Intravaginal Ejaculatory Latency Research Articles

(238) Hyaluronic Acid in Urology: Systematic Review and Meta-Analysis

Abstract Introduction Introduction: The use of hyaluronic acid (HA) as a non-surgical treatment for various pathological and cosmetic conditions within urology has been of great interest in recent literature. HA has been studied for use in several conditions including Peyronie’s disease, penile size augmentation, and premature ejaculation. Currently, HA is not first-line or standard therapy for any of these conditions; however, it has been increasingly utilized in clinical practice. Objective To provide an updated review and meta-analysis of the current state of hyaluronic acid use in urology, characterize its adverse effects, as well as briefly discuss future directions of research for HA in urology. Methods Multiple PubMed search strategies were run utilizing search terms, including: “hyaluronic acid”, “penile OR penis”, “augmentation”, “injection”, “enhancement”, “Peyronie disease”, “penile fibromatosis”, “premature ejaculation”, “cosmetic urology OR genital cosmetic”, “men’s health”, and “penile diseases” among other related iterations. Relevant data extracted included mean and standard deviation (for both pre- and post-HA injection or control treatment): International Index of Erectile Function (IIEF-5) score, intravaginal ejaculatory latency (IELT), glandular circumference/girth, erect penile girth, and plaque size Results Our search strategies yielded 136 studies of which 33 studies were included for systematic review (Figure 1). Among all studies, complications were generally rare with the procedure. 4 studies reported penile ecchymosis and a study reported paresthesia and numbness. There was 1 case report of glans penis necrosis, two of abscess formation, one of acute hypersensitivity reaction, and one of sepsis secondary to HA injection, which represented the most serious complications reported. Several studies also reported irregular nodule formation, which resolved with time or mild pressure application. In the metanalysis, 16 studies were included. IELT, penile girth, glans circumference, and IIEF-5 were all significantly increased on a fixed-effects model. 9 studies examined the change in IELT after HA injection, with an effect size of 2.335 [2.147,2.522], p-value= <0.001 (figure 2). Regardless of intent of study, 4 studies reported increase in glans circumference (figure 3) with effect size: 2.3 [2.066, 2.534], p-value= <0.001. Similarly, 4 studies showed increase in penile girth (figure 4) with effect size: 1.729 [1.504, 1.954], p-value = <0.001. 3 studies demonstrated IIEF-5 improvement with effect size: 0.996 [0.739–1.252], p-value= <0.001. With only 2 studies reporting pre- and post-op plaque length while others reporting the mean reduction in plaque amount, the plaque size was generally reduced after HA treatment, but this was not statistically significant, p-value= 0.069 with effect size: -0.252 [-0.524, 0.019]. It should be noted that of the 26 primary studies (excluding the 7 case reports), only 7 studies were randomized, controlled studies while others were either retrospective or single arm in nature. Conclusions While the use of HA in urology shows promising results in terms of efficacy and minimal side effects, there is a need for more randomized controlled trials to validate its potential advantages. Future research should focus on optimizing treatment protocols and exploring the expertise of sexual medicine specialists in administering HA therapy. Disclosure No.

