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 metaanalysis. 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.Topical anaesthetics were compared with placebo and oral agents for the treatment of premature ejaculation in a systematic review and meta-analysis. Topical anaesthetics are significantly more effective than placebo, sildenafil or paroxetine at increasing intra-vaginal ejaculatory latency time. Topical Eutectic-like Mixture for Premature Ejaculation spray is associated with erectile dysfunction, numbness and burning. More systemic adverse events are reported with tramadol, sildenafil and paroxetine than with lidocaine gel.

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

“…AMSTAR 2 assessments identified several methodologic weaknesses across all included reviews (see Appendix 3). More than half of the reviews did not refer to a protocol,22, 27, 28, 29, 32, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66 66.6% reviews did not explain the study designs for inclusion in the review,12, 28, 34, 54, 56, 57, 58, 59, 60, 61, 62, 64, 65, 66, 70, 71, 72 73.3% did not provide the list of excluded studies,27, 28, 29, 32, 55, 56, 57, 58, 59, 60, 61, 62, 63, 65, 66, 69, 71, 72, 73, 74, 75 and 83.3% of reviews did not clearly state the sources of funding for the included studies 12, 22, 26, 27, 28, 29, 34, 55, 56, 57, 58, 59, 60, 61, 62, 63, 65, 66, 67, 68, 69, 72, 73, 74, 75. Inter-rater agreement of the 2 authors was high (κ = 0.86).…”

“…Evidence of effectiveness was found for the following pharmacologic intervention approaches, in order of decreasing effect size: paroxetine (a selected serotonin reuptake inhibitors [SSRI]), oral clomipramine (a tricyclic antidepressant [TCA]), lidocaine gel (topical anesthetic), citalopram (SSRI), sertraline (SSRI), fluoxetine (SSRI), PDE5-Is, topical eutectic mixture for PE (topical anesthetic), nasal clomipramine nasal (TCA), dapoxetine (SSRI), and tramadol (opioid analgesic). The overall evidence for PDE5-Is, paroxetine, sertraline and nasal and oral clomipramine is limited, and most meta-analyses included a small number (72–231) of participants 34, 67, 75. Dapoxetine and tramadol are currently the only available drugs for which efficacy has been tested in large, well-designed and described clinical trials.…”

Surgical treatment for primary premature ejaculation with an inner condom technique

“…Despite its efficacy, the use of topical anesthetics was associated with penile hypoanesthesia and transvaginal absorption, leading to vaginal numbness and female anorgasmia. [6,7] For surgical intervention, selective resection of dorsal nerves of penis demonstrated an efficacy rate of 90%, and compared to pharmacologic agents, the effect of a single surgery was more long-lasting. [8,9] Disappointedly, perioperative complications such as paraesthesia on the glans penis and erectile dysfunction were reported.…”

Smartphone-Based Therapeutic Exercises for Men Affected by Premature Ejaculation: A Pilot Study

“…The guiding approach of these treatments is to learn to control ejaculation both physically and mentally, while understanding the meaning of the symptoms and the context in which they occur. 7 These treatments can also be integrated with pharmacotherapy, including local anesthetics 8 and/or selective serotonin reuptake inhibitors (SSRIs) that target the depressive psychopathology involved in the disease. 9 , 10 …”