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Alghobary M, Gaballah M, El-Kamel MF, State AF, Ismail SR, Selim MK, Mostafa T. Oral dapoxetine versus topical lidocaine as on-demand treatment for lifelong premature ejaculation: A randomised controlled trial. Andrologia 2020; 52:e13558. [PMID: 32153050 DOI: 10.1111/and.13558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/17/2020] [Accepted: 02/14/2020] [Indexed: 02/05/2023] Open
Abstract
This trial aimed to assess the efficacy of on-demand oral dapoxetine versus topical lidocaine treatments for lifelong PE. Cases with lifelong PE were randomised to start treatment by oral dapoxetine 60 mg or topical lidocaine 10% spray. The intravaginal ejaculatory latency time (ILET), validated Arabic Index for PE (AIPE), Sexual Health Inventory for Men (SHIM) and frequency of intercourse/week were recorded at the baseline and after 12 weeks treatment period of the first medication before two weeks washout period and then crossing over to the other one for another 12 weeks. Results showed that both medications significantly increased both IELT and AIPE scores compared with the baseline being significantly better with topical lidocaine (63.44 s, 179.4 s versus 21.87 s, p < .05). Significant decrease of SHIM score was recorded with lidocaine but not with dapoxetine. Global Efficacy Question for the patient's assessment of the effectiveness of drugs showed that lidocaine was described as being effective by 43 cases and ineffective by 12 cases, oral dapoxetine was described as being effective by 16 cases and ineffective by 39 cases. From these accumulated data, it is concluded that topical lidocaine is more effective on-demand therapy for lifelong PE compared with oral dapoxetine.
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Affiliation(s)
- Moheiddin Alghobary
- Department of Dermatology, Andrology & STIs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammad Gaballah
- Department of Dermatology, Andrology & STIs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed F El-Kamel
- Department of Dermatology, Andrology & STIs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed F State
- Department of Dermatology, Andrology & STIs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sherif R Ismail
- Department of Dermatology, Andrology & STIs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed K Selim
- Department of Dermatology, Andrology & STIs, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Taymour Mostafa
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
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Sun S, Han L, Li Y, Yu X, Bao B, Zhou H, Gong Z. The safety and efficacy of dorsal penile nerve block for premature ejaculation: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16479. [PMID: 31348253 PMCID: PMC6708843 DOI: 10.1097/md.0000000000016479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Premature ejaculation is a common sexual dysfunction disease in adult males. There are many clinical trials shown that dorsal penile nerve block can prolong the ejaculation latency to a certain extent in the vagina. In this study, we aim to use a meta-analysis to evaluate the efficacy and safety of dorsal penile nerve block for premature ejaculation. METHODS AND ANALYSIS We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet, Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to February 2019. The quality of the included RCTs will be evaluated with the risk of bias (ROB) tool and evidence will be evaluated by GRADE. Data analysis will be used the special software like RevMan (version 5.3) and EndNote X7. RESULTS The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. ETHICS AND DISSEMINATION This systematic review will evaluate the efficacy and safety of dorsal penile nerve block for premature ejaculation. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial. TRIAL REGISTRATION NUMBER PROSPERO CRD42019119691.