(253) Usage of Hyaluronic Acid in Urology: Systematic Review and Meta-Analysis

Abstract Introduction The use of hyaluronic acid (HA) as a non-surgical treatment for various pathological and cosmetic conditions within urology has been of great interest in recent literature. HA has been studied for use in several conditions including Peyronie’s disease, penile size augmentation, and premature ejaculation. Currently, HA is not first-line or standard therapy for any of these conditions; however, it has been increasingly utilized in clinical practice. Objective To provide an updated review and meta-analysis of the current state of hyaluronic acid use in urology, characterize its adverse effects, as well as briefly discuss future directions of research for HA in urology. Methods Multiple PubMed search strategies were run utilizing search terms, including: “hyaluronic acid”, “penile OR penis”, “augmentation”, “injection”, “enhancement”, “Peyronie disease”, “penile fibromatosis”, “premature ejaculation”, “cosmetic urology OR genital cosmetic”, “men’s health”, and “penile diseases” among other related iterations. Relevant data extracted included mean and standard deviation (for both pre- and post-HA injection or control treatment): International Index of Erectile Function (IIEF-5) score, intravaginal ejaculatory latency (IELT), glandular circumference/girth, erect penile girth, and plaque size. Results Our search strategies yielded 136 studies of which 33 studies were included for systematic review (Figure 1). Among all studies, complications were generally rare with the procedure. 4 studies reported penile ecchymosis and a study reported paresthesia and numbness. There was 1 case report of glans penis necrosis, two of abscess formation, one of acute hypersensitivity reaction, and one of sepsis secondary to HA injection, which represented the most serious complications reported. Several studies also reported irregular nodule formation, which resolved with time or mild pressure application. In the metanalysis, 16 studies were included. IELT, penile girth, glans circumference, and IIEF-5 were all significantly increased on a fixed-effects model. 9 studies examined the change in IELT after HA injection, with an effect size of 2.335 [2.147,2.522], p-value= <0.001 (figure 2). Regardless of intent of study, 4 studies reported increase in glans circumference (figure 3) with effect size: 2.3 [2.066, 2.534], p-value= <0.001. Similarly, 4 studies showed increase in penile girth (figure 4) with effect size: 1.729 [1.504, 1.954], p-value = <0.001. 3 studies demonstrated IIEF-5 improvement with effect size: 0.996 [0.739-1.252], p-value= <0.001. With only 2 studies reporting pre- and post-op plaque length while others reporting the mean reduction in plaque amount, the plaque size was generally reduced after HA treatment, but this was not statistically significant, p-value= 0.069 with effect size: -0.252 [-0.524, 0.019]. It should be noted that of the 26 primary studies (excluding the 7 case reports), only 7 studies were randomized, controlled studies while others were either retrospective or single arm in nature. Conclusions While the use of HA in urology shows promising results in terms of efficacy and minimal side effects, there is a need for more randomized controlled trials to validate its potential advantages. Future research should focus on optimizing treatment protocols and exploring the expertise of sexual medicine specialists in administering HA therapy. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

A randomized controlled trial of combined low-intensity extracorporeal shockwave therapy and Dapoxetine use in the management of lifelong premature ejaculation

We aimed to evaluate the efficacy of combined low-intensity extracorporeal shockwave therapy (LI-ESWT) and dapoxetine administration for the treatment of lifelong premature ejaculation (LPE) in comparison to LI-ESWT and dapoxetine alone. In the randomized controlled trial, 212 men diagnosed with LPE were enrolled. The participants were randomized into four subgroups: control (n = 50), dapoxetine (n = 56), LI-ESWT (n = 50) and LI-ESWT + dapoxetine (n = 56). The intravaginal ejaculation latency (IELT), premature ejaculation profile (PEP), and Global Impression of Change (GIC) were evaluated. There were substantial improvements in the fold-increase of the IELT (F-IELT), and PEP and GIC-I scores in both the dapoxetine (p < 0.001) and LI-ESWT + Dapoxetine (p < 0.001) groups than in the control and LI-ESWT groups. Although the LI-ESWT group demonstrated a minor improvement in the F-IELT score (p = 0.04), there were no noticeable improvements in the PEP (p = 0.12) and GIC-I (p = 0.15) scores. In conclusion, a combination of dapoxetine administration and LI-ESWT might be more effective in treating LPE than LI-ESWT or dapoxetine alone, indicating a potential synergistic effect.

Altered Structural and Functional Connectivity Contribute to Rapid Ejaculation: Insights from a Multimodal Neuroimaging Study

Little is known about how the aberrant structural and functional connectivity relates to the rapid ejaculation. Data of diffusion tensor imaging and resting state functional magnetic resonance imaging were acquired from 32 PE patients and 38 healthy controls (HCs). Firstly, we investigated the structural connectivity (SC) disruptions of PE patients using the method of graph theoretical analysis. Brain regions with impaired nodal strength were then defined as regions of interest (ROI). Secondly, the corresponding functional connectivity (FC) changes were explored. Finally, the correlation analyses were performed between brain areas with abnormal connectivity and clinical characteristics. Structural analysis revealed that PE patients had increased nodal strength in the right superior frontal gyrus (dorsolateral), left middle frontal gyrus, right superior frontal gyrus (medial), right superior frontal gyrus (medial orbital) and decreased nodal strength in the left amygdala. FC analysis revealed that PE patients had decreased FC values in the default mode network, visual recognition network and subcortical network, as well as increased FC values in the attention network. Moreover, correlation analysis revealed that the nodal strength of right superior frontal gyrus (dorsolateral) was negatively associated with the intra-vaginal ejaculation latency, while FC values between the left middle frontal gyrus and middle occipital gyrus were positively related to the total scores of the premature ejaculation diagnostic tool (PEDT). Our results indicated that PE might be associated with the abnormal SC of areas in the prefrontal-amygdala pathway and aberrant FC in certain functional brain networks, especially in default mode network.

