---
title: "Premature ejaculation"
url: "https://acuiq.com/wiki/evidence/premature-ejaculation"
updated: 2026-10-15
last_verified: 2026-10-15
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-15"
reading_minutes: 10
sources: 16
---

# Premature ejaculation

_What systematic reviews, sham-controlled trials and the EAU, AUA/SMSNA and ISSM guidelines report on acupuncture and electroacupuncture for premature ejaculation._

The [2014 guidelines of the International Society for Sexual Medicine](https://pmc.ncbi.nlm.nih.gov/articles/PMC4184677/) (ISSM) define premature ejaculation by three things: ejaculation that always or nearly always comes within about a minute of vaginal penetration from a man's first sexual experiences (lifelong), or a clinically significant fall in that time, often to about three minutes or less (acquired); being unable to delay it; and distress, frustration or avoidance of intimacy as a result. Trials measure it with the intravaginal ejaculatory latency time (IELT), the minutes from penetration to ejaculation, which only half the trials in the [Cooper review](https://pmc.ncbi.nlm.nih.gov/articles/PMC5302385/) timed with a stopwatch, and with questionnaires such as the Premature Ejaculation Diagnostic Tool (PEDT), on which a lower score means fewer symptoms. The acupuncture trials compare needling with selective serotonin reuptake inhibitors (SSRIs), the antidepressant class the guidelines use as drug treatment, with sham acupuncture, a control procedure built to resemble it, or with herbal medicine. Three trials have used a sham control.

## No Cochrane review

Cochrane has published no review of acupuncture for premature ejaculation. Its reviews of the condition cover drugs and talking treatments. The [2021 Cochrane review of SSRIs](https://doi.org/10.1002/14651858.CD012799.pub2) by Sathianathen and colleagues, searched to May 2020, included 31 trials with 8,254 men randomised to an SSRI or placebo. It found that SSRIs probably improve men's own rating of their symptoms, satisfaction with intercourse and sense of control, at moderate certainty, and may lengthen IELT by about 3 minutes, at low certainty, with more adverse events and more men stopping treatment because of them. The [2011 Cochrane review of psychosocial interventions](https://doi.org/10.1002/14651858.CD008195.pub2) by Melnik and colleagues found few randomised trials of behavioural therapy, the largest showing longer intercourse than a waiting list. Neither review assessed acupuncture.

## Systematic reviews

| Review | Searched to | Acupuncture trials (people) | Comparisons | Certainty |
| --- | --- | --- | --- | --- |
| Cooper 2017 | September 2015 | 2 (201), of 10 trials of complementary medicine | Sham; SSRIs | Risk of bias unclear in every trial; not graded |
| Zhang 2023 | April 2022 | 7 (603) | Sham; SSRIs; acupuncture added to another treatment | GRADE low against sham, very low against SSRIs |
| Leisegang 2023 | September 2022 | 3, of 22 trials of complementary medicine | Sham; SSRIs; herbal medicine | All three acupuncture trials at high risk of bias |
| Tahmasbi 2025 | May 2024 | 10 studies of electrical stimulation, some at acupuncture points | Mixed; no meta-analysis | Not graded |

The [2023 review](https://pmc.ncbi.nlm.nih.gov/articles/PMC10308367/) by Zhang and colleagues, published in the ISSM's journal _Sexual Medicine_, is the only meta-analysis limited to acupuncture. It searched five English and four Chinese databases and two trial registries and found seven trials, six from China published in Chinese and one from Turkey. Against an SSRI, five trials with 291 men showed no clear difference in IELT and two showed none on the PEDT, and the review rated those results very low certainty. Grouped by country, the Chinese trials showed the SSRI and acupuncture similar and the Turkish trial showed the SSRI better. Against sham acupuncture, two trials with 97 men reported longer IELT and lower PEDT scores with acupuncture, rated low certainty. Added to an SSRI or a herbal formula, acupuncture lengthened IELT in three trials with 174 men, at very low certainty. No trial reported how allocation was concealed and none blinded the people measuring outcomes. The authors wrote that the low quality of the evidence means larger, well-designed trials are needed, and named as a shortcoming that they could not include the Sunay trial described below, for which they could not obtain data. The points the trials needled most often were [`ST36`](/points/st36) (Zusanli), [`BL23`](/points/bl23) (Shenshu), [`LV03`](/points/lv03) (Taichong) and [`SP06`](/points/sp06) (Sanyinjiao); the review writes the liver point LR3.

