title: Current Pharmacological Management of Premature Ejaculation: A Systematic Review and Meta-analysis.
abstract: Premature ejaculation (PE) is the most prevalent male sexual dysfunction. In the last few years, several pharmacologic approaches for oral or topical treatment of PE have been studied.
  
  
  
  To systematically review the literature on the outcome of pharmacologic interventions for PE on intravaginal ejaculation latency time (IELT) in comparison to placebo.
  
  
  
  A systematic literature search of PubMed and Scopus using the term "premature ejaculation" was performed on 10 April 2015. Full-text articles on prospective randomized controlled trials (RCTs) investigating pharmacotherapy were included. The main outcome measure was IELT.
  
  
  
  Out of 266 unique records, a total of 22 were reviewed. The majority of RCTs were of unclear methodological quality because of limited reporting of methods. Pooled evidence suggests that selective serotonin reuptake inhibitors (SSRIs), topical anesthetic creams (TAs), tramadol, and phosphodiesterase type 5 inhibitors (PDE5is) are more effective than placebo at increasing IELT (all p<0.05). However, interpretation of the current meta-analyses may be impaired as a result of frequent heterogeneity in the pooled analyses (all I(2) > 70%). Only pooled analyses for dapoxetine 30mg and 60mg were characterized by homogeneous data (both I(2)<30%) while showing a modest but statistically significant improvement in IELT compared with placebo (mean difference 1.39min, 95% confidence interval 1.23-1.54min; p<0.00001).
  
  
  
  Meta-analysis revealed that treatment with dapoxetine significantly improves IELT in patients with PE but with modest efficacy. The efficacy of SSRIs, TAs, tramadol, and PDE5is remains unclear owing to high heterogeneity of the available RCT data. There is a persisting need for drug research and development in the field.
  
  
  
  Premature ejaculation is a condition for which the cause is not well understood. Several types of treatment with medium to low efficacy are available. More research is necessary to identify the ideal treatment.
authors.affiliation: Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy; Laboratory for Experimental Urology, Gene and Stem Cells Applications, Department of Development and Regeneration, University of Leuven, Leuven, Belgium. Electronic address: fox.castiglione@gmail.com.
authors.forename: Fabio
authors.initials: F
authors.lastname: Castiglione
authors.affiliation: Laboratory for Experimental Urology, Gene and Stem Cells Applications, Department of Development and Regeneration, University of Leuven, Leuven, Belgium.
authors.forename: Maarten
authors.initials: M
authors.lastname: Albersen
authors.affiliation: Department of Clinical Pharmacology, Linköping, Sweden.
authors.forename: Petter
authors.initials: P
authors.lastname: Hedlund
authors.affiliation: Deparment of Urology, Klinikum Großhadern, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Gratzke
authors.affiliation: Division of Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.affiliation: Department of Physical Medicine and Rehabilitation, Neuro-Urology-Andrology, Raymond Poincaré Hospital Garches, Versailles Saint Quentin en Yvelines University, Garches, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Giuliano
mesh_terms: D000279:Administration, Cutaneous; D000701:Analgesics, Opioid / Q000494:pharmacology / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001596:Benzylamines / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009281:Naphthalenes / Q000627:therapeutic use; D058986:Phosphodiesterase 5 Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D061686:Premature Ejaculation / Q000188:drug therapy* / Q000503:physiopathology; D011930:Reaction Time / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D014147:Tramadol / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D001596:Benzylamines; D009281:Naphthalenes; D058986:Phosphodiesterase 5 Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors; D014147:Tramadol; C080598:dapoxetine
keywords: Ejaculation; Medical treatment; Pharmacology of ejaculation; Premature ejaculation