Characteristics of men who are bothered by rapid ejaculation: results from clinical intake surveys.

The objective of this study is to identify factors associated with bother with rapid ejaculation in a cohort of men presenting to a sexual dysfunction clinic, independent of a diagnosis of PE. A prospective institutional database has been maintained on patients completing an 89-item intake questionnaire querying various areas of sexual dysfunction. Regarding ejaculatory dysfunction, patients are asked "Do you feel bothered, annoyed, and/or frustrated by ejaculating too quickly?" Statistical modeling was performed to identify associations. A total of 1359 men completed the intake survey, and 694 responded to the question on bother with rapid ejaculation. Overall, 42.9% (298/694) of respondents reported bother with rapid ejaculation. Men reporting bother were more likely to report lower intravaginal ejaculatory latency (IELT) time (4.2 vs 12.2 min, p < 0.0001), problems with depression (32% vs 21%, p = 0.001), negative impact on relationship (73% vs 51%, p < 0.0001), and negative impact on partner's sexual satisfaction (26% vs 15%, p < 0.001). These results highlight the importance of asking all men presenting with sexual health concerns about their bother with rapid ejaculation for complete assessment of sexual and mental wellbeing.

Effectiveness comparisons of acupuncture for premature ejaculation: Protocol for a network meta-analysis.

Background:As one of the common male sexual dysfunction diseases, the treatment effect of premature ejaculation is often difficult to guarantee. In China, there are many randomized clinical trials that confirm that acupuncture has a good therapeutic effect on premature ejaculation. The aim of this study was to compare the efficacy and safety of acupuncture for premature ejaculation from intravaginal ejaculation latency (IELT), premature ejaculation diagnostic tool (PEDT), Arab premature ejaculation index (AIPE), and premature ejaculation index (IPE).Methods:We will use PubMed, EMBASE, Nursing and Related Health Literature Cumulative Index, Joint and Supplemental Drug Database, Cochrane Center Controlled Trials Registry (CENTRAL), China Biomedical Literature Database (CBM) and China Knowledge Infrastructure (CNKI), The Chinese Science and Technology Periodical Database (VIP), and Wanfang Database conduct systematic searches until October 31, 2018. At the same time, manually search for gray documents, including unpublished meeting articles. The primary outcome included intravaginal ejaculation latency (IELT). Secondary outcomes were premature ejaculation diagnostic tools (PEDT), Arab premature ejaculation index (AIPE), and premature ejaculation index (IPE). The quality and evidence that the risk of inclusion of the BiB tool will be assessed will be assessed on a scale.Results:This study will generate a comprehensive review of current evidence of acupuncture for premature ejaculation.Conclusion:The study will provide updated evidence to evaluate the efficacy and safety of acupuncture for premature ejaculation.Ethics and Communication:Because this research is based on a meta-analysis of published research, ethical recognition and patient consent are unnecessary.Agreement registration number:PROSPERO CRD42018111661.

Acquired premature ejaculation in Parkinson's disease and possible mechanisms.

Premature ejaculation (PE) has been reported in 40.6-51.5% of men affected by Parkinson's disease (PD), however, this non-motor sexual complaint has not been studied in detail. We describe eight PD patients who asked for a sexological consultation between 2008 and 2014 because of a new-onset of PE. They were diagnosed with acquired PE (APE) according to the DSM-V criteria and the International Society for Sexual Medicine (ISSM) committee. Patients' demographic, medical and sexual related data were retrieved and studied. The average age of onset of PD was 53.3 ± 12.7 years (range 38-77 years) and the sexual problem appeared 4.0 ± 3.1 years later. The mean intravaginal ejaculation latency (IELT) before APE onset was 7.3 (range 2-20) min. Interestingly, the ejaculatory disorder appeared abruptly, characterized by a dramatically shortened IELT in all patients, while in three of the cases ejaculation occurred before vaginal penetration, hampering sexual intercourse. Some patients had 2 additional sexual problems, (four with erectile dysfunctions, five with libido changes: increased desire in four and reduced in one). In this case series of PD patients with APE, the ejaculatory dysfunction developed when patients were on antiparkinsonian medications, suggesting a possible medication effect.