Two reviews from the University of Sheffield came earlier. A [2015 Health Technology Assessment report](https://doi.org/10.3310/hta19210) for the UK's National Institute for Health Research, searched to August 2013, covered every treatment for premature ejaculation in 103 studies and reported that acupuncture improved IELT over sham acupuncture, with conflicting results against SSRIs. Its [2017 review of complementary medicine](https://pmc.ncbi.nlm.nih.gov/articles/PMC5302385/) by Cooper and colleagues, searched to September 2015, found two acupuncture trials: the Sunay trial, in which IELT was about half a minute longer than with sham, and a 2009 Chinese trial of 111 men in which daily acupuncture scored better than citalopram, an SSRI, on a Chinese symptom index. The authors rated the risk of bias unclear in all ten trials they found, because allocation concealment or blinding was not reported, and called the evidence preliminary.

A [2023 review](https://doi.org/10.3390/medicina59091607) by Leisegang and colleagues at the University of the Western Cape searched PubMed and Scopus in September 2022 and found three acupuncture or electroacupuncture trials among 22 trials of complementary medicine for disorders of ejaculation. It rated all three at high risk of bias. A [2025 review of electrical stimulation](https://pmc.ncbi.nlm.nih.gov/articles/PMC12477390/) by Tahmasbi and colleagues at Tabriz University of Medical Sciences found ten studies that stimulated through the skin, some at acupuncture points and others over the nerves of the penis or ankle. The protocols differed too much to pool, so the review made no meta-analysis; it reported a trend towards longer IELT, no consistent adverse events, and a need for trials measuring men's own sense of control.

## Trials

Two Turkish trials ran acupuncture against both a drug and sham. In the [2011 trial](https://pubmed.ncbi.nlm.nih.gov/21256670/) by Sunay and colleagues at Ankara Training and Research Hospital, published in _European Urology_, 90 men aged 28 to 50 were randomised to 20 mg of paroxetine daily, acupuncture twice a week for four weeks, or sham acupuncture on the same schedule. IELT rose by 82.7 seconds with paroxetine, 65.7 with acupuncture and 33.1 with sham; both active groups differed from sham, and paroxetine delayed ejaculation more than acupuncture. PEDT scores fell with paroxetine and acupuncture and did not change with sham. The authors named the lack of follow-up after treatment as the main limitation. The [Cooper review](https://pmc.ncbi.nlm.nih.gov/articles/PMC5302385/) lists the points as [`ST36`](/points/st36) (Zusanli), [`LI04`](/points/li04) (Hegu), [`KD03`](/points/kd03) (Taixi), [`LV03`](/points/lv03) (Taichong), [`XH03`](/points/xh03) (Yintang) and [`CV03`](/points/cv03) (Zhongji).

The [2016 trial](https://pubmed.ncbi.nlm.nih.gov/27049323/) by Sahin and colleagues at Bakırköy Dr. Sadi Konuk Training and Research Hospital in Istanbul randomised 120 men to dapoxetine 30 mg or 60 mg taken before sex, acupuncture in eight sessions over four weeks, or sham. After four weeks IELT had lengthened in all four groups. The change was largest with 60 mg of dapoxetine, then 30 mg, then acupuncture, and smallest with sham, each step statistically significant. According to the [Zhang review](https://pmc.ncbi.nlm.nih.gov/articles/PMC10308367/), the sham needles were placed 1 cm from each point and did not pierce the skin, and the real points included [`BL30`](/points/bl30) (Baihuanshu), [`BL52`](/points/bl52) (Zhishi) and the points of the Sunay trial except Taixi.

