1
|
Leisegang K, Opuwari CS, Moichela F, Finelli R. Traditional, Complementary and Alternative Medicines in the Treatment of Ejaculatory Disorders: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1607. [PMID: 37763726 PMCID: PMC10535559 DOI: 10.3390/medicina59091607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Ejaculatory dysfunction (EjD) is a common male sexual disorder that includes premature ejaculation, delayed ejaculation, retrograde ejaculation, and anejaculation. Although psychological and pharmacological treatments are available, traditional, complementary, and alternative medicine (TCAM) is reportedly used. However, the clinical evidence for TCAM in EjD remains unclear. Therefore, this study aims to systematically review human clinical trials investigating the use of TCAM to treat EjD. Materials and Methods: A systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted by searching Scopus and PubMed databases. Controlled clinical trials investigating a cohort of male patients diagnosed primarily with EjD and undergoing any TCAM intervention compared to any comparison group were included. Quality of the studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials. Results: Following article screening, 22 articles were included. Of these, 21 investigated TCAM in premature ejaculation, and only 1 investigated TCAM in retrograde ejaculation. Different TCAM categories included studies that investigated lifestyle, exercise and/or physical activities (n = 7); herbal medicine supplements (n = 5); topical herbal applications (n = 4); acupuncture or electroacupuncture (n = 3); vitamin, mineral and/or nutraceutical supplements (n = 1); hyaluronic acid penile injection (n = 1); and music therapy (n = 1). Only 31.8% (n = 7) of the included studies were found to have a low risk of bias. The available studies were widely heterogenous in the TCAM intervention investigated and comparison groups used. However, the included studies generally showed improved outcomes intra-group and when compared to placebo. Conclusions: Different TCAM interventions may have an important role particularly in the management of PE. However, more studies using standardized interventions are needed.
Collapse
Affiliation(s)
- Kristian Leisegang
- School of Natural Medicine, University of the Western Cape, Bellville 7535, South Africa;
| | - Chinyerum Sylvia Opuwari
- Department of Medical Biosciences, University of the Western Cape, Bellville 7535, South Africa; (C.S.O.); (F.M.)
| | - Faith Moichela
- Department of Medical Biosciences, University of the Western Cape, Bellville 7535, South Africa; (C.S.O.); (F.M.)
| | | |
Collapse
|
2
|
Zhang H, Colonnello E, Sansone A, Wang F, Guo J, Wang C, Zhang Y, Jannini EA. Acupuncture for premature ejaculation: a systematic review and meta-analysis. Sex Med 2023; 11:qfad034. [PMID: 37397031 PMCID: PMC10308367 DOI: 10.1093/sexmed/qfad034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Background Although acupuncture is widely used to treat premature ejaculation (PE), its effectiveness remains highly controversial. Aim To evaluate the efficacy and safety of acupuncture on PE. Methods According to the relevant keywords, 11 major English and Chinese databases were searched for randomized controlled trials (RCTs) of acupuncture alone or in combination with other treatments for PE. The quality of evidence across studies was assessed by the GRADEpro tool. Outcomes Study outcome measures included the intravaginal ejaculation latency time (IELT), the Premature Ejaculation Diagnostic Tool (PEDT), the Chinese Index of Premature Ejaculation-5 (CIPE-5), treatment success rate, and adverse events. Results Seven trials were included in this review for a total of 603 participants. A low quality of evidence suggests that it is not possible to determine whether acupuncture, as compared with a selective serotonin reuptake inhibitor, has an advantage in improving the IELT (standardized mean difference [SMD], -1.75; 95% CI, -6.12 to 2.63; P = .43, I2 = 98%), PEDT scores (SMD, 0.32; 95% CI, -0.68 to 1.32; P = .53, I2 = 85%), and treatment success rate (risk ratio, 0.69; 95% CI, 0.41-1.14; P = .15). However, participants receiving acupuncture had a lower CIPE-5 (SMD, -1.06; 95% CI, -1.68 to -0.44; P < .01). As compared with sham acupuncture, acupuncture significantly improved the IELT (SMD, 1.47; 95% CI, 1.01-1.92; P < .01, I2 = 0%) and PEDT scores (SMD, -1.23; 