madman
Super Moderator
Abstract
The arrival of Pfizer’s blue pill Sildenafil in 1998 brought a great relief both to patient and physician signalling the start of a great era of medical therapy in sexual medicine. Since then the sexual medicine experts have been prescribing sildenafil in erectile dysfunction with acceptable minor adverse events. But the use of sildenafil in premature ejaculation (PE) is still debated. 2018 being the 20th anniversary of sildenafil, we have compiled interesting facts about the role of sildenafil in PE from various original articles, systematic reviews, meta-analyses, economic brochures and sexual medicine committee guidelines. The major issues in most of these studies were the heterogeneity in the definition of PE and estimating the exact ejaculatory latency time. This perspective article highlights the positive role of sildenafil in the management of PE (even without ED) with acceptable adverse events. Now that we have a standardised definition of PE from International Society of Sexual Medicine (ISSM) and a psychogenic component in PE definition, more randomised placebo-controlled studies are required to further establish its role.
Conclusion
The evaluation and treatment of PE is complex, and guidelines for such management have recently evolved. Now that we have an evidence based definition for PE from ISSM and standards in sexual dysfunction clinical trials, it’s time we start reporting randomised controlled trials using the CONSORT statement. More convenient methods of reporting IELT should be devised to avoid reporting bias. EAU 2018 guidelines has a “strong” recommendation for the use of sildenafil (PDE5-I) alone or in combination with other therapies in patients with PE (without ED), although AUA and ISSM still do not recommend PDE5-I alone in PE (without ED).
The arrival of Pfizer’s blue pill Sildenafil in 1998 brought a great relief both to patient and physician signalling the start of a great era of medical therapy in sexual medicine. Since then the sexual medicine experts have been prescribing sildenafil in erectile dysfunction with acceptable minor adverse events. But the use of sildenafil in premature ejaculation (PE) is still debated. 2018 being the 20th anniversary of sildenafil, we have compiled interesting facts about the role of sildenafil in PE from various original articles, systematic reviews, meta-analyses, economic brochures and sexual medicine committee guidelines. The major issues in most of these studies were the heterogeneity in the definition of PE and estimating the exact ejaculatory latency time. This perspective article highlights the positive role of sildenafil in the management of PE (even without ED) with acceptable adverse events. Now that we have a standardised definition of PE from International Society of Sexual Medicine (ISSM) and a psychogenic component in PE definition, more randomised placebo-controlled studies are required to further establish its role.
Conclusion
The evaluation and treatment of PE is complex, and guidelines for such management have recently evolved. Now that we have an evidence based definition for PE from ISSM and standards in sexual dysfunction clinical trials, it’s time we start reporting randomised controlled trials using the CONSORT statement. More convenient methods of reporting IELT should be devised to avoid reporting bias. EAU 2018 guidelines has a “strong” recommendation for the use of sildenafil (PDE5-I) alone or in combination with other therapies in patients with PE (without ED), although AUA and ISSM still do not recommend PDE5-I alone in PE (without ED).
