Skip navigation
Link to Back issues listing | Back Issue Listing with content Index | Subject Index

Premature ejaculation treatments reviewed

Systematic review
Results
Comment

Back in 1999 Bandolier 69 did a quick review of premature ejaculation treatments. The upshot of this was that there were a number of trials of varying quality showing that antidepressants taken every day improved the main measure of premature ejaculation, the intravaginal ejaculation latency time (IELT). Now we have a comprehensive systematic review [1] that examines all treatments in all study designs, and gives a cracking overview of the topic. What makes this important is that more specific treatments are presently being designed, and this gives us a foundation on which to make future judgements about quality and efficacy.

Systematic review

Four databases were examined, and all drug treatment reports in any language were included, whatever the design used. Combined behaviour and drug treatments were not included. Studies to be included had to report quantitative data on IELT.

Results

Between 1943 and 2003 there were 79 publications on a variety of treatments, including anaesthetic ointments, neuroleptics, antibiotics, antidepressants and miscellaneous agents. Table 1 shows the number of reports by decade, and how many of them were randomised, double blind trials in which the clinical outcome was measured at each intercourse. Overall just 44% of studies were double blind, 24% used a stopwatch or equivalent for accurate measurement of outcome (and only 15 of these were double blind), only 22% measured the outcome at each intercourse, and only 30% measured outcome in a baseline period.



Table 1: Total trials and RCTs over time



Period
Antidepressants daily
Antidepressants on demand
Anaesthetics and other agents
Total
RCTs
Total
RCTs
Total
RCTs
Before 1960
0
0
0
0
3
0
1961-1970
0
0
0
0
4
0
1971-1980
2
1
0
0
4
0
1981-1990
3
0
0
0
13
1
1991-2000
22
6
5
0
6
2
2000-2003
8
5
3
0
6
2
Total
35
12
8
0
36
5


The definition of what constituted premature ejaculation varied, and only 58% of the studies gave a definition. It was defined as one minute or less in 19 studies, 2 minutes or less in 11, 3 minutes or less in eight, and one study each used 30 seconds, or four and five minutes.

Only the studies on antidepressants were of sufficient quality for meta-analysis, and only eight of the 35 with daily treatment were randomised, double blind, and used prospective measurement of IELT at each intercourse. Results were combined by using the percentage increase in IELT (on-treatment IELT minus baseline IELT/baseline expressed as a percentage).

One analysis used all the available trials, while a second used only the eight best trials. The results (Figure 1) were broadly similar, except that the better quality trials tended to give more conservative estimates of effect. One note of caution, though, is that trials tended not to be large, so even the extended analysis was able to pool data from at best a hundred or so patients.



Figure 1: Intravaginal ejaculation latency time change with different trials and drugs (light bars for all trials, dark bars for randomised, double blind trials with prospective IELT measurement)





Comment

Anyone with a professional interest in premature ejaculation would find this an excellent place to start evidence-based thinking about treatments for the condition. As well as providing some results, it has a useful insight into trial methods, and how to make sure that future trials are conducted better than those in the past. Here is an opportunity to learn from our mistakes.

The analysis also confirms the Bandolier review of five years previously. Antidepressants taken daily are effective. It will be interesting to use this review to judge newly emergent therapies over the next few years.

Reference:

  1. MD Waldinger et al. Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis. International Journal of Impotence Research 2004 16: 369-381.

previous or next story