95% CI, -1.78 to -0.67; P < .01, I2 = 37%). When compared with other treatments alone, a combined treatment with acupuncture can significantly improve the IELT (SMD, 7.06; 95% CI, 2.53-11.59; P < .01, I2 = 97%), CIPE-5 (SMD, 0.84; 95% CI, 0.45-1.22; P < .01, I2 = 0%), and treatment success rate (SMD, 1.60; 95% CI, 1.18-2.16; P < .01, I2 = 53). Clinical Implications The results suggest a significant effect of acupuncture in the treatment of certain important indicators of PE; however, this finding needs to be treated with caution because of the quality of the RCTs included. Strengths and Limitations Comprehensive inclusion of available RCTs has been performed. However, limitations include a low number of studies and a lack of detailed information to allow subgroup analysis. Conclusion The present systematic review and meta-analysis show that acupuncture has a significant effect on several subjective PE parameters, such as improving the feeling of control over ejaculation and distress, particularly when used in an integrated way. However, due to the low quality of evidence, acupuncture still needs larger well-designed RCTs to be confirmed.
Collapse
Affiliation(s)
- Hui Zhang
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Elena Colonnello
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome 00133, Italy
- Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome 00133, Italy
| | - Andrea Sansone
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Fu Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Jun Guo
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Chunling Wang
- Department of Infertility and Sexual Medicine, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yan Zhang
- Department of Infertility and Sexual Medicine, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Emmanuele A Jannini
- Corresponding author: Department of Experimental Medicine, University of Rome Tor Vergata, Italy.
| |
Collapse
|
3
|
Pizzol D, López Sánchez GF, Ilie PC, Bertoldo A, Trott M, Tully MA, Wilson JJ, Veronese N, Soysal P, Carrie A, Ippoliti S, Pratsides L, Shah S, Koyanagi A, Butler L, Barnett Y, Parris C, Lindsay R, Smith L. Non‐pharmacological approaches for treatment of premature ejaculation: a systematic review. TRENDS IN UROLOGY & MEN'S HEALTH 2023. [DOI: 10.1002/tre.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Damiano Pizzol
- Italian Agency for Development Cooperation Khartoum Sudan
| | | | | | | | | | | | | | | | | | - Anne Carrie
- The Queen Elizabeth Hospital Foundation Trust, King's Lynn UK
| | | | | | | | - Ai Koyanagi
- CIBERSAM Barcelona Spain
- ICREA Barcelona Spain
| | | | | | | | | | - Lee Smith
- Anglia Ruskin University Cambridge UK
| |
Collapse
|
4
|
Zhong C, Li C, Geng Q, Han Q, Gao Q, Zhang J, Wang F, Guo J. Reasons and treatment strategy for discontinuation of dapoxetine treatment in premature ejaculation patients in China: A retrospective observational study. Andrologia 2022; 54:1598-1604. [PMID: 35324028 DOI: 10.1111/and.14425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
To assess dapoxetine discontinuation rates and the reasons for discontinuation in Chinese men with premature ejaculation (PE). Information on 906 PE outpatients was obtained from the hospital information system (HIS) in 2019. Of these, 150 patients were chosen. We analysed the dapoxetine discontinuation rate and the reasons for discontinuation over a 12-week follow-up period. The mean age of all patients was 33.6 years (range = 18-55), the mean PE duration was 12.36 ± 9.45 months. The 5-item International Index of Erectile Function (IIEF-5) score was 21.51 ± 3.80. A total of 37.3% of all the patients remained on the treatment until the 12th week. The cumulative discontinuation rates at the 4th, 8th and 12th weeks were 12%, 41.3% and 62.7%, respectively. The discontinuation rates for all the patients in weeks 0-4, weeks 4-8 and weeks 8-12 were 19.1%, 46.8% and 34.0%, respectively. After 4 weeks, the discontinuation rates dropped sharply. The reasons for patients' discontinuation were as follows: overexpectation of efficacy (30.9%), relapsing after drug withdrawal (26.6%), high cost (25.5%), side effects (9.6%), fear of drug addiction (4.3%), failure of follow-up (2.1%) and choosing other treatments (1.1%). The dapoxetine treatment discontinuation rate was very high. The main reasons for discontinuation were overexpectation of efficacy and high cost.
