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McMahon CG, Althof SE, Waldinger MD, Porst H, Dean J, Sharlip ID, Adaikan PG, Becher E, Broderick GA, Buvat J, Dabees K.

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Moreover, studies comparing combination therapies and exploring the role of psychological factors in treatment outcomes would further enhance our understanding of the optimal management strategies for PE. Additionally, further exploration of the safety profiles of these medications, particularly in patients with comorbid conditions, is warranted to ensure their safe and effective use in a broader patient population. In this study, treatment with citalopram, dapoxetine, and silodosin was associated with significant improvements in IELT and patient-reported outcomes in men with lifelong PE. Among the interventions studied, citalopram was associated with the greatest improvements, particularly in measures of sexual satisfaction and psychological burden. The differential efficacy and side-effect profiles of these treatments may provide clinicians with options for personalized patient care.

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However, these results are limited to the studied sample and should be interpreted cautiously due to study limitations. Further research with larger sample sizes is needed to confirm these findings. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Frequency of etiological factors among patients with acquired premature ejaculation: prospective, observational, single-center study. New insights on premature ejaculation: a review of definition, classification, prevalence and treatment.

Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?

Jarman AF, Mumma BE, Singh KS, Nowadly CD, Maughan BC. Crucial considerations: sex differences in the epidemiology, diagnosis, treatment, and outcomes of acute pulmonary embolism in non-pregnant adult patients. Song WH, Yoo S, Oh S, Park J, Cho SY, Cho MC, Jeong H, Son H. Ten-year interval changes in the prevalence of self-identified premature ejaculation and premature ejaculation based on an estimated intravaginal ejaculation latency time of < 3 minutes in the general population: the Korean internet sexuality survey (KISS) 2016. Rosen RC, Althof S. An evidence-based definition of lifelong premature ejaculation: report of the international society for sexual medicine (ISSM) ad hoc committee for the definition of premature ejaculation.

• Identifying genuine dapoxetine from counterfeit items is crucial.
• OTC availability may change as regulations evolve.
• Some men report improved control after using dapoxetine.
• Avoid self-diagnosing and self-medicating.
• Pharmacist advice can guide safe use.
• Natural remedies might supplement or replace medication.
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• Always prioritize health and safety over convenience.
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Efficacy and safety of Dapoxetine for premature ejaculation: an updated systematic review and meta-analysis. A.Ab : Data Analysis, Literature Review, Writing – Original Draft. A.R : Formal Analysis, Validation, Writing – Review & Editing. A.A : Patient Recruitment, Data Collection, Project Administration.

• Dapoxetine is not FDA-approved for OTC sale in the US.
• In some countries, OTC sale is strictly prohibited.
• Patients should understand potential side effects.
• Purchase from licensed pharmacies whenever possible.
• Use caution with online sources claiming OTC availability.
• Combining dapoxetine with other drugs can be dangerous.
• Recognize the importance of accurate dosage.
• Not suitable for people with certain health conditions.
• Dapoxetine should be part of a comprehensive treatment plan.
• Regular medical checkups are recommended.

A.E : Investigation, Data Curation, Writing – Original Draft.

• Dapoxetine is designed specifically for men with PE.
• Over-the-counter sales increase the risk of misuse.
• Some online platforms may sell banned drugs illegally.
• Personal health history should guide dapoxetine use.
• Pharmacovigilance ensures medication safety.
• Consider counseling along with medication for better results.
• Check expiration date before use.
• Keep medication in a cool, dry place.
• Report any adverse reactions to health authorities.
• Be aware of regional laws regarding dapoxetine sales.

A.L : Statistical Analysis, Visualization, Writing – Original Draft. O.M : Methodology, Resources, Writing – Review & Editing.

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M.Y : Methodology, Resources, Writing – Review & Editing.

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Impact of premature ejaculation: the psychological, quality of life, and sexual relationship consequences. Evolving therapeutic strategies for premature ejaculation: the search for on-demand treatment–topical versus systemic. Safety and efficacy of Citalopram in the treatment of premature ejaculation: a double-blind placebo-controlled, fixed dose, randomized study. Liu G, Yin Y, Zhang L, He D, Yang L. Efficacy of Dapoxetine in the treatment of patients with lifelong premature ejaculation as an alternative to Sertraline therapy.

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Voyvoda B, Memik O, Karsli O, Ustuner M, Ozcan L. Can we use the silodosin as second line treatment of benign prostate hyperplasia? Evolving role of silodosin for the treatment of urological disorders–A narrative review. Evolving Role of Silodosin for the Treatment of Urological Disorders - A Narrative Review. EDITION F. M.A : Conceptualization, Methodology, Supervision, Writing – Review & Editing.

Design and Search Strategy

The greater improvement observed in the Citalopram group may reflect the strong impact of SSRIs on ejaculation delay, as well as their ability to reduce performance anxiety, a common factor contributing to premature ejaculation. In addition to improvements in ejaculation latency, all four treatment groups showed statistically significant enhancements in psychological and relational dimensions of sexual function, as evaluated by the PEPQ. These improvements were observed across all four domains: perceived control, sexual satisfaction, personal distress, and interpersonal difficulty. The Citalopram group demonstrated the highest improvement in patient-reported outcomes. Additionally, Dapoxetine 30 mg (daily) was superior to 30 mg (on demand) in reducing interpersonal difficulty, consistent with dose-dependent responses seen in previous trials.

