1726

ORIGINAL RESEARCH—EJACULATORY DISORDERS

Yoga in Premature Ejaculation: A Comparative Trial

with Fluoxetine

Vikas Dhikav, MD,* Girish Karmarkar, MBBS, MD,† Mallika Gupta, MBBS,* and
Kuljeet Singh Anand, DM‡
*All India Institute of Medical Sciences, New Delhi, India; †Private Practice, Thane-Mumbai, India; ‡Dr. RML Hospital and
Post Graduate Institute of Medical Education and Research-Guru Gobind Singh-Inderprastha University—Neurology,
Delhi, India

DOI: 10.1111/j.1743-6109.2007.00603.x

ABSTRACT

Introduction. Yoga is a popular form of complementary and alternative treatment. It is practiced both in developing
and developed countries. Use of yoga for various bodily ailments is recommended in ancient ayvurvedic (ayus = life,
veda = knowledge) texts and is being increasingly investigated scientifically. Many patients and yoga protagonists
claim that it is useful in sexual disorders. We are interested in knowing if it works for patients with premature
ejaculation (PE) and in comparing its efficacy with fluoxetine, a known treatment option for PE.
Aim. To know if yoga could be tried as a treatment option in PE and to compare it with fluoxetine.
Methods. A total of 68 patients (38 yoga group; 30 fluoxetine group) attending the outpatient department of
psychiatry of a tertiary care hospital were enrolled in the present study. Both subjective and objective assessment tools
were administered to evaluate the efficacy of the yoga and fluoxetine in PE. Three patients dropped out of the study
citing their inability to cope up with the yoga schedule as the reason.
Main Outcome Measure. Intravaginal ejaculatory latencies in yoga group and fluoxetine control groups.
Results. We found that all 38 patients (25–65.7% = good, 13–34.2% = fair) belonging to yoga and 25 out of 30 of the
fluoxetine group (82.3%) had statistically significant improvement in PE.
Conclusions. Yoga appears to be a feasible, safe, effective and acceptable nonpharmacological option for PE. More
studies involving larger patients could be carried out to establish its utility in this condition. Dhikav V, Karmarkar
G, Gupta M, and Anand KS. Yoga in premature ejaculation: A comparative trial with fluoxetine. J Sex Med
2007;4:1726–1732.
Key Words. Premature Ejaculation; Yoga; Fluoxetine; Nonpharmacological Treatment; Complementary and Alter-
native Treatments

Introduction PE is generally defined as the occurrence of

ejaculation prior to the wishes of both sexual part-

P remature ejaculation (PE) is the most

common sexual disorder of young males.
Normative data suggest that men with an intra-
vaginal ejaculatory latency time of less than
1 minute have “definite” PE, while men with
intravaginal ejaculatory latency times of between
1.0 and 1.5 minutes have “probable” PE [1].
Prevalence rates of 20–30% have been reported
[2].
ners. This broad definition, thus, avoids specifying
a precise duration for sexual relations and reaching
a climax.
An occasional instance of PE may not be cause
for concern, but if the problem occurs with more
than 50% of attempted sexual relations, a dysfunc-
tional pattern should be suspected and appropriate
diagnostic and therapeutic measures must be
initiated.