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Affiliation(s)
- Song Sun
- Department of Surgery, Beijing Changping Hospital of Traditional Chinese Medicine
| | - Liang Han
- Department of Andrology, Fangshan Hospital, Beijing University of Chinese Medicine, Fangshan District, Chinan
| | - Yufeng Li
- Department of Surgery, Beijing Changping Hospital of Traditional Chinese Medicine
| | - Xudong Yu
- Department of Andrology, Dongzhimen Hospital, Dongcheng District, Hai Yun Cang on the 5th ZIP, Beijing, China
| | - Binghao Bao
- Department of Andrology, Dongzhimen Hospital, Dongcheng District, Hai Yun Cang on the 5th ZIP, Beijing, China
| | - Hong Zhou
- Department of Surgery, Beijing Changping Hospital of Traditional Chinese Medicine
| | - Ziqi Gong
- Department of Surgery, Beijing Changping Hospital of Traditional Chinese Medicine
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Jian Z, Wei X, Ye D, Li H, Wang K. Pharmacotherapy of premature ejaculation: a systematic review and network meta-analysis. Int Urol Nephrol 2018; 50:1939-1948. [PMID: 30225547 DOI: 10.1007/s11255-018-1984-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/14/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of the study was to conduct a systematic evaluation of the different general prescribed drugs for premature ejaculation (PE). METHODS A systematic literature search of MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science for Systematic Reviews was performed on 1 March 2018. Intravaginal ejaculation latency time (IELT) was the main outcome. Analysis was performed under multivariate random-effects network model and efficacies of drugs were ranked with surface under the cumulative ranking (SUCRA) probabilities. RESULTS A total of 48 studies were reviewed and 40 of them were further enrolled into network meta-analysis. The majority of RCTs were of unclear methodological quality. Pooled evidence suggested that topical anaesthetic creams (TAs), tramadol, selective serotonin reuptake inhibitors (SSRIs), and phosphodiesterase type 5 inhibitors (PDE5is) are more effective at prolonging IELT comparing with placebo. TAs (90%) on demand (OD) and PDE5is plus SSRI (89.8%) had the highest SUCRA, which meant the most probable to be the most effective intervention. CONCLUSIONS We recommend the initial use of dapoxetine 30 mg OD for PE because it has been tested in largest and better designed clinical trials rather than it is more effective than the other drugs studied. TAs and tramadol 50 mg OD can be used as a viable alternative to oral treatment with SSRIs. PDE5is combined with SSRIs are more effective than SSRIs monotherapy but are also associated with more side effects. PDE5is OD can be recommended to PE patients with ED.
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Affiliation(s)
- Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Wei
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Donghui Ye
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Cooper K, Martyn-St James M, Kaltenthaler E, Dickinson K, Cantrell A. Interventions to treat premature ejaculation: a systematic review short report. Health Technol Assess 2016; 19:1-180, v-vi. [PMID: 25768099 DOI: 10.3310/hta19210] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Premature ejaculation (PE) is commonly defined as ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it. PE can be either lifelong and present since first sexual experiences (primary), or acquired (secondary), beginning later (Godpodinoff ML. Premature ejaculation: clinical subgroups and etiology. J Sex Marital Ther 1989;15:130-4). Treatments include behavioural and pharmacological interventions. OBJECTIVE To systematically review evidence for clinical effectiveness of behavioural, topical and systemic treatments for PE. DATA SOURCES The following databases were searched from inception to 6 August 2013 for published and unpublished research evidence: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effects and the Health Technology Assessment database; ISI Web of Science, including Science Citation Index, and the Conference Proceedings Citation Index-Science. The US Food and Drug Administration website and the European Medicines Agency (EMA) website were also searched. METHODS Randomised controlled trials (RCTs) in adult men with PE were eligible (or non-RCTs in the absence of RCTs). RCT data were extrapolated from review articles when available. The primary outcome was intravaginal ejaculatory latency time (IELT). Data were meta-analysed when possible. Other outcomes included sexual satisfaction, control over ejaculation, relationship satisfaction, self-esteem, quality of life, treatment acceptability and adverse events (AEs). RESULTS A total of 103 studies (102 RCTs, 65 from reviews) were included. RCTs were available for all interventions except yoga. The following interventions demonstrated significant improvements (p < 0.05) in arithmetic mean difference in IELT compared with placebo: topical anaesthetics - eutectic mixture of local anaesthetics (EMLA(®), AstraZeneca), topical eutectic mixture for PE (Plethora Solutions Ltd) spray; selective