Dapoxetine combined with non-pharmacological approaches for lifelong premature ejaculation. A systematic review and meta-analysis.

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.