Recent Chinese trials compare acupuncture methods with each other or with herbs. A [2024 trial](https://pubmed.ncbi.nlm.nih.gov/39111790/) by Sun and colleagues at Lianyungang, published in Chinese with an English abstract, randomised 240 men with lifelong premature ejaculation to warm acupuncture, in which burning moxa heats the needle, plain acupuncture, or dapoxetine 30 mg; points included [`CV04`](/points/cv04) (Guanyuan) and [`BL23`](/points/bl23) (Shenshu). IELT was longer and PEDT scores lower with warm acupuncture and with dapoxetine than with plain acupuncture. A [2022 trial](https://pmc.ncbi.nlm.nih.gov/articles/PMC8964190/) by Lu and colleagues in Heilongjiang compared electroacupuncture with Longdan Xiegan decoction, a herbal formula, in 50 men and reported longer IELT with electroacupuncture. Neither had a sham group.

## What guidelines say

The European Association of Urology's [Sexual and Reproductive Health guideline](https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/disorders-of-ejaculation), in its 2026 edition, a limited update of 2025 that fully revised the section on disorders of ejaculation, recommends dapoxetine or a lidocaine and prilocaine spray first for lifelong premature ejaculation, daily SSRIs or clomipramine second, and tramadol with caution third. It lists acupuncture, citing the Sunay and Sahin trials and the Lu trial, among methods that need more evidence before they can be considered in the clinical setting, and makes no recommendation on it. It also recommends treating erectile dysfunction or a genitourinary infection such as prostatitis first; [Chronic prostatitis and chronic pelvic pain syndrome](/wiki/evidence/chronic-prostatitis) reports the acupuncture evidence for that condition.

The [2020 guideline of the American Urological Association and the Sexual Medicine Society of North America](https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation) (AUA/SMSNA) advises, as expert opinion, that clinicians tell patients there is insufficient evidence for alternative therapies in premature ejaculation. Its discussion of that statement describes the Sunay and Sahin trials and says acupuncture is generally low risk, that its efficacy appears inferior to drug treatment, and that it is not a first-line therapy but may be considered for patients who fail other treatments. The AUA's guideline page carries it as the 2020 version.

The [2014 ISSM guideline](https://pmc.ncbi.nlm.nih.gov/articles/PMC4184677/) describes the Sunay trial and concludes there are limited positive data on acupuncture, graded level 3b on the Oxford Centre for Evidence-Based Medicine scale. A [2024 comparison of international guidelines](https://pmc.ncbi.nlm.nih.gov/articles/PMC11353472/) by Romano and colleagues at the University of Campania in Naples found the 2014 document still the ISSM's latest guideline in April 2024. The [2026 recommendations of the Fifth International Consultation on Sexual Medicine](https://pubmed.ncbi.nlm.nih.gov/42855438/), published for the ISSM and graded with GRADE, name SSRIs, topical anaesthetics and psychotherapy in their abstract; AcuiQ could not open the full text to check what they say about acupuncture. [Clinical guidelines](/wiki/evidence/clinical-guidelines) compares how guideline bodies treat acupuncture across conditions.

## What the reviews could not settle

The sham comparison rests on three small trials, two pooled by Zhang and colleagues and the Sunay trial they could not include, which enrolled 270 men across all their arms. Each measured outcomes at the end of four weeks of treatment; the Sunay authors named the missing follow-up as their main limitation, and the [2015 report](https://doi.org/10.3310/hta19210) asked for every treatment it covered whether effects last once treatment stops. The shams differed, from needles beside the points to needles that did not pierce the skin, and [Sham acupuncture](/wiki/research/sham-acupuncture) sets out what each kind of control does and does not rule out. Against SSRIs the trials disagree by country: the Chinese trials found no difference and the Turkish ones found the drug better. Zhang and colleagues grouped the trials by country for that reason and lacked the data for any further analysis. Most trials did not record whether men had lifelong or acquired premature ejaculation, so Zhang and colleagues could not test whether results differ between the two. Adverse events were recorded unevenly: Cooper and colleagues found them inconsistently assessed, and in the trials Zhang and colleagues pooled the events one trial reported after acupuncture were dizziness and haematoma.

AcuiQ's [premature ejaculation page](/symptoms/premature-ejaculation) lists the protocols individual studies prescribed, each with its citation.

