Psychosocial interventions for premature ejaculation

BackgroundPremature ejaculation (PE) is a very common sexual dysfunction among patients, and with varying prevalence estimates ranging from 3% to 20%. Although psychological issues are present in most patients with premature PE, as a cause or as a consequence, research on the effects of psychological approaches for PE has in general not been controlled or randomised and is lacking in long-term follow up.ObjectivesTo assess the efficacy of psychosocial interventions for PE.To investigate any differences in efficacy between different types of psychosocial treatments for PE.To compare psychosocial interventions with pharmacological treatment and pharmacological treatment in association with psychosocial treatment for PE.Search strategyTrials were searched in computerized general and specialized databases, such as: MEDLINE by PubMed (1966 to 2010); PsycINFO (1974 to 2010); EMBASE (1980 to 2010); LILACS (1982 to 2010); the Cochrane Central Register of Controlled Trials (Cochrane Library, 2010); and by checking bibliographies, and contacting manufacturers and researchers.Selection criteriaRandomised or quasi-randomised controlled trials evaluating psychosocial interventions compared with different psychosocial interventions, pharmacological interventions, waiting list, or no treatment for PE.Data collection and analysisInformation on patients, interventions, and outcomes was extracted by at least two independent reviewers using a standard form. the primary outcome measure for comparing the effects of psychosocial interventions to waiting list and standard medications was improvement in IELT (i.e., time from vaginal penetration to ejaculation). the secondary outcome was change in validated PE questionnaires.Main resultsIn one study (De Carufel 2006) behavioral therapy (BT) was significantly better than waiting list for duration of intercourse (MD (mean difference) 407.90 seconds, 95% CI 302.42 to 513.38), and couples' sexual satisfaction (MD -26.10, CI -50.48 to -1.72). BT was also significantly better for a new functional-sexological treatment (FS) (MD 412.00 seconds, 95% CI 305.88 to 518.12), change over time in subjective perception of duration of intercourse (Women: MD 2.88, 95% CI 2.06 to 3.70; Men: MD 2.52, CI 1.65 to 3.39) and couples' sexual satisfaction (MD -25.10, 95% CI -47.95 to -2.25), versus waiting list.One study (Li 2006) showed that the combination of chlorpromazine and BT was superior than chlorpromazine alone for IELT (MD 1.11, 95% CI 0.82 to 1.40), SAS (Self-rating Anxiety Scale) (MD -8.72, 95% CI -11.09 to -6.35) and for some CIPE (Chinese Index Premature Ejaculation) questions (' anxiety in sexual activity', ' partner sexual satisfaction', ' patient sexual satisfaction', ' control ejaculatory reflex' and ' ejaculatory latency') (' Analysis 1.2').One study (Yuan 2008) showed that citalopram significantly improved IELT (RR (risk ratio) 0.52, 95% CI 0.34 to 0.78) and the number of couples satisfied with their sex life after treatment (RR 0.60, 95% CI 0.39 to 0.93), versus BT.In the last study (Abdel-Hamid 2001), 31 patients received 1 of 4 drugs administered on an as-needed basis 35 hours before anticipated coitus (clomipramine, sertraline, paroxetine, sildenafil), or were instructed to use the pause-squeeze technique. the study consisted of five four-week periods of treatment, separated by two-week washout periods. Anxiety score and ejaculation latency time were measured before treatment, after each treatment and during washout periods. Sexual satisfaction scores were measured after each treatment. However the available data from the article were not sufficient to be included, and the related database was not available anymore, according to the main author.Authors' conclusionsOverall, there is weak and inconsistent evidence regarding the effectiveness of psychological interventions for the treatment of premature ejaculation. Three of the four included randomised controlled studies of psychotherapy for PE reported our primary outcome (Improvement in IELT), and the majority have a small sample size. the early success reports (97.8%) of Masters and Johnson could not be replicated. One study found a significant improvement from baseline in the duration of intercourse, sexual satisfaction and sexual function with a new functional-sexological treatment and behavior therapy compared to waiting list. One study showed that the combination of chlorpromazine and BT was superior to chlorpromazine alone. Randomised trials with larger group samples are still needed to further confirm or deny the current available evidence for psychological interventions for treating PE.Prostatic Diseases and Urological Cancers groupUniversidade Federal de São Paulo, Brazilian Cochrane Ctr, Escola Paulista Med, São Paulo, BrazilCtr Marital & Sexual Hlth S Florida, W Palm Beach, FL USAInst H Ellis, São Paulo, BrazilUniversidade Federal de São Paulo, Brazilian Cochrane Ctr, Escola Paulista Med, São Paulo, BrazilWeb of Scienc