A review of controlled trials in the pharmacological treatment of premature ejaculation

Abstract

Premature ejaculation is a common sexual problem which presents to genitourinary (GU) medicine services. Five main treatment approaches have been used in clinical trials: behavioural therapy, antidepressants, phosphodiesterase-5 (PDE5) inhibitors, topical anaesthetic agents and alpha-blockers. We have carried out a systematic review of published pharmacological trials. All antidepressants appeared to delay ejaculation to some extent at all doses. Anaesthetic creams appeared to be as successful in slowing ejaculation as antidepressants without systemic side-effects, although some patients did experience erectile problems or unpleasant local symptoms. Anecdotally, behavioural therapy is effective and appears to have long-lasting efficacy. There is a need for quality comparative trial of behavioural therapy, topical anaesthetic agents and antidepressants, including appropriate measures of relapse, follow-up and acceptability of continuing long-term treatment.

Interventions to treat premature ejaculation: a systematic review short report

“…64,65,67 One review was conducted in Australia, 68 one in the Netherlands, 52 one in the USA 66 and one in the UK. 69 The overall AMSTAR quality score was 1 out of 11 in three of the reviews, 52,65,69 2 out of 11 in one review 68 and 3 out of 11 in one review. 64 Two reviews scored 0 out of 11.…”

“…Eight further RCTs [124][125][126][127][128][129][130][131] that also evaluated oral clomipramine were identified from three reviews of low methodological quality. 52,68,69 Full details of the AMSTAR assessment for these and all other included reviews are presented in Appendix 4. A further three RCTs were identified from the literature search, 107,132,133 and the RCT by Tuncel et al 107 evaluated clomipramine, sertraline, terazosin and placebo.…”

“…The reviewers reported a p-value compared with placebo of p < 0.001. Richardson et al 69 estimated the mean increase in latency over baseline or placebo, combining data from different trials weighted by sample size. The latency increase was 3.66 minutes with clomipramine 25 mg and 5.31 minutes with clomipramine 50 mg.…”

“…133 No significant effects are evident at 1 mg. Summary evidence from one review 52 that estimated a weighted mean increase in IELT across included studies and one review that estimated a mean percentage increase in IELT across RCTs, non-RCTs, and from single-arm studies, suggests that oral clomipramine may be more effective than placebo on this outcome. 69 Various assessment methods in terms of treatment satisfaction, sexual satisfaction and ejaculation control have been used across RCTs to measure the effectiveness of clomipramine. Evidence from one crossover trial suggests that treatment satisfaction is greater with oral sildenafil and paroxetine than with oral clomipramine.…”

Methods for a rapid systematic review and metaanalysis in evaluating selective serotonin reuptake inhibitors for premature ejaculation

“…For SSRIs, eleven existing reviews were identified and it was possible to check the data across these reviews for concordance (Cong et al 2012;Huang et al 2009;Luo et al 2012;McCarty and Dinsmore 2012;McMahon 2012;McMahon and Porst 2011;Moreland and Makela 2005;Richardson et al 2005;Waldinger et al 2004a;Wang et al 2007;Wang et al 2010). Outcome data from RCTs not reported in reviews was extracted from the RCT publication.…”