Effectiveness of physiotherapy in male premature ejaculation. A systematic review and metaanalysis

Premature ejaculation (PE) is clinically defined as an intravaginal ejaculatory latency time (IELT) of 1 min or less. While pharmacological treatments have demonstrated rapid and effective results, they are frequently associated with adverse side effects. In contrast, physiotherapeutic approaches offer a safer alternative, with a lower risk of undesirable reactions.

To assess the efficacy of physiotherapeutic interventions in increasing IELT, compared to pharmacological treatment, in men diagnosed with PE.

A systematic search was conducted across multiple databases (PubMed, PEDro, Scopus, and Researchgate) to identify clinical trials published within the past 10 years. Eligible studies included those that compared physiotherapy with pharmacological interventions, using IELT as the primary outcome variable in male patients with PE. A quality assessment was performed using the PEDro scale. The data were pooled and a meta-analysis was completed. This systematic review was conducted in accordance with the (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) PRISMA guideline statement. It was registered in the PROSPERO database with registration number CRD42024613802 (blinded for reviewers).

Six studies, encompassing a total of 416 participants, met the inclusion criteria and were analyzed. The pooled effect is statistically significant (P = .03), showing a mean difference in IELT of -0.80 s (95% confidence interval, -1.53 to -0.06) which significantly favors dapoxetine, with a high heterogeneity between studies (I2 = 83%).

The results of the meta-analyses suggest that dapoxetine at a dose of 30 mg is significantly more effective than physiotherapy for prolonging IELT in men with lifelong PE. Physiotherapy can be considered a safe and beneficial intervention, positioning it as a promising alternative for patients who are intolerant to pharmacological treatment. Nevertheless, the qualitative review suggests that a combined therapeutic approach yields the most significant improvements in IELT.