Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation: a novel therapeutic approach

Surgical treatment of premature ejaculation: a narrative review

Recurrence after drug cessation is the biggest drawback of medical premature ejaculation (PE) treatments. Although these treatments are demonstrated to be safe and effective, most of the PE patients are interested in a more permanent solution. Despite the fact that currently available guidelines do not recommend surgical treatment for PE, some surgical interventions have been commonly performed for many years, especially in the Asian countries. The main purpose of these surgical treatments is to decrease the sensitivity of the glans penis. However, they are associated with irreversible complications such as penile deformity, sensory loss and erectile dysfunction. The aim of this narrative review is to summarize the advantages and disadvantages of various surgical interventions introduced for the treatment of PE. PubMed, Scopus and Web of Science have been utilized to search articles about glans penis augmentation and penile dorsal nerve interventions. A total of 11 articles were included, three articles excluded because they were in non-English languages. Glans penis augmentation offered a less invasive treatment that avoids severe side effects but requires retreatment in time. Selective dorsal neurectomy provided a more invasive but curative treatment alternative. However, more clinical data are necessary before surgical treatment options can be recommended to patients with PE.

Effects of physical exercise interventions on ejaculation control

INTRODUCTION

Premature ejaculation is a prevalent male sexual dysfunction that causes significant distress for men and their partners on a global scale. Despite its widespread impact, effective treatment options without undesirable side effects remain limited.

OBJECTIVES

The present review aimed to provide an overview of experimental studies that analyzed the effects of physical exercise interventions on premature ejaculation.

METHODS

The inclusion criteria for the review included: Population: Adult men. Intervention: An intervention designed to increase physical exercise was delivered in the study. Comparison: Before versus after intervention with or without a comparison group receiving a drug treatment or an active or no control intervention. Outcomes: Self-reported or clinician-rated premature ejaculation or its symptoms. Study type: Experimental designs. We conducted the search process in 9 databases: APA PsycNET, PubMed, Scopus, SPORTDiscus, JSTOR, ScienceDirect, Web of Science, Embase, and CAB Direct. This review included six intervention studies that included 433 participants (307 men with premature ejaculation) ranging from 18 to 50 years of age. All participants had a stable female sexual partner and had not any other physical or mental problems.

RESULTS

The synthesized results indicated that yoga, running, and high-intensity interval training alleviate premature ejaculation symptoms in men with premature ejaculation after varying intervention duration times. The effectiveness of physical exercise for premature ejaculation symptoms was similar to that of drug treatments.

CONCLUSION

Physical exercise can be one of the potential treatment modalities for premature ejaculation. The intensity of physical exercise and the effort of participants during exercise are key factors affecting improvements in ejaculation control. A potential limitation was that the review did not include any literature written in non-English languages.

A novel on-demand therapy for lifelong premature ejaculation using a miniature transperineal electrical stimulator-the vPatch: an as-treated analysis

BACKGROUND

While premature ejaculation (PE) is a common and disturbing sexual dysfunction in men, current available treatment modalities have limited efficacy and low treatment adherence.

AIM

To assess the feasibility, safety, and efficacy of the vPatch, a miniaturized on-demand perineal transcutaneous electrical stimulation device for treating PE.

METHODS

This prospective bicenter international first-in-human clinical study consisted of 2 arms, was sham controlled, and had a randomized double-blind design. In terms of statistical power calculation, 59 patients aged 21 to 56 years (mean ± SD, 39.8 ± 9.28) with lifelong PE were included. During the initial visit, intravaginal ejaculatory latency time (IELT) was measured over a 2-week run-in period. Eligibility was confirmed in visit 2, based on IELT values, medical and sexual history, and patients' individualized sensory and motor activation thresholds during perineal stimulation with the vPatch. Patients were randomized to the active (vPatch) and sham device groups in a 2:1 ratio, respectively. The vPatch device's safety profile was determined by comparing the incidence of treatment-emergent adverse events. During visit 3, IELTs, Clinical Global Impression of Change scores, and Premature Ejaculation Profile questionnaire outcomes were recorded. Primary end points assessed vPatch device efficacy as mean change in geometric mean IELT; each person was compared with himself, with and without the device, and the sham group was compared with the active group.

OUTCOMES

Outcomes included changes in IELT and Premature Ejaculation Profile before and after treatment, last visit Clinical Global Impression of Change scores, and vPatch safety profile.

