Common Male Sexual Dysfunction Research Articles

Research progress on the therapeutic application of extracellular vesicles in erectile dysfunction.

Erectile dysfunction (ED) is one of the most common male sexual dysfunctions and is related to many pathogenic factors. However, first-line treatment, represented by phosphodiesterase 5 inhibitors, is unable to maintain long-term efficacy. Extracellular vesicles (EVs) have recently attracted the attention of researchers in the fields of cardiovascular disease, neurologic disease, and regenerative medicine and may become a treatment for ED. This article reviews recent applications of EVs in the treatment of ED from the aspects of the source, the therapeutic mechanism, and the strategies to enhance therapeutic efficacy. These research advances lay the foundation for further research and provide references for in-depth understanding of the therapeutic mechanism and possible clinical application of EVs in ED.

Comparison of Current International Guidelines on Premature Ejaculation: 2024 Update.

Premature ejaculation (PE) is a common male sexual dysfunction that can cause significant distress in the patient and partner. This study aimed to compare the current international guidelines on PE to highlight their similarities and differences. We examined the latest guidelines from the European Association of Urology (EAU), American Urological Association/Sexual Medicine Society of North America (AUA/SMSNA), and International Society of Sexual Medicine (ISSM) by comparing definitions, classifications, epidemiology, pathophysiology, and recommendations on diagnosis and therapy. The quality of guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) Global Rating Scale (GRS). We found significant variations in the definitions of PE and recommendations on management of patients. The EAU guidelines were the most recent, the AUA/SMSNA guidelines lacked detail in some areas, and the ISSM guidelines were the most complete but also the least updated. The search for a unified definition and the development of standardized diagnostic and therapeutic pathways remain concrete issues to improve the management of patients with PE worldwide.

Male Sexual Dysfunction and Hypogonadism in Young Adults with Type 2 Diabetes Mellitus: A Cross Sectional Study.

Male sexual dysfunction (MSD) is a common occurrence in diabetic patients, which is not routinely assessed in clinical settings. The aim of the study was to assess the prevalence of MSD and hypogonadism in young type 2 diabetes mellitus (T2DM) patients aged between 20 and 40 years and its association with duration, glycaemic control and complications of diabetes. This is a cross-sectional study involving 70 men with T2DM of 20-40 years of age visiting the endocrinology department in a tertiary care centre. This study was conducted from November 2021 to March 2023. Seventy subjects satisfying inclusion criteria were included in the study and assessed using the International Index of Erectile Function-15 questionnaire, intravaginal ejaculation latency time, androgen deficiency in ageing male questionnaire, hormonal parameters (Luteinising Hormone, Follicle stimulating hormone, Testosterone and sex hormone-binding globulin) and penile Doppler. The statistical analysis was done using SPSS version 21. A P < 0.05 is considered statistically significant. Data were checked for normality using Kolmogorov-Smirnov and Shapiro-Wilk tests. For determining statistical significance between continuous variables with non-normal data, the Mann-Whitney U test and Kruskal-Wallis tests were used. Pie charts, bar diagrams and scatter plots were used for descriptive statistics. Frequency, percentage, means, median, range and standard deviation were used for all quantitative data. The Chi-square test was used to find a significant association between categorical variables. Sixty per cent of men had at least one form of MSD. Hypoactive sexual desire disorder (HSDD) - 44.28% was the most common MSD, followed by erectile dysfunction (ED) - 42.85% and ejaculatory disorders - 18.57%. Penile Doppler was done in 15 patients, of whom 9 patients had normal Doppler, venous incompetence was present in 3, followed by mixed (arterial and venous) in 2 and arterial insufficiency in 1 subject. Hypogonadism was present in 27.14% of men and secondary hypogonadism was the most common cause (84.21%). There was a significant association between neuropathy and ED and between hypogonadism and HSDD. There was also a significant association between fasting plasma glucose, post-prandial plasma glucose and MSD. MSD is common in young T2DM men, which should be given due importance in clinical practice to improve their quality of life. Glycaemic control is of utmost importance in these men.