J Sex Med 2007;4:1726–1732 © 2007 International Society for Sexual Medicine

Yoga in Premature Ejaculation
A number of treatment options are used for PE.
Although selective serotonin reuptake inhibitors
(SSRIs) have the potential to improve the quality
of life for men with PE and their partners [3–5],
patients’ satisfaction and drug side effects may
remain to be a problem. New treatments are
therefore desirable. Because the condition has
stigma and patients may not be aware that medical
treatment options are available, nonpharmacologi-
cal treatment options seem preferable.
Yoga is a popular nonpharmacological inter-
vention. There are many types of yoga: hatha
yoga is an element of raja yoga and deals mainly
with physical postures and breathing. Karma yoga
emphasizes spiritual practice to help the indi-
vidual “unify” body, mind, and heart through
certain practices in daily life and work. Bhakti
yoga, a devotional form, generally encompasses
chanting, reading of scriptures and worship prac-
tices. We focused mainly on hatha yoga by
various asanas. An asana is a particular posture of
the body, which is both steady and comfortable.
In yoga, there are more than a hundred classical
poses, and these probably have as many varia-
tions. These can be subdivided into two catego-
ries: active and passive. Active poses are supposed
to tone specific muscle and nerve groups, and
benefit organs and the endocrine glands. The
passive poses are employed primarily in medita-
tion, relaxation, and pranayama practices. We
employed both active and passive poses during
the present study (see Figure 1).
Each posture, or asana, is held for a period of
time and is synchronized with the breath. Gen-
erally, a yoga session begins with gentle asanas
and works up to the more vigorous or challeng-
ing postures. A full yoga session includes exer-
cises of every part of the body, pranayama
(prana = life; breath control practices), relaxation,
and meditation.
Yoga is a popular nonpharmacological treatment
method for a number of conditions, and there are
claims of it being effective in bodily disorders
including the sexual ones; we thought it worthwhile
to investigate its efficacy and to compare it to flu-
oxetine, a commonly used SSRI for PE.
Materials and Methods
We studied 68 patients (Table 1) attending the
outpatient department of a tertiary care psychiatric
hospital in North Delhi. A detailed history of each
patient was taken. A general physical examination
of all systems was performed. After establishing
1727
Table 1 Demographic data
38 cases Mean age = 38.9 ⫾ 10.1 years
30 controls Mean age = 38.6 ⫾ 9.2 years
Total number = 68; age range = 22–58 years; mean duration of premature
ejaculation = 1.7 ⫾ 1.5 years.
the diagnosis using Diagnostic and Statistical
Manual IV, the patients were offered to choose
between pharmacological (capsule fluoxetine–
fluoxetine group) and nonpharmacological (yoga–
yoga group) treatments. Three patients opted out
of the study citing inability to adhere to the yoga
regime. Because these opted out of the yoga group
before the study began, we did not include them in
the final analysis.
The wives of the patients were briefed about
starting the stopwatch once the penetration began
and then to stop it once the husbands ejaculated.
They was asked to note down the intra-ejaculatory
latencies in seconds in a diary.
Those who opted for drugs were given fluoxet-
ine capsule (group 1) in dose of 20–60 mg/day as a
single dose, while for those who opted for yoga
(group 2) the protocol was explained (Table 2).
The patients were encouraged to report any side
effects occurring during the course of treatment in
both groups.
Patients included in the study had PE, were
fluoxetine naïve, had no history of trauma, dia-
betes, hypertension, or any other chronic physi-
cal or mental disorder. There was no history of
substance abuse. The patients were not on any
concurrent medications and had unremarkable
general physical examinations. The mean age of
onset of PE was 28 years and the mean duration
was 1.7 ⫾ 1.5 years.
The patients were briefed by a sexologist and a
yoga expert about the protocol they had to follow
over 12 weeks (Tables 2 and 3). They were told to
practice 12 asnas and 2 pranayanams for 1 hour/day.
The patients were examined after 4 and 8 weeks,
respectively. Their intravaginal ejaculatory laten-
cies were noted and analyzed.
Although the average suggested duration was 1
hour, it was not rigidly fixed, and the patients were
told to practice yogasanas depending upon their
stamina. This was because in yoga, the advice gen-
erally given was that the patients should not exert
themselves. Three repetitions of each asana were
suggested. Differential relaxation was taught to the
patients once they finished their daily yoga proto-
col with a breathing technique called as anulom-
vilom (breathing via alternative nostrils) and
J Sex Med 2007;4:1726–1732
1728 Dhikav et al.

A B

D E
C

F G H

Figure 1 Various yoga postures employed during the study (figures run from A to K from top left).

shavasan (Sanskrit—shav = a dead body, lying
dead). That means in the end, the patients per-
formed breathing as mentioned and laid still for
few minutes. In this, they were able to relax those
muscles, which were stretched during yoga. That
is why this is named as “differential relaxation.” All
patients were told to practice mehabhed mudra,
which included doing perineal and pubococcygeal
exercises for 10–15 seconds at a time and for 15–20
times a day. They could do it anywhere including
at their workplace, while, e.g., traveling, reading,
or watching TV.
Statistical Analysis
Statistical analysis was performed using SPSS
version 10 (SPSS Inc., Chicago, IL, USA). Paired

