Complementary and alternative medicine for management of premature ejaculation: a systematic review and meta-analysis

Introduction: Premature ejaculation (PE) is defined as ejaculation within one minute (lifelong PE) or three minutes (acquired PE); inability to delay ejaculation; and negative personal consequences. Management includes behavioral and pharmacological approaches. Aim: To systematically review effectiveness, safety, and robustness of evidence for complementary and alternative medicine (CAM) in managing PE. Methods: Nine databases including MEDLINE were searched to September 2015. Randomized controlled trials (RCTs) evaluating CAM for PE were included. Outcome measures: Studies were included if they reported intra-vaginal ejaculatory latency time (IELT) and/or another validated premature ejaculation measure. Adverse effects were summarized. Results: Ten RCTs were included. Two assessed acupuncture, five Chinese herbal medicine, one Ayurvedic herbal medicine, and two topical “severance secret” (SS) cream. Risk of bias was unclear in all studies due to 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 min, p=0.001). In another study, Ayurvedic herbal medicine slightly increased IELT over placebo (MD=0.80 min, p=0.001). Topical SS cream improved IELT over placebo in two studies (MD=8.60 min, p<0.001), though inclusion criteria were broad (IELT <3 min). Three studies comparing Chinese herbal medicine against selective serotonin reuptake inhibitors (SSRIs) favored SSRIs (MD=1.01 min, p=0.02). However, combination treatment with Chinese medicine plus SSRIs improved IELT over SSRIs alone (two studies, MD=1.92 min, p<0.00001) and over Chinese medicine alone (two studies, MD=2.52 min, p<0.00001). Adverse effects were not consistently assessed, but where reported were generally mild. Conclusions: There is preliminary evidence for effectiveness of acupuncture, Chinese herbal medicine, Ayurvedic herbal medicine and topical SS cream in improving IELT and other outcomes. However, results are based on clinically heterogeneous studies of unclear quality. There is little data on adverse effects or potential for drug interactions. Further well-conducted RCTs would be valuable.