LncRNA MALAT1 facilitates BM-MSCs differentiation into endothelial cells and ameliorates erectile dysfunction via the miR-206/CDC42/PAK1/paxillin signalling axis

BackgroundErectile dysfunction (ED) is a common male sexual dysfunction, with an increasing incidence, and the current treatment is often ineffective.MethodsVascular endothelial growth factor (VEGFA) was used to treat bone marrow-derived mesenchymal stem cells (BM-MSCs), and their cell migration rates were determined by Transwell assays. The expression of the von Willebrand Factor (vWF)VE-cadherin, and endothelial nitric oxide synthase(eNOS) endothelial markers was determined by qRT‒PCR and Western blot analyses. The MALAT1-induced differentiation of BM-MCs to ECs via the CDC42/PAK1/paxillin pathway was explored by transfecting VEGFA-induced BM-MSC with si-MALAT1 and overexpressing CDC42 and PAK1. The binding capacity between CDC42, PAK1, and paxillin in VEGFA-treated and non-VEGFA-treated BM-MSCs was examined by protein immunoprecipitation. MiR-206 was overexpressed in VEGFA-induced BM-MSC, and the binding sites of MALAT1, miR-206, and CDC42 were identified using a luciferase assay. Sixty male Sprague‒Dawley rats were divided into six groups (n = 10/group). DMED modelling was demonstrated by APO experiments and was assessed by measuring blood glucose levels. Erectile function was assessed by measuring the intracavernosa pressure (ICP) and mean arterial pressure (MAP). Penile erectile tissue was analysed by qRT‒PCR, Western blot analysis, and immunohistochemical staining.ResultsMALAT1 under VEGFA treatment conditions regulates the differentiation of BM-MSCs into ECs by modulating the CDC42/PAK1/paxillin axis. In vitro experiments demonstrated that interference with CDC42 and MALAT1 expression inhibited the differentiation of BM-MSCs to ECs. CDC42 binds to PAK1, and PAK1 binds to paxillin. In addition, CDC42 in the VEGFA group had a greater ability to bind to PAK1, whereas PAK1 in the VEGFA group had a greater ability to bind to paxillin. Overexpression of miR-206 in VEGFA-induced BM-MSCs demonstrated that MALAT1 competes with the CDC42 3’-UTR for binding to miR-206, which in turn is involved in the differentiation of BM-MSCs to ECs. Compared to the DMED model group, the ICP/MAP ratio was significantly greater in the three BM-MSCs treatment groups.ConclusionsMALAT1 facilitates BM-MSC differentiation into ECs by regulating the miR-206/CDC42/PAK1/paxillin axis to improve ED. The present findings revealed the vital role of MALAT1 in the repair of BM-MSCs for erectile function and provided new mechanistic insights into the BM-MSC-mediated repair of DMED.

(259) Comparison of Dapoxetine vs Paroxetine vs Clomipramine for Premature Ejaculation Patients

Abstract Introduction Premature ejaculation (PE) is a common male sexual dysfunction. The International Society for Sexual Medicine (ISSM) defines PE as the inability to delay ejaculation during all or nearly all vaginal penetrations with latency time before or within 1 minute of penetration for lifelong PE and within 3 minutes for acquired PE and negative personal consequences such as distress, bother, frustration. The introduction of Selective Serotonin reuptake inhibitors (SSRIs) and Tricyclic antidepressants (TCA) revolutionized the treatment of PE. However not many studies have compared the efficacy and safety of these drugs in a single study. Objective To compare the clinical efficacy and safety of Dapoxetine, Paroxetine, and Clomipramine for the oral pharmacotherapy of PE. Methods Men presenting with self-reported PE were evaluated with full medical/sexual history, comorbidities, focused physical examination, assessment for Erectile function, any investigations suggested by these findings. IELT was determined by stopwatch method for every intercourse attempt. IELT were recorded before and after using the above medications in each group. ISSM definition of PE formed basis of diagnosis. All patients were married potent men in a stable relationship for at least 6 months and possible sexual intercourse equal or greater than one per week. None of the patients had received other treatment for PE for at least 4 weeks before the start of the study. All subjects gave their written informed consent before entering the study. Standardized assessment measures such as validated questionnaires &amp; Patient Reported Outcomes (PRO) used as adjunct for assessment. Results 48 Patients with PE were recruited in this study. Patients were randomly assigned to receive 60 mg Dapoxetine ‘on-demand’(group 1, n = 24), or 20 mg Paroxetine daily (group 2, n = 12) or 50 mg Clomipramine (group 3, n = 12) orally daily during a 12-week period for each agent. After 12 weeks of treatment with Dapoxetine, Paroxetine and Clomipramine, the IELT was increased from the pretreatment mean of 35 seconds to 184 seconds, from 32 seconds to 178 seconds and from 34 seconds to 169 seconds, respectively (P = 0.01 in group 1 and 2,P = 0.02 in group 3). Baseline and 12-week mean intercourse satisfaction domain values of the IIEF were 10, 11, 10 and 14, 15, 13 in groups 1, 2, and 3 respectively. The mean number of coitus per week pretreatment and at 12-week treatment were 1.4, 1.3 and 1.3/week which rose to 2.4, 2.3 and 2.2 for Dapoxetine, Paroxetine and Clomipramine, respectively. The most common adverse effects of each drug were nausea, diarrhea, headache and perspiration. Conclusions Oral SSRIs &amp; TCA are safe and effective treatments for PE. Dapoxetine, although approved, does Not appear to be widely used; cost could be an issue. Its use can result in better QoL for the patient and their sexual partner. Paroxetine has the advantage of improving IELT with well-tolerated side effects. It has good efficacy in the treatment of PE. Higher dose of Clomipramine results in a longer IELT without higher risk of adverse events. Larger studies with different dosages and treatment regimens are required to yield more credible outcomes. Disclosure No.