serotonin reuptake inhibitors (SSRIs) - citalopram (Cipramil(®), Lundbeck), escitalopram (Cipralex(®), Lundbeck), fluoxetine, paroxetine, sertraline, dapoxetine (Priligy(®), Menarini), 30 mg or 60 mg; serotonin-noradrenaline reuptake inhibitors - duloxetine (Cymbalta(®), Eli Lilly & Co Ltd); tricyclic antidepressants - inhaled clomipramine 4 mg; phosphodiesterase-5 (PDE5) inhibitors - vardenafil (Levitra(®), Bayer), tadalafil (Cialis(®), Eli Lilly & Co Ltd); opioid analgesics - tramadol (Zydol SR(®), Grünenthal). Improvements in sexual satisfaction and other outcomes compared with placebo were evident for SSRIs, PDE5 inhibitors and tramadol. Outcomes for interventions not compared with placebo were as follows: behavioural therapies - improvements over wait list control in IELT and other outcomes, behavioural therapy plus pharmacotherapy better than either therapy alone; alpha blockers - terazosin (Hytrin(®), AMCO) not significantly different to antidepressants in ejaculation control; acupuncture - improvements over sham acupuncture in IELT, conflicting results for comparisons with SSRIs; Chinese medicine - improvements over treatment as usual; delay device - improvements in IELT when added to stop-start technique; yoga - improved IELT over baseline, fluoxetine better than yoga. Treatment-related AEs were evident with most pharmacological interventions. LIMITATIONS Although data extraction from reviews was optimised when more than one review reported data for the same RCT, the reliability of the data extraction within these reviews cannot be guaranteed by this assessment report. CONCLUSIONS Several interventions significantly improved IELT. Many interventions also improved sexual satisfaction and other outcomes. However, assessment of longer-term safety and effectiveness is required to evaluate whether or not initial treatment effects are maintained long term, whether or not dose escalation is required, how soon treatment effects end following treatment cessation and whether or not treatments can be stopped and resumed at a later time. In addition, assessment of the AEs associated with long-term treatment and whether or not different doses have differing AE profiles is required. STUDY REGISTRATION This study is registered as PROSPERO CRD42013005289. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Katy Cooper
- School of Health and Related Research (ScHARR) Technology Assessment Group, The University of Sheffield, Sheffield, UK
| | - Marrissa Martyn-St James
- School of Health and Related Research (ScHARR) Technology Assessment Group, The University of Sheffield, Sheffield, UK
| | - Eva Kaltenthaler
- School of Health and Related Research (ScHARR) Technology Assessment Group, The University of Sheffield, Sheffield, UK
| | - Kath Dickinson
- School of Health and Related Research (ScHARR) Technology Assessment Group, The University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR) Technology Assessment Group, The University of Sheffield, Sheffield, UK
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Martyn-St James M, Cooper K, Ren K, Kaltenthaler E, Dickinson K, Cantrell A, Wylie K, Frodsham L, Hood C. Topical anaesthetics for premature ejaculation: a systematic review and meta-analysis. Sex Health 2016; 13:114-23. [DOI: 10.1071/sh15042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 10/09/2015] [Indexed: 11/23/2022]
Abstract
Eutectic Mixture of Local Anaesthetics (EMLA) is recommended for use off-label as a treatment for premature ejaculation (PE). Other topical anaesthetics are available, some of which have been evaluated against oral treatments. The purpose of this systematic review was to evaluate the evidence from randomised controlled trials (RCTs) for topical anaesthetics in the management of PE. Bibliographic databases including MEDLINE were searched to August 2014. The primary outcome was intra-vaginal ejaculatory latency time (IELT). Methodological quality of RCTs was assessed. IELT and other outcomes were pooled across RCTs in a meta-analysis. Between-trial heterogeneity was assessed. Nine RCTs were included. Seven were of unclear methodological quality. Pooled evidence (two RCTs, 43 participants) suggests that EMLA is significantly more effective than placebo at increasing IELT (P < 0.00001). Individual RCT evidence also suggests that Topical Eutectic-like Mixture for Premature Ejaculation (TEMPE) spray and lidocaine gel are both significantly more effective than placebo (P = 0.003; P < 0.00001); and lidocaine gel is significantly more effective than sildenafil or paroxetine (P = 0.01; P = 0.0001). TEMPE spray is associated with significantly more adverse events than placebo (P = 0.003). More systemic adverse events are reported with tramadol, sildenafil and paroxetine than with lidocaine gel. Diverse methods of assessing sexual satisfaction and ejaculatory control with topical anaesthetics are reported and evidence is conflicting. Topical anaesthetics appear more effective than placebo, paroxetine and sildenafil at increasing IELT in men with PE. However, the methodological quality of the existing RCT evidence base is uncertain.
