American Board of Psychiatry and Neurology (ABPN) Practice Exam

Which medication is known to delay ejaculation?

1. Alprostadil

2. Testosterone

3. Sildenafil

4. SSRIs

The correct answer is: SSRIs

The choice of SSRIs (selective serotonin reuptake inhibitors) as the medication known to delay ejaculation is grounded in their pharmacological effects. SSRIs are primarily used as antidepressants, but a notable side effect observed in many patients is delayed ejaculation. This effect is attributed to the way SSRIs enhance serotonin neurotransmission, which can lead to an increase in the time it takes to achieve ejaculation during sexual activity. This mechanism makes SSRIs beneficial for individuals experiencing premature ejaculation. They are often prescribed for this purpose, both off-label and with the intent to specifically address sexual dysfunction. The evidence supporting the use of SSRIs for this purpose includes clinical studies demonstrating their efficacy in prolonging the time to ejaculation and improving patient satisfaction. In contrast, medications like Alprostadil and Sildenafil primarily focus on erectile function. Alprostadil promotes penile blood flow, enhancing erection, while Sildenafil, a phosphodiesterase type 5 inhibitor, supports erection by increasing blood flow in the presence of sexual stimulation but does not have a significant impact on ejaculation timing. Testosterone, while influencing libido and overall sexual function, does not directly delay ejaculation and can have varying effects on individual patients. Thus, SSRIs are specifically recognized for their ability to delay ejaculation.