Efectos del consumo de drogas y de la ansiedad en la eyaculación precoz en una muestra de drogodependientes españoles

IntroductionPremature ejaculation may be due to many factors and one of them may be drug use. AimsThe main objective of this study is to show how drug abuse affects the ejaculatory response, keeping in mind the different substances consumed, the level of anxiety and the period of withdrawal. MethodTwo samples were used, one for men who were addicted to drugs (N=925) and one of non-consumers (N=82). Both samples were selected from 28 treatment centers. The Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire and the State Anxiety Trait Questionnaire (STAI) were used. ResultsThe results show that men with a history of consumption obtain higher percentages in premature ejaculation compared to non-users (44.3%> 15.9%) and also higher mean scores in anxiety (State Anxiety=19.83>11, 89; Trait Anxiety=25.66>12.39). These differences were statistically significant (P=.000). The results confirm that the withdrawal period does not improve ejaculatory response and having a partner does not work as a protective factor in premature ejaculation. ConclusionsMen with a history of drug use are more likely to suffer from premature ejaculation and higher levels of anxiety, which does not improve during the period of withdrawal, leading to the belief that drug users have personality traits that facilitate premature ejaculation and/or that the neurological damages caused by the drugs contribute to a decrease in the intravaginal ejaculatory latency, issues that should be studied in future investigations.

Differences in sympathetic nervous system activity and NMDA receptor levels within the hypothalamic paraventricular nucleus in rats with differential ejaculatory behavior.

Differences in intravaginal ejaculation latency reflect normal biological variation, but the causes are poorly understood. Here, we investigated whether variation in ejaculation latency in an experimental rat model is related to altered sympathetic nervous system (SNS) activity and expression of N-methyl-D-aspartic acid (NMDA) receptors in the paraventricular nucleus of the hypothalamus (PVN). Male rats were classified as “sluggish,” “normal,” and “rapid” ejaculators on the basis of ejaculation frequency during copulatory behavioral testing. The lumbar splanchnic nerve activity baselines in these groups were not significantly different at 1460 ± 480 mV, 1660 ± 600 mV, and 1680 ± 490 mV, respectively (P = 0.71). However, SNS sensitivity was remarkably different between the groups (P < 0.01), being 28.9% ± 8.1% in “sluggish,” 48.4% ± 7.5% in “normal,” and 88.7% ± 7.4% in “rapid” groups. Compared with “normal” ejaculators, the percentage of neurons expressing NMDA receptors in the PVN of “rapid” ejaculators was significantly higher, whereas it was significantly lower in “sluggish” ejaculators (P = 0.01). In addition, there was a positive correlation between the expression of NMDA receptors in the PVN and SNS sensitivity (r = 0.876, P = 0.02). This study shows that intravaginal ejaculatory latency is associated with SNS activity and is mediated by NMDA receptors in the PVN.

Perceptions of normal and abnormal ejaculatory latency times: an observational study in Ghanaian males and females.

BackgroundThis cross-sectional study aimed at quantifying the perceptions of Ghanaian men and women on how long they thought sex should last, from intromission until ejaculation.MethodA random sample of 568 heterosexual men and women within the Kumasi Metropolis was surveyed from December 2009 to February 2010. The question of primary interest in the present study includes perceived intravaginal ejaculatory latency (IELT), in minutes, for four different conditions: “adequate,” “desirable,” “too short,” and “too long” IELT.ResultsThe interquartile range for the respondent’s judgment of an “adequate” length for IELT was from 7.0 to 20.3 min; “desirable” from 10.0 to 25.0 min; “too short” from 2.0 to 5.0 min; “too long” from 10.5 to 60.0 min. However, the “actual” IELT (i.e. what the respondents are capable of doing) as found in this study was from 6 to 15 min. Ghanaian perceptions about ejaculatory latencies were in part consistent with data from Germany and contrary to data from the USA on ejaculatory latency and were not affected by age or educational level.ConclusionThese results suggest that the average Ghanaian believes that intercourse that lasts 7.0–25.0 min is normal. Dissemination of the present finding to the public may modify their expectations for IELT which will lead to a realistic replica of sexuality and hence help prevent sexual disappointments and dysfunctions. It will also be beneficial to couples who are being treated for sexual problems by normalizing their expectations.