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Cormio L, Massenio P, La Rocca R, Verze P, Mirone V, Carrieri G. The Combination of Dapoxetine and Behavioral Treatment Provides Better Results than Dapoxetine Alone in the Management of Patients with Lifelong Premature Ejaculation. J Sex Med 2015; 12:1609-15. [PMID: 26077706 DOI: 10.1111/jsm.12925] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It is not known whether the efficacy of dapoxetine, the only drug approved for the on-demand treatment of premature ejaculation (PE), can be increased by the addition of sexual behavioral treatment (SBTx). AIM To test the hypothesis that combined dapoxetine and SBTx provide better result than dapoxetine alone in the management of patient with lifelong PE. METHODS After a 4-week run-in period, 50 patients with lifelong PE entered a 24-week, open-label, prospective study with a 1:1 assignment. Twenty-five patients (group A) received on-demand dapoxetine 30 mg alone, and the remaining 25 patients (group B) combined on-demand dapoxetine 30 mg and SBTx. The CONSORT 2010 statement was adhered to where possible. MAIN OUTCOME MEASURES The intravaginal ejaculatory latency time (IELT), the premature ejaculation diagnostic tool (PEDT) score, and the treatment-emergent adverse events (TEAEs) were analyzed. RESULTS Mean age was 34.16 years in group A and 34.44y in group B. From baseline to 4-, 12- and 24-week evaluation, both groups experienced a significant (P < 0.0001) increase in mean IELT and decrease in mean PEDT score, but patients in group A showed a significantly lower increase in mean IELT (85.0; 84.8; 130.7; 160.0 vs. 92.0; 137.9; 232.7; 370.7 seconds, respectively; P < 0.0001) and a significantly lower decrease in mean PEDT score (20.4; 18.16; 15.88; 14.68 vs. 19.56; 16.0; 11.96; 7.92, respectively; P < 0.0001) than those in group B. At 24-week evaluation, no patient in group A reached a PEDT score ≤8 (absence of PE) as opposed to 80% of patients in group B. There was no difference between groups in TEAEs rate (16% vs. 16%; P = 1.00). Limitations included the absence of a group receiving SBTx alone or group crossover. CONCLUSIONS Combined dapoxetine and SBTx proved to be more effective than dapoxetine alone in treating patients with lifelong PE, up to restoring a normal ejaculatory function in most of them.
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Affiliation(s)
- Luigi Cormio
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Paolo Massenio
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Roberto La Rocca
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Paolo Verze
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
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Mantovani F, Patelli E, Antolini C. Terapia Farmaco-riabilitativa Dinamica e Comportamentale Dell'eiaculazione Precoce: Risultati di uno Studio Prospettico Randomizzato. Urologia 2015. [DOI: 10.1177/039156031508200102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJ, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, Torres LO. An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). Sex Med 2014; 2:60-90. [PMID: 25356302 PMCID: PMC4184677 DOI: 10.1002/sm2.28] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts. AIM The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. METHOD A comprehensive literature review was performed. RESULTS This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. CONCLUSION Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60-90.
