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Try out PMC Labs and tell us what you think. Learn More. Premature ejaculation PME is defined as ejaculation with the minimal sexual stimulation before, on or shortly after penetration and or before a person wishes it. It is a function of the time between intra-vaginal penetration and intra-vaginal ejaculation.
Tramadol has shown efficacy in PME when used as sporadic basis. In this study, we compared the use of mg of tramadol as sporadic treatment administered h before coitus versus continued treatment with the objective of evaluating the therapeutic of both modalities. We assumed our alternative hypothesis that they have similar effects.
A prospective study was carried out on 60 patients divided into two groups of 30 patients each. Intra-vaginal ejaculation latency time IELT and coital frequency were measured both prior to and after the treatment. Group A received tramadol mg daily for 4 weeks and on request sporadically for 4 weeks more. Group B was given placebo in the same manner. were statistically analyzed using the Student t -test.
Mean IELT prior to treatment was Mean pre-treatment coital frequency was 2. Mean IELT was Mean IELT with daily placebo was Coital frequency increased to 4. Coital frequency increased to 2. The of PME treatment with tramadol are similar with both continued and sporadic administration. The sex life of patients improved and they reported greater satisfaction with the sporadic treatment. Premature ejaculation PME is one of the most common male sexual dysfunction. The current definition of PME is based on intra-vaginal ejaculation latency time IELT which is measured as the time between intra-vaginal penetrations to intra-vaginal ejaculation by using stopwatch method.
Operation criteria provided by the American Psychiatric Association is the accepted guide. Diagnosis of this condition is made when: a There is a persistent problem of minimal sexual stimulation before or after ejaculation, b This problem causes anxiety in the patient that is not a side effect of any medication or substance, and c IELT is less than 1 min. There are several treatment options available for PME such as topical agents, creams, sprays, and systemic therapies.
The mechanism by which tramadol delays ejaculation has not been identified; numerous laboratory studies have shown that tramadol acts as a mild mu-opioid agonist, 5-hydroxytryptamine 5-HT2C receptor antagonist, and a serotonin and norepinephrine modulator. It is possible that one or a combination of these effects le to a delay in ejaculation. To compare the effect of daily and sporadic treatment of PME with tramadol.
Healthy not presenting with major physical illness such as type 2 diabetes mellitus, high blood pressure, sexually transmitted diseases, or psychiatric illnesses. Not taking medication such as benzodiazepines, drugs to relieve anxiety, sleep-inducing drugs. Strict stopwatch use during coitus patients were taught how to use stopwatch in their mobile phone. All participants were informed and written consents were taken.
All men were heterosexual; sexually active; in an ongoing, stable, sexual relationship for at least 3 months; and had no other sexual disorders, including erectile dysfunction ED as determined by the international index of erectile function questionnaire. Patients with chronic psychiatric or systemic diseases, such as diabetes mellitus; with hypertension; with alcohol or substance abuse; or who used any medications were excluded.
Urinalysis and urine cultures were performed routinely to exclude urinary infections. IELTs before and after treatment were calculated by using a partner-held stopwatch. Patients who did not abide to strict stopwatch use during coitus, who changed their sexual partner or whose partner did not agree to participate in the study and patients who did not tolerate the side-effects of tramadol were excluded from the study. All patients ed letters of informed consent. A total of 60 patients were randomly distributed into two groups 30 each. Group A patients were given mg daily of tramadol for 4 weeks and then on request every 2 or 8 h before sexual contact for next 4 weeks.
Group B patients were given a placebo tablet for 4 weeks then a placebo on request 2 or 8 h prior to sexual contact for next 4 weeks. Subjects were instructed to take study medication h before engaging in vaginal intercourse, with an interval between sexual intercourse events of at least 20 h to ensure wash-out of the drug and its effect.
Female partners were instructed to time the IELT for each event by using the stopwatch mobile phone stopwatch application and recording the time in a study diary. Data were analyzed with descriptive tests and data inference analysis was obtained using the Student t -test.
