Behavioral Therapies for Management of Premature Ejaculation: A Systematic Review

Abstract

IntroductionPremature ejaculation (PE) is defined by short ejaculatory latency and inability to delay ejaculation causing distress. Management may involve behavioral and/or pharmacological approaches.AimTo systematically review the randomized controlled trial (RCT) evidence for behavioral therapies in the management of PE.MethodsNine databases including MEDLINE were searched up to August 2014. Included RCTs compared behavioral therapy against waitlist control or another therapy, or behavioral plus drug therapy against drug treatment alone. [Correction added on 10 September 2015, after first online publication: Search period has been amended from August 2013 to August 2014.]Main Outcome MeasureIntravaginal ejaculatory latency time (IELT), sexual satisfaction, ejaculatory control, and anxiety and adverse effects.ResultsTen RCTs (521 participants) were included. Overall risk of bias was unclear. All studies assessed physical techniques, including squeeze and stop-start, sensate focus, stimulation device, and pelvic floor rehabilitation. Only one RCT included a psychotherapeutic approach (combined with stop-start and drug treatment). Four trials compared behavioral therapies against waitlist control, of which two (involving squeeze, stop-start, and sensate focus) reported IELT differences of 7–9 minutes, whereas two (web-based sensate focus, stimulation device) reported no difference in ejaculatory latency posttreatment. For other outcomes (sexual satisfaction, desire, and self-confidence), some waitlist comparisons significantly favored behavioral therapy, whereas others were not significant. Three trials favored combined behavioral and drug treatment over drug treatment alone, with small but significant differences in IELT (0.5–1 minute) and significantly better results on other outcomes (sexual satisfaction, ejaculatory control, and anxiety). Direct comparisons of behavioral therapy vs. drug treatment gave mixed results, mostly either favoring drug treatment or showing no significant difference. No adverse effects were reported, though safety data were limited.ConclusionsThere is limited evidence that physical behavioral techniques for PE improve IELT and other outcomes over waitlist and that behavioral therapies combined with drug treatments give better outcomes than drug treatments alone. Further RCTs are required to assess psychotherapeutic approaches to PE.

On-demand Take of Dapoxetine for the Treatment of Lifelong Premature Ejaculation: Prospective, Randomized, Placebo Controlled Study

“…Psychotherapy involve education both patients and their partners,which may improve their sexual skills and increase self-confidence and reduce anxiety during sex [7].However, the majority of studies aim to treat PE by psychotherapy didn't meet the criteria for high level evidence based studies [8].The effectiveness of behavior therapy reported was different, with poor compliance of the patient.Although their utility are limited today, they are used to treat PE combined with drugs [9]. Surgical therapy such as ablation and modulation of dorsal penile nerve [10] is an innovative modality need further study and may cause irreversible damage which limit its clinical application.Circumcision seems to have some role in treating PE which can extend the ejaculation time [11],but it could not be interpreted as a justification for circumcision in men with PE even there were no adversely affect ejaculatory function [12].Although drug therapy is widely used for the treatment of PE in clinic, few studies devote to on-demand use of dapoxetine to treat LPE.…”

Lidocaine/prilocaine spray for premature ejaculation

“…A systematic review included three randomised controlled trials (RCTs; n=82) of behavioural techniques among men with primary premature ejaculation 17. One study found no significant difference between behavioural techniques and a waiting list control group.…”

Current and emerging therapies in premature ejaculation: Where we are coming from, where we are going

“…Developed by Semans in 1956, the “start–stop” technique involves stimulating the penis until one feels the urge to ejaculate, then removing the stimulation until the urge to ejaculate subsides . By repeating this maneuver multiple times before allowing oneself to ejaculate, the “start–stop” technique allows the patient to improve control over the ejaculatory response by learning to identify the physical and emotional parameters involved in arousal . Although once considered the gold standard for the treatment of PE, the “start–stop” technique has been under scrutiny, as recent studies disagree on the effectiveness of this behavioral‐based treatment .…”

“…However, the authors failed to include a placebo arm to the trial, so the total effect of pelvic floor rehabilitation is undetermined . Pelvic floor rehabilitation also improves the quality of erections and increases the intracavernosal pressure . Some or all of the improvement in PE could be due to a concomitant improvement in ED .…”

“…5 By repeating this maneuver multiple times before allowing oneself to ejaculate, the "start-stop" technique allows the patient to improve control over the ejaculatory response by learning to identify the physical and emotional parameters involved in arousal. 6 Although once considered the gold standard for the treatment of PE, the "start-stop" technique has been under scrutiny, as recent studies disagree on the effectiveness of this behavioralbased treatment. [7][8][9] The "squeeze" technique, established by Masters and Johnson in 1970, involves squeezing the glans of the penis until the urge to ejaculate subsides.…”