Collapse
Affiliation(s)
- Chongfu Zhong
- Department of Andrology, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chunlei Li
- College of Pharmacy, Linyi University, Linyi, China
| | - Qiang Geng
- Department of Andrology, The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qiang Han
- Department of Andrology, Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University, Beijing, China
| | - Qinghe Gao
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiwei Zhang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Fu Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jun Guo
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
5
|
Sathianathen NJ, Hwang EC, Mian R, Bodie JA, Soubra A, Lyon JA, Sultan S, Dahm P. Selective serotonin re-uptake inhibitors for premature ejaculation in adult men. Cochrane Database Syst Rev 2021; 3:CD012799. [PMID: 33745183 PMCID: PMC8094926 DOI: 10.1002/14651858.cd012799.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Premature ejaculation (PE) is a common problem among men that occurs when ejaculation happens sooner than a man or his partner would like during sex; it may cause unhappiness and relationship problems. Selective serotonin re-uptake inhibitors (SSRIs), which are most commonly used as antidepressants are being used to treat this condition. OBJECTIVES To assess the effects of SSRIs in the treatment of PE in adult men. SEARCH METHODS We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, CINAHL), clinical trial registries, conference proceedings, and other sources of grey literature, up to 1 May 2020. We applied no restrictions on publication language or status. SELECTION CRITERIA We included only randomized controlled clinical trials (parallel group and cross-over trials) in which men with PE were administered SSRIs or placebo. We also considered 'no treatment' to be an eligible comparator but did not find any relevant studies. DATA COLLECTION AND ANALYSIS Two review authors independently classified and abstracted data from the included studies. Primary outcomes were participant-perceived change with treatment, satisfaction with intercourse and study withdrawal due to adverse events. Secondary outcomes included self-perceived control over ejaculation, participant distress about PE, adverse events and intravaginal ejaculatory latency time (IELT). We performed statistical analyses using a random-effects model. We rated the certainty of evidence according to GRADE. MAIN RESULTS We identified 31 studies in which 8254 participants were randomized to receiving either SSRIs or placebo. Primary outcomes: SSRI treatment probably improves self-perceived PE symptoms (defined as a rating of 'better' or 'much better') compared to placebo (risk ratio (RR) 1.92, 95% confidence interval (CI) 1.66 to 2.23; moderate-certainty evidence). Based on 220 participants per 1000 reporting improvement with placebo, this corresponds to 202 more men per 1000 (95% CI 145 more to 270 more) with improved symptoms with SSRIs. SSRI treatment probably improves satisfaction with intercourse compared to placebo (defined as a rating of 'good' or 'very good'; RR 1.63, 95% CI 1.42 to 1.87; moderate-certainty evidence). Based on 278 participants per 1000 reporting improved satisfaction with placebo, this corresponds to 175 more (117 more to 242 more) per 1000 men with greater satisfaction with intercourse with SSRIs. SSRI treatment may increase treatment cessations due to adverse events compared to placebo (RR 3.80, 95% CI 2.61 to 5.51; low-certainty evidence). Based 11 study withdrawals per 1000 participants with placebo, this corresponds to 30 more men per 1000 (95% CI 17 more to 49 more) ceasing treatment due to adverse events