Escitalopram for Premature Ejaculation Affects Semen
Escitalopram for Premature Ejaculation Affects Semen
The aim of this study was to determine the impact of long-term escitalopram treatment on semen parameters of patients with lifelong premature ejaculation (PE). Between November 2008 and January 2010, patients admitted to urology outpatient clinic with a self-reported complaint of PE were evaluated. Medical and sexual history of patients were recorded and patients with lifelong PE (a total of 25 patients) who met the International Society of Sexual Medicine definition were asked to record their intravaginal ejaculatory latency time (IELT) for 1 month, complete Premature Ejaculation Diagnostic Tool (PEDT) questionnaire and give semen samples. Afterwards, patients received 10 mg escitalopram daily for 12 weeks and were invited for control visits at first and third month of treatment. During control visits, PEDT was administered again whereas IELTs were recorded and semen samples were re-examined. PEDT scores, arithmetic means of IELTs and results of semen analyses, which were recorded at baseline, first and third month were compared. At the third month of treatment, a significant increase in mean IELTs and a significant decrease in PEDT scores were detected. However there was a significant decrease in sperm concentration, motility and morphology when compared with the baseline semen measures. Daily escitalopram treatment effects the semen parameters of patients with lifelong PE. Further investigations with larger series are needed to see whether other serotonin reuptake inhibitors have similar side effects and to expose the exact mechanism underlying it. Different treatment modalities should be suggested to patients who desire fertility.
Premature ejaculation (PE) is one of the most common sexual dysfunctions in men with prevalence rates ranging from 21–31%. PE is characterized with a short ejaculatory latency time, lack of ejaculatory control, decreased satisfaction with sexual intercourse causing interpersonal distress, negative impact on man's self-esteem, reduced sexual function and reduced quality of life.
PE can be classified as either a lifelong condition or acquired condition. Lifelong PE is characterized by ejaculation that always or nearly always occurs before or within about 1 min of vaginal penetration, and inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy.
Pharmacotherapy is the basis for the treatment of lifelong PE. Although no drug for PE has been approved by either US Food and Drug Administration (FDA) or European Medicines Agency (EMEA), chronic selective serotonin reuptake inhibitors (SSRIs) and on-demand topical anesthetics are proved to be effective in treating PE. However, SSRI treatment has adverse effects such as sexual dysfunctions, insomnia, fatigue, nausea and constipation, most of which are usually mild and gradually improve after 2–3 weeks. As no universal agreement has been reached on how long SSRIs must be employed to treat PE so as to get ideal effect, there are limited data regarding the adverse effects of long-term SSRI treatment in PE patients. Although there are only a few studies, which determined the negative effect of SSRIs on semen parameters of depressed men or healthy volunteers, to our knowledge, the impact of this treatment on semen parameters of lifelong PE patients has not been evaluated yet.
Escitalopram, which is the enantiomer of citalopram, is one of the most widely used SSRIs and its efficacy in treating PE has been previously demonstrated. The purpose of this study was to determine the impact of long-term escitalopram treatment on semen parameters including sperm concentration, motility and morphology.
Abstract and Introduction
Abstract
The aim of this study was to determine the impact of long-term escitalopram treatment on semen parameters of patients with lifelong premature ejaculation (PE). Between November 2008 and January 2010, patients admitted to urology outpatient clinic with a self-reported complaint of PE were evaluated. Medical and sexual history of patients were recorded and patients with lifelong PE (a total of 25 patients) who met the International Society of Sexual Medicine definition were asked to record their intravaginal ejaculatory latency time (IELT) for 1 month, complete Premature Ejaculation Diagnostic Tool (PEDT) questionnaire and give semen samples. Afterwards, patients received 10 mg escitalopram daily for 12 weeks and were invited for control visits at first and third month of treatment. During control visits, PEDT was administered again whereas IELTs were recorded and semen samples were re-examined. PEDT scores, arithmetic means of IELTs and results of semen analyses, which were recorded at baseline, first and third month were compared. At the third month of treatment, a significant increase in mean IELTs and a significant decrease in PEDT scores were detected. However there was a significant decrease in sperm concentration, motility and morphology when compared with the baseline semen measures. Daily escitalopram treatment effects the semen parameters of patients with lifelong PE. Further investigations with larger series are needed to see whether other serotonin reuptake inhibitors have similar side effects and to expose the exact mechanism underlying it. Different treatment modalities should be suggested to patients who desire fertility.
Introduction
Premature ejaculation (PE) is one of the most common sexual dysfunctions in men with prevalence rates ranging from 21–31%. PE is characterized with a short ejaculatory latency time, lack of ejaculatory control, decreased satisfaction with sexual intercourse causing interpersonal distress, negative impact on man's self-esteem, reduced sexual function and reduced quality of life.
PE can be classified as either a lifelong condition or acquired condition. Lifelong PE is characterized by ejaculation that always or nearly always occurs before or within about 1 min of vaginal penetration, and inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy.
Pharmacotherapy is the basis for the treatment of lifelong PE. Although no drug for PE has been approved by either US Food and Drug Administration (FDA) or European Medicines Agency (EMEA), chronic selective serotonin reuptake inhibitors (SSRIs) and on-demand topical anesthetics are proved to be effective in treating PE. However, SSRI treatment has adverse effects such as sexual dysfunctions, insomnia, fatigue, nausea and constipation, most of which are usually mild and gradually improve after 2–3 weeks. As no universal agreement has been reached on how long SSRIs must be employed to treat PE so as to get ideal effect, there are limited data regarding the adverse effects of long-term SSRI treatment in PE patients. Although there are only a few studies, which determined the negative effect of SSRIs on semen parameters of depressed men or healthy volunteers, to our knowledge, the impact of this treatment on semen parameters of lifelong PE patients has not been evaluated yet.
Escitalopram, which is the enantiomer of citalopram, is one of the most widely used SSRIs and its efficacy in treating PE has been previously demonstrated. The purpose of this study was to determine the impact of long-term escitalopram treatment on semen parameters including sperm concentration, motility and morphology.
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