Selective Serotonin Re-Uptake Inhibitors for Premature Ejaculation in Adult Men: A Cochrane Systematic Review

Abstract

Purpose Selective serotonin re-uptake inhibitors (SSRIs) are frequently used to treat premature ejaculation (PE) in men. We performed a Cochrane review to assess the efficacy of SSRI treatment for PE. Materials and Methods We extensively searched a range of databases up to May 2020 and only included randomized controlled trials. Results A total of 31 studies with 8,254 men were included in this analysis. We found that SSRI treatment probably improves self-perceived PE symptoms (defined as a rating of ‘better’ or ‘much better’; risk ratio [RR], 1.92; 95% confidence interval [CI], 1.66–2.23; moderate-certainty evidence) and satisfaction with intercourse (defined as a rating of ‘good’ or ‘very good’; RR, 1.63; 95% CI, 1.42–1.87; moderate-certainty evidence) compared to placebo. Furthermore, SSRI treatment likely improve participants’ self-perceived control over ejaculation (defined as rating of ‘good’ or ‘very good’; RR, 2.29; 95% CI, 1.72–3.05; moderate-certainty evidence) and probably lessens distress (defined as rating of ‘a little bit’ or ‘not at all’) about PE (RR, 1.54; 95% CI, 1.26–1.88; moderate-certainty evidence). SSRI treatment may increase IELT compared to placebo (mean difference, 3.09 minutes higher; 95% CI, 1.94 higher to 4.25 higher; low-certainty evidence). However, SSRIs may increase treatment cessations due to adverse events compared to placebo (RR, 3.80; 95% CI, 2.61–5.51; low-certainty evidence). Conclusions SSRI treatment for PE appears to substantially improve a number of outcomes of direct patient importance such as symptom improvement, satisfaction with intercourse and perceived control over ejaculation when compared to placebo.

Nuevo estudio para confirmar el criterio de validez predictiva en un modelo animal para evaluar la eyaculación precoz: efectos de la sertralina y la fluoxetina

“…In this regard, the rapid ejaculation displayed by male rats in MPCA conditions resembles acquired premature ejaculation in men, which is often influenced by the presence of anxiety or stressful factors during sexual intercourse. [1][2][3]14 Another important parameter of male sexual behavior to analyze is the number of intromissions preceding ejaculation, as it plays a role in the rat's ejaculatory threshold. 24 Our results demonstrated that fluoxetine caused a significant increase (p < 0.05) in the number of intromissions at a dose of 10 mg/kg, compared to saline, which was not observed in the sertraline group at the same dose.…”

“…1,2,7,8,[10][11][12][13] The treatment for premature ejaculation currently uses SSRIs, which increase the synaptic levels of this neurotransmitter. 14 It is assumed that the ejaculatory process inhibition is due to their effect on the 5-HT2C receptor. [5][6][7][8] Additionally, dapoxetine is the primary SSRIs employed for premature ejaculation treatment but has disadvantages such as cost and potential side effects for some men.…”

“…[5][6][7][8] Additionally, dapoxetine is the primary SSRIs employed for premature ejaculation treatment but has disadvantages such as cost and potential side effects for some men. 6,8,14,15 Therefore, it would be beneficial to find alternative medications for men who are sensitive to dapoxetine or lack sufficient economic resources to purchase it.…”

“…25 In this regard, we were able to demonstrate that the MPCA satisfies this criterion because the SSRI dapoxetine, which is the most used drug in the treatment of premature ejaculation in men, was able to significantly prolong the rapid ejaculation exhibited by male rats in this arena. 14,23 To further validate the predictive validity criterion and strengthen the power of our model, we decided to analyze whether other SSRIs, such as sertraline and fluoxetine, are capable of delaying rapid ejaculation in male rats when evaluated in the MPCA, as they do in men with premature ejaculation. 6,8,10 These SSRIs have been shown to increase the intravaginal ejaculatory latency time in men with premature ejaculation.…”

“…6,8,10 These SSRIs have been shown to increase the intravaginal ejaculatory latency time in men with premature ejaculation. 6,14,26 Therefore, the objective of our study was to confirm that the MPCA satisfies the criterion of predictive validity by assessing whether sertraline and fluoxetine can significantly delay rapid ejaculation in male rats when evaluated in the MPCA.…”