with SSRIs. Secondary outcomes: SSRI treatment likely improve participants' self-perceived control over ejaculation (defined as rating of 'good' or 'very good') compared to placebo (RR 2.29, 95% CI 1.72 to 3.05; moderate-certainty evidence). Assuming 132 per 1000 participants perceived at least good control, this corresponds to 170 more (95 more to 270 more) reporting at least good control with SSRIs. SSRI probably lessens distress (defined as rating of 'a little bit' or 'not at all') about PE (RR 1.54, 95% CI 1.26 to 1.88; moderate-certainty evidence). Based on 353 per 1000 participants reporting low levels of distress, this corresponds to 191 more men (92 more to 311 more) per 1000 reporting low levels of distress with SSRIs. SSRI treatment probably increases adverse events compared to placebo (RR 1.71, 95% CI 1.48 to 1.99; moderate-certainty evidence). Based on 243 adverse events per 1000 among men receiving placebo, this corresponds to 173 more (117 more to 241 more) men having an adverse event with SSRIs. SSRI treatment may increase IELT compared to placebo (mean difference (MD) 3.09 minutes longer, 95% CI 1.94 longer to 4.25 longer; low-certainty evidence). AUTHORS' 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. Undesirable effects are a small increase in treatment withdrawals due to adverse events as well as substantially increased adverse event rates. Issues affecting the certainty of evidence of outcomes were study limitations and imprecision.
Collapse
Affiliation(s)
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea, South
| | - Ruma Mian
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joshua A Bodie
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ayman Soubra
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Jennifer A Lyon
- Library Services, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Shahnaz Sultan
- Gastroenterology Section III-D, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| |
Collapse
|
6
|
Liu H, Zhang M, Huang M, Cai H, Zhang Y, Liu G, Deng C. Comparative efficacy and safety of drug treatment for premature ejaculation: A systemic review and Bayesian network meta-analysis. Andrologia 2020; 52:e13806. [PMID: 32892379 DOI: 10.1111/and.13806] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/17/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022] Open
Abstract
To assess the comparative efficacy and safety of drug treatments for premature ejaculation. A systemic review and Bayesian network meta-analysis were executed on randomised controlled trials of drug interventions for premature ejaculation. Intravaginal ejaculation latency time and related adverse effects were outcome measures. A total of 44 RCTs with 11,008 patients were included in our NMA. In therapy <8 weeks, the ranking of drug efficacy was topical creams >selective serotonin reuptake inhibitor (SSRI)+ phosphodiesterase 5 inhibitor (PDE5i) > PDE5i > sertraline > clomipramine > paroxetine > dapoxetine 60 milligram (mg) > dapoxetine 30 mg > fluoxetine>citalopram > duloxetine>placebo. In therapy ≥ 8 weeks, the ranking of drug efficacy was SSRI + PDE5i > topical creams > paroxetine > tramadol > PDE5i > fluoxetine > dapoxetine 60 mg > dapoxetine 30 mg > clomipramine>citalopram > placebo. For total adverse events, clomipramine, dapoxetine 30 mg, dapoxetine 60 mg, paroxetine, PDE5i, SSRI + PDE5i and tramadol had a higher risk than placebo. In conclusion, in ≥8 weeks of therapy, the drug combination of SSRI + PDE5i was the most effective PE therapy. In <8 weeks of therapy, the efficacy of local anaesthetics was best. All drug treatments were ranked better than placebo. In general, drugs with better effects had more obvious side effects.
