Recent guidelines have recommended topical anesthetic

Recent guidelines have recommended topical anesthetic creams or daily or on-demand SSRIs as first-line pharmacotherapy for PE. However, psychotherapy (alone or in combination with pharmacotherapy) also can be beneficial. Most participants in this survey noted that they preferred the combination of pharmacotherapy and psychotherapy for PE, whereas 17% recommended psychotherapy only, despite inconsistent evidence supporting its long-term efficacy. Although we believe that sexual counseling and other psychological interventions should not be completely abandoned, educational courses on modern PE treatment could be of benefit for increasing the awareness of physicians of pharmacologic treatment options.
In a similar study designed to ascertain the practice patterns of 207 U.S. urologists in the management of PE, Shindel et al reported that 73% of respondents saw fewer than one patient with PE per week. However, half the physicians who participated in our survey reported that they frequently encountered men with PE (more than 10 new cases per month). This discrepancy could be explained by the different characteristics of the participants, because in the present study the survey was administrated to attendees of a sexual medicine congress, whereas Shindel et al randomly generated a mailing list of practicing urologists from the American Urological Association member directory. In contrast, the most commonly preferred drug in the present study was on-demand SSRI (44%), which is in accordance with the findings of Shindel et al.
Dapoxetine, which is a rapidly acting SSRI with a short half-life, is the first approved oral medication for the treatment of PE in many countries. Several well-controlled studies have demonstrated the efficacy of dapoxetine 30 or 60 mg when taken orally 1 to 2 hours before intercourse. These studies reported intravaginal ejaculation latency time increases of 2.5- to 3.0-fold. However, it VE821 manufacturer must be noted that 20% of patients with PE who were prescribed on-demand dapoxetine did not start the medication because of fear of using a new drug or because of the cost of the treatment. Moreover, one study found that 90% of patients with PE who initiated dapoxetine therapy discontinued the treatment within 1 year owing to an efficacy below expectations (24.4%), cost (22.1%), adverse effects (19.8%), and loss of interest in sex (19.8%). We believe that physicians must be aware of these high discontinuation rates when prescribing dapoxetine to patients with PE. Further studies must be conducted to determine the true effectiveness and adverse effects of the different treatments of PE and for the possibility of educational activities to change the treatment approaches of medical specialists.

Conclusions

Statement of authorship

Introduction
Ospemifene (Osphena; Shionogi Inc, Florham NJ, USA) is a selective estrogen-receptor modulator that has been approved by the Food and Drug Administration for the treatment of moderate to severe vulvar and vaginal atrophy and moderate to severe dyspareunia (a symptom of vulvovaginal atrophy) with a suggested dosage of 60 mg once daily. The prescribing guidelines for ospemifene are based on two 12-week, double-blinded, placebo-controlled, parallel-group efficacy trials and one double-blinded, placebo-controlled, parallel-group, 52-week long-term safety trial.
The first clinical trial was a 12-week, double-blinded, placebo-controlled, parallel-group efficacy trial that included 826 menopausal women in three randomized groups. The first group received ospemifene 30 mg/d for 12 weeks (n = 282), the second group received ospemifene 60 mg/d for 12 weeks (n = 276), and the third group received a placebo (n = 268). The co-primary end points included the mean change from baseline in vaginal dryness or dyspareunia as indicated on a four-point scoring system, with participants stratified and assessed by the symptoms that were most bothersome at baseline (none = 0, mild = 1, moderate = 2, severe = 3) as taken at the screening appointment and again at weeks 4 and 12. Vaginal dryness was further assessed by the percentage of superficial cells and parabasal cells and vaginal pH as seen on a vaginal culture wet mount. The results of the trial indicated that women who received ospemifene in the two strata showed an improvement from baseline in vaginal dryness or dyspareunia by the four-point scale and an improvement in total Female Sexual Function Index score that was evident at week 4 and increased in magnitude until week 12.