Complementary and alternative medicine options may help men manage premature ejaculation, according to a new review of existing research.
The improvements were small, and the studies were of varying quality, but preliminary evidence suggests that acupuncture, Chinese herbal medicine, Ayurvedic herbal medicine and a Korean topical cream may all have desirable effects, researchers conclude in the journal Sexual Medicine, online December 29.
"There are a range of treatments available for premature ejaculation, including drug treatments, behavioural techniques and counseling, however, some men may not want to visit the doctor, take drugs long-term or be on a long wait list for counseling," said lead author Katy Cooper of the University of Sheffield in the UK.
"It's important to evaluate the evidence for other therapies," she told Reuters Health by email. "To our knowledge, this is the first systematic review to assess complementary and alternative medicine for premature ejaculation."
In the current study, researchers evaluated 10 randomized controlled trials that included comparisons either to another type of treatment or to a placebo. Two studies were of acupuncture, five were of Chinese herbal medicine, one of Ayurvedic herbal medicine and two of Korean topical "severance secret" cream.
Together, the two acupuncture studies found that the treatment slightly increased intravaginal ejaculatory latency time (IELT) by about half a minute compared to placebo.
Chinese herbal medicine increased IELT by about two minutes, Ayurvedic herbal medicine increased IELT by nearly a minute and topical cream increased IELT by more than eight minutes.
In some instances, a combination of traditional and alternative options was the most effective. For example, Chinese medicine paired with selective serotonin reuptake inhibitors (SSRIs) increased IELT by two minutes longer than SSRIs alone and nearly three minutes longer than the Chinese medicine alone.
"There are no approved treatments for premature ejaculation," said Donald Patrick, vice chair for research at the University of Washington in Seattle.
"This is a common condition that has serious psychological effects on relationships," said Patrick, who wasn't involved in the study.
"We need treatments to address it, and it should be treated with equal seriousness as erectile dysfunction."
The prevalence of premature ejaculation is difficult to measure because of the differing definitions of the problem and some men's reluctance to report it.
Some studies suggest that between 20 and 30 per cent of men report early ejaculation concerns, but the International Society for Sexual Medicine estimates that about 4 per cent of men have a lifelong condition.
"Although it is not openly discussed in the media - at least not as much as erectile problems have been discussed in the post-Viagra era - numerous studies report men feel frustrated, depressed and anxious because of this problem," said Ege Can Serefoglu of the Bagcilar Training and Research Hospital in Istanbul, Turkey.
The main limitation of the study is the underlying weakness of the studies evaluated. Bias was unclear in most of the studies, and only five used stopwatches to measure IELT, which is the "gold standard" for premature ejaculation studies, Patrick said.
In addition, the authors write, the studies are so different, it's tough to draw conclusions about the different options. For example, the five Chinese medicine studies tested different substances, including Qilin pills, Yimusake and Uighur.
Some studies, but not all, discussed side effects such as gastrointestinal discomfort, dizziness, mild pain and decreased libido. When they were reported, the adverse effects were generally mild, the study team writes.
"Nowadays, I am encountering alternative medicine-obsessed patients more than I used to, and it doesn't make sense to argue with them about the treatment they want," Serefoglu told Reuters Health by email.
"After all, the placebo is a well-known clinical phenomenon, and some of my patients report surprisingly favourable outcomes."