Psychological intervention for premature ejaculation.

While psychological issues are present in most patients with premature ejaculation (PE), whether as a cause or a consequence of the disorder, the effectiveness of psychological intervention for PE is not clear. Searches of the MEDLINE, EMBASE, PsychINFO, LILACS and the Cochrane Library electronic databases find little high-quality evidence for the psychosexual and behavioral approaches to treatment of PE. Five randomized and four quasi-randomized trials were included in this Review. Little evidence was found that psychological interventions are effective in the treatment of PE. Three studies showed strong evidence in support of improved intravaginal ejaculatory latency times following psychosexual therapy combined with pharmacotherapy, compared with monotherapy. One study found that functional-sexological treatment markedly improved duration of intercourse, sexual satisfaction, and sexual function. Limitations of published studies include a lack of randomization, uncertain clinical significance of outcomes, absence of compelling follow-up data that show long-term response and lack of reproducibility. Randomized trials with large sample sizes are still needed to expand the currently available evidence on psychological intervention for treating PE. Besides examining the main effects of treatment, trials in this field should also address the complex interactions between patient characteristics, PE subtype and treatment approach.