University of Sheffield Sheffield, UK.
Porterbrook Clinic Sheffield, UK.
Sex Med. 2015 Sep;3(3):174-88. doi: 10.1002/sm2.65. Epub 2015 May 8.
Premature ejaculation (PE) is defined by short ejaculatory latency and inability to delay ejaculation causing distress. Management may involve behavioral and/or pharmacological approaches.
To systematically review the randomized controlled trial (RCT) evidence for behavioral therapies in the management of PE.
Nine databases including MEDLINE were searched up to August 2014. Included RCTs compared behavioral therapy against waitlist control or another therapy, or behavioral plus drug therapy against drug treatment alone. [Correction added on 10 September 2015, after first online publication: Search period has been amended from August 2013 to August 2014.].
Intravaginal ejaculatory latency time (IELT), sexual satisfaction, ejaculatory control, and anxiety and adverse effects.
Ten RCTs (521 participants) were included. Overall risk of bias was unclear. All studies assessed physical techniques, including squeeze and stop-start, sensate focus, stimulation device, and pelvic floor rehabilitation. Only one RCT included a psychotherapeutic approach (combined with stop-start and drug treatment). Four trials compared behavioral therapies against waitlist control, of which two (involving squeeze, stop-start, and sensate focus) reported IELT differences of 7-9 minutes, whereas two (web-based sensate focus, stimulation device) reported no difference in ejaculatory latency posttreatment. For other outcomes (sexual satisfaction, desire, and self-confidence), some waitlist comparisons significantly favored behavioral therapy, whereas others were not significant. Three trials favored combined behavioral and drug treatment over drug treatment alone, with small but significant differences in IELT (0.5-1 minute) and significantly better results on other outcomes (sexual satisfaction, ejaculatory control, and anxiety). Direct comparisons of behavioral therapy vs. drug treatment gave mixed results, mostly either favoring drug treatment or showing no significant difference. No adverse effects were reported, though safety data were limited.
There is limited evidence that physical behavioral techniques for PE improve IELT and other outcomes over waitlist and that behavioral therapies combined with drug treatments give better outcomes than drug treatments alone. Further RCTs are required to assess psychotherapeutic approaches to PE.
早泄（PE）的定义是射精潜伏期短，无法延迟射精，导致痛苦。治疗方法可能包括行为和/或药物治疗。
系统回顾治疗 PE 的行为疗法的随机对照试验（RCT）证据。
检索了包括 MEDLINE 在内的 9 个数据库，截至 2014 年 8 月。纳入的 RCT 比较了行为疗法与候补对照组或其他疗法，或行为加药物治疗与单独药物治疗。[2015 年 9 月 10 日更正：搜索期已从 2013 年 8 月修改为 2014 年 8 月。]。
阴道内射精潜伏期时间（IELT）、性满意度、射精控制和焦虑及不良反应。
纳入 10 项 RCT（521 名参与者）。整体偏倚风险不明确。所有研究均评估了物理技术，包括挤压和停止-启动、感觉焦点、刺激装置和盆底康复。只有一项 RCT 包括心理治疗方法（与停止-启动和药物治疗相结合）。四项试验比较了行为疗法与候补对照组，其中两项（涉及挤压、停止-启动和感觉焦点）报告 IELT 差异为 7-9 分钟，而另外两项（基于网络的感觉焦点、刺激装置）报告治疗后射精潜伏期无差异。对于其他结果（性满意度、欲望和自信心），一些候补比较明显有利于行为疗法，而其他则不明显。三项试验表明，联合行为和药物治疗优于单独药物治疗，IELT 有较小但显著的差异（0.5-1 分钟），其他结果（性满意度、射精控制和焦虑）明显更好。行为疗法与药物治疗的直接比较结果喜忧参半，大多倾向于药物治疗或显示无显著差异。未报告不良反应，但安全性数据有限。
有限的证据表明，PE 的物理行为技术可改善 IELT 和其他结果，优于候补和行为疗法与药物治疗相结合的治疗方法优于单独药物治疗。需要进一步的 RCT 来评估治疗 PE 的心理治疗方法。
