Selective serotonin re-uptake inhibitors for premature ejaculation in adult men

• Published in: Cochrane database of systematic reviews 2021-03, Vol.3 (3), p.CD012799
• Main Authors: Sathianathen, Niranjan J, Hwang, Eu Chang, Mian, Ruma, Bodie, Joshua A, Soubra, Ayman, Lyon, Jennifer A, Sultan, Shahnaz, Dahm, Philipp
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Coitus - psychology; Confidence Intervals; Ejaculation - drug effects; Humans; Male; Middle Aged; Odds Ratio; Patient Satisfaction - statistics & numerical data; Placebos - therapeutic use; Premature ejaculation (PE); Premature Ejaculation - drug therapy; Premature Ejaculation - psychology; Randomized Controlled Trials as Topic; Reproductive & sexual health; Selective Serotonin Reuptake Inhibitors - adverse effects; Selective Serotonin Reuptake Inhibitors - therapeutic use; Urology; Young Adult
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD012799.pub2

Premature ejaculation (PE) is a common problem among men that occurs when ejaculation happens sooner than a man or his partner would like during sex; it may cause unhappiness and relationship problems. Selective serotonin re-uptake inhibitors (SSRIs), which are most commonly used as antidepressants are being used to treat this condition. To assess the effects of SSRIs in the treatment of PE in adult men. We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, CINAHL), clinical trial registries, conference proceedings, and other sources of grey literature, up to 1 May 2020. We applied no restrictions on publication language or status. We included only randomized controlled clinical trials (parallel group and cross-over trials) in which men with PE  were administered SSRIs or placebo. We also considered 'no treatment' to be an eligible comparator but did not find any relevant studies. Two review authors independently classified and abstracted data from the included studies. Primary outcomes were participant-perceived change with treatment, satisfaction with intercourse and study withdrawal due to adverse events. Secondary outcomes included self-perceived control over ejaculation, participant distress about PE, adverse events and intravaginal ejaculatory latency time (IELT). We performed statistical analyses using a random-effects model. We rated the certainty of evidence according to GRADE. We identified 31 studies in which 8254 participants were randomized to receiving either SSRIs or placebo. Primary outcomes: SSRI treatment probably improves self-perceived PE symptoms (defined as a rating of 'better' or 'much better') compared to placebo (risk ratio (RR) 1.92, 95% confidence interval (CI) 1.66 to 2.23; moderate-certainty evidence). Based on 220 participants per 1000 reporting improvement with placebo, this corresponds to 202 more men per 1000 (95% CI 145 more to 270 more) with improved symptoms with SSRIs.  SSRI treatment probably improves satisfaction with intercourse compared to placebo (defined as a rating of 'good' or 'very good'; RR 1.63, 95% CI 1.42 to 1.87; moderate-certainty evidence). Based on 278 participants per 1000 reporting improved satisfaction with placebo, this corresponds to 175 more (117 more to 242 more) per 1000 men with greater satisfaction with intercourse with SSRIs. SSRI treatment may increase treatment cessations due to adverse events compared to placebo (RR 3.80, 95% CI 2.61 t