Eutectic Mixture of Local
Anaesthetics (EMLA) is recommended for use off-label as a treatment for
premature ejaculation (PE). Other topical anaesthetics are available, some of
which have been evaluated against oral treatments.
The purpose of this
systematic review was to evaluate the evidence from randomised controlled
trials (RCTs) for topical anaesthetics in the management of PE. Bibliographic
databases including MEDLINE were searched to August 2014. The primary outcome
was intra-vaginal ejaculatory latency time (IELT). Methodological quality of
RCTs was assessed. IELT and other outcomes were pooled across RCTs in a
meta-analysis. Between-trial heterogeneity was assessed. Nine RCTs were
included. Seven were of unclear methodological quality.
Pooled evidence (two
RCTs, 43 participants) suggests that EMLA is significantly more effective than
placebo at increasing IELT (P < 0.00001). Individual RCT evidence
also suggests that Topical Eutectic-like Mixture for Premature Ejaculation
(TEMPE) spray and lidocaine gel are both significantly more effective than
placebo (P = 0.003; P < 0.00001); and lidocaine gel is
significantly more effective than sildenafil or paroxetine (P = 0.01; P = 0.0001).
TEMPE spray is associated
with significantly more adverse events than placebo (P = 0.003).
More systemic adverse events are reported with tramadol, sildenafil and
paroxetine than with lidocaine gel.
Diverse methods of assessing sexual
satisfaction and ejaculatory control with topical anaesthetics are reported and
evidence is conflicting. Topical anaesthetics appear more effective than
placebo, paroxetine and sildenafil at increasing IELT in men with PE. However,
the methodological quality of the existing RCT evidence base is uncertain.
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By:
A School for Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. B Porterbrook Clinic, Sexual Medicine, 9 Sunderland Street, Sheffield, S11 8HN, UK. C Institute of Psychosexual Medicine, Building 3 Chiswick Park, 566 Chiswick High Road, London, W4 5YA, UK. D St George’s Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK. E Corresponding author. Email: m.martyn-stjames@sheffield.ac.uk
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