Improved Ejaculatory Latency, Control and Sexual Satisfaction When PSD502 is Applied Topically in Men with Premature Ejaculation: Results of a Phase III, Double-Blind, Placebo-Controlled Study

PSD502 is a novel aerosolized, lidocaine-prilocaine, spray being developed for the treatment of lifelong premature ejaculation. The clinical profile of PSD502 is described in one of two double-blind, placebo-controlled, phase III studies. To determine the effect of PSD502 on the Index of Premature Ejaculation (IPE) and intravaginal ejaculatory latency (IELT) of men with lifelong PE. Men with lifelong PE who documented an IELT ≤ 1 minute with two or more of the first three sexual encounters during a 4-week baseline period were randomized to receive double-blind treatment with PSD502 or placebo for 3 months. Patients completed IPE and Premature Ejaculation Profile questionnaires at entry and monthly visits, and recorded stop-watch timed IELT during each encounter. Safety was assessed by collecting adverse event data and standard safety measures. Stopwatch timed IELT recordings and a patient-reported outcome questionnaire the IPE were used in this study to determine the effect of PSD502 applied topically 5 minutes before intercourse. Two hundred fifty-six men with PE were randomized from 38 centers in the U.S., Canada, and Poland. The geometric mean IELT over the 3-month treatment period increased from a baseline of 0.56 minute and 0.53 minute in the PSD502 and placebo group respectively to 2.60 and 0.80 minute. There were significantly greater increases in the scores for the IPE domains of ejaculatory control, sexual satisfaction and distress in the PSD502 group than in the placebo group, with a mean 5.0 point difference between treatments in change from baseline in the IPE domain for ejaculatory control, 4.6 point difference in change from baseline in the IPE domain for sexual satisfaction, and a 2.5 point difference in change from baseline in the IPE domain for distress. This was supported by improvements in all secondary endpoints. In this study, PSD502 applied topically to the glans penis 5 minutes before intercourse showed significantly improved ejaculatory latency, ejaculatory control, sexual satisfaction and distress and was shown to be well tolerated by patients and partners.

Differences in the Spinal Command of Ejaculation in Rapid Ejaculating Rats

It has been hypothesized that lifelong premature ejaculation is part of a biological variation in the intravaginal ejaculation latency, but what causes this variation remains poorly understood. The aim of this study is to elucidate whether variations in ejaculation latencies in an experimental rat model for premature ejaculation are linked to differences in the spinal command of ejaculation. Electrical microstimulation of the spinal generator for ejaculation revealed an accelerated expulsion phase in rapid ejaculating rats. Adult male Wistar rats were categorized as "sluggish,""normal," or "rapid" ejaculators on the basis of their ejaculation frequency in sexual mating tests. One to three weeks after selection, males were urethane anesthetized and electrically microstimulated in the spinal generator for ejaculation, evoking ejaculation. Bulbospongiosus muscle electromyographic and intraluminal vas deferens pressure were measured simultaneously, representing, respectively, the expulsion and emission phase in ejaculation. Electrical microstimulation of the spinal generator for ejaculation evoked ejaculation in "sluggish" (N = 9), "normal" (N = 13), and "rapid" (N = 11) ejaculating rats. Vas deferens contraction (emission phase) was evoked at different stimulation strengths, but response properties were not statistically different between "sluggish,""normal," and "rapid" ejaculator rats. Bulbospongiosus muscle contractions (expulsion phase) following microstimulation was significantly accelerated in "rapid" rats as compared with "sluggish" and "normal" rats. The total duration of bulbospongiosus muscle contractions remained unchanged between the three ejaculator groups. Our results provide the first scientific evidence supporting a neurophysiological difference between "rapid,""normal," and "sluggish" ejaculators, expressed as an accelerated expulsion phase in "rapid" ejaculator rats. This bridges the gap between a sexual behavior trait and the spinal command of ejaculation.

Canadian and American Sex Therapists' Perceptions of Normal and Abnormal Ejaculatory Latencies: How Long Should Intercourse Last?

