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Erectile Dysfunction
Viagra, Paxil Help Premature Ejaculation
By WebMD Medical News: Martin Downs and Reviewed By Gary Vogin, MD
Nov 13, 2002, 10:13pm

Once again, Viagra comes to the rescue. A new study shows that Viagra in combination with Paxil helps premature ejaculators who have not improved with standard treatment.

If a man can work up the nerve to talk to his doctor about premature ejaculation, the doctor may refer him to a psychiatrist or a sex therapist, or may prescribe one of several possible medications including Paxil, an antidepressant, or a lidocaine numbing ointment that is rubbed on the head of the penis before sex.

The study, presented this week at the annual meeting of the American Urological Association in Orlando, Fla., looked at 138 premature ejaculators who started out using a numbing ointment. Thirty-eight were satisfied with that treatment. The remaining 100 started taking Paxil, and 42 of them were satisfied with that, leaving 58 who took Paxil with Viagra.

Over the course of three months, the men took one dose of Paxil seven hours before sex and one dose of Viagra one hour before sex. They noted how long they were able to have sexual intercourse, from the moment they entered a partner's vagina to the moment they ejaculated. In the beginning, they were able to sustain intercourse for less than one minute to three minutes.

They also rated their performance on a scale. At first they ejaculated too soon from "half of the time" to "almost always."

By the end of the study, 56 of the 58 men were able to have intercourse for more than three minutes most of the time.

It's well known that Paxil has sexual side effects, including delayed ejaculation. But Viagra? There can be several explanations for this, says study author Juza Chen, MD, of the Tel Aviv Sourasky Medical Center in Israel.

One possibility is that Viagra acts on the part of the brain that controls ejaculation. This function involves the chemical nitric oxide. Too much nitric oxide inhibits ejaculation. Viagra increases the amount of nitric oxide in the body, which is how it helps men get erections. Juza says there is some scientific evidence that Viagra increases the amount of nitric oxide in the brain, although that is not certain.

"Another possibility could be a decrease of sensitivity in the [head of the penis]," Juza says.

Arnold Melman, MD, head of the urology department at the Montefiore Medical Center in New York City, says he doubts that has anything to do with it. "What evidence is there?" he says. "Do you think when you have a hard erection you're less sensitive?"

Viagra may have had a psychological effect, too: With a firmer erection, they had more confidence, so they had more control. Melman says he thinks that is a more likely explanation. "I'm sure that's true," he says. "Much of the reason for premature ejaculation is psychological, not physical."

Juza says more research is needed to learn about using Viagra as a treatment for premature ejaculation. He plans to study the effects of Viagra alone compared with a placebo, and Viagra alone compared with Paxil alone.

"I think it's a good concept," Melman says.