Nieves Martín M. et al., 2025: Dapoxetine combined with non-pharmacological approaches for lifelong premature ejaculation. A systematic review and meta-analysis.
Marta Nieves Martín 1, Patricia Marín Novoa 2, Juan Avendaño-Coy 3
1Woman & Health Research Group, Department of Physiotherapy, Faculty of Medicine, Health and Sports, European University of Madrid, Madrid 28670, Spain.
2Hospital Universitario San Pedro, Logroño, 26006, Spain.
3Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Universidad de Castilla-La Mancha, Toledo 45071, Spain.
Abstract
Introduction: Recent research has highlighted the potential advantages of combining pharmacologic and non-pharmacologic approaches in treating lifelong premature ejaculation (LPE). Individual therapies have demonstrated efficacy but there is a lack of comprehensive analysis comparing combined treatments to pharmacologic monotherapy.
Objectives: To assess the combined effect of dapoxetine with non-pharmacological therapies compared to drug monotherapy in improving ejaculatory latency, functionality, and self-perception of sexual dysfunction in individuals with LPE.
Methods: A systematic search was performed in PubMed, PEDro, Cochrane, Web of Science, CINAHL, and Academic Search Ultimate databases from inception to October 2024 to identify randomized controlled trials (RCTs). The primary outcome was the intravaginal ejaculatory latency time (IELT), while secondary outcomes were self-perception improvements, assessed using the Premature Ejaculation Diagnostic Tool (PEDT), the premature ejaculation profile (PEP), and other evaluation instruments.
Results: Eight RCTs (n = 656 participants) were included. Pooled analysis of studies showed a significant effect of dapoxetine combined with non-pharmacological therapies in improving IELT compared to dapoxetine monotherapy (SDM = 1.6; 95%CI, 0.5-2.8; P = .01), PEDT scores (SDM = 0.9; 95%CI, 0.4-1.4; P < .001) and PEP subscales, with moderate certainty of evidence according to the GRADE guidelines. The non-pharmacological therapies included shockwave therapy, biofeedback, electric stimulation, pelvic floor muscle training, desensitization techniques, psychotherapy, and behavioral therapy.
Conclusion: This systematic review and meta-analysis indicate that while dapoxetine is recognized for its beneficial effects, its clinical efficacy is significantly enhanced when combined with non-pharmacological interventions. Combination therapy increases IELT, reduces PEDT scores, and improves PEP scores. These findings suggest that combination therapy is more effective than dapoxetine monotherapy in improving functional outcomes and self-perception in patients with LPE, supported by moderate certainty of evidence.
J Sex Med. 2025 Nov 2;22(11):1948-1957. doi: 10.1093/jsxmed/qdaf238. PMID: 41020367.
Comments 1
The article aims to evaluate the effectiveness of combining dapoxetine, a pharmacological treatment for lifelong premature ejaculation (LPE), with various non-pharmacological therapies, comparing this combination to dapoxetine monotherapy.
Methods: A systematic literature search was conducted across multiple databases (PubMed, Cochrane, PEDro, etc.) to identify randomized controlled trials (RCTs) that examined the effects of dapoxetine in conjunction with non-pharmacological treatments. The non-pharmacological therapies included shockwave therapy (i.e. 3000 pulses with 0.25 mJ/mm2 at 8 Hz), biofeedback, electric stimulation, pelvic floor muscle training, desensitization techniques, psychotherapy, and behavioral therapy. The primary outcome measured was the intravaginal ejaculatory latency time (IELT), while secondary outcomes included self-perception of sexual dysfunction assessed through tools like the Premature Ejaculation Diagnostic Tool (PEDT) and the premature ejaculation profile (PEP).
Results: The review included eight RCTs involving 656 participants. The findings indicated that the combination of dapoxetine and non-pharmacological therapies significantly improved IELT (Standardized Mean Difference [SDM]= 1.6), PEDT scores (SDM= 0.9), and PEP scores compared to dapoxetine alone. However, the single study which included the combination of dapoxetine with Li-ESWT unfortunately was negative (Dogan et al. 2023).
Conclusion: The study concluded that combining dapoxetine with non-pharmacological approaches enhances treatment outcomes for LPE, suggesting that such combination therapies may be more effective than dapoxetine monotherapy in improving both functional outcomes and self-perception of sexual dysfunction.
Discussion: This systematic review and meta-analysis provide valuable insights into the treatment of lifelong premature ejaculation, a condition affecting a significant portion of the male population. The findings underscore the importance of a multifaceted approach to treatment, integrating both pharmacological and non-pharmacological strategies.
There are some strenghts such as
The inclusion of multiple studies to allow for a robust analysis of the efficacy of combination therapies, addressing a gap in the literature regarding comparative effectiveness.
The variety of non-pharmacological treatments examined which may provide insights into different therapeutic modalities, catering to a range of patient needs and preferences.
The statistically significant improvements in both IELT and self-perception scores strengthen the argument for combining therapies, offeringpractical implications for clinical practice.
However there are also significant limitation:
1. The heterogeneity of the study: The variability in the non-pharmacological therapies and the methods used to assess outcomes may limit the generalizability of the findings. Future studies could benefit from standardized approaches to enhance comparability.
2. The sample Size: While the review included a reasonable number of participants, the overall sample size across studies may still be considered modest for drawing broad conclusions.
3. The dropout rates: The article mentions dropout rates and reasons, which could influence the reliability of the results. High dropout rates may introduce bias and affect the validity of the findings.
The results suggest that clinicians should consider recommending a combination of dapoxetine with non-pharmacological therapies for patients with LPE. Such an approach not only addresses the physiological aspects of the condition but also incorporates psychological and behavioral strategies that can enhance the overall treatment experience and outcomes. However, concerning the efficacy of Li-ESWT future studies are necessary. Until now, the effect is minimal.
Jens Rassweiler