Effect of cranial electrotherapy stimulation (CES) in treatment of premature ejaculation: a randomized clinical trial

BackgroundPremature ejaculation is one of the most common male sexual dysfunction, affecting approximately 30% of men. The aim of this study is to evaluate the efficacy and at the same time the safety of the cranial electrotherapy stimulation (CES) device in treatment of premature ejaculation disorder.MethodsBased on a randomized clinical trial, two groups were included in the study, so that the first group was treated with sertraline along with an ATANG (AT-9 model) CES, and the second group with sertraline and inactive the CES device (as the placebo group). The state of premature ejaculation after treatment (using the Premature Ejaculation Diagnostic Tool (PEDT) questionnaire) was evaluated and compared for both groups.ResultsIn the intervention and placebo groups, the average score of the PEDT questionnaire before the intervention did not differ significantly between the two groups (p-value equal to 0.93). However, the average score of the PEDT questionnaire after the intervention for CES group and placebo group was 10.28 ± 1.93 and 13.23 ± 3.05, respectively, which demonstrated a significant decrease in the intervention group (p-value equal to 0.01).ConclusionThe use of CES device as a complementary treatment along with routine drug treatment (sertraline) is associated with a significant improvement in the condition of premature ejaculation of patients.Trial registrationName of the registry: IRCT Iranian Registry of Clinical Trials.Trial registration number: IRCT20210621051657N1.Date of registration: December 11, 2022.URL of trial registry record: https://en.irct.ir/trial/57201.

(258) Trends in Prevalence, Incidence and Pharmacological Prescriptions for Premature and Delayed Ejaculation – A Claims Database Analysis

Abstract Introduction Premature (PE) and delayed (DE) ejaculation are common male sexual dysfunction disorders. Despite a community-reported prevalence of approximately 30% for PE and 5% for DE, the clinical prevalence, incidence, and rates of pharmacological prescriptions for both disorders remain under-investigated in the literature. Objective Our objective is to assess the trends in prevalence, incidence, and pharmacological treatment of PE and DE using a large claims database. Methods The TriNetX Research database, a large insurance claims database, was queried to identify all adult (≥18 years) males that were evaluated from January 2012 through December 2022. The number of men diagnosed with PE (ICD-10 F52.4) and DE (F52.32 and N53.11) was compared to the total number of men evaluated using six-month intervals (January-June, July-December) to calculate percent prevalence and incidence. A chi-squared test of linear trends was performed for prevalence and incidence. Rates of prescribed treatments were calculated comparing the number of men receiving the treatment to the total number of men with the assessed disorder using six-month intervals for PE and one-year intervals for DE. Results A total of 17,647 adult males with a diagnosis of PE and 6,304 adult males with a diagnosis of DE were identified from January 2012 to December 2022. The prevalence and incidence for both disorders are found in Figure 1. The chi-square test for trends showed a significant increasing trend in the prevalence of PE (χ2 = 303.44, p-value = &amp;lt;0.0001) and DE (χ2 = 314.14, p-value = &amp;lt;0.0001) and incidence of PE (χ2 = 6.40, p-value = 0.0114) and DE (χ2 = 187.43, p-value = &amp;lt;0.0001). In the final period, 63.5% males with PE and 33.4% males with DE received at least one medication of the investigated therapies. The most common medications prescribed to men with PE were phosphodiesterase-5 inhibitors (25.7%), paroxetine (17.4%), topical anesthetics (13.4%), and sertraline (12.2%). The most common medications prescribed to men with DE were testosterone (11.7%), bupropion (12.2%), and cabergoline (10.0%). The prescription rates of all of the investigated medications for PE and DE are shown in Figures 2 and 3, respectively. Conclusions In this large US claims database analysis, premature and delayed ejaculation are overall diagnosed at low but increasing rates. Furthermore, the rates of pharmacological prescriptions for PE remains relatively low, despite pharmacotherapy being recommended as first-line options under the current guidelines. Additional research is necessary to investigate the long-term efficacy of individual medications for both PE and DE. Disclosure No.