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Affiliation(s)
- Stanley E Althof
- Department of Psychiatry, Case Western Reserve University School of Medicine West Palm Beach, FL, USA
| | | | - Marcel D Waldinger
- Division of Pharmacology, Department of Pharmaceutical Sciences, Utrecht University Utrecht, The Netherlands
| | - Ege Can Serefoglu
- Department of Urology, Bagcilar Training & Research Hospital Istanbul, Merkez Mah, Turkey
| | - Alan W Shindel
- Department of Urology, University of California at Davis CA, USA
| | - P Ganesan Adaikan
- Department of Obstetrics and Gynecology, National University of Singapore Singapore, Singapore
| | - Edgardo Becher
- Division of Urology, University of Buenos Aires Buenos Aires, Argentina
| | - John Dean
- St. Peter's Sexual Medicine, The London Clinic London, UK
| | - Francois Giuliano
- Neuro-Uro-Andrology, Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital Garches, France
| | - Wayne Jg Hellstrom
- Department of Urology, Tulane University Health Sciences Center New Orleans, LA, USA
| | - Annamaria Giraldi
- Department of Sexological Research, Psychiatric Center Copenhagen, Rigshospitalet Copenhagen, Denmark
| | - Sidney Glina
- Department of Urology, Instituto H. Ellis Sao Paulo, Brazil
| | - Luca Incrocci
- Erasmus MC-Daniel den Hoed Cancer Center Rotterdam, The Netherlands
| | - Emmanuele Jannini
- School of Sexology, Department of Clinical, Applied and Biotechnological Sciences, University of L'Aquila L'Aquila, Italy
| | - Marita McCabe
- School of Psychology, Deakin University Burwood, Vic., Australia
| | - Sharon Parish
- Albert Einstein College of Medicine, Department of Medicine, Montefiore Medical Center Bronx, NY, USA
| | - David Rowland
- Graduate School, Valparaiso University Valparaiso, IN, USA
| | - R Taylor Segraves
- Department of Psychiatry, Case Western Reserve University School of Medicine Cleveland, OH, USA
| | - Ira Sharlip
- Department of Urology, University of California San Francisco, CA, USA
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Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med 2014; 11:1392-422. [PMID: 24848686 DOI: 10.1111/jsm.12504] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts. AIM The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. METHOD A comprehensive literature review was performed. RESULTS This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. CONCLUSION Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years.
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Affiliation(s)
- Stanley E Althof
- Department of Psychiatry, Case Western Reserve University School of Medicine, West Palm Beach, FL, USA
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Steggall MJ, Pryce A. Loose nerves and weak blood: a thematic analysis of premature ejaculation in Bangladeshi Muslim men. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2014. [DOI: 10.1111/ijun.12018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Porto R, Giuliano F. L’éjaculation prématurée. Prog Urol 2013; 23:647-56. [DOI: 10.1016/j.purol.2013.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/12/2013] [Accepted: 01/14/2013] [Indexed: 01/23/2023]
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Mohammadi SD, Mohammadkhani P, Dolatshahi B, Dadkhah A. Effectiveness of cognitive behavioral therapy on the signs, symptoms and clinical consequences of premature ejaculation. JAPANESE PSYCHOLOGICAL RESEARCH 2013. [DOI: 10.1111/jpr.12020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Asghar Dadkhah
- University of Social Welfare and Rehabilitation Sciences
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Berry MD. Historical revolutions in sex therapy: a critical examination of men's sexual dysfunctions and their treatment. JOURNAL OF SEX & MARITAL THERAPY 2013; 39:21-39. [PMID: 23152967 DOI: 10.1080/0092623x.2011.611218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
History, recent and ancient, presents innumerable methods intended to ensure or restore male sexual performance. Although these methods have regularly claimed to be "revolutionary," they have often been remarkably similar, and of questionably efficacy. This article provides a critical account of key historical trends in the treatment of male sexual dysfunctions in order to contextualize and critique the current treatment field. The author uses historical analysis to contextualize contemporary sex therapy techniques, arguing that even clinically verified contemporary revolutions, such as the advent of Viagra and similar drugs, may not present broadly efficacious standalone cures. Using critical historical analysis to illustrate the limitations of single-method treatments, the article argues for the value of comprehensive, biopsychosocial therapy methods. A common tendency--to seek a 'magic bullet' solution to sexual dysfunctions--is apparent throughout history, the author argues. While Viagra differs biomedically from historical treatments, it may appeal to the same logic, raising the question of whether it constitutes a truly revolutionary development in treatment. The article concludes with a set of recommendations regarding the implementation of biopsychosocial practice in sex therapy.