J Sex Med 2007;4:1726–1732

Yoga in Premature Ejaculation 1729

Table 2 Yogasanas followed in the protocol

Kapal bhati Sanskrit—kapal = skull, bhati = bright; “forehead brightener”
Vajarasan Sanskrit—vajra = diamond
Yog mudra Yog = after Yogis, mudra = posture; “symbol of yoga”
Bhujangasan Sanskrit—bhujang = snake, asana = posture; serpent-like posture
Dhanurasan Sanskrit—dhanu = bow, asana = posture; to adopt a bow-like posture
Paschimottoansana Sanskrit—paschim = working on posterior
Gomukasan Sanskrit—gomukh = cow’s mouth
Veerasan A typical sitting posture of soldiers
Ardhmatsyendra mudra Sanskrit—ardha = half, matsyenddra = name of a yogic practitioner, mudra = posture;
“half spinal twisting” exercises
Viparita karani mudra Sanskrit—viprit = opposite, mudra = posture; “legs-up-the-wall pose”
Sarvang Asana “Shoulder stand”
Halasan “Plow posture”
Mehabhed mudra Sanskrit—“great secret”
Agnisar mudra Sanskrit—agni = heat; a series of rapid “abdominal lifts”

t-test was used to calculate the P value. A P value of
less than 0.05 was considered significant.
Results
We found that all 38 patients in the yoga group
had subjective (Table 4) and statistically significant
(P < 0.0001) improvement (Table 5). Twenty-five
of 30 patients of fluoxetine (82.3%) had clinical
improvement in PE (Table 5, P < 0.001). The
patients were interviewed at the end of the 4th and
8th weeks. Results in both groups at the 4th week
did not achieve statistical significance, while those
of the 8th week were significant (P < 0.001—see
Table 5). A subjective evaluation was carried out by
asking the wife to rate the husband’s performance
and her satisfaction after the end of the study
period (Table 4). A side-effect profile of fluoxetine
based upon patients reporting adverse effects was
prepared (Table 6). None of the side effects,
however, required drug discontinuation.
Yoga was well tolerated by patients who chose
to enroll themselves for this form of treatment.
There were no significant side effects or dropouts
reported during the course of treatment.
Discussion
PE is an extremely common disorder affecting
young males. SSRI, like fluoxetine, is a commonly
used treatment option for PE [6,7]. Although
SSRIs offer several advantages like convenience
of administration and acceptable therapeutic
response, they have disadvantages like failure in
many patients and unacceptable side effects.
Moreover, drug prescription requires a visit to a
sexologist or psychiatrist, an idea with which many
patients of PE may not be fully comfortable. This
is due to stigma with PE. It has been said that most
patients remain unaware that PE is a medical con-
dition. A nonpharmacological treatment option in
PE should, thus, presumably be a welcome idea.

Table 3 Brief description of yogasanas used in the present study

1. Kapalbhati (Figure 1A)—Sit straight in squatting posture with eyes closed. Put hands on the knees. Fix the chest and consciously
contract abdominal muscles.
2. Pranayama (Figure 1B)—Sit comfortably with eyes closed in squatting posture. Deep breathing should be done via alternating
nostrils as shown.
3. Yog mudra (Figure 1C)—Take hands to the lower back. Catch the right wrist with the left palm and bend forward.
4. Vajarasan (Figure 1D)—Fold legs at knee joints and sit on the legs, and touch knee caps as shown.
5. Bhujangasan (Figure 1E)—Lie down in prone position and transfer weight on palms. Attempt should be made to stretch the back
muscles.
6. Dhanurasan (Figure 1F)—Body gets a “bow-like shape.”
7. Halasan (Figure 1G)—Lie down flat; then, turn legs overhead while maintaining hands on the ground firmly.
8. Paschimottoasana (Figure 1H)—Sit with legs straight, touch toes, and try to bend the head forward and kiss the toes.
9. Ardhmatsyendra mudra (Figure 1I)—Sit straight, bend right knee, and put it below buttocks. Now cross the left leg and bring it in
front of the right knee.
10. Sarvang asana (Figure 1J)—Lie down straight and gradually lift legs. Then, once adequate lift is achieved; support pelvis and lower
back with the palms of both hands.
11. Shava asana (Figure 1K)—It involves lying relaxed, eyes closed with arms placed on both sides of the body. It relaxes muscles that
are stretched during yogic exercises. In practical terms, this means a posture in which patients lay still with superior and inferior
extremities asunder and perform slow deep breathing with a relaxed mind.

