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Sexual Health Apr 2016Eutectic Mixture of Local Anaesthetics (EMLA) is recommended for use off-label as a treatment for premature ejaculation (PE). Other topical anaesthetics are available,... (Meta-Analysis)
Meta-Analysis Review
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.
Topics: Anesthetics, Local; Humans; Male; Premature Ejaculation; Randomized Controlled Trials as Topic
PubMed: 26599522
DOI: 10.1071/SH15042 -
BMC Urology Jan 2015Tramadol is a centrally acting analgesic prescribed off-label for the treatment of premature ejaculation (PE). However, tramadol may cause addiction and difficulty in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tramadol is a centrally acting analgesic prescribed off-label for the treatment of premature ejaculation (PE). However, tramadol may cause addiction and difficulty in breathing and the beneficial effect of tramadol in PE is yet not supported by a high level of evidence. The purpose of this study was to systematically review the evidence from randomised controlled trials (RCT) for tramadol in the management of PE.
METHODS
We searched bibliographic databases including MEDLINE to August 2014 for RCTs. The primary outcome was intra-vaginal ejaculatory latency time (IELT). Methodological quality of RCTs was assessed. Between-group differences in IELT and other outcomes were pooled across RCTs in a meta-analysis. Statistical and clinical between-trial heterogeneity was assessed.
RESULTS
A total of eight RCTs that evaluated tramadol against a comparator were included. The majority of RCTs were of unclear methodological quality due to limited reporting. Pooled evidence (four RCTs, 721 participants), suggests that tramadol is significantly more effective than placebo at increasing IELT over eight to 12 weeks (p = 0.0007). However, a high level of statistical heterogeneity is evident (I-squared = 74%). Single RCT evidence indicates that tramadol is significantly more effective than paroxetine taken on-demand, sildenafil, lidocaine gel, or behavioural therapy on IELT in men with PE. Tramadol is associated with significantly more adverse events including: erectile dysfunction, constipation, nausea, headache, somnolence, dry mouth, dizziness, pruritus, and vomiting, than placebo or behavioural therapy over eight to 12 weeks of treatment. However, addiction problems or breathing difficulties reported by patients for PE is not assessed in the current evidence base.
CONCLUSIONS
Tramadol appears effective in the treatment of PE. However, these findings should be interpreted with caution given the observed levels of between-trial heterogeneity and the reporting quality of the available evidence. The variability across placebo-controlled trials in terms of the tramadol dose evaluated and the treatment duration does not permit any assessment of a safe and effective minimum daily dose. The long-term effects and side effects, including addiction potential, for men with PE have not been evaluated in the current evidence base.
TRIAL REGISTRATION
The review is registered on PROSPERO 2013: CRD42013005289 .
Topics: Drug Administration Schedule; Evidence-Based Medicine; Humans; Male; Off-Label Use; Orgasm; Patient Satisfaction; Premature Ejaculation; Prevalence; Randomized Controlled Trials as Topic; Tramadol; Treatment Outcome
PubMed: 25636495
DOI: 10.1186/1471-2490-15-6 -
Medicine Feb 2019Premature ejaculation (PE) is one of the most common male sexual dysfunctions, which can directly harm men's self-esteem and affect the stability of the relationship... (Review)
Review
BACKGROUND
Premature ejaculation (PE) is one of the most common male sexual dysfunctions, which can directly harm men's self-esteem and affect the stability of the relationship between husband and wife. To some extent, PE even affects the harmony and stability of society. So, men's health has gained more and more attention. As one of the long-acting selective serotonin reuptake inhibitors (SSRIs), fluoxetine has been proven to be effective in the treatment of PE by many trails. In this study, we aim to evaluate the effectiveness and safety of fluoxetine for PE to provide the newest evidence for clinical use.
METHODS AND ANALYSIS
Literature research will be divided into 2 parts: electronic search and manual search. We will search PubMed, EMBASE, The Cochrane Library, the China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), the China Science and Technology Journal database (VIP), and the Wanfang database online. We will select the eligible studies published up to December 31, 2018. Manual searches mainly retrieve dissertations, ongoing trails, internal reports, and so on. We use intravaginal ejaculatory latency time (IELT) as the primary outcome of PE and we also care about the following indexes: PE Diagnostic Tool (PEDT); Arabic index of PE (AIPE); Index of PE (IPE). In addition, we will carefully observe the patient's adverse reactions during the medication. Two reviewers will read the articles, extract the data information, and assess the risk of bias independently. Data analysis will be used the software such as RevMan V.5.3.5; EndNote X7 and Stata 13.0.
RESULTS
This study will provide a high-quality synthesis of current evidence of fluoxetine for PE from several aspects, including IELT, PEDT, AIPE, IPE, and adverse events.
CONCLUSION
This systematic review will provide evidence to assess the effectiveness and safety of fluoxetine in the treatment of PE.
TRIAL REGISTRATION NUMBER
PROSPERO CRD42018109722.