Associations between Self-Reported Anatomical Characteristics of the Penis and Sexual Dysfunction in Men

Premature ejaculation and erectile dysfunction are common male sexual dysfunctions worldwide, causing substantial distress in men as well as their partners and decreasing the quality and stability of romantic relationships. We investigated the associations between the self-reported anatomical characteristics of penises and sexual dysfunctions in an urban sample of Chinese men. We recruited 1085 Chinese urban men aged from 18 to 50 (M = 31.37; SD = 5.52) to fill out an online questionnaire regarding the anatomical characteristics of their penis, as well as early ejaculation and erectile problems via two Chinese online survey platforms. The participants reported their age, height, weight, penile length, penile circumference, circumcision status, and foreskin characteristics as well as answered the International Index of Erectile Function-5 and Checklist for Early Ejaculation Symptoms. Both an increasing penile length (M = 14.49; SD = 2.22) and girth (M = 15.46; SD = 4.36) were associated with fewer early ejaculation problems, but only an increasing penile length was associated with fewer erectile problems. Less foreskin covering the glans of the penis was associated with fewer early ejaculation and erectile problems. Age was found to have a non-linear relationship with early ejaculation and erectile problems in this cross-sectional study. Specifically, early ejaculation problems decreased until a certain age (31), and then increased with further increases in age. The relationship between the anatomical characteristics of the penis and sexual function is complex. Also, the results suggest that there is a curvilinear non-monotonic relationship between age and sexual dysfunction.

Safety and efficacy of LibidUp-PE supplement on premature ejaculation: A randomized, placebo-controlled double-blind, crossover study

Premature ejaculation (PE) is the most common male sexual dysfunction. Selective serotonin reuptake inhibitors (SSRIs) are currently recommended for PE. However, the side effects of SSRIs, such as nausea, vomiting, and xerostomia, pose challenges to clinicians. Simultaneously, evidence indicates that psychological and behavioral treatments are often insufficient. LibidUp-PE is a nutraceutical designed to enhance sexual wellness and contains a combination of essential amino acids to boost stamina and vigor, addressing concerns like erectile dysfunction (ED). This study aimed to assess the safety and efficacy of LibidUp-PE in the treatment of PE. In this crossover, double-blind, placebo-controlled trial, 76 patients with PE were randomly divided into two groups. Group A received LibidUp-PE, whereas Group B received a placebo for 12 weeks. Following a 2-week wash-out period, the groups switched treatments for another 12 weeks. Intravaginal ejaculatory latency time (IELT) and post-ejaculatory refractory time (PERT) were measured as the primary outcomes to evaluate PE improvement. Plasma serotonin levels were measured as secondary parameters using enzyme-linked immunosorbent assay. The results showed that LibidUp-PE significantly improved the IELT score, increasing from 0.8 ± 0.2 min to 2.9 ± 1.1 min (p < 0.01). PERT scores also significantly decreased from 15.8 ± 1.7 min to 5.6 ± 0.6 min after 12 weeks of LibidUp-PE treatment. Plasma serotonin levels significant increased from 93.6 ± 7.8 ng/mL to 168.4 ± 12.8 ng/mL (p < 0.001) with LibidUp-PE treatment. In contrast, no significant improvements were observed in the placebo group. Notably, none of the participants withdrew their consent due to adverse reactions, which is indicative of the safety and tolerability of LibidUp-PE. In conclusion, 12-week treatment with LibidUp-PE demonstrated a beneficial effect in reducing PE symptoms, as reflected by improved IELT, reduced PERT, and increased plasma serotonin levels. Therefore, LibidUp-PE could be a promising solution for individuals with PE.

Impact of type D personality and depressive symptoms on premature ejaculation in young adult males.