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Affiliation(s)
- Michael D Berry
- Department of Psychology, University College London, London, England.
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14
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New insights on premature ejaculation: a review of definition, classification, prevalence and treatment. Asian J Androl 2012; 14:822-9. [PMID: 23064688 DOI: 10.1038/aja.2012.108] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
There are ongoing debates about the definition, classification and prevalence of premature ejaculation (PE). The first evidence-based definition of PE was limited to heterosexual men with lifelong PE who engage in vaginal intercourse. Unfortunately, many patients with the complaint of PE do not meet these criteria. However, these men can be diagnosed as one of the PE subtypes, namely acquired PE, natural variable PE or premature-like ejaculatory dysfunction. Nevertheless, the validity of these subtypes has not yet been supported by evidence. The absence of a universally accepted PE definition and lack of standards for data acquisition have resulted in prevalence studies that have reported conflicting rates. The very high prevalence of 20%-30% is probably due to the vague terminology used in the definitions at the time when such surveys were conducted. Although many men may complain of PE when questioned for a population-based prevalence study, only a few of them will actively seek treatment for their complaint, even though most of these patients would define symptoms congruent with PE. The complaints of acquired PE patients may be more severe, whereas complaints of patients experiencing premature-like ejaculatory dysfunction seem to be least severe among men with various forms of PE. Although numerous treatment modalities have been proposed for management of PE, only antidepressants and topical anaesthetic creams have currently been proven to be effective. However, as none of the treatment modalities have been approved by the regulatory agencies, further studies must be carried to develop a beneficial treatment strategy for PE.
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Graziottin A, Althof S. What does premature ejaculation mean to the man, the woman, and the couple? J Sex Med 2012; 8 Suppl 4:304-9. [PMID: 21967392 DOI: 10.1111/j.1743-6109.2011.02426.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The relational impact of male and female sexual dysfunction, and specifically premature ejaculation (PE), is an important consideration. Published findings are consistent in identifying the negative psychosocial impact of PE on the man. However, the effect of PE on the female partner, especially in relation to her sexual functioning, has been less well studied. AIM Provide an overview of the impact of PE on the man, the woman, and the couple. METHODS Review of relevant literature. RESULTS Female partners of men with PE report significantly greater sexual problems, with reduced satisfaction, increased distress and interpersonal difficulty, and more orgasmic problems than partners of non-PE men. Both men with PE and their partners feel control over ejaculation is the central issue in PE. For both, the lack of control leads to dissatisfaction, a feeling that something is missing from the relationship, and an impaired sense of intimacy. If left untreated, the situation can lead to increased irritability, interpersonal difficulties, and deepening of an emotional divide. CONCLUSIONS When treating a man with PE, the partner's participation should be encouraged to enable the physician to fully understand the extent of the problem, and consider other relevant factors, from her perspective. Identifying the best approach for the couple requires consultation with each person individually and together. In clinical practice, treatments for PE are likely to include a combination of pharmacological, psychological, sexological, and/or behavioral approaches for both the man and his partner. It is important that physicians regard PE as the couple's problem and endeavor to include the partner in its management where possible.
