaluatedIf they had stopped taking dapoxetinethey discussed the reasons why.

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