Premature ejaculation (PE) is one of the most common male sexual dysfunctions with prominent psychological consequences. Type D personality (TDP) is also associated with multiple psychological disorders, such as depression and anxiety. However, the correlation between PE and TDP remains unknown. The study sought to investigate the relationships between depressive symptoms, TDP, and PE. Adult males in Taiwan who were 20 to 40years of age and who had sexual intercourse in the past 6 months were recruited to complete online questionnaires composed of general demographics, the Premature Ejaculation Diagnostic Tool (PEDT), 5-item International Index of Erectile Function (IIEF-5), Type D Scale-14, and Depression and Somatic Symptom Scale (DSSS). Chi-square test and independent Student's t test were used to compare the parameters between the TDP and non-TDP groups. Univariate and multivariate logistic regression analyses were conducted to evaluate factors related to PE. Outcomes were the prevalence of PE and TDP in young Taiwanese men, the associations between depressive symptoms and PE and TDP, and the predictive factors of PE. In total, 2558 men with a mean age of 31.3 ± 5.3years were included in the present study. Among them, 315 (12.3%) and 767 (30.1%) participants were classified as having PE and moderate-to-severe erectile dysfunction (ED), respectively. In total, 1249 (48.8%) participants met the criteria for TDP. The PEDT, IIEF-5, and DSSS, including the total scores and depression and somatic subscales, were significantly higher in men with TDP (all P < .001). PE prevalence was significantly greater in men with TDP than in those without TDP (16.2% vs 8.6%; P < .001). Most parameters, including age, moderate-to-severe ED, the Type D Scale-14 subscales, and the DSSS somatic and depressive subscales, were significantly associated with PE in the univariate analysis. Only the depressive subscale of the DSSS and moderate-to-severe ED (IIEF-5 ≤16) were the independent predictors of PE in the multivariate analysis. The results suggest that it is important to consider the psychological effects of PE in young men, and the study has provided a biopsychosocial aspect to manage patients with PE. This is the first study to evaluate the association between PE, TDP, and depression in a large population of young adult males. However, the cross-sectional design may have limited the investigation of causality, and selection bias may be present. Men with TDP tended to have higher PEDT scores and a prevalence of PE and ED. Moderate-to-severe ED and depressive symptoms are the independent predictive factors of PE.

Prevalence, lifestyle, and risk factors of erectile dysfunction, premature ejaculation, and low libido in middle-aged men: first results of the Bavarian Men's Health-Study.

Erectile dysfunction (ED), premature ejaculation (PE), and low libido (LL) are reported as the most common male sexual dysfunctions. To evaluate the prevalence of ED, PE, and LL and associations with lifestyle risk factors and comorbidities in middle-aged men. This study included a population-based random sample of 2500 50-year-old men who completed validated questionnaires, including the International Index of Erectile Function, the Erection Hardness Score, the Sexual Complaints Screener, and further questionnaires. Multiple logistic regression of outcomes ED, PE, and LL was used to model the association with explanatory factors. The prevalence of at least one sexual dysfunction was 30%. 21%, 5.2%, and 7.2% of men had ED, PE, and LL, respectively. The risk of ED increased with PE (odds ratio [OR]: 1.94, 95% confidence interval [95%CI]: 1.22-3.08), LL (OR: 2.04, 95%CI: 1.26-3.29), higher waist circumference (OR: 2.23, 95%CI: 1.67-2.96), and lower urinary tract symptoms (LUTS) (OR: 1.88, 95%CI: 1.39-2.55), partnership was associated with a lower risk (OR: 0.57, 95%CI: 0.39-0.85). The risk of PE increased with ED (OR: 1.94, 95%CI: 1.23-3.07), partnership (OR:5.42, 95%CI: 1.30-22.60), depression (OR: 2.37, 95%CI: 1.09-5.14), and LUTS (OR: 2.42, 95%CI: 1.52-3.87), and decreased with physical activity (OR: 0.44, 95%CI: 0.21-0.93). The risk of LL increased with ED (OR: 2.09, 95%CI: 1.31-3.34) and poorer self-rated health (OR: 2.97, 95%CI: 1.54-5.71). Roughly one in three 50-year-old men experience some form of sexual dysfunction and risk factors identified in this study underline the multifactorial nature of ED, PE, and LL. Many risk factors are modifiable which underlines the role of patient education. Modifiable risk factors should be addressed in patient education and men should take active measures to remove the risk posed by these factors.

Radiofrequency pulse modulation of the penile dorsal nerve for the treatment of premature ejaculation: evaluation of effectiveness

Introduction. Premature ejaculation (PE) is the second most common male sexual dysfunction with a significant negative impact on quality of life. A significant number of conservative and surgical methods for the treatment of PE are proposed, but their effectiveness and, in some cases, safety, remain the subject of discussion.Objective. To study the effectiveness of pulsed radiofrequency impulse neuromodulation (RPN) with different modes on the penile dorsal nerve in treatment of patients with premature ejaculation.Materials &amp; methods. Two groups of PE-patients participated in a prospective multicenter study: Group 1 — 11 patients aged 22 – 34 years; Group 2 — 12 patients aged 23 – 34 years. Group 1 received pulsed RPN at a temperature of 42°C, a stimulation frequency of 2 Hz, 45 V, and a duration of 180 seconds; in Group 2 — pulsed RPN at a temperature of 50 °C and the same frequency and duration of stimulation as Group 1. All patients before and after treatment measured intravaginal ejaculation latency time (IELT) and completed a premature ejaculation profile (PEP). The results were evaluated after 30 days.Results. In both groups, there was a statistically significant increase in IEDT and PEP. Thus, in Group 1, IELT increased from 58 to 101.9 seconds, PEP from 3.8 to 12.6 points. In Group 2, IELT increased from 66.5 to 210.9 seconds, PEP from 3.2 to 12.6 points. At the same time, in Group 2, IELT increased by 107% more than in Group 1. No significant side effects were observed in both groups.Conclusion. RPN appears to be a very promising treatment for premature ejaculation, as it is a minimally invasive, safe, and reversible procedure. The technique of influencing the penile dorsal nerve at an electrode temperature of 50 °C compared to 42 °C seems to be more effective, however, additional studies are needed.