Topics: China; Fluoxetine; Humans; Male; Men's Health; Premature Ejaculation; Randomized Controlled Trials as Topic; Research Design; Selective Serotonin Reuptake Inhibitors
PubMed: 30762772
DOI: 10.1097/MD.0000000000014481 -
Nature Reviews. Urology Feb 2021Premature ejaculation (PE) and poor ejaculatory control are multidimensional sexual symptoms estimated to affect almost one-third of men, severely impairing the overall... (Review)
Review
Premature ejaculation (PE) and poor ejaculatory control are multidimensional sexual symptoms estimated to affect almost one-third of men, severely impairing the overall quality of life of patients and their partners. However, patients who do not completely fulfil the definition criteria for PE rarely receive a diagnosis or adequate treatment, with the risk of subsequent progression from initial, subclinical symptoms to clinically overt PE, frequently with other sexual comorbidities. Thus, the current definitions of PE warrant review, in order to consider and propose a new taxonomy encompassing other unaddressed, crucial clinical aspects of PE. These newly proposed criteria include the recommendation for a primary screening for erectile dysfunction (ED), as PE and ED can be comorbid in up to 50% of patients but have never before been considered as a unified clinical entity. In order to facilitate clinical practice and improve clinical management of men with PE and comorbid conditions, we propose and define the new taxonomic clinical entities of subclinical PE (SPE) and loss of control of erection and ejaculation (LCEE). Application of these diagnoses to men who meet the criteria for SPE and/or LCEE, but not the overt conditions, could improve access to treatment for these patients and reduce progression to the more serious clinical disorder.
Topics: Coitus; Comorbidity; Culture; Erectile Dysfunction; Humans; Male; Practice Guidelines as Topic; Premature Ejaculation; Quality of Life; Terminology as Topic; Time Factors
PubMed: 33442049
DOI: 10.1038/s41585-020-00417-1 -
International Journal of Impotence... Sep 2023Concomitant sexual disorders have progressively shown increased prevalence in men at first outpatient presentation. We sought to i) estimate the prevalence of unreported...
Concomitant sexual disorders have progressively shown increased prevalence in men at first outpatient presentation. We sought to i) estimate the prevalence of unreported premature ejaculation (PE) in a homogenous cohort of 1258 men seeking first medical help for erectile dysfunction (ED) as their primary compliant; ii) compare the baseline sociodemographic and clinical characteristics of men with only ED(ED-only) compared to those with ED and PE(ED + PE); and, iii) investigate the likelihood of detecting PE among men self-reporting only ED over a 16-year period at a single tertiary-referral centre. Descriptive statistics compared sociodemographic and clinical characteristics between ED-only patients and those with unreported concomitant primary/secondary PE(ED + PE). Logistic regression models predicted the risk of having ED + PE at baseline. Local polynomial regression models graphically explored the probability of reporting PE among ED men with ≤40 vs. 41-60 vs. >60 years over the analysed timeframe. Of all, 932 (74.1%) were ED-only and 326 (25.9%) ED + PE patients, respectively. ED + PE patients were younger, presented with fewer comorbidities, and lower rates of severe ED (all p ≤ 0.04). At multivariable logistic regression analysis, younger age (OR:0.98) and low sexual desire/interest (OR:1.54) were independently associated with ED + PE at first clinical assessment (all p = 0.03). The likelihood of detecting unreported concomitant primary/secondary PE among patients complaining of only ED at first presentation worrisomely increased among younger and middle-aged men over the last 16 years.
Topics: Male; Middle Aged; Humans; Erectile Dysfunction; Premature Ejaculation; Cross-Sectional Studies; Sexual Behavior; Libido
PubMed: 35915329
DOI: 10.1038/s41443-022-00601-4 -
Medicine Aug 2016Premature ejaculation (PE) is the most prevalent male sexual dysfunction. Epidemiologic findings are inconsistent concerning the risk for depression associated with PE. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Premature ejaculation (PE) is the most prevalent male sexual dysfunction. Epidemiologic findings are inconsistent concerning the risk for depression associated with PE.
OBJECTIVE
The aim of this study was to investigate the potential association between between depression and risk of PE.
DATA SOURCES
We conducted a literature search of PubMed, Embase, and the Cochrane Library from these databases' inception through June 2014 for observational epidemiological studies examining the association between depression on risk of PE.
STUDY ELIGIBILITY CRITERIA
Studies were selected if they reported the risk estimates for PE associated with depression.
PARTICIPANTS
patients>18 years of age suffering from PE.
INTERVENTIONS
a history of depressive disorder.
STUDY APPRAISAL AND SYNTHESIS METHODS
These odds ratios (ORs) were pooled using a random or fixed effects model and were tested for heterogeneity. Subgroup analysis was employed to explore heterogeneity.
RESULTS
Eight trials involving 18,035 patients were included in the meta-analysis. Depression were statistically significantly associated with the risk of PE (OR = 1.63, 95% CI:1.42-1.87). There was no evidence of between-study heterogeneity (P = 0.623, I = 0.0%). The association was similar when stratified by mean age, geographical area, study design, sample size, publication year, and controlling key confounders.