RESULTS

Of 59 patients, 51 completed the study: 34 in the active group and 17 in the sham group. The baseline geometric mean IELT significantly increased from 67 to 123 seconds (P < .01) in the active group, as compared with an insignificant increase from 63 to 81 seconds (P = .17) in the sham group. The increase in mean IELT in the active group was significantly higher than in the sham group (56 vs 18 seconds, P = .01). IELT significantly increased by 3.1 times in the active vs sham group. The mean ratio of fold change (active:sham) was 1.4, significantly different from 1.0 (P = .02). No serious adverse events were reported.

CLINICAL IMPLICATIONS

Therapeutic use of the vPatch during coitus may become an on-demand, noninvasive, and drug-free treatment for PE.

STRENGTHS AND LIMITATIONS

To our knowledge, this is the first rigorous study investigating whether transcutaneous electrical stimulation during coitus could improve the symptoms of men with lifelong PE. The study is limited by the small number of patients, the exclusion of patients with acquired PE, the short-term follow up, and the use of a device based on a theoretic mechanism of action.

CONCLUSION

We demonstrated the possibility to treat lifelong PE by prolonging coitus on demand, using electric stimulation of ejaculation muscles with the vPatch.Clinical trial registration: NCT03942367 (ClinicalTrials.gov).

The Men’s Training Cup Keep Training: a masturbation aid improves intravaginal ejaculatory latency time and Erection Hardness Score in patients who are unable to delay ejaculation

Introduction

Premature ejaculation (PE) has negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy. In Japan, no oral drugs or devices are approved or used clinically to treat PE. The Men’s Training Cup Keep Training (MTCK), a masturbation aid, was developed for PE. MTCK offers 5 grades of tightness and strength.

Aim

We aimed to investigate the efficacy of the MTCK in patients who are unable to delay ejaculation.

Methods

Inclusion criteria were 20- to 60-year-old men feeling distressed and frustrated by PE and who had the same sexual partners throughout the study period. Exclusion criteria were neurologic disease and uncontrolled diabetes mellitus, as well as the use of antidepressants, α-blockers, and 5α-reductase inhibitors. The protocol comprised an 8-week training period with the MTCK from level 1 to level 5, with each level used twice before moving to the next level.

Outcome Measures

The main outcome measure was the extension of intravaginal ejaculation latency time (IELT). The secondary outcome measures were score improvements on the Premature Ejaculation Diagnostic Tool, Sexual Health Inventory for Men, Erection Hardness Score, and Difficulty in Performing Sexual Intercourse Questionnaire–5.

Results

We enrolled 37 patients, and after 19 patients withdrew, 18 concluded the study without experiencing any adverse events. The mean patient age was 39.9 years. Geometric IELT after the 8-week training with the MTCK increased significantly (mean ± SE; 232.10 ± 72.16 seconds) vs baseline (103.91 ± 50.61 seconds, P = .006). Mean scores on the Premature Ejaculation Diagnostic Tool, Difficulty in Performing Sexual Intercourse Questionnaire–5, and Erection Hardness Score after 8-week training improved significantly vs the baseline values. The mean score on the Sexual Health Inventory for Men did not improve significantly after the 8-week training, but domain 1 did significantly improve after 8 weeks of MTCK use.

Clinical Implications

The MTCK may be one possible treatment option for patients who are unable to delay ejaculation.

Strengths and Limitations

This is the first study to show that the MTCK is effective for patients who are unable to delay ejaculation. A major limitation is that the present study was not strictly limited to an IELT &lt;3 minutes.

Conclusions

The MTCK may offer benefits not only for delay of ejaculation but also for erectile function.

Current and emerging treatment options for premature ejaculation

Premature ejaculation (PE) is a prevalent male sexual dysfunction. Current standard treatment regimens include behavioural therapies, topical anaesthetics, dapoxetine and other selective serotonin reuptake inhibitors (SSRIs). Most of the pharmacotherapeutic options target neurotransmitters (such as serotonin and oxytocin) that have a role in the ejaculation mechanism. However, these treatments are mildly effective and only provide a temporary delay in the ejaculation latency time, and PE recurs when the treatment is stopped. Thus, a treatment for PE is urgently needed and research is ongoing to find the ideal PE therapy. The efficacy and safety of topical anaesthetics and SSRIs in delaying ejaculation have been confirmed in many well-designed controlled trials. Both preclinical and clinical studies on new-generation SSRIs are ongoing. Moreover, promising results came from clinical trials in which the efficacy of on-demand PE therapies targeting neurotransmitters other than serotonin, such as α1-adrenoceptor antagonists and oxytocin antagonists, was assessed. Surgical intervention and neuromodulation have been proposed as potential treatment options for PE; however, current PE guidelines do not recommend these treatments owing to safety concerns.