A 2-week high-intensity interval training intervention improves ejaculation control among men with premature ejaculation.

Premature ejaculation (PE), which leads to substantial distress in men and their partners, is a common male sexual dysfunction worldwide. However, there is still a lack of effective treatments without side effects. We investigated the effect of high-intensity interval training (HIIT) on PE symptoms. We recruited 92 Chinese men aged 18-36 to complete the experiment. There were 22 (13 in the control group; 9 in the HIIT group) men diagnosed with PE and 70 (41 in the control group; 29 in the HIIT group) men with normal ejaculatory function. In the HIIT group, participants completed HIIT exercises every morning for 14 days. Participants also completed surveys inquiring about demographic information, erectile function, PE symptoms, body image (including sexual body image), physical activity, and sexual desire. The heart rate was measured before and after each HIIT. In the control group, participants were instructed not to do HIIT, but other procedures were the same as in the HIIT group. Results indicated that the HIIT intervention alleviated PE symptoms in men with PE. In addition, in the HIIT group, men with PE who had a higher heart-rate increase during the HIIT intervention reported the greatest overall decrements in PE symptoms. In men with normal ejaculatory function, HIIT did not decrease PE symptoms. In addition, increments in the heart rate during the intervention were associated with more pronounced PE symptoms post-intervention in this group. Analyses of secondary outcome measures suggested that the HIIT intervention improved general and sexual body image satisfaction of men with PE compared to before the intervention. In summary, HIIT intervention may reduce PE symptoms in men with PE. The heart-rate increase during the intervention may be a key factor influencing the effect of the HIIT intervention on PE symptoms.

(182) The Differences in Brain Function Between Lifelong Premature Ejaculation and Delayed Ejaculation: A Study Based on High-density Electroencephalogram

Abstract Introduction Ejaculatory dysfunction is common male sexual dysfunction, which is a conceptual continuum, and premature ejaculation (PE) and delayed ejaculation (DE) anchor the opposite ends of this conceptual continuum, and normal ejaculation is in the center. The pathogenesis of PE and DE is still not fully elucidated, and the studies on the central nervous mechanisms are highly lacking, and the differences in brain function between PE and DE are unclear. Objective We try to use a high-density electroencephalogram (HDEEG) to explore the differences in brain function to compensate for the deficiency of previous studies based on functional magnetic resonance Imaging (fMRI) and provide a theoretical foundation for future studies exploring the treatment methods. Methods We included 12 lifelong premature ejaculation (LPE) patients and 11 lifelong delayed ejaculation (LDE) patients, and all of them are right-handed. We evaluated the conditions of all subjects, who reported estimated intravaginal ejaculation latency time (eIELT). We used the premature ejaculation diagnostic tool (PEDT), the abridged international index of erectile function (IIEF-6), and erection hardness score (EHS) to quantify the sexual function and sexual arousal. EEG signals were recorded in patients with LDE and LPE during two segments of resting and watching an erotic video, respectively. The duration of the recording was about five minutes and fifteen minutes, respectively. The subjects whose EEG signals were less than 30 segments were excluded from the final analysis. The power spectral density was analyzed based on fast Fourier transform (FFT). Differences in the power spectral density during resting and sexual arousal between the two groups were compared. We analyzed changes in the power spectral density of β oscillation with sexual arousal in each group. Results There were no statistical differences in the general clinical characteristics. The mean eIELT of LPE patients was 0.8 ± 0.4 minutes. The scores of EHS were not statistically different during watching an erotic video between the two groups. There were no significant differences in δ, θ, and α oscillations between the LDE group and the LPE group during resting, but the LDE group had significantly higher power of β1, β2, and β3 oscillations. The power of β1, β2, and β3 oscillations was significantly higher in the LDE group during watching an erotic video, and other oscillations were not significantly different. The power of β1, β2, and β3 oscillations significantly increased in the LDE group during sexual arousal, and β2 and β3 oscillations significantly increased in the LPE group. Conclusions Based on the previous literature and our results, we proposed a scientific hypothesis to explain the increase of β oscillation in LDE patients. The increase of β oscillation is associated with the activation of the inhibitory brain area. The over-activation of the inhibitory brain area leads to LDE and the under-activation leads to LPE. The activation of the inhibitory brain area may be associated with gamma-aminobutyric, which is an inhibitory neurotransmitter. Disclosure No