J Sex Med 2007;4:1726–1732

1730
Table 4 Subjective responses of patients with yoga
(n = 38)
Satisfaction type Number
Good 25
Fair 13
Poor 0 0%
An online medical dictionary defines yoga as
“a way of life that includes ethical precepts,
dietary prescriptions, and physical exercise.” A
large survey shows that about one in every five
adults has used at least one such therapy in the
last 1 year [8].
Pranayama is the method of “proper” breathing.
“The way” we breathe is supposed to have an effect
on the nervous system. By regulating the breath
and increasing oxygenation to the brain cells, it is
supposed to “strengthen” the voluntary and invol-
untary nervous systems. At the beginning of each
of yoga, pranayama practice is performed in order
to prepare patients for the asanas that follow.
The present study is an attempt to explore the
therapeutic potential of yoga as a nonpharmaco-
logical treatment in PE and to compare it to flu-
oxetine, a known treatment option. Fluoxetine
had a response rate of 83.3%, which is in agree-
ment with some of the previously reported
studies [9,10]. Although fluoxetine generally pro-
duces symptomatic improvement at the end of 3
weeks, results of the present study suggest that
improvement may not be noticeable until the
end of 8 weeks, with yoga. Thus, relatively late
improvement can be an important limitation of
the present study. It could, however, be compen-
sated somewhat by some form of counseling. An
additional limitation is that the patients were
Table 5 Intravaginal ejaculatory latencies of various
study groups*
Group Before After t value df
1 29.9 ⫾ 15.1 64.1 ⫾ 29.4 5.65 58
2 33.2 ⫾ 17.9 112.8 ⫾ 35.6 12.29 74
*Scores are expressed as mean ⫾ standard deviation.
Table 6 Adverse effects of fluoxetine in the present
study (N = 30)
Adverse drug reaction Number of patients (N) Percentage (%)
Nausea 14 46.6
Vomiting 4 13.3
Anxiety 4 13.3
Insomnia 8 26.6
J Sex Med 2007;4:1726–1732
Dhikav et al.
given the option of choosing between yoga and
fluoxetine, hence introducing a selection bias.
Percentage Three patients chose not to participate in the
65.8% present study because of their inability to adhere
34.2% to yoga regime.
Although we do not know an exact mechanism
by which yoga is useful in PE, several postulations
could be made about its putative mechanisms of
usefulness. Yogasanas and breathing exercises have
long been considered in obtaining the “optimum
mental and physical health state.” Yoga could
perhaps be causing better anxiety control. This
assertion is supported by several studies [11–14].
One of these studies [11] included 175 patients (98
males, 77 females) between age group 19–76 years
who belonged to the heterogenous group. The
study evaluated anxiety scores using the State Trait
Anxiety Inventory and showed that scores dipped
significantly after yogic exercises. The same study
showed that a measurable decline in anxiety scores
could be achieved as early as within 10 days if the
patients adopt healthy lifestyle interventions con-
sisting mainly of asanas, pranayama and relaxation
techniques [11]. Others have reported that yoga
promotes well-being, improves quality of life [12],
and has an antidepressant effect [13]. Additional
mechanisms contributing to a state of calm alert-
ness include increased parasympathetic drive,
calming of stress response systems, neuroendo-
crine release of hormones, and thalamic genera-
tors [13]. Relaxation induced by meditation helps
to stabilize the autonomic nervous system with a
tendency toward parasympathetic dominance.
Physiological benefits, which follow, may help
practitioners become more resilient to stressful
conditions and may reduce a variety of important
risk factors for various diseases, especially cardio-
respiratory diseases [14]. Two published clinical
trials in obsessive compulsive disorder, an anxiety
disorder using a specific form of yoga known as
kundalini yoga, have been described. This is a form
P value of yogic exercise consisting of yogic kriyas, mantra
<0.0001 chanting, following a particular dietary pattern,
<0.0001 etc. [15]. A recent meta-analysis, however, has
concluded that although results of studies involv-
ing yoga were positive, the methodology adopted
was poor; hence, deriving conclusions were diffi-
cult. It emphasized the need of future well-
designed studies in this regard [16].
The yogasanas selected in the present study, in
addition to their general putative health benefits,
were primarily aimed at improving the muscle
tone and plasticity of the pelvic and perineal