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These findings reinforce that Citalopram not only offers effective ejaculatory delay but also confers broad improvements in the psychological burden of premature ejaculation, making it a strong candidate for first-line pharmacological management. These results are in line with findings from Akin et al. [16], who similarly reported improvements in psychological outcomes such as perceived control and sexual satisfaction following treatment for PE. Pairwise analysis revealed that Citalopram was significantly more effective than Silodosin in all PEPQ domains, and it outperformed both doses of Dapoxetine in most comparisons, particularly in terms of interpersonal difficulty. These findings are consistent with the study by Liu et al.

Treatment of premature ejaculation in the Asia-Pacific region: results from a phase III double-blind, parallel-group study of dapoxetine

[9], which found SSRIs, including citalopram, to be highly effective in improving both ejaculation latency and sexual satisfaction. In contrast, Dapoxetine 30 mg (daily) showed superior performance compared to the 30 mg dose (on demand), particularly in reducing interpersonal difficulty. This finding aligns with Peng et al. [17], who reported that higher doses of Dapoxetine were more effective in improving sexual satisfaction and reducing distress. These results highlight the importance of the specific pharmacological treatment in influencing IELT which is the primary outcome of this study, while other factors including baseline characteristics and comorbidities appear to have a minimal impact. The study protocol complied with the Declaration of Helsinki.

• Only a licensed healthcare provider can determine the appropriate treatment.
• Illegally imported dapoxetine may have incorrect storage conditions, affecting potency.
• Some men may experience fainting (syncope) with dapoxetine, requiring caution.
• Official medication guides detail all potential side effects and instructions.
• Stress and anxiety can contribute to PE; addressing these may be beneficial.
• Support groups can provide shared experiences and coping strategies.

Participants and their parents were informed about the study procedures, their right to refuse or withdraw, and the confidentiality of their data. Ethical approval was obtained from the Faculty of Medicine, Beni-Suef University Research Ethical Committee before the study began.

Jurisdiction	Purchase Legality	Required Documentation	Age Restrictions	Additional Notes
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Germany	Prescription Only	Prescription required	18+	Not available OTC legally
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Approval No: FMBSUREC/07052024/Ahmed and all participants provided written informed consent.

Medication Class	Common Drugs	Interaction Notes	Risk Level
Monoamine Oxidase Inhibitors (MAOIs)	Phenelzine, Tranylcypromine	Severe serotonin syndrome risk	High
Other SSRIs	Sertraline, Fluoxetine	Increased risk of serotonin syndrome	Moderate to high
Blood Pressure Medications	Beta-blockers	Possible hypotensive effect	Low to moderate

All participants provided written consent to publish anonymized data.

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Sharma SS, Priyadarshi S, Vyas N, Yadav SS, Sharma G. Comparison of silodosin and Dapoxetine in on-demand treatment of premature ejaculation: A randomized controlled study. Comparison of alpha blockers in treatment of premature ejaculation: tadalafil with dapoxetine online a pilot clinical trial. Peng J, Fang D, Li H, Tang Y, Yuan Y, Cui W, Gao B, Li H, Zhang Z. Efficacy of Dapoxetine treatment in Chinese patients with premature ejaculation and possible factors affecting efficacy in the real-world practice. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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This finding is consistent with McMahon et al. [18], who found that treatment type was the primary determinant of improvement in PE symptoms. Regarding side effects, there were no significant differences between groups in terms of nausea, diarrhea, vomiting, or headache. However, Group B (Silodosin 4 mg) exhibited a higher incidence of adverse effects such as decreased semen volume, retrograde ejaculation, and anejaculation. On the other hand, Group D (Dapoxetine 30 mg (daily)) showed significant increases in constipation, dizziness, sleep disturbances, and dry mouth compared to other groups.

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These side effects are consistent with the findings from Liu et al. [9], who also reported similar adverse events with these medications. The higher incidence of side effects in the Silodosin and Dapoxetine groups may influence the choice of treatment, depending on individual patient tolerability and preferences. Nonetheless, the overall safety profile of these treatments remains favorable, as they are generally well-tolerated with mild and manageable adverse effects. Additionally, a previous meta-analysis [19] recommended a stepwise approach, starting with 30 mg on demand, then 60 mg on demand and finally 60 mg dapoxetine daily.

Cite this article

First, it was conducted at a single center with a relatively short follow-up period. Second, the sample size, although adequate for detecting statistical differences, may limit the generalizability of the findings. Third, assessment relied on patient-reported vardenafil with dapoxetine tablets outcomes, which may be influenced by subjective bias. Finally, due to ethical issues we couldn’t compare the groups to a controlled group. Future multicenter trials with larger populations and longer follow-up are warranted to confirm these findings compared to controlled group. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material.

Dosage (mg)	Typical Usage Frequency	Recommended Maximum Dose	Common Side Effects
30	Once daily	60 mg/day	Nausea, headache
60	Once daily	60 mg/day	Dizziness, dry mouth
30-60	As needed (pre-intimate)	60 mg per occasion	Insomnia, diarrhea

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Diagnostic and statistical manual of mental disorders. Washington, DC: American psychiatric association; 1980. pp. Patrick DL, Giuliano F, Ho KF, Gagnon DD, McNulty P, Rothman M. The premature ejaculation profile: validation of self-reported outcome measures for research and practice.