The mean ages of the groups were similar: The frequency of sexual intercourse and the characteristics of PE are shown in Table 1. The majority of the subjects The frequency of sexual intercourse and the characteristics of IELT after treatment are shown in Table 2. The mean IELT has increased to Coital frequency has also increased from 2. In the placebo group, mean IELT has increased Coital frequency has increased from 2. It has been seen that sporadic treatment has produced slightly higher effects, although, it was not statistically ificant in compare to daily treatment. The overall AE rate was 9.
Vertigo was observed in 3. There were no serious AEs. The of this study demonstrate that tramadol is an effective treatment for PE, resulting in a ificant prolongation of IELT that showed clinical improvements in satisfaction with sexual intercourse and control over ejaculation, and decreases in ejaculation-related personal distress and interpersonal difficulty.
Tramadol was well tolerated; the overall AE rate was 6. Salem et al. Chronic use of serotonergic and selective serotonin reuptake inhibitor SSRI agents has shown effectiveness in delaying ejaculation. Today, they are the main treatment option available for the treatment of PME.
Dapoxetine has shown efficacy in PME when used as on-demand basis. However, very few studies on tramadol therapeutic efficacy comparing forms of administration sporadic or continuous have been published. Tramadol has shown ificant improvement in IELT in both doses over placebo.
Although, abuse potential of tramadol is less but with continued treatment it has been reported. Besides this, considering the economical aspects, tramadol has greater advantage over other drugs used in the treatment of PME. The of the present study show a similar efficacy in the administration of tramadol on request and on a fixed schedule. It is worth noting that in relation to degree of satisfaction patients stated that they felt better with the on request administration.
This is perhaps due to the fact that the are the same with both types of administration but with the on request regimen there was a reduction in undesirable side-effects and there was also a lower monetary cost. Even though, mg of tramadol has been reported to be well-tolerated in other studies,[ 20 ] perhaps, it would be worthwhile to evaluate the of administering a lower dosage.
Another important point of the present study is that both an improvement in quality of sexual life of the patient and increase in coital frequency after tramadol administration were reflected. Recently, there have been many therapeutic options have been tried such as creams, sprays, and systemic therapies. Source of Support: Nil.
Conflict of Interest: None. National Center for Biotechnology Information , U. Indian J Psychol Med. Amil H. Khan and Deepa Rasaily. Author information Copyright and information Disclaimer. Address for correspondence: Dr. Khan, House No. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract Aim: Premature ejaculation PME is defined as ejaculation with the minimal sexual stimulation before, on or shortly after penetration and or before a person wishes it.
Materials and Methods: A prospective study was carried out on 60 patients divided into two groups of 30 patients each. Conclusions: The of PME treatment with tramadol are similar with both continued and sporadic administration. Keywords: Intra-vaginal ejaculatory latency time , premature ejaculation , tramadol. Patients who fit the following criteria were included in the study: Male years of age Healthy not presenting with major physical illness such as type 2 diabetes mellitus, high blood pressure, sexually transmitted diseases, or psychiatric illnesses Not taking medication such as benzodiazepines, drugs to relieve anxiety, sleep-inducing drugs In an emotionally stable relationship Not using barrier contraception methods Strict stopwatch use during coitus patients were taught how to use stopwatch in their mobile phone.
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Diagnostic and Statistical Manual of Mental Disorders. International Society for Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation. Premature ejaculation. Am Urol Assoc Update Ser. Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: An integrated analysis of two double-blind, randomised controlled trials. Tramadol HCL has promise in on-demand use to treat premature ejaculation. Receptor binding, analgesic and antitussive potency of tramadol and other selected opioids.
The effects of tramadol and its metabolite on glycine, gamma-aminobutyric acidA, and N-methyl-D-aspartate receptors expressed in Xenopus oocytes. Anesth Analg. J Clin Psychopharmacol. Selective serotonin reuptake inhibitor discontinuation syndrome: Proposed diagnostic criteria. J Psychiatry Neurosci.
Treatment of premature ejaculation with paroxetine hydrochloride as needed: 2 single-blind placebo controlled crossover studies. J Urol. Paroxetine treatment of premature ejaculation: A double-blind, randomized, placebo-controlled study. Am J Psychiatry. Paroxetine use in premature ejaculation: Continued versus sporadic treatment.Sex at least a few times a week
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