Collapse
Affiliation(s)
- Hanchao Liu
- Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingxiao Zhang
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingchuan Huang
- Department of Transplantation, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hongcai Cai
- Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yadong Zhang
- Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guihua Liu
- Reproductive Medicine Center, the Sixth Affiliate Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chunhua Deng
- Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
7
|
Abstract
OBJECTIVE Premature ejaculation (PE) is regarded as one of the most common male sexual dysfunctions. This review introduced several pharmaceutical and surgical methods for the management of PE. The definition, etiology, behavioral, and psychological therapy of PE were also discussed. DATA SOURCES "Premature," "ejaculation," or "sexual dysfuction" were used as the medical subject headings (MeSH) to obtain relevant articles before June 2019 on Pubmed, Google Scholar and CNKI. Most articles used were written in English and several Chinese articles were also cited. STUDY SELECTION Full-text articles of retrospective/prospective/randomized controlled trials were analyzed. Animal experiments and letters were excluded. RESULTS There are four PE sub-types: lifelong PE, acquired PE, natural variable PE, and subjective PE. Behavioral therapy, psychotherapy, medication, topical anesthetics, and surgery are currently used for the treatment of PE. However, all the above treatments have limitations. Therefore, novel ways should be investigated to more efficiently control PE. CONCLUSIONS The pharmaceutical therapy that is currently being used in clinical practice for the management of PE is still the main choice globally due to its good efficacy. Surgery may be a choice for patients who are resistant to medication. However, it should be performed cautiously.
Collapse
|
8
|
Sun S, Mo X, Li Y, Gong Z, Wang J, Yu X, Han L, Zhou H. Effectiveness comparisons of Chinese patent medicine on treating premature ejaculation: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17729. [PMID: 31689816 PMCID: PMC6946358 DOI: 10.1097/md.0000000000017729] [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: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Premature ejaculation (PE) is a form of male sexual dysfunction. As people's lifestyle changes and the population ages, the incidence of PE continues to increase. Chinese patent medicines have been widely used in clinical practice as derivatives of traditional Chinese medicine (TCM). Many clinical trials have proven that Chinese patent medicine has a significant effect in the treatment of PE. In this systematic review, we aim to evaluate the effectiveness and safety of Chinese patent medicine for PE. METHODS We will search for PubMed, Cochrane Library, AMED, Embase, WorldSciNet, Nature, Science online and China Journal Full-text Database, China Biomedical Literature CD-ROM Database, and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to September 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the RevMan 5.3 and Stata 13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of PE. ETHICS AND DISSEMINATION This systematic review will evaluate the efficacy and safety of TCM for treating PE. Because all of the data used in this systematic review and meta-analysis have 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 CRD42017065316.
Collapse
Affiliation(s)
- Song Sun
- Department of Surgery, Beijing Changping Hospital of Traditional Chinese Medicine
| | - Xuwei Mo
- Department of Andrology, Dongzhimen Hospital, Beijing
| | - Yufeng Li
- Department of Surgery, Beijing Changping Hospital of Traditional Chinese Medicine
| | - Ziqi Gong
- Department of Surgery, Beijing Changping Hospital of Traditional Chinese Medicine
| | - Jisheng Wang
- Department of Andrology, Dongzhimen Hospital, Beijing
| | - Xudong Yu
- Department of Andrology, Dongzhimen Hospital, Beijing
| | - Liang Han
- Department of Andrology, Fangshan Hospital, Beijing University of Chinese Medicine, Chinan, China
| | - Hong Zhou
- Department of Surgery, Beijing Changping Hospital of Traditional Chinese Medicine
| |
Collapse
|
9
|
Martin-Tuite P, Shindel AW. Management Options for Premature Ejaculation and Delayed Ejaculation in Men. Sex Med Rev 2019; 8:473-485. [PMID: 31668585 DOI: 10.1016/j.sxmr.2019.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/06/2019] [Accepted: 09/21/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Many men experience distressing issues regarding the timing of orgasm and ejaculation, such as premature ejaculation (PE) and delayed ejaculation (DE). Despite being highly prevalent, both PE and DE are poorly understood and present a management challenge for sexual medicine specialists. AIM To summarize existing data on the medical management of PE and DE. METHODS A comprehensive literature review pertaining to the management of PE and DE was conducted using PubMed and clinicaltrials.gov for data published up until May 2019. Our focus was on double-blind, placebo-controlled trials and meta-analyses of such studies. MAIN OUTCOME MEASURE Peer-reviewed studies on treatment options for PE and DE were critically analyzed for results and methodological rigor. RESULTS The peer-reviewed data on PE management continue to evolve. Psychotherapy, pharmacotherapy, and procedural interventions have all been associated with some degree of efficacy. A strong evidence base supports the off-label use of selective serotonin reuptake inhibitors and local anesthetics in PE given consistent increases in ejaculation latency time. Education and mental health assessments remain important components of PE management despite a dearth of peer-reviewed data on these interventions. Numerous treatment strategies have been evaluated for DE; limited data support psychotherapy, pharmacotherapy, and/or penile vibratory stimulation as management options. CONCLUSION A number of management options for PE or DE exist but none has been formally approved by the US Food and Drug Administration. New and novel treatments would be of great value in managing issues regarding the timing of ejaculation/orgasm. Martin-Tuite P, Shindel AW. Management Options for Premature Ejaculation and Delayed Ejaculation in Men. Sex Med Rev 2020; 8:473-485.
