Table 3.

Pharmacotherapy of EjD^† from the viewpoint of pharmacological action

Inhibitory substance for ejaculation	Valid for PE ‡	Valid for DE §
Serotonin	Selective serotonin reuptake inhibitor (SSRI) (dapoxetine, tramadol, etc). Non‐selective serotonin reuptake inhibitor (clomipramine); Serotonin↑	Serotonin antagonist (yohimbine, cyproheptadine, etc)
Lidocaine	Topical anesthetic jelly: Lidocaine↑
GABA ¶	GABA
α1‐adrenergic antagonist	Silodosin, alfuzosin, terazosin, etc (Noradrenaline↓→suppression of seminal vesicle contraction)

Ejaculation‐promoting substances	Valid for PE	Valid for DE
Dopamine		Dopamine receptor agonists(amantadine, apomorphine, cabergoline); Dopamine↑ Noradrenaline‐dopamine reuptake inhibitor (Bupropion); Noradrenaline↑ & Dopamine↑
Noradrenaline		Sympathetic α1 receptor agonists (ephedrine, midodrine, etc): Noradrenaline↑ Noradrenaline reuptake inhibitory action with sympathetic α2 receptor antagonist (yohimbine, etc); Noradrenaline↑ Noradrenaline‐dopamine reuptake inhibitor (Bupropion); Noradrenaline↑&Dopamine↑ Noradrenaline reuptake inhibitory action by amine transporter inhibition (imipramine, amoxapine, etc); Noradrenaline↑
Oxytocin	Oxytocin‐Antagonist	Oxytocin

PDE5 inhibitors have unknown pharmacological effects but are effective for PE in combination with SSRI.

Dapoxetine (SSRI) has been approved for PE worldwide except Japan. However, it should be noted that other drugs are for off‐label use.

Silodosin is effective for spontaneous ejaculation (anhedonic ejaculation).

^†EjD: ejaculatory dysfunction.

^‡PE: premature ejaculation.

^§DE: delayed ejaculation (include emission less, retrograde ejaculation, intravaginal ejaculatory dysfunction).

^¶GABA: γ‐aminobutyric acid.