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Behaviour therapy, anesthetic creams and sprays, medications, and other types of treatments can improve symptoms of premature ejaculation

Cooper K, Martyn-St James M, Kaltenthaler E, et al. Interventions to treat premature ejaculation: a systematic review short report. Health Technol Assess. 2015;19(21):1-180.

Review question

How effective are treatments for premature ejaculation?

Background

Premature ejaculation occurs when ejaculation happens sooner than a man or his partner would like during sexual intercourse, usually within 1 minute of penetration. It can be lifelong (primary) and start at the beginning of sexual encounters or acquired (secondary) and start after previous sexual relations. If premature ejaculation happens frequently or causes distress, frustration, or avoidance of sexual encounters, then a man may seek treatment from a doctor. There are several treatments for the condition that include behaviour therapy and medications.

How the review was done

The researchers did a systematic review, searching for studies that were published up to August 2013. They found 102 randomized controlled trials.

Treatments included psychological or psychosocial behaviour therapy, anesthetic creams and sprays, antidepressants, phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil), analgesics, acupuncture, Chinese medicine, and devices that delay ejaculation. These were mostly compared with placebo.

Most of the trials measured intravaginal ejaculatory latency time, which is the time from vaginal penetration to ejaculation, sexual satisfaction, and side effects.

What the researchers found

Most of the trials included men who were seen in specialized clinics and who did not have other conditions, such as erectile dysfunction, at the same time. Men received treatment for 2 to 24 weeks.

Many of the treatments increased time from vaginal penetration to ejaculation (by about 1 to 6 minutes) and sexual satisfaction.

Conclusions

Various treatments, including behaviour therapy, anesthetic creams and sprays, medications, and other types of treatments, can improve premature ejaculation. Individual preferences and side effects vary, so it is best to talk to a health professional about the treatment options.

Treatments for premature ejaculation

Treatments

Number of trials

Main findings

Behaviour therapy

12 trials

·   Increased time to ejaculation more than no treatment.

·   When added to medication, increased time to ejaculation more than either treatment alone.

Anesthetic creams or sprays (EMLA)

9 trials

·   Increased time to ejaculation more than placebo.

·   Side effects included loss of sensation, irritation, and loss of erection after about 20 minutes.

Selective serotonin reuptake inhibitors (SSRIs)

42 trials

·   Citalopram, escitalopram, fluoxetine, paroxetine, and sertraline increased time to ejaculation more than placebo. Fluvoxamine did not.

·   Clomipramine increased time to ejaculation more than paroxetine.

·   Side effects included nausea, headache, dry mouth, and dizziness.

Dapoxetine (Priligy®)

8 trials

·   Increased time to ejaculation more than placebo.

·   Side effects included nausea, headache, dry mouth, and dizziness.

Serotonin–noradrenaline reuptake inhibitors (SSRIs)

3 trials

·   Duloxetine and venlafaxine increased time to ejaculation more than placebo.

·   Side effects included nausea and dry mouth.

Tricyclic antidepressants

13 trials

·   Clomipramine increased time to ejaculation more than placebo.

·   Side effects included constipation and dry mouth, and nose irritation with nasal clomipramine.

Phosphodiesterase-5 inhibitors

12 trials

·   Vardenafil or tadalafil increased time to ejaculation more than placebo; sildenafil did not.

·   Increased time to ejaculation more than sertraline but not fluoxetine.

·   Increased time to ejaculation more when added to treatment with an SSRI.

·   Increased time to ejaculation more than behaviour therapy.

·   Side effects included flushing, headache, and palpitations

Alpha-blockers

2 trials

·   Terazosin improved ejaculation control more than placebo.

·   Side effects included headache, hypotension, drowsiness, ejaculation disorder

Analgesics

7 trials

·   Tramadol increased time to ejaculation more than placebo.

Acupuncture

2 trials

·   Increased time to ejaculation more than sham acupuncture.

Chinese medicine

5 trials

·   Increased time to ejaculation more than usual care.

·   Did not increase time to ejaculation compared with fluoxetine.

Delay devices

1 trial

·   A desensitizing band plus stop–start technique increased time to ejaculation more than behaviour therapy plus stop–start technique.

·   Side effects were soreness with overuse.

 



Related Topics


Glossary

Alpha-blockers
A type of drug that relaxes certain muscles. They can be used to treat high blood pressure (by relaxing blood vessels to help blood flow). They are also used to treat urinary problems, often related to an enlarged prostate in men.
Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

  • Screening for chlamydia and gonorrhea: Consumer fact sheet

    U.S. Preventive Services Task Force (USPSTF)
    Sexually active women over 24 years old who do not use condoms or have more than one sexual partner should get screened for chlamydia and gonorrhea.
  • Uterine (endometrial) cancer

    Patient.co.uk
    Uterine cancer is most likely to occur in women in their 50s and 60s. If uterine cancer is found at an early stage, there is a good chance of a cure. Talk to your doctor if you experience vaginal bleeding past menopause, bleeding between periods, or bleeding after sex.
  • Vaginal dryness

    UpToDate - patient information
    Vaginal dryness can affect any woman but it is most common after menopause. Symptoms may include burning, itching, pain during sex and abnormal vaginal discharge. Treatments include vaginal moisturizers, vaginal lubricants and vaginal estrogen. Speak with your doctor to learn more about which treatment might be right for you.
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