Premature ejaculation in the era of mobile health application: A current analysis and evaluation of adherence to EAU guidelines

Introduction: Several mobile health applications (MHAs) have been developed to assist and improve the quality of life of patients affected by premature ejaculation, but the scientific quality and adherence to guidelines are not yet addressed. Materials and methods: On 25 May 2022, we conducted a search in the Apple App Store and Google Play Store. We reviewed all mobile apps from Apple App Store and Google Play Store for premature ejaculation and evaluated their usage in screening, prevention, management, and adherence to EAU guidelines. Results: In total 9 MHA were reviewed. All MHAs are geared towards the patient and provide information about diagnoses and treatment of PE. The mean score were 2.87, 3.69, 2.77, 2.55, 2.86 for Engagement, Functionality, Aesthetics, Information, and Subjective quality respectively. MHAs reported low and medium adherence to EAU guidelines. Conclusions: MHAs provide different services in many medical fields, including male sexual dysfunction. Their development is constantly increasing, but the problems of scientific validation, content, and quality are not yet solved. Much future research is necessary to improve the quality of the apps and promote new user designed, and high-quality apps.

Hypothetical Role of Growth Factors to Reduce Intervertebral Disc Degeneration Significantly through Trained Biological Transformations

BACKGROUND

Given the evidence of little or no therapeutic benefit of injection-based growth factor therapies, it has been proposed that a naturally triggered uninterrupted blood circulation of the growth factors would be superior.

OBJECTIVE

We seek to stimulate discussions and more research about the possibility of using the already available growth factors found in the prostate gland and endometrium by starting novel educable physiology, known as biological transformations controlled by the mind.

METHODS

We summarized the stretch-gated ion channel mechanism of the cell membrane and offer several practical methods that can be applied by anyone, in order to stimulate and enhance the blood circulation of the growth factors from the seminal fluid to sites throughout the body. This study describes, in detail, the practical application of our earlier published studies about biological transformations.

RESULTS

A previously reported single-patient case study has been extended, adding more from his personal experiences to continually improve this novel physiological training and extending the ideas from our earlier findings in detail.

CONCLUSION

The biological transformation findings demonstrate the need for additional research to establish the benefits of these natural therapies to repair and rejuvenate tissues affected by various chronic diseases or aging processes.

The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction: A Narrative Review

INTRODUCTION

Increasing evidence has suggested that pelvic floor exercises and manual physical therapy may improve premature ejaculation (PE) and erectile dysfunction (ED) in males.

OBJECTIVES

To examine the effects of pelvic floor physical therapy treatment in men suffering from PE and ED.

METHODS

We searched Google Scholar, PubMed, Medline, PEDro databases from inception till January 2020 applying the following keywords: pelvic floor, erectile dysfunction, impotence, physiotherapy, exercises, rehabilitation, and pelvic floor muscle exercises.

RESULTS

The review included 37 papers reporting on PE and ED, of which 5 were randomized controlled trials, 2 meta-analyses, and 4 observational studies. Pelvic floor physical therapy treatment included education and rehabilitation. The rehabilitation part encompassed manual therapy techniques that contribute to the normalization of muscle tone and improvement of muscle relaxation. Moreover, exercises, according to the patients' clinical assessment were presented. Most of the studies reported that by strengthening the pelvic floor muscles (PFMs), ED and PE can be improved if manual physical therapy treatments are combined with PFM training.

CONCLUSIONS

A multifaceted approach should be chosen by physical therapists when evaluating and treating ED and PE and contending with both musculoskeletal dysfunction and behavioral contributions. It is recommended that exercises be monitored and situations involving, that is, hyperactivity/increased tone of the PFMs should be avoided. PFM training is simple, safe, and noninvasive; therefore, it should be a preferred approach in the management of ED and PE. This paper presents narrative reviews with a potential bias that systematic reviews or meta-analyses do not have, however, we strove to be all-encompassing and unbiased. There is a demand for high-quality scientific reviews examining the effectiveness of PFM training, manual therapy, and the rationale of pelvic floor physical therapy, in general, in treating individuals with PE and ED.

"The Overactive Pelvic Floor (OPF) and Sexual Dysfunction" Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response

INTRODUCTION

Overactive pelvic floor (OPF) muscles are defined as muscles that do not relax, or may even contract, when relaxation is needed, for example, during micturition or defecation. Conditions associated with OPF are multifactorial and include multiple possible etiologies and symptom complexes. The complex interplay between biological and psychosocial elements can lead to the persistence of OPF symptoms along with psychological and emotional distress.

