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Purpose Selective serotonin re-uptake inhibitors (SSRIs) are frequently used to treat premature ejaculation (PE) in men. We performed a Cochrane review to assess the efficacy of SSRI treatment for PE. Materials and Methods We extensively searched a range of databases up to May 2020 and only included randomized controlled trials. Results A total of 31 studies with 8,254 men were included in this analysis. We found that SSRI treatment probably improves self-perceived PE symptoms (defined as a rating of ‘better’ or ‘much better’; risk ratio [RR], 1.92; 95% confidence interval [CI], 1.66–2.23; moderate-certainty evidence) and satisfaction with intercourse (defined as a rating of ‘good’ or ‘very good’; RR, 1.63; 95% CI, 1.42–1.87; moderate-certainty evidence) compared to placebo. Furthermore, SSRI treatment likely improve participants’ self-perceived control over ejaculation (defined as rating of ‘good’ or ‘very good’; RR, 2.29; 95% CI, 1.72–3.05; moderate-certainty evidence) and probably lessens distress (defined as rating of ‘a little bit’ or ‘not at all’) about PE (RR, 1.54; 95% CI, 1.26–1.88; moderate-certainty evidence). SSRI treatment may increase IELT compared to placebo (mean difference, 3.09 minutes higher; 95% CI, 1.94 higher to 4.25 higher; low-certainty evidence). However, SSRIs may increase treatment cessations due to adverse events compared to placebo (RR, 3.80; 95% CI, 2.61–5.51; low-certainty evidence). Conclusions SSRI treatment for PE appears to substantially improve a number of outcomes of direct patient importance such as symptom improvement, satisfaction with intercourse and perceived control over ejaculation when compared to placebo.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the role of selective serotonin re-uptake inhibitors in the treatment of premature ejaculation. B A C K G R O U N D Description of the conditionPremature ejaculation (PE) is broadly defined as a male sexual disorder in which ejaculation occurs at a time point earlier than desired by the patient or his partner, or both, usually with minimal sexual stimulation before, at the time, or shortly after penetration. Other names for this condition are early ejaculation, rapid ejaculation, rapid climax, premature climax, and (historically) ejaculatio praecox. The International Society of Sexual Medicine's guideline for PE provides a more specific recent definition of "a male sexual dysfunction characterized by ejaculation that always or nearly always occurs prior to or within one minute of vaginal penetration, either present from the first sexual experience or following a new bothersome change in ejaculatory latency, and the inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy" (Althof 2014).

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