LIMITATIONS
The severity of depression and PE could not be identified due to unavailable data of trials. No evidence of publication bias was observed.
CONCLUSIONS
These findings provide evidence that depression is associated with a significantly increased risk of PE. In addition, more prospective studies are necessary to evaluate the association and identify the ideal treatment.
SYSTEMATIC REVIEW REGISTRATION NUMBER
CRD42016041272.
Topics: Depression; Humans; Male; Premature Ejaculation; Risk Factors
PubMed: 27583879
DOI: 10.1097/MD.0000000000004620 -
International Braz J Urol : Official... 2021Tramadol has been used for the treatment of premature ejaculation, however, the studies published for the same are not well designed. The primary objective of this study... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Tramadol has been used for the treatment of premature ejaculation, however, the studies published for the same are not well designed. The primary objective of this study was to explore the literature pertaining to the use of tramadol in patients with PE to determine its safety and efficacy in this population. Materials ande methods: Systematic literature search of various electronic databases was conducted to include all the randomized studies and quasi-randomized studies. Standard PRISMA (Preferred reporting Items for Systematic reviews and Meta-analysis) guidelines were pursued for this review and study protocol was registered with PROSPERO (CRD42019123381).
RESULTS
Out of 9 studies included in this review, 5 were randomized controlled trials, and rests of the 4 studies were quasi-randomized studies. Tramadol resulted in significantly higher improvement of IELT with the mean difference (MD) of 139.6 seconds and confidence interval (CI) 106.5-172.6 seconds with a p-value of p < 0.00001. All dosages except 25mg fared well as compared to placebo. Tramadol fared better than placebo at 1 month, 2 months, and 3 months after initiation of therapy as compared to the placebo. Tramadol group had reported a significantly higher number of adverse events with treatment as compared to placebo but none of them were serious.
CONCLUSION
Tramadol appears to be an effective drug for the management of PE with a low propensity for serious adverse events. However, evidence obtained from this study is of low to moderate quality. Furthermore, effective dose and duration of therapy remain elusive.
Topics: Ejaculation; Humans; Male; Premature Ejaculation; Tramadol; Treatment Outcome
PubMed: 33566469
DOI: 10.1590/S1677-5538.IBJU.2020.0561 -
American Family Physician Jun 2022
Topics: Adult; Humans; Male; Premature Ejaculation; Selective Serotonin Reuptake Inhibitors; Serotonin and Noradrenaline Reuptake Inhibitors
PubMed: 35704830
DOI: No ID Found -
Archives of Sexual Behavior Apr 2024Tarlov cysts adjacent to the spinal cord are usually asymptomatic and found incidentally via magnetic resonance imaging. On rare occasions, they increase in size to...
Tarlov cysts adjacent to the spinal cord are usually asymptomatic and found incidentally via magnetic resonance imaging. On rare occasions, they increase in size to produce symptoms resembling disk herniation. We report a rare case of a sacral cyst resulting in premature ejaculation in a 32-year-old man who presented with pelvic pain and acquired premature ejaculation. Spinal nerve root decompression, excision of intraspinal Tarlov cyst, and spinal nerve root adhesion release surgery significantly improved his pain and premature ejaculation at a six-month follow-up.
Topics: Male; Humans; Adult; Tarlov Cysts; Premature Ejaculation; Pelvic Pain; Magnetic Resonance Imaging
PubMed: 38366312
DOI: 10.1007/s10508-024-02815-7 -
Aktuelle Urologie Jan 2013Premature ejaculation is a frequent male sexual complaint or sexual disturbance found in urological practices and outpatient units. The frequency in the individual... (Review)
Review
Premature ejaculation is a frequent male sexual complaint or sexual disturbance found in urological practices and outpatient units. The frequency in the individual practices varies considerably. In large studies the prevalence is strongly dependent on the definition and ranges between 3% and 25%. Subjectively, the inability to delay ejaculation and the distress resulting from it, is relevant for the patient and his partner. Intravaginal ejaculation latency time (IELT) is used as an objective parameter. Nevertheless, in the everyday routine practice this objective parameter is not practical. Clinically 2 questionnaires have asserted themselves (Premature Ejaculation Profile and Index of Premature Ejaculation). Studies have shown that the self-assessment of patients correlates relatively well with the objective IELT measured by means of a stopwatch. Beside topical anaesthetics and elective serotonin reuptake inhibitors (SSRI), especially Dapexetine which has been approved in Germany since 2009, are treatment options. These drugs differ particularly in their use (daily or on-demand) and their effectiveness (measured by x-fold increase of IELT). This article deals with the clinical approach to EP. Beside the definition, prevalence, aetiology and neurophysiology of EP, the different pharmacological therapies as well as the guidelines of the International Society for Sexual Medicine are discussed.
Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Local; Cross-Sectional Studies; Diagnostic Self Evaluation; Germany; Humans; Lidocaine; Male; Middle Aged; Premature Ejaculation; Referral and Consultation; Selective Serotonin Reuptake Inhibitors; Surveys and Questionnaires; Urology
PubMed: 23381878
DOI: 10.1055/s-0032-1331727