Clomipramine and sexual function in men with premature ejaculation and controls.

We determined whether clomipramine taken as needed increases ejaculation latency in men with premature ejaculation and controls. The study included 8 patients with primary premature ejaculation, 6 with premature ejaculation and erectile dysfunction, and 8 controls. A prospective, double-blind, placebo controlled, crossover design was used that included 2, 3-week periods with clomipramine and placebo. During treatment phases subjects took either 25 mg. clomipramine or placebo as needed, that is 12 to 24 hours before anticipated sexual activity (coitus or masturbation). Subjects also visited the laboratory during these phases for evaluation of sexual response using visual erotic stimulation with and without vibration to the penis. Daily logs of sexual activities were maintained during treatment phases. Clomipramine significantly increased the latency to ejaculation during sexual activity (coitus or masturbation) from approximately 2 to 8 minutes in men with primary premature ejaculation. There were no significant effects in controls and men with premature ejaculation plus erectile dysfunction. Laboratory assessment indicated that men with primary premature ejaculation were better able to control ejaculatory response with clomipramine therapy. In these men clomipramine also resulted in increased satisfaction with sex life and relationship. Clomipramine inhibited nocturnal penile tumescence in all subjects. Clomipramine (25 mg. as needed) effectively increases ejaculatory latency in men with primary premature ejaculation, while treatment is not effective in those with premature ejaculation and erectile dysfunction.

Haensel SM ，Rowland DL ，Kallan KT 《JOURNAL OF UROLOGY》

Fluoxetine and premature ejaculation: a double-blind, crossover, placebo-controlled study.

Haensel SM ，Klem TM ，Hop WC ，Slob AK ... -  《JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY》

An exploration of emotional response to erotic stimulation in men with premature ejaculation: effects of treatment with clomipramine.

Rowland DL ，Tai WL ，Slob AK 《-》

Clomipramine in the treatment of rapid (premature) ejaculation.

Twenty-three premature ejaculators (PEs) and 11 control subjects were administered 25 mg of clomipramine in a double-blind, placebo-controlled, crossover design study. During 2-week trials, subjects took either the drug or the placebo 4 to 6 hours prior to sexual activity. Daily diary data revealed that, for both groups, orgasmic latency was significantly increased when taking the clomipramine. For the PEs, the average increase in orgasmic latency during intercourse was from less than 1 minute to more than 3.5 minutes. Subjects also participated in two laboratory sessions while on the drug and placebo. During these lab sessions they were exposed to erotic videos with and without the addition of vibrotactile stimulation to the penis. Results from the laboratory data support those from the diaries. Specifically, PEs were significantly less likely to reach orgasm during the lab sessions while on the clomipramine than while on the placebo. Further, they reported a significantly greater sense of control over their orgasm while on the drug. The results of this study, along with previous research, strongly support the value of low doses of clomipramine in the treatment of premature ejaculation, specifically when taken on an as-needed basis as little as 4 hours prior to sexual activity. It is important to note, however, that the beneficial effects of the drug were not uniform across clinical subjects. In this study, those PEs with the shortest orgasmic latencies while on the placebo were the least likely to substantially improve while on the drug. Additional research is necessary to determine whether changes in the timing and dosage of the clomipramine administration can extend the benefits of the drug to those with the shortest latencies.

Strassberg DS ，de Gouveia Brazao CA ，Rowland DL ，Tan P ，Slob AK ... -  《JOURNAL OF SEX & MARITAL THERAPY》

Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: a double-blind, placebo controlled study.

We compared the efficacy and safety of fluoxetine, sertraline, clomipramine and placebo for the oral pharmacotherapy of premature ejaculation. The study included 36 men (mean age 44 years) who had intravaginal ejaculation latency of less than 2 minutes. Patients took each of 3 drugs and the placebo consecutively during a 4-week period per each agent. Efficacy and side effects data were obtained by a self-reported patient questionnaire that rated intravaginal ejaculation latency, sexual satisfaction of patient and partner, and possible side effects. After 4 weeks of treatment with placebo, fluoxetine, sertraline and clomipramine the mean intravaginal ejaculation latency time was significantly increased from 46 seconds to 2.27 minutes, 2.30 minutes, 4.27 minutes and 5.75 minutes, respectively (all p <0.01). However, treatment with clomipramine or sertraline caused a greater increase in mean intravaginal ejaculation latency time than fluoxetine or placebo (p <0.01). Patient sexual satisfaction rate after treatment with clomipramine was significantly higher (p <0.05) than with sertraline, fluoxetine or placebo. Partner sexual satisfaction rate was also higher with clomipramine than with sertraline or fluoxetine but no statistical difference was found. The incidence of side effects with clomipramine was significantly higher (p <0.05) compared to that of fluoxetine, sertraline and placebo, while no significant difference among sertraline, fluoxetine and placebo was noted. In men with premature ejaculation clomipramine was the most useful drug in terms of efficacy. Treatment with sertraline was nearly as effective and had a lower incidence of side effects.

Kim SC ，Seo KK 《JOURNAL OF UROLOGY》