A prospective randomized study to compare pelvic floor rehabilitation and dapoxetine for treatment of lifelong premature ejaculation

Abstract

Premature ejaculation (PE) is the most common male sexual disorder. We compared pelvic floor muscle rehabilitation to on-demand treatment with the selective serotonin reuptake inhibitor dapoxetine in 40 men with lifelong PE (baseline intra-vaginal ejaculatory latency time (IELT) ≤1 min). Subjects were randomized into the following two treatment groups: (1) PFM rehabilitation or (2) 30 or 60 mg of on-demand dapoxetine. Total treatment time for both groups was 12 weeks, at the end of which, IELT mean values were calculated to compare the effectiveness of the two different therapeutic approaches. At the end of treatment, 11 of the 19 patients (57%) treated with rehabilitation were able to control the ejaculation reflex, with a mean IELT of 126.6 sec (range: 123.6-152.4 sec). In the dapoxetine group, after 12 weeks of therapy, 5 of 8 (62.5%) patients in the 30 mg subgroup and five of seven (72%) in the 60 mg subgroup had an IELT >180 sec (mean: 178.2 and 202.8 sec, respectively). The results obtained in the group treated with pelvic floor rehabilitation are promising, and this treatment represents an important cost reduction if compared to dapoxetine on-demand treatment. The present study confirms the data that are previously available in the literature on the efficacy and safety of the new inhibitor of serotonin reuptake, dapoxetine, as well as proposes and evaluates a new type of physical treatment that may be a viable therapeutic option for treatment of PE.

Dapoxetine: a new option in the medical management of premature ejaculation

“…Despite regulatory approval in multiple markets, only one independent postmarketing study has been published [Pastore et al 2012]. In an open-label flexible dose trial of dapoxetine in 19 men with lifelong PE and an arithmetic mean baseline IELT, of less than 1 min, 12 weeks of treatment with dapoxetine 30 and 60 mg was associated with a 5.4-and 5.9-fold increase in arithmetic mean IELT, respectively [Pastore et al 2012]. First-dose nausea, which progressively attenuated and disappeared by study end, was experienced by 12.5% and 28.5% of subjects on dapoxetine 30 and 60 mg respectively.…”

Fisioterapia pélvica no tratamento da ejaculação precoce: uma revisão integrativa / Pelvic physiotherapy in the treatment of premature ejaculation: an integrative review

“…Mais tarde, Pastore et al 6 compararam o sucesso dos exercícios para MAP ao tratamento com 30-60 mg de dapoxetina em 40 homens com EP e tempo de latência ejaculatória intravaginal de base (IELT) menor ou igual a 60 segundos. Após 12 semanas de tratamento, os resultados entre os dois grupos foram comparados com base no aumento do IELT.…”

“…No mesmo ano, Pastore et al 6 utilizaram um protocolo que consistia em cinesioterapia, eletroestimulação e biofeedback para a MAP no tratamento da EP de 40 pacientes, em três sessões semanais de no mínimo 60 minutos, sendo 20 minutos para cada técnica, durante 12 semanas. Ao final do tratamento, 83% dos pacientes adquiriram controle sobre o reflexo ejaculatório, sendo que 33% deles mantiveram os resultados mesmo após seis meses do fim do programa.…”

La eyaculación precoz: actualización del tema

“…Los estudios realizados han sido con pocos pacientes, pero confirman éxitos del 60% tras cuatro meses de practicarlos 21,22 .  A estos ejercicios se ha añadido la electroestimulación del suelo pélvico para provocar contracciones en la zona y fortalecer la musculatura e incrementar la discriminación de sus contracciones.…”