The success rate of BT for PE is from 45% to 65%, although its benefits are mainly short term, the authors note.

SSRIs such as clomipramine (Anafranil, Covidien), paroxetine, fluoxetine, sertraline, and citalopram have also been shown to be effective in treating PE, but they are associated with side effects, including yawning, mild nausea, severe sweating, extreme fatigue, change in bowel function, and reduced bone mineral density.

These drugs can also lower libido and erectile rigidity, but in some patients, the side effects gradually disappear after a month of continuous use, the authors write.

In view of these side effects and because PE is a very common sexual disorder, the authors sought to study the impact of sertraline on sperm parameters in PE patients and to compare its efficacy with BT.

The randomized, single-blind study included 60 normally potent men with PE, aged 18 to 40 years, who were heterosexual, married, had no other known sexual disorders, and were sexually active, having intercourse at least twice a week.

Half of the sample received sertraline 25 mg/day in the evening for the first week. The dose was increased up to 50 mg/day for 3 months. For some patients, the dose was increased to 100 mg/day.

Men randomly assigned to behavioral therapy (n = 30) were trained to use the following behavioral therapy techniques:

  • The squeeze technique, in which the erect penis is stimulated until impending orgasm and ejaculation are felt, and then the stimulation is abruptly stopped, and the coronal ridge of the penis is squeezed for several seconds. This is repeated several times.

  • The start-stop technique, in which stimulation is interrupted for several seconds, but no squeeze is applied.

The researchers also conducted a semen analysis and found that sperm concentration (million/mL) and percentage of normal sperm morphology were significantly reduced in the sertraline group (< .05).

They also found a significant increase in percentage of DNA fragmentation of sperm in the sertraline group (< .05), but there was no significant difference in semen volume or percentage of sperm motility, either before or after sertraline therapy.

BT had no effect on any semen parameters.

The investigators report that the reduction of the sperm concentration (million/mL; P <.001) and the percentage of normal morphology (P = .009) in the sertraline group were significantly more than in the BT group. The increase of percentage of DNA fragmentation in the sertraline group was significantly more than in the BT group (P = .004).

"Although in recent years the use of medication in many psychiatric disorders has become quite common and acceptable, the importance of research on the harmful effects of these drugs should not be neglected," the authors write.

They conclude that further studies into the impact of SSRIs are needed in larger populations.

Don't Dismiss Nonpharma Treatments

Commenting on the study for Medscape Medical News, Kenneth Paul Rosenberg, MD, a psychiatrist in private practice who treats men with sexual disorders, including PE, at his clinic, Upper East Health, in New York City, said the study is of interest for several reasons.

Dr. Kenneth Rosenberg

"One, it points out the importance of utilizing nonpharmacologic treatments for all disorders when readily accessible and clinically and experimentally proven.

"I am completely in favor of pharmacology and have improved the lives of countless people with drugs, but at the same time, there is enormous benefit and perhaps more lasting benefit from psychotherapeutic techniques, and that also has been proven," he said.

Dr. Rosenberg emphasized that when treating sexual disorders, "there is no question that you should not ignore the proven benefits of psychotherapeutic and behavioral techniques. The authors have made that point even more imperative because they say that the behavioral therapy techniques are just as good, if not better, for the treatment of premature ejaculation because of the potential side effects of medication. That is a very good point."

The study results need to be replicated, he added, but noted that they highlight the fact that nonpharmacologic interventions are extremely useful and for the most part are without side effects.

"At my clinic, we use yoga and meditation, because for 5000 years there were no medicines for sexual disorders, there were behavioral techniques. So we do a lot of things that are tried and true."

The study was sponsored by the Vice Chancellor for Research of the Kashan University of Medical Sciences. The authors and Dr. Rosenberg report no relevant financial relationships.

Urology. Published online February 12, 2014. Abstract