muscles. Asanas supposedly improve blood flow to
Yoga in Premature Ejaculation
these muscles and thus aid in their better contrac-
tion. This is probably responsible for local effect of
yogasanas in the present study. Studies have shown
that yoga can improve muscular efficiency [17,18].
In one such study [17], 42 volunteers were taken
and their oxygen utilization during yogic and con-
ventional exercises were studied. The study con-
cluded that a yogic practitioner is likely to perform
better on tasks such as cycling at average pace,
walking at average speed, and tailoring, etc.
Decreased fatigue and increased endurance were
shown in another study after 6 months of training
in yogic exercises [18].
It has been observed that a regular practitioner
of yoga shows parasympathetic dominance [11].
Stimulation of the sympathetic nerves causes
contraction of epididymis, ejaculatory ducts, and
seminal vesicles, and leads to ejaculation of semen.
Increasing parasympathetic stimulation is assum-
ably beneficial in enhancing ejaculatory control.
We report a significant therapeutic effect of yoga
in PE. This is in line with earlier studies, which
have reported the efficacy of yogic exercises in the
treatment of physical disorders [13–15].
What are the potential advantages of yoga as a
treatment option in PE? It is popular with good
acceptability, nonpharmacological, has no costs
involved, and patients could be treated without
medical or psychiatric intervention. Additionally,
it could offer other associated health benefits as
well to the patients [19,20]. Studies have shown
that yogic exercises can reduce basal cortisol, cat-
echolamines, metabolic rate, sympathetic activity,
and oxygen consumption. Parasympathetic activity
has been shown to increase [20].
Physical efficiency, autonomic functions, body
flexibility, and biochemical profile have been noted
to improve following yogasnas [19]. A study involv-
ing 48 Indian soldiers found that performance on
isometeric exercises was better after yoga training
as measured by electromyography and spring
pulling capacity [19].
Yogic exercises have been found to be useful in
a variety of “mind–body” problems. PE is often
perceived as a lifestyle problem [21], thus provid-
ing a window for such therapeutic interventions.
Studies have shown that sufferers of PE have
higher prevalence of lifestyle problems that can
affect the individual at both emotional and physi-
cal levels.
Nonpharmacological treatment options, e.g.,
behavioral therapy and psychotherapy, have long
been the mainstay of the treatment of PE [22].
These could be cumbersome and can have limited
1731
efficacy indicating that other nonpharmacological
treatments could be desirable. Although yoga was
found to be a well-tolerated and effective treat-
ment option for PE, the therapeutic response was
delayed by 8 weeks. This is in contrast to SSRIs,
which produce symptomatic relief by the 3rd or
4th week. Some form of counseling on the part of
the physician and patience on part of patients may
be required for satisfactory results.
The etiology of PE is multifactorial; hence,
failure to appreciate this makes the diagnosis dif-
ficult and the treatment harder. Therefore, treat-
ment of PE is undergoing change in recent times
and it is suggested that an integrated approach
should be adopted [23]. This combination therapy
has become more relevant as patients relapse [23]
frequently after taking drugs and has side effects
like dry mouth, nausea, drowsiness, and reduced
libido. Its use may also facilitate the development
of other sexual dysfunctions, such as anejaculation
and erectile dysfunction [24]. Furthermore, it has
been considered that because PE involves both
psychosocial [25] and physiological components
[26], both should be addressed. It is hoped that
such a combination approach would result in pro-
longed ejaculatory latency, improved treatment
satisfaction, and superior long-term outcome. We
have tried to explore the possibility of yoga as a
nonpharmacological treatment in PE. This is
because, as stated earlier [22], nonpharmacological
treatments have been important treatment options
in this condition. A significant therapeutic benefit
of yoga is reported in the study.
Conclusions
PE is the most common male sexual disorder that
is both underdetected and undertreated. It is often
distressing and patients do not come forward for
treatment easily. This is due to shyness, stigma,
feeling of inferiority, and shame in front of the
partner. Yoga seems to be a well-tolerated, safe and
