Objectives. Pharmacotherapy using selective serotonin reuptake inhibitors (SSRIs) for men with primary premature ejaculation is promising. In particular, the strategy of taking a pill “as needed” may offer an attractive option. To investigate the possibility of self-therapy for the treatment of premature ejaculation, we compared the efficacy of sertraline taken as needed with that of continuous medication.

Methods. Since 1996, we have treated 24 men with sertraline on an as needed basis for primary premature ejaculation. Sertraline was chosen from among the SSRIs because a large dose need not be divided and because peak plasma levels occur 4 to 8 hours after oral administration, making 5 pm a suitable time for administration (by which time a man may know whether sexual intercourse is likely to occur later that evening). Each patient was started on 50 mg daily for 2 weeks, and the dose was then adjusted to 50 or 100 mg on the day of intercourse only (PRN).

Results. After 6 weeks, 18 men were still taking medication, and 6 had dropped out. Among the 18, the mean ejaculation latency was 23 ± 19 seconds before treatment, 5.9 ± 4.2 minutes after 2 weeks of 50 mg daily, 5.1 ± 3.8 minutes after 2 weeks of 50 or 100 mg PRN, and 4.5 ± 2.7 minutes after 4 weeks of 50 or 100 mg PRN. Mean sexual satisfaction scores (5, extremely satisfied; 0, extremely unsatisfied) for men were 0.8 ± 0.8 before treatment, 3.8 ± 1.2 after 2 weeks of 50 mg daily, 3.4 ± 1.0 after 2 weeks of 50 or 100 mg PRN, and 3.2 ± 0.7 after 4 weeks of 50 or 100 mg PRN. For their partners, mean sexual satisfaction scores were 1.1 ± 0.7 before treatment, 3.2 ± 1.6 after 2 weeks of 50 mg daily, 3.1 ± 1.4 after 2 weeks of 50 or 100 mg PRN, and 3.3 ± 1.2 after 4 weeks of 50 or 100 mg PRN. Side effects were intermittent excessive delay of ejaculation in 1 patient, fatigue in 2, and numbness in 1.

Conclusions. If our results are supported by additional long-term clinical studies, self-therapy with sertraline taken PRN at 5 pm for the treatment of premature ejaculation could be as attractive as self-injection therapy for the treatment of erectile dysfunction.