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Orgasm is a totally separate eventa sensory experience with considerable subjective variationit can occur independently of ejaculation and even erectionAfter ejaculationdetumescence occursfollowed by a refractory period that lengthens with age and with repeated ejaculationsResearchers have demonstrated that the ejaculatory mechanism consists of two distinct reflexesthe glans-vasal and the urethromuscularwhich are responsible for the emission and expulsion phases of ejaculationrespectivelyShafik 1998This is consistent with the report by Yang and Bradley1999of an electrically distinct pathway localized to the dorsal nerve of the penis and running from the anterior urethra to the bulbocavernous musclethis is distinct from the penile shaft afferent fibersThe cortical representation of the dorsal nerve of the penis now appears both larger and in a different location than was previously conceivedBradley et al 1998
Past studies have revealed high discontinuation rates among men taking dapoxetine for PEeven though trials have shown effectivenessThe current study reported on discontinuation rates and reasons during a 2-year period.
Dapoxetine undergoes rapid absorption and elimination resulting in minimal accumulation and has dose-proportional pharmacokineticswhich are unaffected by multiple dosing and do not vary between ethnic groupsFigure 2Dresser et al2006bDresser et al2004Modi et al2006The pharmacokinetic profile of dapoxetine suggests that it is a good candidate for on-demand treatment of PE.
Sommer et al2005compared vardenafil 10 mg30 minutes pre-intercourseand sertraline 50 mg4 hours pre-intercoursein a prospectiverandomizedcross-over studyEjaculation was assessed with IELT using a stopwatch and graded on a scale of 0 to 80almost never8almost alwaysThe degree of improvement in ejaculation grade was 2.9 with vardenafil and 1.86 with sertralineand the increases in IELT were 5.23 in vardenafil-treated patients and 2.87 in sertraline-treated patientsThis study suggests that there is a potential for vardenafil in the treatment of PE.
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