Interventions to Treat Erectile Dysfunction and Premature Ejaculation: An Overview of Systematic Reviews

Abstract

Introduction Sexual dysfunction in men is common, and optimal treatment is complex. Although several systematic reviews concerning treatment approaches exist, a comprehensive overview without limitations concerning the population, interventions, or outcomes is lacking. Aim To conduct a “review of reviews” to compare the effectiveness of pharmacologic, non-pharmacologic, and combined interventions. Methods 9 electronic databases, relevant journals, and reference lists up to July 2018 were searched. For each intervention, only the most recent and comprehensive meta-analysis or systematic review was included. The methodologic quality of the reviews was appraised using the Assessment of Multiple Systematic Reviews–2 tool. Main Outcome Measure Sexual functioning (via intravaginal ejaculatory latency time and international index of erectile function), sexual satisfaction, and adverse effects. Results 30 systematic reviews were included. For premature ejaculation, several treatments, including oral pharmacotherapy (selective serotonin inhibitors, phosphodiesterase type 5 [PDE5] inhibitors, tricyclic antidepressants, and opioid analgesics), topical anesthetics, and combined drug and behavioral therapies demonstrated significant improvements of 1–5 minutes in the intravaginal ejaculatory latency time. Pharmacologic interventions (PDE5 inhibitors, penile injection, and testosterone), shockwave therapy, lifestyle modifications, and combined therapies (PDE5 inhibitors and psychological intervention) were effective in treating erectile dysfunction. Most pharmacologic therapies were associated with adverse effects. Conclusions There is suggestive evidence that pharmacologic interventions or combined therapies are more effective than non-pharmacologic interventions for treating sexual dysfunction in men; however, a range of treatment options should be presented to individual patients so they may consider the risks and benefits of treatments differently. Evidence related to behavioral and psychological interventions is insufficient compared with that related to drug trials, highlighting the necessity for larger and better randomized controlled trials. Ciocanel O, Power K, Eriksen A. Interventions to Treat Erectile Dysfunction and Premature Ejaculation: An Overview of Systematic Reviews. Sex Med 2019;7:251–269.

Reviewing the evidence for shockwave- and cell-based regenerative therapies in the treatment of erectile dysfunction

“… 8 , 9 Additional treatment options for ED exist, including vacuum erection devices, intracavernosal vasoactive injections, and penile prosthetics. 3 , 10 The AUA states that patients should be informed of all non-contraindicated treatment modalities for ED as potential first-line therapies, regardless of invasiveness or irreversibility. 6 Even with multiple treatment options available for ED, some patients continue to have suboptimal outcomes.…”

Acceptability of Health Professionals’ Address of Sexuality and Erectile Dysfunction - A Qualitative Interview Study with Men in Cardiac Rehabilitation

“…29,30,39 Men with ED may have different preferences depending on their perceptions of the illness and treatment. 40,41 How sexual issues are addressed in cardiac rehabilitation services has not previously been studied. 42 Thus, an overall understanding is needed regarding men's acceptance of HPs' address of sexuality and ED.…”

Alternative medicine and herbal remedies in the treatment of erectile dysfunction: A systematic review

“…Erectile dysfunction (ED) is defined as the inability to achieve and/or maintain an appropriate penile erection that is sufficient for sexual intercourse, and clinically classified as psychogenic (such as relationship dissatisfaction, societal pressures, anxiety or depression) or organic (underlying causes or comorbidities) [ 1 , 2 ]. This is a common and increasing male sexual health concern, with a prevalence of up to 31% [ 2 ] and projected to affect up to 322 million men by 2025 [ 3 ]. The prevalence of ED is reported as 1–10% of males aged <40 years (mostly psychogenic), >40% of men aged >40 years, and 50–100% of men aged >70 years (mostly organic) [ 3 ].…”

“…Pharmaceutical treatments for ED are typically phosphodiesterase-5 inhibitors that inhibit the outflow of blood from the penis to induce erection. Common examples include sildenafil citrate (Viagra), tadalafil (Cialis) and vardenafil (Levitra) [ 2 , 11 ]. Although generally well tolerated, adverse effects include headaches, dyspepsia, nasal congestion, flushing, syncope, vision loss, priapism, and myocardial infarction [ 12 ].…”

“…Although generally well tolerated, adverse effects include headaches, dyspepsia, nasal congestion, flushing, syncope, vision loss, priapism, and myocardial infarction [ 12 ]. More invasive options for ED management include intracavernosal injection therapy of vaso-active substances, vacuum erection devices, and penile prosthesis implants [ 2 , 11 ]. However, not all patients respond to the treatments available, and adverse effects and costs may further limit pharmacological intervention [ 13 ].…”