title: Topical anaesthetics for premature ejaculation: a systematic review and meta-analysis.
abstract: 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.
authors.affiliation: School for Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
authors.forename: Marrissa
authors.initials: M
authors.lastname: Martyn-St James
authors.affiliation: School for Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
authors.forename: Katy
authors.initials: K
authors.lastname: Cooper
authors.affiliation: School for Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Ren
authors.affiliation: School for Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
authors.forename: Eva
authors.initials: E
authors.lastname: Kaltenthaler
authors.affiliation: School for Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
authors.forename: Kath
authors.initials: K
authors.lastname: Dickinson
authors.affiliation: School for Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Cantrell
authors.affiliation: Porterbrook Clinic, Sexual Medicine, 9 Sunderland Street, Sheffield, S11 8HN, UK.
authors.forename: Kevan
authors.initials: K
authors.lastname: Wylie
authors.affiliation: Institute of Psychosexual Medicine, Building 3 Chiswick Park, 566 Chiswick High Road, London, W4 5YA, UK.
authors.forename: Leila
authors.initials: L
authors.lastname: Frodsham
authors.affiliation: St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hood
mesh_terms: D000779:Anesthetics, Local / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D061686:Premature Ejaculation / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000779:Anesthetics, Local