OBJECTIVES

(1) To review and contextualize, from a pathophysiologic perspective, the evidence for OPF, (2) to provide an overview of common clinical presentations and comorbidities of OPF, and (3) to discuss the effect of OPF on sexual function in men and women.

METHODS

Review of the updated literature on the pathophysiology of OPF was carried out. OPF-associated conditions were overviewed, with special emphasis on the impact on sexual function in men and women.

RESULTS

Individuals with suspected OPF often present with a combination of gastrointestinal, gynecological, musculoskeletal, sexual, and urological comorbidities, mostly accompanied by psychoemotional distress. In both women and men, sexual function is significantly impaired by OPF and genitopelvic pain penetration disorders are often the primary manifestation of this condition. Women with OPF report less sexual desire, arousal, and satisfaction; more difficulty reaching orgasm; lower frequencies of intercourse; more negative attitudes toward sexuality; and more sexual distress than women without sexual pain. The most frequently reported sexual dysfunctions in men with OPF include erectile dysfunction, premature ejaculation, and ejaculatory pain.

CONCLUSION

The complex pathophysiology of OPF involving multisystemic comorbidities and psychosocial factors emphasize the importance of a biopsychosocial assessment for guiding effective and personalized management. Padoa A, McLean L, Morin M, et al. "The Overactive Pelvic Floor (OPF) and Sexual Dysfunction" Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med 2021;9:64-75.

Management Options for Premature Ejaculation and Delayed Ejaculation in Men

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.

Pelvic muscle floor rehabilitation as a therapeutic option in lifelong premature ejaculation: long-term outcomes

The aim of the study was to evaluate the long-term outcomes of pelvic floor muscle (PFM) rehabilitation in males with lifelong premature ejaculation (PE), using intravaginal ejaculatory latency time (IELT) and the self-report Premature Ejaculation Diagnostic Tool (PEDT) as primary outcomes. A total of 154 participants were retrospectively reviewed in this study, with 122 completing the training protocol. At baseline, all participants had an IELT ≤60 s and PEDT score >11. Participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. The effectiveness of intervention was evaluated by comparing the change in the geometric mean of IELT and PEDT values, from baseline, at 3, 6, and 12 months during the intervention, and at 24 and 36 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex, with a mean IELT of 161.6 s and PEDT score of 2.3 at the 12-week endpoint of the intervention, representing an increase from baseline of 40.4 s and 17.0 scores, respectively, for IELT and PEDT (P < 0.0001). Of the 95 participants who completed the 36-month follow-up, 64% and 56% maintained satisfactory ejaculation control at 24 and 36 months postintervention, respectively.

Transcutaneous functional electrical stimulation-a novel therapy for premature ejaculation: results of a proof of concept study

Premature Ejaculation (PE) is a very common and disturbing sexual dysfunction in men. Currently available treatment modalities are associated with limited efficacy and low treatment adherence. In this prospective, single-blinded, self-controlled study, we evaluated the efficacy and safety of transcutaneous electrical stimulation (TES) for the treatment of (PE). We included 23 patients aged 20-60 (mean: 38.7) with lifelong PE. On the first visit, we delivered either TES or sham treatment to the perineum, based on the enrollment order. For stimulation, we used a commercial neuromuscular electrical stimulation device. The patients were invited for the second visit after at least 7 days for receiving the alternating treatment. During the treatment sessions, the patients were left alone in a privet silent room to masturbate and a stopwatch was used to measure their masturbation ejaculatory latency time (MELT). The patients also filled-out safety questionnaires after each visit and on each of the 3 following days. Of the 20 patients who completed the study, 17 (85%) experienced prolonged MELT under TES compared with the sham treatment. Mean MELT values increased 3.5-folds under TES (p = 0.0009). We demonstrated a significant increase in MELT in lifelong PE patients using TES. This therapeutic option may have the potential to become an on-demand treatment option for PE. Future studies with wireless devices are needed to confirm the efficacy and safety of this treatment concept during intercourse.

An ideal e-health system for pelvic floor muscle training adherence: Systematic review

BACKGROUND

Nowadays, Pelvic Floor Muscle Training (PFMT) is a first line, level 1 evidence-based treatment for urinary incontinence (UI), but adherence to PFMT is often problematic. Today, there are several mobile applications (mApps) for PFMT, but many lack specific strategies for enhancing adherence.

