title: Complementary and Alternative Medicine for Management of Premature Ejaculation: A Systematic Review.
abstract: BACKGROUND
  Premature ejaculation (PE) is defined as ejaculation within 1 minute (lifelong PE) or 3 minutes (acquired PE), inability to delay ejaculation, and negative personal consequences. Management includes behavioral and pharmacologic approaches.
  
  
  OBJECTIVE
  To systematically review effectiveness, safety, and robustness of evidence for complementary and alternative medicine in managing PE.
  
  
  METHODS
  Nine databases including Medline were searched through September 2015. Randomized controlled trials evaluating complementary and alternative medicine for PE were included.
  
  
  METHODS
  Studies were included if they reported on intravaginal ejaculatory latency time (IELT) and/or another validated PE measurement. Adverse effects were summarized.
  
  
  RESULTS
  Ten randomized controlled trials were included. Two assessed acupuncture, five assessed Chinese herbal medicine, one assessed Ayurvedic herbal medicine, and two assessed topical "severance secret" cream. Risk of bias was unclear in all studies because of unclear allocation concealment or blinding, and only five studies reported stopwatch-measured IELT. Acupuncture slightly increased IELT over placebo in one study (mean difference [MD] = 0.55 minute, P = .001). In another study, Ayurvedic herbal medicine slightly increased IELT over placebo (MD = 0.80 minute, P = .001). Topical severance secret cream increased IELT over placebo in two studies (MD = 8.60 minutes, P < .001), although inclusion criteria were broad (IELT < 3 minutes). Three studies comparing Chinese herbal medicine with selective serotonin reuptake inhibitors (SSRIs) favored SSRIs (MD = 1.01 minutes, P = .02). However, combination treatment with Chinese medicine plus SSRIs improved IELT over SSRIs alone (two studies; MD = 1.92 minutes, P < .00001) and over Chinese medicine alone (two studies; MD = 2.52 minutes, P < .00001). Adverse effects were not consistently assessed but where reported were generally mild.
  
  
  CONCLUSIONS
  There is preliminary evidence for the effectiveness of acupuncture, Chinese herbal medicine, Ayurvedic herbal medicine, and topical severance secret cream in improving IELT and other outcomes. However, results are based on clinically heterogeneous studies of unclear quality. There are sparse data on adverse effects or potential for drug interactions. Further well-conducted randomized controlled trials would be valuable.
authors.affiliation: University of Sheffield, Sheffield, UK. Electronic address: k.l.cooper@sheffield.ac.uk.
authors.forename: Katy
authors.initials: K
authors.lastname: Cooper
authors.affiliation: University of Sheffield, Sheffield, UK.
authors.forename: Marrissa
authors.initials: M
authors.lastname: Martyn-St James
authors.affiliation: University of Sheffield, Sheffield, UK.
authors.forename: Eva
authors.initials: E
authors.lastname: Kaltenthaler
authors.affiliation: University of Sheffield, Sheffield, UK.
authors.forename: Kath
authors.initials: K
authors.lastname: Dickinson
authors.affiliation: University of Sheffield, Sheffield, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Cantrell
authors.affiliation: University of Sheffield, Sheffield, UK.
authors.forename: Shijie
authors.initials: S
authors.lastname: Ren
authors.affiliation: Porterbrook Clinic, Sheffield, UK.
authors.forename: Kevan
authors.initials: K
authors.lastname: Wylie
authors.affiliation: Institute of Psychosexual Medicine, London, UK.
authors.forename: Leila
authors.initials: L
authors.lastname: Frodsham
authors.affiliation: Imperial College, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hood
keywords: Complementary Medicine; Complementary Therapies; Premature Ejaculation; Review; Systematic