Phosphodiesterase Type 5 Inhibitors for Premature Ejaculation: A Systematic Review and Meta-analysis

James, Marrissa Martyn-St; Cooper, Katy; Ren, Shijie; Kaltenthaler, Eva; Dickinson, Kath; Cantrell, Anna; Wylie, Kevan; Frodsham, Leila; Hood, Catherine

doi:10.1016/j.euf.2016.02.001

Cited by 25 publications

(14 citation statements)

References 33 publications

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“…Accordingly, treating ED‐PE men with ED medications improves both erection and ELTs (Chia, ; Li et al ., ; Xu et al ., ; McMahon et al ., ). Conversely, there is no robust evidence for the use of PDE5i in men with only PE (Castiglione et al ., ; Martyn‐St James et al ., ), thus supporting the view that ED‐PE men represent a phenotype different from ‘pure’ PE. In addition, there is no evidence that SSRI could improve ED, which is even negatively affected by their chronic use (Corona et al ., ).…”

Section: Discussionsupporting

confidence: 75%

Clinical characteristics of men complaining of premature ejaculation together with erectile dysfunction: a cross‐sectional study

et al. 2018

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Background: Premature ejaculation (PE) is present in up to 30% of men with erectile dysfunction (ED). Objectives: To assess the clinical features of men complaining of both ED and PE (ED-PE) as compared to men reporting only ED or PE. Materials and methods: A consecutive series of 4024 men (mean age 51.2 AE 13.2 years) consulting for sexual dysfunction was studied. The population was categorized into ED-only (n = 2767; 68.8%), PE-only (n = 475; 1.8%), and ED-PE (n = 782; 19.4%). Sexual symptoms were evaluated using the structured interviews SIEDY and ANDROTEST. Penile color Doppler ultrasound (PDCU) parameters were also assessed. Results: When compared to PE alone, ED-PE reported more sexual complaints, including impaired morning erections [OR = 5.8 (4.1; 8.3)], decreased sexual desire [OR = 2.6 (1.8; 3.7)], decreased ejaculate volume [OR = 2.7 (1.8; 4.0)], and reduced frequency of sexual intercourse [OR = 1.4 (1.0; 2.0)]. Conversely, ED-PE and ED-only men had a similar prevalence of sexual symptoms. In ED-PE men, the characteristics of ED were similar to ED-only men, whereas the characteristics of PE were milder than in PE-only men. ED-PE men had a significantly higher prevalence of hypertension, diabetes, and cardiovascular (CV) diseases [OR = 1.8 (1.1; 3.0), 2.7 (1.3; 5.6) and 2.7 (1.1; 6.5), respectively] than PE-only subjects. Moreover, ED-PE men showed worse dynamic peak systolic velocity at PDCU [B = À12.0 (À17.7; À6.2)] and a greater 10-year estimated CV risk [B = 3.8 (2.5; 5.1)] than PE-only patients. Conversely, comorbidities and PDCU parameters were similar in ED-PE and ED-only men. Discussion: The present results suggest that men reporting ED and PE should be considered as patients with ED-only, at least at first glance. Consequently, the diagnosis-including the CV risk stratification-and treatment should be primarily focused on the erectile problem. Conclusions: Erectile dysfunction-PE patients present several similarities with those consulting only for ED, whereas their characteristics are different from PE-only men. In agreement with the guidelines, our results confirm that ED-PE men might be considered (and managed) primarily as patients with ED.

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Section: Discussionsupporting

confidence: 75%

Clinical characteristics of men complaining of premature ejaculation together with erectile dysfunction: a cross‐sectional study

et al. 2018

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“…AMSTAR 2 assessments identified several methodologic weaknesses across all included reviews (see Appendix 3). More than half of the reviews did not refer to a protocol,22, 27, 28, 29, 32, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66 66.6% reviews did not explain the study designs for inclusion in the review,12, 28, 34, 54, 56, 57, 58, 59, 60, 61, 62, 64, 65, 66, 70, 71, 72 73.3% did not provide the list of excluded studies,27, 28, 29, 32, 55, 56, 57, 58, 59, 60, 61, 62, 63, 65, 66, 69, 71, 72, 73, 74, 75 and 83.3% of reviews did not clearly state the sources of funding for the included studies 12, 22, 26, 27, 28, 29, 34, 55, 56, 57, 58, 59, 60, 61, 62, 63, 65, 66, 67, 68, 69, 72, 73, 74, 75. Inter-rater agreement of the 2 authors was high (κ = 0.86).…”