Collapse
Affiliation(s)
| | - Alan W Shindel
- Department of Urology, University of California, San Francisco, CA, USA.
| |
Collapse
|
10
|
Zhao L, Tian R, Liang C, Zhang L, Song W, Zhao J, Wang Z, Ji Z, Xia S, Li Z. Beneficial effect of tamsulosin combined with dapoxetine in management of type III prostatitis with premature ejaculation. Andrologia 2019; 51:e13319. [PMID: 31131928 DOI: 10.1111/and.13319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 12/20/2022] Open
Abstract
To evaluate the efficacy and safety of tamsulosin combined with dapoxetine in the treatment of type IIIB chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) that is complicated by premature ejaculation (PE), a total of 251 CP/CPPS patients with PE were recruited from nine hospitals across China and were randomly divided into two groups: one received tamsulosin as a control, and the other received a combination therapy of tamsulosin and dapoxetine. Follow-up was conducted at four time points, and indicators describing CP/CPPS and PE were compared between the two groups. In all, 223 patients were followed up at least once, and 114 patients completed all of the treatment process. The combination group showed more improvement in the symptoms of both PE and CP/CPPS, including thrust number (50.5 vs. 45), premature ejaculation profile score (11.39 vs. 6.96), intravaginal ejaculation latency time (5.95 min vs. 2.63 min) and the National Institutes of Health Chronic Prostatitis Symptom Index (7.44 vs. 11.81) in comparison with the tamsulosin group. In conclusion, for CP/CPPS patients with PE, tamsulosin combined with dapoxetine provided better therapeutic efficacy in the treatment of not only PE symptoms but also CP/CPPS indicators in comparison with tamsulosin monotherapy.
Collapse
Affiliation(s)
- Liangyu Zhao
- Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruhui Tian
- Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaozhao Liang
- Urology Surgery Department of the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liyuan Zhang
- Andrology Department of the First Hospital of Lanzhou University, Lanzhou, China
| | - Wei Song
- Urology Surgery Department of Linyi People's Hospital, Linyi, China
| | - Jun Zhao
- Urology Surgery Department of the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zengjun Wang
- Urology Surgery Department of Jiangsu Province Hospital, Nanjing, China
| | - Zhigang Ji
- Urology Surgery Department of Peking, Union Medical College Hospital, Beijing, China
| | - Shujie Xia
- Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Li
- Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
11
|
Li Y, Duan Y, Yu X, Wang J, Yao Z, Gong X, Gong X, Zheng W, Xue Y, Guo J. Traditional Chinese medicine on treating premature ejaculation: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15379. [PMID: 31045785 PMCID: PMC6504282 DOI: 10.1097/md.0000000000015379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Premature ejaculation is a form of male sexual dysfunction. As people's lifestyle changes and the population ages, the incidence of premature ejaculation continues to increase. Many clinical trials have proven that Chinese medicine has a significant effect in the treatment of premature ejaculation. In this systematic review, we aim to evaluate the effectiveness and safety of Traditional Chinese medicine for premature ejaculation. METHODS 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 April 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of premature ejaculation. ETHICS AND DISSEMINATION This systematic review will evaluate the efficacy and safety of Traditional Chinese medicine for treating 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 CRD42017065316.