### Sources

1. Sathianathen NJ, Hwang EC, Mian R, et al., Selective serotonin re-uptake inhibitors for premature ejaculation in adult men, Cochrane Database of Systematic Reviews 2021, CD012799.pub2 — https://doi.org/10.1002/14651858.CD012799.pub2
2. Melnik T, Althof S, Atallah AN, Puga ME, Glina S, Riera R, Psychosocial interventions for premature ejaculation, Cochrane Database of Systematic Reviews 2011, CD008195.pub2 — https://doi.org/10.1002/14651858.CD008195.pub2
3. Zhang H, Colonnello E, Sansone A, et al., Acupuncture for premature ejaculation: a systematic review and meta-analysis, Sexual Medicine 2023 — https://pmc.ncbi.nlm.nih.gov/articles/PMC10308367/
4. Cooper K, Martyn-St James M, Kaltenthaler E, Dickinson K, Cantrell A, Interventions to treat premature ejaculation: a systematic review short report, Health Technology Assessment 2015 — https://doi.org/10.3310/hta19210
5. Cooper K, Martyn-St James M, Kaltenthaler E, et al., Complementary and alternative medicine for management of premature ejaculation: a systematic review, Sexual Medicine 2017 — https://pmc.ncbi.nlm.nih.gov/articles/PMC5302385/
6. Leisegang K, Opuwari CS, Moichela F, Finelli R, Traditional, complementary and alternative medicines in the treatment of ejaculatory disorders: a systematic review, Medicina 2023 — https://doi.org/10.3390/medicina59091607
7. Tahmasbi F, Rahimi-Mamaghani A, Soleimanzadeh F, et al., Peripheral electrical stimulation for premature ejaculation: a systematic review of clinical studies, Therapeutic Advances in Urology 2025 — https://pmc.ncbi.nlm.nih.gov/articles/PMC12477390/
8. Sunay D, Sunay M, Aydoğmuş Y, et al., Acupuncture versus paroxetine for the treatment of premature ejaculation: a randomized, placebo-controlled clinical trial, European Urology 2011 — https://pubmed.ncbi.nlm.nih.gov/21256670/
9. Sahin S, Bicer M, Yenice MG, et al., A prospective randomized controlled study to compare acupuncture and dapoxetine for the treatment of premature ejaculation, Urologia Internationalis 2016 — https://pubmed.ncbi.nlm.nih.gov/27049323/
10. Sun D, Lu M, Zhang L, et al., Primary premature ejaculation of kidney deficiency and liver stagnation treated with warm acupuncture of large-quantity moxibustion: a randomized controlled trial (in Chinese), Chinese Acupuncture and Moxibustion 2024 — https://pubmed.ncbi.nlm.nih.gov/39111790/
11. Lu X, Han H, Zhang Z, et al., Study on the efficacy of electric acupuncture in the treatment of premature ejaculation based on testosterone level, Journal of Healthcare Engineering 2022 — https://pmc.ncbi.nlm.nih.gov/articles/PMC8964190/
12. European Association of Urology, EAU Guidelines on Sexual and Reproductive Health, chapter 6: Disorders of ejaculation, 2026 edition — https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/disorders-of-ejaculation
13. Shindel AW, Althof SE, Carrier S, et al., Disorders of ejaculation: an AUA/SMSNA guideline, American Urological Association 2020 — https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
14. Althof SE, McMahon CG, Waldinger MD, et al., An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE), Sexual Medicine 2014 — https://pmc.ncbi.nlm.nih.gov/articles/PMC4184677/
15. Romano L, Arcaniolo D, Spirito L, et al., Comparison of current international guidelines on premature ejaculation: 2024 update, Diagnostics 2024 — https://pmc.ncbi.nlm.nih.gov/articles/PMC11353472/
16. Serefoglu EC, Shindel AW, Zhang Y, et al., Contemporary consensus and emerging directions in premature and delayed ejaculation: recommendations from the 5th International Consultation on Sexual Medicine, Sexual Medicine Reviews 2026 — https://pubmed.ncbi.nlm.nih.gov/42855438/