effective nonpharmacological treatment option for
PE. The present study reinforces that the “mind–
body” interventions could be beneficial in stress-
related mental and physical disorders. Because
ours is a pilot study with a small sample size, it
would be worthwhile to do more studies involving
a large number of patients in a double-blind
manner to establish yoga as a nonpharmacological
treatment option for PE.
Corresponding Author: Vikas Dhikav, Dr. RML Hos-
pital and PGIMER, GGS-IP University—Neurology,
J Sex Med 2007;4:1726–1732
1732
E\3, Flat Number-280 Sector-18, Delhi Rohini
110085, India. Tel: +91-9910011205; Fax: 011-
26865165; E-mail: vikasdhikav@hotmail.com,
va212001@yahoo.com
Conflict of Interest: None declared.
References
1 Althof S. The psychology of premature ejaculation:
Therapies and consequences. J Sex Med 2006;3
(4 suppl):324–31.
2 Shabsigh R. Diagnosing premature ejaculation: A
review. J Sex Med 2006;3(4 suppl):318–23.
3 Moreland AJ, Makela EH. Selective serotonin-
reuptake inhibitors in the treatment of premature
ejaculation. Ann Pharmacother 2005;39:1296–301.
4 Sharlip I. Diagnosis and treatment of premature
ejaculation: The physician’s perspective. J Sex Med
2005;2(2 suppl):103–9.
5 Safarinejad MR, Hosseini SY. Safety and efficacy of
citalopram in the treatment of premature ejacula-
tion: A double-blind placebo-controlled, fixed dose,
randomized study. Int J Impot Res 2006;18:164–9.
6 Waldinger MD, Zwinderman AH, Olivier B.
On-demand treatment of premature ejaculation
with clomipramine and paroxetine: A randomized,
double-blind fixed-dose study with stopwatch
assessment. Eur Urol 2004;46:510–5; discussion
516.
7 Waldinger MD, Olivier B. Utility of selective sero-
tonin reuptake inhibitors in premature ejaculation.
Curr Opin Investig Drugs 2004;5:743–7.
8 Wolsko PM, Eisenberg DM, Davis RB, Phillips RS.
Use of mind-body medical therapies. J Gen Intern
Med 2004;19:43–50.
9 Metin A, Kayigil O, Ahmed SI. Does lidocaine oint-
ment addition increase fluoxetine efficacy in the
same group of patients with premature ejaculation?
Urol Int 2005;75:231–4.
10 Manasia P, Pomerol J, Ribe N, Gutierrez del Pozo
R, Alcover Garcia, J. Comparison of the efficacy
and safety of 90 mg versus 20 mg fluoxetine in the
treatment of premature ejaculation. J Urol
2003;170:164–5.
11 Gupta N, Khera S, Vempati RP, Sharma R, Bijlani
RL. Effect of yoga based lifestyle intervention on
state and trait anxiety. Indian J Physiol Pharmacol
2006;50:41–7.
J Sex Med 2007;4:1726–1732
Dhikav et al.
12 Mamtani R, Mamtani R. Ayurveda and yoga in car-
diovascular diseases. Cardiol Rev 2005;13:155–62.
13 Brown RP, Gerbarg PL. Sudarshan Kriya yogic
breathing in the treatment of stress, anxiety, and
depression: Part I—Neurophysiologic model. J
Altern Complement Med 2005;11:189–201.
14 Parshad O. Role of yoga in stress management.
West Indian Med J 2004;53:191–4.
15 Shannahoff-Khalsa DS. An introduction to kun-
dalini yoga meditation techniques that are specific
for the treatment of psychiatric disorders. J Altern
Complement Med 2004;10:91–101.
16 Kirkwood G, Rampes H, Tuffrey V, Richardson J,
Pilkington K. yoga for anxiety: A systematic review
of the research evidence. Br J Sports Med
2005;39:884–91.
17 Salgar DC, Bisen VS, Jinturkar MJ. Effect of
padmasana—A yogic exercise on muscular effi-
ciency. Indian J Med Res 1975;63:768–72.
18 Bhatnagar OP, Anantharaman V. The effect of yoga
training on neuromuscular excitability and muscular
relaxation. Neurol India 1977;25:230–2.
19 Ray US, Hegde KS, Selvamurthy W. Improvement
in muscular efficiency as related to a standard task
after yogic exercises in middle aged men. Indian J
Med Res 1986;83:343–8.
20 Khalsa SB. Yoga as a therapeutic intervention:
A bibliometric analysis of published research
studies. Indian J Physiol Pharmacol 2004;48:269–
85.
21 Sotomayor M. The burden of premature ejacula-
tion: The patient’s perspective. J Sex Med 2005;
2(2 suppl):110–4.
22 Sharlip ID. Guidelines for the diagnosis and man-
agement of premature ejaculation. J Sex Med
2006;3(4 suppl):309–17.
23 Perelman MA. A new combination treatment for
premature ejaculation: A sex therapist’s perspective.
J Sex Med 2006;3:1004–12.
24 Hellstrom WJ. Current and future pharmacothera-
pies of premature ejaculation. J Sex Med 2006;3
(4 suppl):332–41.
25 Richardson D, Wood K, Goldmeier D. A qualita-
tive pilot study of Islamic men with lifelong
premature (rapid) ejaculation. J Sex Med
2006;3:337–43.
26 Donatucci CF. Etiology of ejaculation and patho-
physiology of premature ejaculation. J Sex Med
2006;3(4 suppl):303–8.