Diagnóstico clínico e tratamento medicamentoso em ejaculação precoce
Keywords:
Ejaculação, quimioterapia combinada, antidepressivo, coito, anestésicosAbstract
A ejaculação precoce é um dos transtornos sexuais mais prevalentes na população masculina com prevalência média de cerca de 30%. Possui diversas classificações de entidades médicas e classificações internacionais de doenças, todas elas tendo em comum um reduzido tempo de latência intravaginal, incapacidade de controle ejaculatório e consequências psicológicas negativas para o indivíduo e/ou para o casal. Dentre as causas da patologia, destacam-se alterações nas vias de neurotransmissão serotoninérgica, hipersensibilidade genital e causas genéticas nas patologias primárias. Na ejaculação precoce secundária devem-se pesquisar distúrbios psicogênicos, hormonais, sintomas de trato urinário inferior e disfunção erétil. O correto diagnóstico é importante para indicação e planejamento do tratamento adequado. Em casos de ejaculação precoce primária, o tratamento preferencial é o medicamentoso. Os tratamentos medicamentosos disponíveis podem ser por via oral ou de aplicação tópica. Dentre os tratamentos orais, destacam-se os antidepressivos com ação serotoninérgica que devem ser utilizados de modo contínuo. Outras classes de medicações utilizadas são os inibidores da fosfodieterase do tipo 5 e os opioides como tramadol. Como opção às medicações orais, as medicações de aplicação tópica peniana são aplicadas sob demanda na glande um período antes do encontro sexual, cujo tempo varia conforme o medicamento escolhido, e que podem ter apresentação no formato gel ou spray, contendo primariamente uma mistura de lidocaína e prilocaína ou compostos de naturais como o SS-Cream (Severance Secret Cream).
References
Abdo CH. The impact of ejaculatory dysfunction upon the sufferer and his partner. Transl Androl Urol. 2016;5(4):460-9. PMID: 27652218; https://doi.org/10.21037/tau.2016.05.08.
Kempeneers P, Andrianne R, Bauwens S, et al. Functional and psychological characteristics of belgian men with premature ejaculation and their partners. Arch Sex Behav. 2013;42(1):51-66. PMID: 22695640; https://doi.org/10.1007/s10508-012-9958-y.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013. https://doi.org/10.1176/appi.books.9780890425596.
Althof SE, Abdo CHN, Dean J et al. International Society for Sexual Medicine’s Guidelines for the Diagnosis and Treatment of Premature Ejaculation. J Sex Med. 2010;7(9):2947-69. PMID: 21050394; https://doi.org/10.1111/j.1743-6109.2010.01975.x.
Althof SE, McMahon CG, Waldinger MD, et al. An Update of the International Society of Sexual Medicine’s Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). Sex Med. 2014;2(2):60-90. PMID: 25356302; https://doi.org/10.1002/sm2.28.
Patrick DL, Rowland D, Rothman M. Interrelationships among measures of premature ejaculation: the central role of perceived control. J Sex Med. 2007;4(3):780-8. PMID: 17419817; https://doi.org/10.1111/j.1743-6109.2007.00464.x.
Waldinger MD, Schweitzer DH. Differences between ICD11 MMS and DSM-5 definition of premature ejaculation: a continuation of historical inadequacies and a source of serious misinterpretation by some European Regulatory Agencies (PART 2). Int J Impot Res. 2019;31(5):310-8. PMID: 30659291; https://doi.org/10.1038/s41443-018-0108-5.
Martin-Tuite P, Shindel AW. Management Options for Premature Ejaculation and Delayed Ejaculation in Men. Sex Med Rev. 2020;8(3):473-85. PMID: 31668585; https://doi.org/10.1016/j.sxmr.2019.09.002.
McMahon CG, Jannini EA, Serefoglu EC, Hellstrom WJG. The pathophysiology of acquired premature ejaculation. Transl Androl Urol. 2016;5(4):434-49. PMID: 27652216; https://doi.org/10.21037/tau.2016.07.06.
Abdo CHN, Oliveira Jr WM, Moreira Junior ED, Fittipaldi JAS. Perfil sexual da população brasileira: resultados do Estudo do Comportamento Sexual (ECOS) do brasileiro. Rev Bras Med. 2002;59(4):250-7.
Asimakopoulos AD, Miano R, Agrò EF, Vespasiani G, Spera E. Does current scientific and clinical evidence support the use of phosphodiesterase type 5 inhibitors for the treatment of premature ejaculation? a systematic review and meta-analysis. J Sex Med. 2012;9(9):2404-16. PMID: 22248110; https://doi.org/10.1111/j.1743-6109.2011.02628.x.
Puppo V, Sharif H. Premature ejaculation is not a disease. Int J Urol. 2017;24(8):641. PMID: 28556270; https://doi.org/10.1111/iju.13384.
Giuliano F. Neurophysiology of erection and ejaculation. J Sex Med. 2011;8:310-5. PMID: 21967393; https://doi.org/10.1111/j.1743-6109.2011.02450.x.
Pavone C, Abbadessa D, Gambino G, Scaduto G, Vella M. Premature ejaculation: Pharmacotherapy vs group psychotherapy alone or in combination. Arch Ital Urol E Androl. 2017;89(2):114-9. PMID: 28679182; https://doi.org/10.4081/aiua.2017.2.114.
Siroosbakht S, Rezakhaniha S, Rezakhaniha B. Which of available selective serotonin reuptake inhibitors (SSRIs) is more effective in treatment of premature ejaculation? A randomized clinical trial. Int Braz J Urol. 2019;45(6):1209-15. PMID: 31808410; https://doi.org/10.1590/S1677-5538.IBJU.2019.0121.