Section: Resultsmentioning

confidence: 99%

Interventions to Treat Erectile Dysfunction and Premature Ejaculation: An Overview of Systematic Reviews

2019

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Introduction Sexual dysfunction in men is common, and optimal treatment is complex. Although several systematic reviews concerning treatment approaches exist, a comprehensive overview without limitations concerning the population, interventions, or outcomes is lacking. Aim To conduct a “review of reviews” to compare the effectiveness of pharmacologic, non-pharmacologic, and combined interventions. Methods 9 electronic databases, relevant journals, and reference lists up to July 2018 were searched. For each intervention, only the most recent and comprehensive meta-analysis or systematic review was included. The methodologic quality of the reviews was appraised using the Assessment of Multiple Systematic Reviews–2 tool. Main Outcome Measure Sexual functioning (via intravaginal ejaculatory latency time and international index of erectile function), sexual satisfaction, and adverse effects. Results 30 systematic reviews were included. For premature ejaculation, several treatments, including oral pharmacotherapy (selective serotonin inhibitors, phosphodiesterase type 5 [PDE5] inhibitors, tricyclic antidepressants, and opioid analgesics), topical anesthetics, and combined drug and behavioral therapies demonstrated significant improvements of 1–5 minutes in the intravaginal ejaculatory latency time. Pharmacologic interventions (PDE5 inhibitors, penile injection, and testosterone), shockwave therapy, lifestyle modifications, and combined therapies (PDE5 inhibitors and psychological intervention) were effective in treating erectile dysfunction. Most pharmacologic therapies were associated with adverse effects. Conclusions There is suggestive evidence that pharmacologic interventions or combined therapies are more effective than non-pharmacologic interventions for treating sexual dysfunction in men; however, a range of treatment options should be presented to individual patients so they may consider the risks and benefits of treatments differently. Evidence related to behavioral and psychological interventions is insufficient compared with that related to drug trials, highlighting the necessity for larger and better randomized controlled trials. Ciocanel O, Power K, Eriksen A. Interventions to Treat Erectile Dysfunction and Premature Ejaculation: An Overview of Systematic Reviews. Sex Med 2019;7:251–269.

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“…Some articles reported that either as a single drug or as a combination drug, PDE5Is have been used to treat PE (Aversa et al, 2009; McMahon et al, 2005). Martyn-St James found that PDE5Is are significantly more effective than placebo and PDE5I combined with an SSRI is significantly more effective than SSRI alone for increasing IVELT and improving other effectiveness outcomes (Martyn-St James et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Phosphodiesterase-5 Inhibitors for Premature Ejaculation: Systematic Review and Meta-Analysis of Placebo-Controlled Trials

Zhang

Chi

Sun³

et al. 2020

Am J Mens Health

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The purpose of this analysis is to assess the efficacy and safety of phosphodiesterase-5 inhibitors (PDE5Is) for the treatment of premature ejaculation (PE). A comprehensive search was performed to ascertain from trials about PDE5Is for the treatment of PE and compare the results, including intravaginal ejaculatory latency time (IVELT), score of sexual satisfaction scale, and side effects, between the group treated with PDE5Is and that treated with placebo. Seven studies involving a total of 471 patients were included in this meta-analysis. This analysis showed that patients who were treated with PDE5Is had significantly increased IVELT (mean difference [MD] 2.60; 95% CI [1.85, 3.36]; p < .00001) and score of sexual satisfaction scale (MD 2.04; 95% CI [0.78, 3.30]; p = .002) compared with the group on placebo. More patients had side effects while taking PDE5Is, such as headache, dizziness, flushing, and nasal congestion. PDE5Is were significantly more effective than placebo in the treatment of PE. Side effects were more common among patients who were treated with PDE5Is.

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Phosphodiesterase Type 5 Inhibitors for Premature Ejaculation: A Systematic Review and Meta-analysis

Abstract: PROSPERO registration number CRD42013005289.

Cited by 25 publications

References 33 publications

Clinical characteristics of men complaining of premature ejaculation together with erectile dysfunction: a cross‐sectional study

Clinical characteristics of men complaining of premature ejaculation together with erectile dysfunction: a cross‐sectional study

Interventions to Treat Erectile Dysfunction and Premature Ejaculation: An Overview of Systematic Reviews

Phosphodiesterase-5 Inhibitors for Premature Ejaculation: Systematic Review and Meta-Analysis of Placebo-Controlled Trials

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