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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

1 Department of UrologySisli Etfal Training and Research HospitalIstanbulTurkey.

Patient is in a stablemonogamous sexual relationship with the same woman for at least 6 months and plans to maintain this relationship for the duration of the study history of premature ejaculation in the 6 months before study initiation not due to distressinterpersonal difficulty or medication withdrawal history of intravaginal ejaculatory latency timeIELTof.

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Dapoxetine undergoes rapid absorption and elimination resulting in minimal accumulation and has dose-proportional pharmacokineticswhich are unaffected by multiple dosing and do not vary between ethnic groupsFigure 2Dresser et al2006bDresser et al2004Modi et al2006The pharmacokinetic profile of dapoxetine suggests that it is a good candidate for on-demand treatment of PE.

Sommer et al2005compared vardenafil 10 mg30 minutes pre-intercourseand sertraline 50 mg4 hours pre-intercoursein a prospectiverandomizedcross-over studyEjaculation was assessed with IELT using a stopwatch and graded on a scale of 0 to 80almost never8almost alwaysThe degree of improvement in ejaculation grade was 2.9 with vardenafil and 1.86 with sertralineand the increases in IELT were 5.23 in vardenafil-treated patients and 2.87 in sertraline-treated patientsThis study suggests that there is a potential for vardenafil in the treatment of PE.

The use of topical anesthetic ointments is probably the oldest treatment for delaying ejaculationbut only a few controlled studies gave been reportedIn one studythe results of lidocaine-prilocaine cream 10 minutes before intercourse were describedBerkovitch et al 1995Alsoan aerosol formulation of lidocaine-prilocaine is effective in prolonging IELT and in improving sexual satisfaction in men with PE and their partnersThe main drawback of topical anesthetics is their potential to cause a reduction in penile sensation and vaginal numbness in his partner.

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