Management of erectile dysfunction and premature ejaculation: The perspective of Spanish urologists. Results of the PANDORA Project (Part II)

IntroductionED and PE are the most common male sexual dysfunctions, although they remain underdiagnosed and undertreated. AimTo ascertain how a group of Spanish urologists currently address ED and PE. MethodsDescriptive study based on a self-designed questionnaire about the clinical practice in ED and PE upon diagnosis, treatment and monitoring, patient–physician relationship and the role of the patient's partner. ResultsThe survey was completed by 188 experienced urologists. Most patients went to the urologist's office without a previous diagnosis (92% of the urologists found <10 PE-diagnosed patients in public settings). The diagnosis of ED and/or PE was mainly carried out by the current urologist and not by another professional, particularly in private centres as opposed to public centres (78.8% vs 57.0% for ED; 82.0% vs 62.6% for PE). Most urologists believed that these disorders are underdiagnosed and deemed them as general health issues. 38% of urologists acknowledged using validated questionnaires to diagnose ED. PE was considered a subjective problem rather than a true disease and the use of PRO-based diagnosis of PE was not generally accepted (14%). Treatment options of both disorders were chosen as expected. Referral to the andrologist is usually scheduled in moderate-to-severe PE or severe ED. The cohort seemed to be mostly neutral (50%–75% for ED and 40%–55% for PE) regarding patient reluctancy to talk about their sexual problem. Patients’ partners play an important role in helping men seeking treatment. ConclusionUrologists should show more proactivity during anamnesis and routine visits to improve management of ED and PD.

Premature ejaculation among Chinese urban men: prevalence and correlates.

Premature ejaculation (PE) is a common male sexual dysfunction worldwide. It leads to substantial distress in men and their partners, constitutes a serious threat to the quality and stability of romantic relationships, and results in a decreased quality of life in a large part of the population. We investigated the prevalence of PE and correlated factors in an urban sample of Chinese men. In total, 1976 Chinese men aged 18 to 50 years responded to an online questionnaire regarding background information, present and previous sexual experience, frequency of different types of sex, as well as erectile and ejaculatory function. Participants' age, assigned sex at birth, sexual identity, relationship status, present and previous sexual experience, frequency of sexual activities, International Index of Erectile Function-5, and Checklist for Early Ejaculation Symptoms were used in the analyses. Forty-four (2.3%) participants had scores that were indicative or strongly indicative of PE, which was highly correlated with erectile problems. Men with more sexual experience (ie, more sexual partners and longer duration of being sexually active) had fewer ejaculatory problems. More frequent masturbation was associated with ejaculatory problems when controlling for age and education. More frequent partnered sex (ie, penile-vaginal sex) was associated with fewer ejaculatory problems. Ejaculation latency times for different types of sexual activities were positively correlated. The results indicated that ejaculatory problems have complex relationships with sexual experience that clinicians should be aware of. This study was the first to investigate PE with the Checklist for Early Ejaculation Symptoms as the measurement tool and the associations between PE and sexual experience, frequency of sexual activities, and sexual function in a large Chinese sample. However, self-reported ejaculation latency times may suffer from problems with validity. Men's sexual experience (ie, more sexual partners and longer duration of being sexually active) has an effect on their sexual function, which in turn affects their sexual activity.

Advances in physical diagnosis and treatment of male erectile dysfunction.

Erectile dysfunction (ED) is the most common male sexual dysfunction by far and the prevalence is increasing year after year. As technology advances, a wide range of physical diagnosis tools and therapeutic approaches have been developed for ED. At present, typical diagnostic devices include erection basic parameter measuring instrument, erection hardness quantitative analysis system, hemodynamic testing equipment, nocturnal erection measuring instrument, nerve conduction testing equipment, etc. At present, the most commonly used treatment for ED is pharmacological therapy represented by phosphodiesterase five inhibitors (PDE5i). As a first-line drug in clinical, PDE5i has outstanding clinical effects, but there are still some problems that deserve the attention of researchers, such as cost issues and some side effects, like visual disturbances, indigestion, myalgia, and back pain, as well as some non-response rates. Some patients have to consider alternative treatments. Moreover, the efficacy in some angiogenic EDs (diabetes and cardiovascular disease) has not met expectations, so there is still a need to continuously develop new methods that can improve hemodynamics. While drug have now been shown to be effective in treating ED, they only control symptoms and do not restore function in most cases. The increasing prevalence of ED also makes us more motivated to find safer, more effective, and simpler treatments. The exploration of relevant mechanisms can also serve as a springboard for the development of more clinically meaningful physiotherapy approaches. Therefore, people are currently devoted to studying the effects of physical therapy and physical therapy combined with drug therapy on ED. We reviewed the diagnosis of ED and related physical therapy methods, and explored the pathogenesis of ED. In our opinion, these treatment methods could help many ED patients recover fully or partially from ED within the next few decades.

