Acceptance of and Discontinuation Rate from Paroxetine Treatment in Patients with Lifelong Premature Ejaculation

Introduction. Selective serotonin reuptake inhibitors are the most widely used agents for delaying ejaculation in patients with premature ejaculation (PE). Aim. The aim of this study was to assess the acceptance of and the discontinuation rate from paroxetine treatment in patients with lifelong PE. Methods. We analyzed the acceptance of and discontinuation rates of 93 consecutive potent patients (mean age, 37.6 years) seeking medical treatment for lifelong PE. The patients were assessed with detailed medical and sexual history, self-reported intravaginal ejaculatory latency time, self-administered International Index of Erectile Function, complete physical examination, and the Meares-Stamey test. The patients received a paroxetine prescription (10 mg daily for 21 days and then 20 mg as needed) for the first 3 months. Thereafter, the patients could either stay with the same on-demand treatment or take paroxetine 10 mg daily for 3 months. The patients were evaluated at 3 and 6 months, and requested to complete multiple-choice global assessment questions regarding specific reasons for eventual therapy discontinuation. Main Outcome Measures. The primary end point was acceptance and discontinuation rates for paroxetine treatment in patients seeking medical treatment for lifelong PE. The secondary end point was the reasons for nonacceptance of treatment or discontinuation. Results. Twenty-eight (30.10%) patients decided not to start paroxetine. Fear of using an "antidepressant drug" was the main reason (42.9%) for treatment nonacceptance. Twenty (30.8%) patients who initiated therapy eventually discontinued it. Treatment effect below expectations was the main reason of treatment dropout (75%) during the first 3 months, followed by temporary loss of interest in sex because of relationship issues (15%) and side effects (10%). Of the patients who continued treatment, 77.8% preferred daily paroxetine, while 22.2% continued as-needed therapy. Conclusions. Thirty percent of lifelong PE patients seeking medical treatment for complaints of early ejaculation freely decided not to start any paroxetine treatment, and roughly 30% of patients who started therapy eventually discontinued it. Salonia A, Rocchini L, Sacca A, Pellucchi F, Ferrari M, Del Carro U, Ribotto P, Gallina A, Zanni G, Deho' F, Rigatti P, and Montorsi F. Acceptance of and discontinuation rate from paroxetine treatment in patients with lifelong premature ejaculation. J Sex Med 2009;6:2868-2877.