AIMS

To review available mApps for improvement of adherence to PFMT, and to introduce a new App so called iPelvis.

METHODS

Review study all available mApps for PFMT and relevant literature regarding adherence by electronic search through the databases Pubmed, Embase, CINAHL, LILACS, PEDro, and Scielo. Based on these results, development of a mApp, called "iPelvis" for Apple™ and Android™ systems, implementing relevant strategies to improve adherence.

RESULTS

Based on the current adherence literature we were able to identify 12 variables helping to create the optimal mApp for PFMT. None of the identified 61 mApps found for Android™ and 16 for Apple™ has all these 12 variables. iPelvis mApp and websites were constructed taking into consideration those 12 variables and its construct is now being subject to ongoing validation studies.

CONCLUSION

MApps for PFMT are an essential part of first-line, efficient interventions of UI and have potentials to improve adherence, in case these respect the principles of PFMT, motor learning and adherence to PFMT. iPelvis has been constructed respecting all essential variables related to adherence to PFMT and may enhance the effects of UI treatment.

Transcutaneous neuromuscular electrical stimulation may be beneficial in the treatment of premature ejaculation

Approximately 20-30% of sexually active men suffer from Premature Ejaculation (PE), but the pathophysiology still remains unclear and the current available treatments for PE are unsatisfying. Considering the role of rhythmic bulbospongiosus and ischiocavernosus Muscles contractions on the ejaculatory reflex, we hypothesize that weakening this muscles via inhibiting it's contractions by Application of Neuromuscular Electrical Stimulation prior to the planned sexual activity, may have a beneficial effect in the treatment of PE. Using miniaturized perineal on-demand stimulation device, in a home setting during sexual intercourse may become the first line of treatment for PE.

Ejaculatory training lengthens the ejaculation latency and facilitates the functioning of the spinal generator for ejaculation of rats with rapid ejaculation

A spinal pattern generator controls the ejaculatory response. Central pattern generators (CPGs) may be entrained to improve the motor patterns under their control. In the present study we tested the hypothesis that training of the spinal generator for ejaculation (SGE) by daily copulation until ejaculation, could promote substantive changes in its functioning permitting a better SGE control of the genital motor pattern of ejaculation (GMPE) and, as a consequence, a normalization of the ejaculation latency of rats with rapid ejaculation. To that aim, we evaluated in sexually experienced male rats with rapid ejaculation (1) the effects of daily copulation to ejaculation, following different entrainment schedules, on their ejaculation latencies, (2) the impact of these different ejaculatory entrainment schedules upon the parameters of the GMPE and (3) the possible emergence of persistent changes in the functioning of the SGE associated to the daily ejaculation entrainment schedules. The data obtained show that intense ejaculatory training of rats with rapid ejaculation lengthens the ejaculation latency during copulation and augments the ejaculatory capacity of the SGE in this population when spinalized. Thus, present data reveal that like other CPGs, the SGE can be trained and put forward that training of the SGE by daily copulation to ejaculation might be a promising alternative that should be taken into consideration for the treatment of premature ejaculation.

Rhodiola rosea, folic acid, zinc and biotin (EndEP®) is able to improve ejaculatory control in patients affected by lifelong premature ejaculation: Results from a phase I-II study

The therapeutic armamentarium currently available for the treatment of premature ejaculation (PE) is not highly satisfactory. However, phytotherapeutics appear to be an interesting option for PE management. The present study aimed to evaluate the tolerability and efficacy of a phytotherapeutic combination of Rhodiola rosea, folic acid, biotin and zinc (EndEP^®) in the treatment of patients affected by lifelong PE. All patients affected by lifelong PE who were attending three Urological Institutions from July to December 2014 were enrolled in this prospective, multicentre, phase I–II study. All patients were assigned to receive oral tablets of EndEP^® (one tablet per day) for 90 days. Clinical and instrumental analyses were carried out at enrolment and at the end of the study. International Prostatic Symptom Score (IPSS), International Index of Erectile Function (IIEF)-15, Premature Ejaculation Diagnostic Tool (PEDT) and Short Form (SF)-36 questionnaires were used. The intravaginal ejaculation latency time (IELT) for each event was also evaluated using the stop-watch technique. The main outcome measure was the difference from baseline in PEDT questionnaire and mean IELT at the end of the follow-up period. In total, 91 patients (mean age, 32.3±5.6 years) were analysed. The baseline questionnaires mean scores were 1.1±1.6, 26.1±2.9, 15.3±3.4 and 98.2±0.5, for IPSS, IIEF-15, PEDT and SF-36, respectively. The mean IELT at baseline was 73.6±46.9s. At the follow-up examination (90 days after the start of treatment), no statistically significant differences were identified in terms of IPSS (1.4±1.5) or IIEF-15 (26.3±3.1) compared with the pre-treatment values (P=0.19 and P=0.64, respectively). A statistically significant difference was detected between the mean IELT at enrolment and after treatment (73.6±46.9 vs. 102.3±60.0; P<0.001) and SF-36 questionnaire (98.2±0.5 vs. 99.4±0.1; P<0.001). Fifty-five patients reported improvement in the control of ejaculation (60.4%). Very few adverse events were reported (4.4%). In conclusion, it was found that EndEP^® significantly improved ejaculatory control and the quality of sexual life in patients affected by lifelong PE, with a very low rate of adverse events.