Селективная криоаблация нервов полового члена в качестве метода лечения преждевременной эякуляции.

Introduction. Premature ejaculation (PE) is the second most common male sexual dysfunction with a significant negative impact on quality of life. To date, there is no satisfactory treatment for PE. Surgical methods of treatment are based on reducing the sensitivity of the glans penis by various methods, the main of which is selective dorsal neurotomy (SDN). Recently, methods have been developed for temporary demyelination of the dorsal nerve of the penis using cryoablation. This article discusses the results of selective minimally invasive cryoablation for the treatment of PE. as a treatment for premature ejaculation. Materials and methods. Materials and methods. The methods of SDN by the criablation method are described. The study involved 29 patients aged 22 to 35 years (mean age 28.7 years). All patients met the Criteria for Premature Ejaculation. Patients filled out the Premature Ejaculation Profile and recorded the time of Intravaginal Ejaculation Latency Time (IELT) before and after 3 months after SDN by cryoablation. Results. After the operation average IELT increased from of 75.8 seconds to 227.6 seconds (+298%), the average Premature Ejaculation Profile score increased from 3.6 to 11.35 points (+315%). Conclusions. Selective minimally invasive cryoablation of penile nerves is a promising treatment for premature ejaculation. However, additional studies with a larger number of participants are needed.

Changes of insular function in lifelong premature ejaculation patients before and after SSRI administration.

Lifelong premature ejaculation (PE) is regarded as one of the most common male sexual dysfunction. We aimed to detect whether insula-related brain functional networks are altered in lifelong PE patients and whether such alterations are "normalised" after selective serotonin reuptake inhibitors (SSRI) administration. Twenty-three drug-naive lifelong PE patients and 30 healthy controls (HC) were recruited in current study. All subjects underwent resting-state functional magnetic resonance imaging (fMRI) scan at first. One hour after dapoxetine administration, all patients underwent fMRI scanning again. The degree centrality (DC), amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) analysis, and ROI-based functional connectivity (FC) analysis were applied to calculate the abnormalities in insula-related functions among three groups. Compared to HC group, PE patients at baseline showed significantly altered DC, ALFF, and ReHo value of the bilateral insula, which subsequently showed a "normalised" trend after dapoxetine administration. Additionally, compared to HC group, PE patients at baseline showed significantly decreased FC between insula and precentral gyrus, inferior frontal gyrus, middle/inferior temporal gyrus, and caudate, while patients after dapoxetine administration showed increased insula-related FC in anterior cingulate cortex and decreased FC in thalamus and middle/inferior temporal gyrus. The main effects of dapoxetine were located in precentral gyrus, inferior frontal gyrus, caudate, and limbic system. Our findings report altered brain mechanism of insula in lifelong PE patients and also indicate that dapoxetine can "normalise" the abnormal function of the insula to certain extent in lifelong PE patients.

Sexual needs and sexual function of patients with Parkinson's disease.

Sexual dysfunction (SD) is a frequent non-motor symptom in Parkinson's disease (PD) that is rarely addressed, and sexual counseling is sporadic. To investigate PD patients' SD and sexual counseling motivation and to propose an interventional strategy for movement disorder specialists. All consecutive PD patients who presented to a movement disorder unit between 2018 and 2019 completed anonymous questionnaires containing the Female Sexual Function Index, the International Index of Erectile Function, and a questionnaire on sexual needs and motivation to receive sexual counseling. The age range of the 100 recruited patients (78 men) was 40-80years, and the mean disease duration was 8.64 ± 6.84years. SD appeared at all PD stages. The presence of SD pre-PD diagnosis significantly predicted SD post-diagnosis in men. Erectile dysfunction was the most common male SD (70%). Women reported frequent SD before PD diagnosis and currently. More than half of the responders (74% of the men and 40% of the women) were motivated to receive sexual counseling. Most of them (77.4%) were in a relationship. The findings of this analysis revealed that most PD patients had experienced SD before being diagnosed with PD and were interested in receiving sexual counseling. We propose a six-step intervention strategy for the management of SD in PD designed for application in a movement disorder unit. We also recommend that neurologists and other healthcare providers undergo training to provide basic sexual counseling tailored to the needs of PD patients.