Comparative effect of dapoxetine and venlafaxine in the treatment of premature ejaculation in men injured as a result of hostilities

Аннотация

Premature ejaculation is one of the most common male sexual disorders and occurs with a frequency of 21-33% in various populations. The etiology of premature ejaculation is practically not established, although it is a fairly common type of sexual dysfunction. According to various data, sexual dysfunction occurs in 49.1-80% veterans of combat-actions with post-traumatic stress disorder. Premature ejaculation can interfere with sexual satisfaction, leading to a reduced quality of life for men and their partners. It has been shown that serotonin reuptake inhibitors may be the drugs of choice in the treatment of premature ejaculation. The aim of the work was to improve methods of treating sexual dysfunction accompanied by premature ejaculation in men injured as a result of hostilities. 56 men injured as a result of hostilities with sexual dysfunction and complaints of premature ejaculation were examined. Patients were divided into two groups depen­ding on the selected selective serotonin reuptake inhibitors – venlafaxine (n=24) and dapoxetine (n=32) which they had been receiving for at least 1.5 months. After treatment with both serotonin reuptake inhibitors, reactive and personality anxiety symptoms objectively decreased, as assessed by the Spielberger-Hanan scale. Treatment with venlafaxine and paro­xetine resulted in a significant reduction in depressive symptoms in men with premature ejaculation. They turned out to be relatively balanced drugs with satisfactory efficacy and relatively few side effects. However, venlafaxine, compared to dapoxetine, produced 2.1 times fewer side effects and 20% fewer relapses. The average duration of sexual intercourse after treatment with both drugs positively correlated with the overall improvement of sexual function according to the IIEF-5 scale (r=0.70; p<0.05 for the first group; r=0.85; p<0.05 for the second group). An inverse correlation was found between the average duration of sexual intercourse and the score of anxiety symptoms on the Spielberger-Hanin scale in patients of both study groups (r= -0.69; p<0.05 for the first group; r= -0.68; p<0.05 for the second group). Although dapoxetine is considered the “gold standard” among serotonin reuptake inhibitors for the treatment of premature ejaculation, the drug is used by the patient only on demand, and other drugs in this group, which are antidepressants, may have a more positive effect on patients with depression and concomitant premature ejaculation, who have suffered as a result of hostilities. The study demonstrates that the neurotransmitter serotonin plays a key role in the modulation of ejaculation, as the use of its reuptake inhibitors, in particular dapoxetine and venlafaxine, contributes to an increase in intravaginal latency time to ejaculation.