(LONDON) -- Researchers have called into question the effectiveness of a psychological approach to treating premature ejaculation, a sexual disorder that affects up to 30 percent of men worldwide.
A Cochrane Review analysis of four previously published studies of 253 men found insufficient evidence to support behavioral therapy for premature ejaculation, despite small studies and anecdotes proclaiming its success. But some experts maintain that the therapy, which aims to ease the anxiety surrounding the condition for both men and their partners, can be useful together with medication.
"The assumption behind psychosocial interventions is that when patients learn about [premature ejaculation] they begin to develop new sexual management strategies to deal with restrictive sexual patterns, such as avoidance of sexual activity and an unwillingness to discuss sex with a partner," said the review's lead author Tamara Melnik, a professor of internal medicine at the Federal University of Sao Paulo in Brazil. "There is a consensus that psychological aspects are very important to ensure success and maintenance of the results after discontinuation of medication."
Medications like Paxil, Zoloft and others in the selective serotonin reuptake inhibitor class of antidepressants can inhibit the ejaculatory reflex at low doses. And topical anesthetics like lidocaine cream can numb the penis, drawing out intercourse. But because none are FDA-approved for premature ejaculation, doctors are forced to prescribe drugs off-label and monitor patients closely for possible side-effects.
"One of the greatest unmet needs in the field is the lack of FDA-approved treatments right now," said Dr. Wayne Hellstrom, a urologist at Tulane University Health Sciences Center in New Orleans, Lousiana. "But behavioral therapy does work in some people. And it does work in combination with other treatments, either oral or topical medications."
Premature ejaculation can crumble men's sexual self-confidence and make it difficult for them to establish comfortable sexual relationships. In up to 90 percent of cases, psychological factors are implicated as cause or a consequence.
The cause of premature ejaculation remains unknown, complicating the search for effective treatments. And outside of the four studies included in the Cochrane review, 13 others were too small or failed to sufficiently control biases or rule out the placebo effect, resulting in their exclusion.
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