Collapse
Affiliation(s)
- Yongqiang Li
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Yunyun Duan
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Xudong Yu
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing
| | - Jisheng Wang
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing
| | - Zeyu Yao
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing
| | - Xihao Gong
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing
| | - Xiaoyong Gong
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Wei Zheng
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Yahui Xue
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Jianen Guo
- Academy of Traditional Chinese Medicine, Chengde Medical University, Heibei, China
| |
Collapse
|
12
|
Safety and efficacy characteristics of oral drugs in patients with premature ejaculation: a Bayesian network meta-analysis of randomized controlled trials. Int J Impot Res 2019; 31:356-368. [DOI: 10.1038/s41443-019-0146-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 03/04/2019] [Accepted: 04/01/2019] [Indexed: 02/08/2023]
|
13
|
Zhao Q, Dai H, Gong X, Wang L, Cao M, Li H, Wang B. Acupuncture for premature ejaculation: Protocol for a systematic review. Medicine (Baltimore) 2018; 97:e11980. [PMID: 30170398 PMCID: PMC6392721 DOI: 10.1097/md.0000000000011980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Premature ejaculation is a common sexual dysfunction disease in adult males. It can be divided into primary and secondary premature ejaculation. Acupuncture is widely used in the treatment of premature ejaculation in China. There are many clinical trials confirmed that acupuncture can prolong the ejaculation latency in the vagina. We aim to use a meta-analysis to evaluate the efficacy and safety of acupuncture for premature ejaculation. METHOD We will systematically search all randomized controlled trials (RCTs) by electronic and manual search, until June 31, 2018. Electronic retrieval of the database includes Medline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, the Cochrane Library, the Chinese BioMedical Literature Database, the China National Knowledge Infrastructure (CNKI), the China Science and Technology Journal database (VIP), and the Wanfang database. Manual search will retrieve gray literature, including unpublished conference articles. The primary outcomes include the Intravaginal Ejaculatory Latency Time (IELT). At the same time, Premature Ejaculation Diagnostic Tool (PEDT), Arabic index of Premature Ejaculation (AIPE), Index of Premature Ejaculation (IPE) will be the secondary outcomes. Two reviewers will independently read the articles, extract the data information, and give the assessment of risk of bias. Data analysis will be used the special software like RevMan (version 5.3) and EndNote X7. ETHICS AND DISSEMINATION This systematic review will evaluate the efficacy and safety of acupuncture for premature ejaculation. This review does not require ethical approval and will be reported in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER PROSPERO CRD42018092783.