Waldinger MD. Drug treatment options for premature ejaculation. Expert Opin Pharmacother. 2018;19(10):1077-85. PMID: 30028639; https://doi.org/10.1080/14656566.2018.1494725.
Salem AM, Kamel II, Rashed LA, GamalEl Din SF. Effects of paroxetine on intravaginal ejaculatory latency time in Egyptian patients with lifelong premature ejaculation as a function of serotonin transporter polymorphism. Int J Impot Res. 2017;29(1):7-11. PMID: 27679962; https://doi.org/10.1038/ijir.2016.36.
McMahon C, Kim SW, Park NC, et al. Treatment of premature ejaculation in the Asia-Pacific region: results from a phase iii double-blind, parallel-group study of dapoxetine. J Sex Med. 2010;7(1 Pt 1):256-68. PMID: 19878447; https://doi.org/10.1111/j.1743-6109.2009.01560.x.
Buvat J, Tesfaye F, Rothman M, Rivas DA, Giuliano F. Dapoxetine for the treatment of premature ejaculation: results from a randomized, double-blind, placebo-controlled phase 3 trial in 22 countries. Eur Urol. 2009;55(4):957-67. PMID: 19195772; https://doi.org/10.1016/j.eururo.2009.01.025.
Balon R. Burden of Sexual Dysfunction. J Sex Marital Ther. 2017;43(1):49-55. PMID: 26683616; https://doi.org/10.1080/0092623X.2015.1113597.
Hisasue S. The drug treatment of premature ejaculation. Transl Androl Urol. 2016;5(4):482-6. PMID: 2765222; https://doi.org/10.21037/tau.2016.06.10.
Saitz TR, Serefoglu EC. Advances in understanding and treating premature ejaculation. Nat Rev Urol. 2015;12(11):629-40. PMID: 26502991; https://doi.org/10.1038/nrurol.2015.252.
Choi JB, Kang SH, Lee DH, et al. Efficacy and Safety of On Demand Clomipramine for the Treatment of Premature Ejaculation: A Multicenter, Randomized, Double-Blind, Phase III Clinical Trial. J Urol. 2019;201(1):147-52. PMID: 30086277; doi: https://doi.org/10.1016/j.juro.2018.07.089.
Bar-Or D, Salottolo KM, Orlando A, Winkler JV; Tramadol ODT Study Group. A randomized double-blind, placebo-controlled multicenter study to evaluate the efficacy and safety of two doses of the tramadol orally disintegrating tablet for the treatment of premature ejaculation within less than 2 minutes. Eur Urol. 2012;61(4):736-43. PMID: 21889833; https://doi.org/10.1016/j.eururo.2011.08.039.
Gameel T, Tawfeek A, Abou Farha M, et al. 184 On-demand use of Tramadol, Sildenafil, Paroxetine and Local Anaesthetics for the Management of Premature Ejaculation: A Randomized Placebo-controlled Clinical Trial. J Sex Med. 2018;15(2 Suppl 1):S57. https://doi.org/10.1016/j.jsxm.2017.11.143.
Martyn-St James M, Cooper K, Ren S, et al. Phosphodiesterase Type 5 Inhibitors for Premature Ejaculation: A Systematic Review and Meta-analysis. Eur Urol Focus. 2017;3(1):119-29. PMID: 28720356; https://doi.org/10.1016/j.euf.2016.02.001.
Morales A, Barada J, Wyllie MG. A review of the current status of topical treatments for premature ejaculation. BJU Int. 2007;100(3):493-501. PMID: 17608824; https://doi.org/10.1111/j.1464-410X.2007.07051.x.
Busato W, Galindo CC. Topical anaesthetic use for treating premature ejaculation: a double-blind, randomized, placebocontrolled study. BJU Int. 2004;93(7):1018-21. PMID: 15142155; https://doi.org/10.1111/j.1464-410X.2003.04773.x.
Xia JD, Han YF, Zhou LH, Chen Y, Dai YT. Efficacy and safety of local anaesthetics for premature ejaculation: a systematic review and meta-analysis. Asian J Androl. 2013;15(4):497-502. PMID: 23708465; https://doi.org/10.1038/aja.2012.174.
Porst H, Burri A. Novel Treatment for Premature Ejaculation in the Light of Currently Used Therapies: A Review. Sex Med Rev. 2019;7(1):129-40. PMID: 30057136; https://doi.org/10.1016/j.sxmr.2018.05.001.
Sutton M, Hunn C, Summers-Colquitt RB, et al. Promescent Has a Cytotoxic Impact on Fresh Human Sperm In Vitro. Urology. 2018;114:95-8. PMID: 29307732; https://doi.org/10.1016/j.urology.2017.12.027.
Porst H, Burri A. FortacinTM Spray for the Treatment of Premature Ejaculation. Urologia. 2017;84(2_suppl):1-10. PMID: 30047847; https://doi.org/10.5301/uj.5000275.
Xin ZC, Choi YD, Lee WH, et al. Penile vibratory threshold changes with various doses of SS-cream in patients with primary premature ejaculation. Yonsei Med J. 2000;41(1):29-33. PMID: 10731916; https://doi.org/10.3349/ymj.2000.41.1.29.
Butcher MJ, Zubert T, Christiansen K, et al. Topical Agents for Premature Ejaculation: A Review. Sex Med Rev. 2020;8(1):92-9. PMID: 30987933; https://doi.org/10.1016/j.sxmr.2019.03.003
