Is there a role for phosphodiesterase type-5 inhibitors in the treatment of premature ejaculation?

Abstract

Premature ejaculation (PE) is considered to be the most common male sexual dysfunction. The realization that PE may co-exist with ED prompted the use of PDE5-i's alone or in combination with selective serotonin reuptake inhibitors (SSRIs) for treating ejaculatory disorders. Until recently, there was little evidence that PDE5-i's alone may have a role in the treatment of PE in the absence of ED, and current available treatments include only on-demand dapoxetine. However, available data indicate that there is clinical, anatomical, physiological, pharmacological and genetic evidence to explain the efficacy of PDE5-i's. Nine manuscripts that examined the efficacy of PDE5-i's in the treatment of PE, alone or in combination with SSRIs, were retrieved. All studies reported some significant changes in the intravaginal ejaculatory latency time and sexual satisfaction scores, although not all were clinically meaningful. Well-designed multicenter studies are urgently required to further elucidate the efficacy and safety, as well as the mechanisms of action of PDE5-i's in the treatment of PE. The aim of this review is to discuss basic rationale and to show clinical evidence sustaining the possibility to use off-label PDE5-i's to treat PE.

Interventions to treat premature ejaculation: a systematic review short report

“…Only four reviews reported independent double data extraction 36,53,135,149 (see Appendix 4). Reported search strategies varied in terms of the search dates and resources searched.…”

“…37 Details of the review type, the databases searched and dates, included RCTs and the AMSTAR quality assessment for these reviews of effectiveness are presented in Table 26. The overall AMSTAR quality score was 2 out of 11 in three of the reviews, 134,136,137 3 out of 11 in one review 135 and 4 out of 11 in one review. 37 However, the review by Asimakopoulos et al 134 was the most comprehensive in terms of included studies.…”

“…The current evidence base for PDE5 inhibitors in the treatment of PE comprises 10 RCTs 39,55,138-145 captured in five systematic reviews 37,[134][135][136][137] of low to moderate methodological quality reviews and two further RCTs, 101,120 one of which is at overall low risk of bias and the other at overall unclear risk. …”

“…Reviews Two of the systematic reviews were conducted in Italy, 134,135 one review was conducted in Australia, 136 one in Israel 137 and one in the USA. 37 Details of the review type, the databases searched and dates, included RCTs and the AMSTAR quality assessment for these reviews of effectiveness are presented in Table 26.…”

“…Phosphodiesterase-5 inhibitors were evaluated by five systematic reviews, 37,[134][135][136][137] one of which pooled data in a meta-analysis. 134 Two further RCTs evaluating PDE5 inhibitors were identified.…”