Collapse
Affiliation(s)
- Qi Zhao
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital, Beijing, China
| | - Hengheng Dai
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital, Beijing, China
| | - Xihao Gong
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital, Beijing, China
| | - Lu Wang
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital, Beijing, China
| | - Minran Cao
- Graduate School of Beijing University of Chinese Medicine
| | - Haisong Li
- Department of Andrology, Dongzhimen Hospital, Beijing, China
| | - Bin Wang
- Department of Andrology, Dongzhimen Hospital, Beijing, China
| |
Collapse
|
14
|
Traditional Chinese Medicine for Sexual Dysfunction: Review of the Evidence. Sex Med Rev 2018; 6:410-418. [PMID: 29371144 DOI: 10.1016/j.sxmr.2017.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/17/2017] [Accepted: 11/26/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Despite the growing popularity of traditional Chinese medicine (TCM) in the Western world, biomedical students and practitioners struggle to understand TCM and how it relates to their standard diagnosis and treatment practices. AIMS To describe the fundamentals of TCM theory and practice relevant to sexual dysfunction; to review and critique the current state of TCM research within Western biomedical literature; and to identify sites for improvement of future research and for collaborative integration of TCM and biomedicine in practice. METHODS Information about TCM from an insider perspective was obtained from English-language textbooks and lectures intended to teach Western students its theory and practice. PubMed search using Medical Subject Heading terms for Western sexual diagnoses and TCM treatments was performed in April and October 2017 to represent the evidence for TCM in Western biomedical literature. Articles in non-English languages and without human subjects were excluded. MAIN OUTCOME MEASURES 27 studies were included in this review. The most commonly studied intervention was acupuncture. An equal number of studies addressed sexual dysfunction in men and women, but only women were included in studies of physically passive mindfulness meditation. RESULTS Compared with Western biomedicine, TCM offers a more interdisciplinary and individualized approach to disease and its treatment. This embrace of individual idiosyncrasy in diagnosis and treatment presents a challenge to Western biomedical research norms that rely almost exclusively on quantitative methods that compare large and homogeneous groups with a fixed diagnosis and treatment regimen. CONCLUSION TCM offers a very different understanding of the human body, health, and disease from Western biomedicine. There is value in the study and application of these 2 medical systems, particularly for biopsychosocial problems of sexual dysfunction. However, this must be done cautiously, with attention to appropriate study design, to avoid shallow and unscientific cultural appropriation of TCM practices. Chubak B, Doctor A. Traditional Chinese Medicine for Sexual Dysfunction: Review of the Evidence. Sex Med Rev 2018;6:410-418.
Collapse
|
15
|
Discontinuation of Dapoxetine Treatment in Patients With Premature Ejaculation: A 2-Year Prospective Observational Study. Sex Med 2017; 5:e99-e105. [PMID: 28395997 PMCID: PMC5440632 DOI: 10.1016/j.esxm.2017.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 02/13/2017] [Accepted: 02/28/2017] [Indexed: 01/23/2023] Open
Abstract
Introduction Although dapoxetine is the only oral pharmacologic agent approved for the treatment of premature ejaculation (PE) and is very effective, the discontinuation rate is high. Aim To assess the discontinuation rate of patients with PE and the reasons for discontinuation in real-world practice. Methods In total, 182 consecutive patients were enrolled. Type of PE, self-estimated intravaginal ejaculation latency time, and medical history were evaluated in all patients who also completed the erectile function domain of the International Index of Erectile Function (IIEF). Visits were scheduled 1, 3, 6, 12, and 24 months after initiation of therapy; treatment status and the reasons for discontinuation in those who did discontinue were checked. The relations of discontinuation rates were compared with various parameters and the time to discontinuation after treatment commencement. Results Of all patients, 9.9% continued treatment to 2 years. The cumulative discontinuation rates at 1, 3, 6, 12, and 24 months were 26.4%, 61.6%, 79.1%, 87.3%, and 90.1%, respectively. Moreover, 79.1% of all patients discontinued treatment within 6 months. After 12 months, the discontinuation rate decreased sharply. The reasons for discontinuation were cost (29.9%), disappointment that PE was not curable and that dapoxetine was required every time sexual intercourse was contemplated (25%), side effects (11.6%), perceived poor efficacy (9.8%), a search for other treatment options (5.5%), and unknown (18.3%). Patients with acquired PE (vs lifelong PE), with intravaginal ejaculation latency time longer than 2 minutes before treatment, on phosphodiesterase type 5 inhibitors, and with IIEF erectile function scores lower than 26 tended to discontinue early and thus exhibited high dropout rates. Conclusion The treatment discontinuation rate of dapoxetine was very high. The main reasons for discontinuation were the cost and disappointment that treatment was required every time adequate sexual function was required. Park HJ, Park NC, Kim TN, et al. Discontinuation of Dapoxetine Treatment in Patients With Premature Ejaculation: A 2-Year Prospective Observational Study. Sex Med 2017;5:e99–e105.
Collapse
|