A Prospective Randomized Controlled Study to Compare Acupuncture and Dapoxetine for the Treatment of Premature Ejaculation

PURPOSE

To compare the safety and efficacy of dapoxetine and acupuncture for the treatment of premature ejaculation (PE) with other treatment methods.

METHODS

One hundred twenty patients with PE in an outpatient urology clinic were randomized to receive dapoxetine 30 mg and 60 mg, acupuncture or sham acupuncture. The intravaginal ejaculatory latency time (IELT), the PE diagnostic tool (PEDT) score, and adverse events were compared.

RESULTS

There were no differences between the groups in terms of age, body mass index, baseline IELT and PEDT scores (p > 0.05). After 4 weeks, IELT was significantly longer compared to baseline values in all groups (p < 0.001 for all comparisons). Comparisons between the groups showed that changes in IELT and PEDT observed after 4 weeks with dapoxetine 60 mg was significantly higher than those achieved in all other groups (p < 0.001 for all comparisons), changes observed with dapoxetine 30 mg was significantly higher than those achieved with acupuncture and sham acupuncture groups (p < 0.001 for both comparisons) and changes observed with acupuncture was significantly higher than those observed with sham acupuncture (p < 0.001).

CONCLUSION

Our results confirm previous reports on the efficacy and safety of dapoxetine. Although less effective than dapoxetine, acupuncture had a significant ejaculation-delaying effect.

Current and Emerging Treatments for Premature Ejaculation

INTRODUCTION

Over the past 20-30 years, the premature ejaculation (PE) treatment paradigm, previously limited to behavioral psychotherapy, has expanded to include drug treatment. Pharmacotherapy for PE predominantly targets the multiple neurotransmitters and receptors involved in the control of ejaculation, which include serotonin, dopamine, oxytocin, norepinephrine, gamma amino-butyric acid (GABA) and nitric oxide (NO).

AIM

The objective of this article is to review current and emerging PE interventions.

METHODS

Contemporary data on the treatment of PE were reviewed and critiqued using the principles of evidence-based medicine.

MAIN OUTCOME MEASURE

Integrated pharmacotherapy and cognitive behavioral therapy (CBT) may achieve superior treatment outcomes in some patients. Phosphodiesterase type 5 inhibitors alone or in combination with selective serotonin reuptake inhibitors (SSRIs) should be limited to men with acquired PE secondary to comorbid erectile dysfunction (ED). New on-demand rapid-acting SSRIs, oxytocin receptor antagonists, or single agents that target multiple receptors may form the foundation of more effective future on-demand medication.

RESULTS

Multiple well-controlled evidence-based studies have demonstrated the efficacy and safety of SSRIs in delaying ejaculation, confirming their role as first-line agents for the medical treatment of lifelong and acquired PE. Daily dosing of SSRIs is likely to be associated with superior fold increases in intravaginal ejaculation latency time compared with on-demand SSRIs. On-demand SSRIs are less effective but may fulfill the treatment goals of many patients.

CONCLUSIONS

Current evidence suggests that psychosexual CBT has a limited role in the contemporary management of PE and confirms the efficacy and safety of dapoxetine, off-label SSRI drugs, and topical anesthetics drugs. Treatment with tramadol, α1-adrenoceptor antagonists cannot be recommended until the results of large, well-designed randomized controlled trials are published in major international peer-reviewed medical journals. As our understanding of the neurochemical control of ejaculation improves, new therapeutic targets and candidate molecules will be identified, which may increase our pharmacotherepeutic armamentarium. McMahon CG. Current and emerging treatments for premature ejaculation. Sex Med Rev 2015;3:183-202.