Premature ejaculation (PE) is defined as a disorder caused by a short ejaculatory latency and an inability to delay ejaculation. The management of premature ejaculation can involve behavioral and/or pharmacological treatments.
The purpose of this study was to systematically review and analyze the evidence from randomized controlled trials on behavioral treatment of PE.
Researchers reviewed nine databases, including MEDLINE, with articles published through August 2014. A total of 521 patients were included in 10 randomized controlled trials including behavioral therapy compared with wait-list therapy and other therapies or behavioral therapy compared with medication-only therapy. The primary observations included intravaginal ejaculation latency time (IELT), sexual satisfaction, ejaculatory control, anxiety, and adverse effects.
All studies evaluated physical therapy techniques, including squeeze and pause – start, sensual focus exercises, stimulation devices, and pelvic floor rehabilitation training. Only one randomized controlled trial included psychotherapy (combined with pause – start and medication). Four trials compared the effects of behavioral therapy with other alternate therapies, with two of the studies (including squeeze, pause and start, and sensual focus exercises) showing a 7-9 minute difference in IELT, while the remaining two studies (sensual focus exercises and stimulation devices) found no difference in IELT. For the other effects (sexual satisfaction, libido, and self-confidence), some of the alternate therapies were beneficial to behavioral therapy, while the rest were not significant. The three randomized trials tended to combine behavioral and pharmacological treatment rather than pharmacological treatment alone, with minimal differences in IELT (0.5-1 min) and significant improvements in other indicators (sexual satisfaction, ejaculatory control, and anxiety). Direct comparisons of behavioral therapy with medication showed different results, with most either benefiting from medication or not showing significant differences. In terms of adverse effects, no studies were reported, but safety data are limited.
In conclusion, based on this study, it is suggested that behavioral therapy is better than waitlist therapy for PE in improving IELT and other symptoms, and that behavioral therapy in combination with pharmacotherapy is more effective than pharmacotherapy alone. Further randomized controlled trials are needed to evaluate the effectiveness of psychotherapy for PE.
Original source.
Cooper K, Martyn-St James M, Kaltenthaler E, Dickinson K, Cantrell A, Wylie K, Frodsham L, Hood C. Behavioral Therapies for Management of Premature Ejaculation: A Systematic Review.?Sex Med. 2015 Sep;3(3):174-88. doi: 10.1002/sm2.65. Epub 2015 May 8.