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[9], who also reported similar adverse events with these medications.

• Dapoxetine is designed specifically for men with PE.
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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,

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as they are generally well-tolerated with mild and manageable adverse effects.

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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 dapoxetin sildenafil 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. 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.

Types and Prices of AGA Treatments

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. [9], which found SSRIs, including citalopram, to be highly effective in improving both ejaculation latency and sexual satisfaction. 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.

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Responder rates were correspondingly high and exceeding the MCID threshold largely (Table 5). Figure 2 shows that there was no statistically significant difference among studied groups regarding nausea, diarrhea, vomiting and headache, while there was statistically significant increase of incidence in Group B (Silodosin 4 mg) than other groups regarding decrease semen volume, retrograde ejaculation and anejaculation and statistically significant increase in Group D (Dapoxtine 30 mg (daily)) than other groups regarding constipation, dizziness, sleep disturbance and dry mouth. This study aimed to evaluate the effects of citalopram, dapoxetine, and silodosin in the treatment of premature ejaculation (PE), with a focus on changes in intravaginal ejaculatory latency time (IELT) and the psychological aspects of sexual function, including perceived control, satisfaction, personal distress, and interpersonal difficulty. Baseline characteristics were comparable across all groups, with no statistically significant differences observed in age, duration of PE, comorbid conditions (diabetes mellitus, hypertension, cardiac disease, hepatic/renal disease), or laboratory parameters (FSH, LH, free testosterone, cholesterol, and triglycerides). These findings suggest that the observed changes in treatment outcomes were independent of these baseline characteristics.

Cite this article

This is consistent with other studies in this field, which also found no significant baseline differences across treatment groups [11, 12]. The results demonstrated significant increases in IELT across all treatment groups, with the most substantial improvement observed in the Citalopram group. Increasing IELT represents a considerable improvement in ejaculation latency. These results corroborate previous studies indicating that SSRIs like citalopram are highly effective in prolonging ejaculation latency [13, 14]. 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. First, it was conducted at a single center with a relatively short follow-up period.

Additional information

Physical examination focused on genitourinary abnormalities (e.g., prostatitis, hypospadias). Lab tests: including FSH, LH, free testosterone, cholesterol, and triglycerides. The assessors of the outcomes were blinded during the study procedures. Adherence was assessed at each visit by pill count and patient diaries. We assessed clinical meaningfulness using distribution-based MCID thresholds because there is currently no published literature which identifies a clinically significant threshold response to IVELT and PEPQ.

International Society for Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation

Following established methodology, we prespecified 0.5 SD of baseline IVELT and PEPQ as the primary MCID. Intravaginal Ejaculatory Latency Time (IELT): Measured by the partner using a wristwatch (Casio®, Tokyo, Japan), defined as the interval between vaginal penetration and ejaculation. IELT was recorded pre- and post-intervention (after 3 months). Premature Ejaculation Profile Questionnaire (PEPQ) [13]: Evaluated perceived ejaculatory control, sexual satisfaction, personal distress, and interpersonal difficulty. Each domain was assessed via a single-item, 5-point Likert scale (0–4), with higher scores indicating improved functioning. Second, the sample size, although adequate for detecting statistical differences, may limit the generalizability of the findings.

What Is Dapoxetine?

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 dapoxetine tadalafil tablets 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. This finding is consistent with McMahon et al.

What's the closest approved alternative to Priligy (dapoxetine) for premature ejaculation?

[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. These side effects are consistent with the findings from Liu et al. Third, assessment relied on patient-reported outcomes, which may be influenced by subjective bias.

Finally, due to ethical issues we couldn’t compare the groups to a controlled group.

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Side effects: Adverse effects were evaluated in terms of occurrence of nausea, diarrhea, vomiting, headaches, decreased semen volume, retrograde ejaculation, anejaculation, constipation, dizziness, sleep disturbance, and dry mouth. Statistical analysis was performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± SD; tadalafil with dapoxetine tablets categorical variables as number and percentage. Between-group comparisons were analyzed using ANOVA with post-hoc Tukey tests. Within-group pre/post comparisons were analyzed using paired t-tests.

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Categorical variables were compared using χ² or Fisher’s exact test. Significance was set at p < 0.05. A total of 400 participants were included. Figure 1 shows the CONSORT flow diagram of the study procedures (Table 1), show Baseline characteristics were comparable across the four groups, with no statistically significant differences in age, duration of the disorder, comorbidities (diabetes mellitus, hypertension, cardiac or hepatic/renal disease), or laboratory data including FSH, LH, free testosterone, cholesterol, and triglycerides. Age ranged from 33.91 ± 8.84 years to 36.21 ± 8.98 years. Future multicenter trials with larger populations and longer follow-up

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are warranted to confirm these findings compared to controlled group.

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Comorbid conditions were distributed without significant group differences. In (Table 2) All treatment groups demonstrated a significant increase in IELT following 3 months of therapy. The greatest improvement was observed in the Citalopram group, where IELT increased from 110.4 ± 31.5 s to 391.2 ± 45.9 s. Median percent change in IELT was highest in the Citalopram group at + 260% (IQR: 197.5–330.5), followed by Dapoxetine 30 mg (daily) at + 220%, Dapoxetine 30 mg (on demand) at + 197%, and Silodosin at + 149.5% All within-group comparisons were statistically significant (P < 0.001). In terms of subjective outcomes (Table 3), all treatment groups showed statistically significant improvements in PEPQ scores (P < 0.001), reflecting enhanced ejaculatory control, sexual satisfaction, and reduced personal distress and interpersonal difficulty.

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Among the groups, Citalopram resulted in the highest median percentage improvement (300%), followed by Dapoxetine 30 mg (daily) (225%), Dapoxetine 30 mg (on demand) (166.7%), and Silodosin (175%). These findings indicate that Citalopram not only prolonged latency time objectively but also yielded the most favorable patient-reported outcomes, suggesting a greater overall benefit in the psychological and relational aspects of premature ejaculation management. Pairwise analysis post treatment according to PEPQ (Table 4) showed that Citalopram was significantly more effective than Silodosin in all domains (P < 0.001), and superior to both Dapoxetine doses in most comparisons, including interpersonal difficulty (P < 0.01). Dapoxetine 30 mg (daily) outperformed 30 mg (on demand) in select categories (P = 0.01 for interpersonal difficulty), though not all comparisons reached statistical significance. All treatment arms exceeded the 0.5 SD MCID for IELT and PEPQ.