Rédacteurs : Johan Nguyen, Claude Pernice, Henri Truong

Premature ejaculation

Ejaculation précoce : évaluation de l'acupuncture

1. Systematic Reviews and Meta-Analysis

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

1.1. Cooper 2016 ☆

Cooper K, Martyn-St James M, Kaltenthaler E, Dickinson K, Cantrell A, Ren S, Wylie K, Frodsham L, Hood C. Complementary and Alternative Medicine for Management of Premature Ejaculation: A Systematic Review. Sex Med. 2016. [190567].

Objectives 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. AIM: 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. MAIN OUTCOME MEASURES: 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.

1.2. Cooper 2015 ☆☆

Cooper K, Martyn-St James M, Kaltenthaler E, Dickinson K, Cantrell A. Interventions to treat premature ejaculation: a systematic review short report. Health Technol Assess. 2015;19(21):1-180. [178963].

BackgroundPremature ejaculation (PE) is commonly defined as ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it. PE can be either lifelong and present since first sexual experiences (primary), or acquired (secondary), beginning later (Godpodinoff ML. Premature ejaculation: clinical subgroups and etiology. J Sex Marital Ther 1989;15:130-4). Treatments include behavioural and pharmacological interventions.
ObjectiveTo systematically review evidence for clinical effectiveness of behavioural, topical and systemic treatments for PE.
Data sourcesThe following databases were searched from inception to 6 August 2013 for published and unpublished research evidence: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effects and the Health Technology Assessment database; ISI Web of Science, including Science Citation Index, and the Conference Proceedings Citation Index-Science. The US Food and Drug Administration website and the European Medicines Agency (EMA) website were also searched.
MethodsRandomised controlled trials (RCTs) in adult men with PE were eligible (or non-RCTs in the absence of RCTs). RCT data were extrapolated from review articles when available. The primary outcome was intravaginal ejaculatory latency time (IELT). Data were meta-analysed when possible. Other outcomes included sexual satisfaction, control over ejaculation, relationship satisfaction, self-esteem, quality of life, treatment acceptability and adverse events (Aes).
ResultsA total of 103 studies (102 RCTs, 65 from reviews) were included. RCTs were available for all interventions except yoga. The following interventions demonstrated significant improvements (p < 0.05) in arithmetic mean difference in IELT compared with placebo: topical anaesthetics - eutectic mixture of local anaesthetics (EMLA(®), AstraZeneca), topical eutectic mixture for PE (Plethora Solutions Ltd) spray; selective serotonin reuptake inhibitors (SSRIs) - citalopram (Cipramil(®), Lundbeck), escitalopram (Cipralex(®), Lundbeck), fluoxetine, paroxetine, sertraline, dapoxetine (Priligy(®), Menarini), 30 mg or 60 mg; serotonin-noradrenaline reuptake inhibitors - duloxetine (Cymbalta(®), Eli Lilly & Co Ltd); tricyclic antidepressants - inhaled clomipramine 4 mg; phosphodiesterase-5 (PDE5) inhibitors - vardenafil (Levitra(®), Bayer), tadalafil (Cialis(®), Eli Lilly & Co Ltd); opioid analgesics - tramadol (Zydol SR(®), Grünenthal). Improvements in sexual satisfaction and other outcomes compared with placebo were evident for SSRIs, PDE5 inhibitors and tramadol. Outcomes for interventions not compared with placebo were as follows: behavioural therapies - improvements over wait list control in IELT and other outcomes, behavioural therapy plus pharmacotherapy better than either therapy alone; alpha blockers - terazosin (Hytrin(®), AMCO) not significantly different to antidepressants in ejaculation control; acupuncture - improvements over sham acupuncture in IELT, conflicting results for comparisons with SSRIs; Chinese medicine - improvements over treatment as usual; delay device - improvements in IELT when added to stop-start technique; yoga - improved IELT over baseline, fluoxetine better than yoga. Treatment-related Aes were evident with most pharmacological interventions. Limitations: Although data extraction from reviews was optimised when more than one review reported data for the same RCT, the reliability of the data extraction within these reviews cannot be guaranteed by this assessment report.
ConclusionsSeveral interventions significantly improved IELT. Many interventions also improved sexual satisfaction and other outcomes. However, assessment of longer-term safety and effectiveness is required to evaluate whether or not initial treatment effects are maintained long term, whether or not dose escalation is required, how soon treatment effects end following treatment cessation and whether or not treatments can be stopped and resumed at a later time. In addition, assessment of the Aes associated with long-term treatment and whether or not different doses have differing AE profiles is required. Study registration: This study is registered as PROSPERO CRD42013005289. Funding: The National Institute for Health Research Health Technology Assessment programme.

1.3. Bai 2012 ☆

Bai Min, Wang Qiang-Ping. [Effectiveness of acupuncture in treatment of premature ejaculation: A Meta-analysis]. Medical Journal of West China. 2012;2:261-264. [187047].

Objective To evaluate the efficacy of acupuncture in patients with premature ejaculation.
Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 4 of 12, Apr 2011), MEDLINE (1998 to April 2011), EMBASE (1998 to April 2011), the Chinese Biomedical Database (CBM) (1998 to April 2011), Chinese National Knowledge Infrastructure (CNKI) (1998 to 2010) and WanFang Database (1998 to April 2011), and We manually searched the relevant journals. All the RCTs confirmed to treat premature ejaculation with acupuncture and other methods were enrolled. The Cochrane Collaboration’s software RevMan 5. 1 was used for meta-analysis.
Results A total of 4 RCTs involving 411 patients with premature ejaculation were included. The results of meta-analysis showed that: ① The effective rate of acupuncture plus herbs was higher than herbs alone in treatment of premature ejaculation, but without statistically difference (P=0. 06); ② One study demonstrated that the effective rate of acupuncture was significantly higher than paroxetine, however, two studies found that the two methods had no difference in improving sexual function between two groups (Meta-analysis could not be conducted due to the missing data). ③One study conformed than acupuncture was more effective than sham-acupuncture (P<0. 05).
Conclusion The present study showed that acupuncture was effective in treatment of premature ejaculation. Multi-factors which lead to bias affected the authenticity of our review, such as few-studies, low-quality and difference between outcome estimating, so further large-scale trials are required.

2. Recommandation de bonne pratique

⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation, (or lack of evidence)

2.1. European Association of Urology (EAU) 2019

Male Sexual Dysfunction. European Association of Urology. 2019. 196861

Some authors compared the efficacy of acupuncture and dapoxetine for the treatment of PE [407]. Although the authors demonstrated that acupuncture had a significant ejaculation-delaying effect, this was less effective compared with that of dapoxetine.

2.2. International Society for Sexual Medicine (ISSM) 2014

Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med. 2014;11(6):1392-422. [168740].

There are limited positive data regarding the effectiveness of acupuncture therapy. (LOE 3b)