Lay public perceptions about how long intercourse should last are discrepant from objective data on ejaculatory latencies. This may be problematic as the subjective interpretation of latency is a factor related to perceived distress with length of intercourse. Quantify the opinion of expert sex therapists as to what are "adequate,""desirable,""too short," and "too long" intravaginal ejaculatory latencies. Method. A random sample of members of the Society for Sex Therapy and Research in the United States and Canada was surveyed. Intravaginal ejaculatory latency, in minutes, for four different conditions: coitus that lasts an amount of time that is "adequate,""desirable,""too short," and "too long." Results. The interquartile range for the sex therapists' opinions regarding an "adequate" length for ejaculatory latency was from 3 to 7 minutes; "desirable" from 7 to 13 minutes; "too short" from 1 to 2 minutes; "too long" from 10 to 30 minutes. Therapists' beliefs about ejaculatory latencies were consistent with objective data on ejaculatory latency and were not affected by therapist demographic characteristics such as sex or experience. These results suggest that the average sex therapist believes that intercourse that lasts 3 to 13 minutes is normative and not prima facie worthy of clinical concern. Dissemination to the public of these results may change lay expectations for intravaginal ejaculatory latency and prevent distress. These results may also be beneficial to couples in treatment for sexual problems by normalizing expectations.

TEMPE: Topical Eutectic-Like Mixture for Premature Ejaculation

Background: Premature ejaculation (also known as rapid or early ejaculation) is the most common form of sexual dysfunction experienced by men, but there is presently an unmet need for a licensed pharmaceutical product that can be used on demand and that is effective from the first dose. Objective: TEMPE® (Topical Eutectic-Like Mixture for Premature Ejaculation; Plethora Solutions Plc.) is a proprietary metered-dose aerosol containing a combination of the well-known local anaesthetics lidocaine and prilocaine in a novel formulation. The authors evaluate here the progress that has been made towards the reformulation of these local anaesthetic agents into a unique eutectic-like formulation for use as a desensitising agent in the treatment of premature ejaculation, as well as examining other potential uses for the spray, such as pain relief at skin-graft donor sites. Methods: Both lidocaine and prilocaine are soluble in the hydrofluoroalkane (HFA-134a) propellant, providing a unique formulation in which the pressurised liquid propellant is used as the solvent. Deployment of the metered-dose chamber vaporises the propellant, spraying lidocaine and prilocaine, now forced into a eutectic-like combination that remains in liquid form at temperatures well below their individual melting points, onto the target surface. The site is thus easily covered in a controlled dose of pure local anaesthetic in base form, providing ideal circumstances for optimised absorption through non- or poorly-keratinised skin, mucus membranes and wound surfaces. Results/conclusion: TEMPE has been developed for use in premature ejaculation and preliminary results show promising improvements in intravaginal ejaculatory latency, as well as patient-reported outcomes.

Efficacy of Sildenafil Citrate (Viagra) in Men with Premature Ejaculation

Premature ejaculation (PE) is the most common ejaculatory dysfunction. We assessed the efficacy of sildenafil to increase the time to ejaculation, improve ejaculatory control, and decrease the postejaculatory erectile refractory time in men with PE. The main study was an 8-week, double-blind, placebo-controlled, parallel group study in men between 18 and 65 years of age with diagnosed PE. A substudy was also conducted using a subset of patients (two-way crossover, one center) before entry to the main study. The primary study measured intravaginal ejaculatory latency (IELT) and responses to the Index of Premature Ejaculation (IPE) questionnaire. The substudy measured vibrotactile stimulation ejaculatory latency time (VTS-ELT) and postejaculatory erectile refractory time. Differences between treatment groups were determined by ancova at the 5% level of significance. The change in IELT (1.6 +/- 6.08 vs. 0.6 +/- 2.07 minutes) and VTS-ELT (2.9 +/- 0.4 vs. 2.4 +/- 0.4 minutes) were higher after taking sildenafil, compared with placebo, but did not reach statistical significance. However, patients who took sildenafil (vs. placebo) reported significantly (P < 0.05) increased ejaculatory control (1.8 +/- 0.3 vs. 1.5 +/- 0.3), increased ejaculatory confidence (2.2 +/- 0.2 vs. 1.9 +/- 0.2), and improved overall sexual satisfaction scores (3.1 +/- 0.2 vs. 2.8 +/- 02) on the IPE, and had a decreased postejaculatory erectile refractory time (3.2 +/- 0.7 vs. 6.4 +/- 0.7 minutes). The most common adverse events for sildenafil (vs. placebo) were headache (15% vs. 1%), flushing (15% vs. 0%), dyspepsia (5% vs. 1%), abnormal vision (5% vs. 0%), and rhinitis (5% vs. 0%). Although IELT and VTS-ELT were not significantly improved, sildenafil increased confidence, the perception of ejaculatory control, and overall sexual satisfaction, and decreased the refractory time to achieve a second erection after ejaculation in men with PE.