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Steggall M. Premature ejaculation: definition, assessment and clinical management. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2010. [DOI: 10.1111/j.1749-771x.2010.01101.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Althof SE, Abdo CH, Dean J, Hackett G, McCabe M, McMahon CG, Rosen RC, Sadovsky R, Waldinger M, Becher E, Broderick GA, Buvat J, Goldstein I, El-Meliegy AI, Giuliano F, Hellstrom WJ, Incrocci L, Jannini EA, Park K, Parish S, Porst H, Rowland D, Segraves R, Sharlip I, Simonelli C, Tan HM. International Society for Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation. J Sex Med 2010; 7:2947-69. [DOI: 10.1111/j.1743-6109.2010.01975.x] [Citation(s) in RCA: 248] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Steggall MJ. Premature ejaculation: definition, assessment and management. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/tre.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Porst H, McMahon CG, Althof SE, Sharlip I, Bull S, Aquilina JW, Tesfaye F, Rivas DA. Baseline characteristics and treatment outcomes for men with acquired or lifelong premature ejaculation with mild or no erectile dysfunction: integrated analyses of two phase 3 dapoxetine trials. J Sex Med 2010; 7:2231-2242. [PMID: 20412423 DOI: 10.1111/j.1743-6109.2010.01820.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Premature ejaculation (PE) is classified as an acquired or lifelong condition but data on baseline characteristics and response to treatment of men with acquired or lifelong PE and mild erectile dysfunction (ED) or normal erectile function (EF) is limited. AIM To present integrated analyses of baseline characteristics and treatment outcomes from phase 3 dapoxetine trials in men with acquired or lifelong PE and mild or no ED. METHODS Data were analyzed from two randomized, double-blind, placebo-controlled, phase 3 clinical trials (International and Asia-Pacific) that evaluated efficacy and safety of dapoxetine (30 mg or 60 mg as needed [PRN]) in patients with PE. Men were ≥18 years, in a stable monogamous relationship for ≥6 months, met DSM-IV-TR criteria for PE for ≥6 months, had an International Index of Erectile Function EF domain score ≥21, and had an intravaginal ejaculatory latency time (IELT) ≤2 minutes in ≥75% of intercourse episodes. MAIN OUTCOME MEASURES Demographics, sexual history, and PE symptomatology at baseline, and mean IELT and patient-reported outcomes (PROs) at study end (week 12), were analyzed for men with acquired or lifelong PE and mild or no ED (EF score 21-25 vs. ≥26). RESULTS Baseline characteristics except duration of PE were similar in men with acquired and lifelong PE, with no other differentiating features by ED status. Dapoxetine treatment improved significantly mean IELT (arithmetic and geometric) and PRO responses (perceived control over ejaculation, satisfaction with sexual intercourse, ejaculation-related personal distress, and interpersonal difficulty) for acquired and lifelong subtypes, but presence of mild ED diminished PRO responsiveness in both subtypes, particularly those with lifelong PE. CONCLUSIONS Baseline characteristics and treatment outcomes were generally similar in men with acquired and lifelong PE. The presence of mild ED appears to be associated with a more modest treatment response, irrespective of lifelong or acquired PE subtype.
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Affiliation(s)
- Hartmut Porst
- Private Urology and Andrology Practice and Hospital, Hamburg, Germany.
| | - Chris G McMahon
- Australian Centre for Sexual Health, St. Leonards, Sydney, NSW, Australia
| | - Stanley E Althof
- Case Western Reserve University School of Medicine, Center for Marital and Sexual Health of South Florida, West Palm Beach, FL, USA
| | - Ira Sharlip
- University of California, San Francisco, CA, USA
| | - Scott Bull
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ, USA
| | - Joseph W Aquilina
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ, USA
| | - Fisseha Tesfaye
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ, USA
| | - David A Rivas
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ, USA
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Abstract
INTRODUCTION "Is there anything new in sex therapy?" Has the field of sex therapy been stagnating and failing to develop new treatments? Clearly, the important pharmaceutical advances of the past 11 years have overshadowed the developments in the field of sex therapy. AIM The goal of this manuscript is to call attention to the recent innovations in the field of sex therapy. METHOD Review of the literature. RESULTS There are four candidates to consider: (i) combination medical and psychological therapy; (ii) the technique of mindfulness for women with complaints of arousal disorder and low sexual desire; (iii) Internet sexual therapy and; and (iv) reconceptualization of genital pain and psychological interventions for women with these complaints. This article reviews the literature in these areas and offers commentary regarding the benefits and limitations of the research. Finally, future directions for research in these four areas are discussed. CONCLUSIONS Psychological innovation and intervention remains a vital aspect in the field of sexual medicine. New methods continue to be developed and appraised and the methodology, design, and sophistication of sex therapy outcome research have significantly advanced.
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Affiliation(s)
- Stanley E Althof
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL 33401, USA.
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