MedWire News: Pelvic floor muscle (PFM) rehabilitation may be a viable therapeutic option for treatment of premature ejaculation (PE), report Italian researchers.
The study also confirms previous data on the efficacy and safety of dapoxetine, a newly-developed selective serotonin reuptake inhibitor (SSRI), for the treatment of PE, they say.
"Many currently available treatment options for PE have limited long-term efficacy and undesirable sexual side effects," explain Antonio Pastore (Sapienza University of Rome) and colleagues. "The primary objective of the current study was to compare the effectiveness of PFM rehabilitation with that of on-demand SSRI treatment."
The researchers recruited 40 men, aged 19-51 years, who were diagnosed with PE according to the International Society for Sexual Medicine definition of an intra-vaginal ejaculatory latency time (IELT) of 1 minute or less.
Each of the men had lifelong PE with a mean IELT of 43.2 seconds and had tried different types of therapy including anesthetic creams and antidepressants, without any substantial effect.
In the current study, pre-treatment IELT was measured during a 4-week baseline period. Patients were provided with a stopwatch and instructions on how to measure IELT and were asked to experience coitus at least four times.
The team then randomly allocated the men to receive either PFM rehabilitation or on-demand dapoxetine (30 or 60 mg) and compared the mean IELT values of the patients in the two groups after 12 weeks of treatment.
The PFM rehabilitation protocol consisted of physiokinesitherapy to achieve muscle contraction that allows the patient to be aware of motor activity; electrical stimulation of the perineal floor to directly stimulate the pudendal nerve; and biofeedback, in which the patient learns to control the muscle contractions of the perineal floor and the genito-urinary sphincter. Patients attended three 60-minute sessions per week during which these three techniques were applied for 20 minutes each.
Patients assigned to dapoxetine therapy took the drug, as required, 1-3 hours before sexual intercourse over a 12-week period.
The patients' IELT values were measured at 6 weeks and again at the end of therapy.
As reported in the International Journal of Andrology, in the PFM group, 11 (57%) of the patients were able to control the ejaculation reflux, with a mean IELT of 114.6 seconds after 6 weeks and of 126.2 seconds after 12 weeks.
Patients in the 30 and 60 mg dapoxetine groups also experienced increases in IELT, achieving respective mean IELTs of 168.2 seconds and 193.2 seconds after 6 weeks and of 168.6 seconds and 222.6 seconds after 12 weeks.
The researchers also say that while there were no reported side effects with PFM rehabilitation, nausea was frequently reported by 12.5% and 28.5% of those in the 30 mg and 60 mg dapoxetine subgroups, respectively, although no severe adverse events were reported and no one discontinued treatment because of adverse events.
"The PFM rehabilitation protocol is easy to perform, has no side effects, and although not yet standardized, our results suggest that it can be included among the therapeutic options for patients with PE," say Pastore et al.
Furthermore, PFM rehabilitation represents an important cost reduction if compared with dapoxetine on-demand treatment, they add.
The researchers note that the size of the study population enrolled was small and say that further studies are needed to compare treatment of PE using physical therapy and SSRIs.
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