Diagnosis Of Premature Ejaculation Research Articles

(215) Investigating if Hormonal Dysfunctions are Risk Factors in Men Complaining of Premature Ejaculation

Abstract Introduction Most epidemiological studies suggest that premature ejaculation (PE), also referred to as early ejaculation and rapid ejaculation, may be the most common male sexual disorder. The exact etiology of PE is unknown. Psychological/behavioristic and biogenic etiologies have been proposed. Objective Initial reports indicate that there are hormone differences between men with primary (lifelong) and secondary (acquired) PE. This study was designed to investigate hormone profiles of these two subgroups. Methods Men who presented to our outpatient clinic with PE were enrolled in this study. The diagnosis and classification (primary or secondary) of PE was based on patient medical and sexual history according to guidelines of international society of sexual medicine (ISSM) and European association of urology (EAU). Complete physical examination was done and we measured thyroid stimulating hormone (TSH), testosterone (T), and prolactin (P) for all patients. Statistical analyses included descriptive statistics and independent-measures t-test for univariate analyses. Analysis of covariance was used for multivariable analyses. Results 506 men were included in this analysis. The average age of these men was 44±12 years old and the mean body mass index (BMI) was 26.7±5.5. The mean levels of T, TSH, and P for the entire sample was 4.38±1.69, 2.31±3.56, and 10.56±11.04, respectively. There were 267 men in the primary PE group and 239 men in the secondary PE group. The men with primary PE were significantly younger than those with secondary PE (37±11 vs. 52±12, p=0.001). There were no significant differences in BMI between the groups. On univariate analyses, there was no differences between the primary PE and secondary PE groups in T (4.39±1.66 vs. 4.38±1.84, p=0.94), TSH (2.31±4.89 vs. 2.20±2.07, p=0.76), and P (10.65±8.13 vs. 10.46±13.46, p=0.86). When controlling for age in multivariable analyses, there continued to be no differences between the two groups (p values ranging from p=0.56 to 0.81). Conclusions hormonal profile including T, TSH and P seem to be in the normal range in men with PE and there is no statistical difference in these hormones between primary and secondary PE Disclosure No.

The association of reproductive hormones, thyroid function, and vitamin levels with premature ejaculation: A prospective case-control study.

To investigate whether serum hormone (testosterone, prolactin, gonadotropins, and thyroid hormones) and vitamin (vitamin B12, folic acid, and vitamin D) levels are associated with premature ejaculation (PE). This prospective case-control study included 126 patients with PE (lifelong PE [LPE] in 94 and acquired PE [APE] in 32) who presented to the urology outpatient clinic between April 2016 and January 2023 and 92 healthy men as a control group. The diagnosis of PE was based on the criteria defined by the International Society for Sexual Medicine. Serum total testosterone (TT), free and bioavailable testosterone, follicle-stimulating hormone, luteinizing hormone, prolactin, thyroid-stimulating hormone, free triiodothyronine, thyroxine (fT4), vitamin B12, folic acid, and vitamin D levels were measured. Serum TT, fT4, and vitamin D levels were significantly higher in patients with PE than in the control group (p=0.022, p=0.002, and p=0.044, respectively). However, the serum vitamin B12 level was significantly lower in the PE group (p=0.021). In the multivariate logistic regression analysis, only vitamin B12 was found to be an independent risk factor for PE, with an estimated odds ratio of 0.997 (95% confidence interval 0.994-0.999, p=0.036). This study demonstrated that lower vitamin B12 levels are associated with the presence of PE. Therefore, we believe that it would be beneficial to consider vitamin B12 levels in the evaluation of patients with PE.

Perceived intravaginal ejaculation latency time: The diagnosis of premature ejaculation among Vietnamese men.

Premature ejaculation (PE) is a prevalent sexual dysfunction in men that greatly affects their quality of life. In PE, the duration of sexual performance is considered an important aspect. However, a self-estimated value of intravaginal ejaculation latency time (perceived IELT, PIELT) as a criterion for diagnosis has not been specified. This study aimed to determine the validity and a threshold value for PIELT in PE diagnosis. In our cross-sectional study, we recruited 550 men from March 2019 to January 2020 and interviewed them regarding their general demographic characteristics, sexual habits, PIELT and completed a premature ejaculation diagnostic tool (PEDT) questionnaire. Eventually, a combination of a clinical diagnosis and PEDT score was used, in which those with PEDT ≥ 11 and diagnosed with possible PE were assigned to the final PE(+) group; those with PEDT score ≤ 8 and diagnosed with no PE were included in the final PE(-) group. Men PE(-) had more frequent sexual intercourse (9.74±5.38vs. 6.69±5.38 episodes per month, p<0.001) and had higher marriage rate (72.7%vs. 60.4%, p=0.002) than PE(+) patients. No significant difference was noted regarding age, smoking habit, age of first sexual experience, and number of sexual partners between the two groups. The mean PIELT of control subjects and PE(+) patients were 11.69±6.83 min and 2.01±1.21 min, respectively. On receiver operating characteristic curve analysis, the cut-off value of PIELT of 3.75 min can be used to distinguish PE men (area under the curve=0.982, sensitivity/specificity=0.961/0.909), which means that men with a PIELT ≤ 3.5 min is suggestive of PE. The impact of PE is dramatic both from a social and a personal perspective. PE(+) patients married significantly less and have significantly lower sexual activity compared to a PE(-) population. Furthermore, a PIELT of ≤ 3.5 min predicts PE demonstrating the need to revise its taxonomy and definition.

Erektil disfonksiyon şikâyeti ile başvurup eşlik eden prematür ejakulasyonu olan heteroseksüel hastalarda günlük tadalafil ve sertralin kombinasyon tedavisinin etkinliği ve güvenilirliği

Efficacy and safety of daily tadalafil and sertraline combination therapy in heterosexual patients presenting with erectile dysfunction and concomitant premature ejaculation OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of daily tadalafil 5 mg and sertraline 50 mg treatment in 3-month follow-up in patients presenting with erectile dysfunction (ED) complaints and accompanying premature ejaculation (PE) symptoms. MATERIAL and METHODS: This prospective, observational single-arm study was conducted between March and September 2021 among patients suffering from ED and concomitant Lifetime/acquired PE. The Turkish validity of the International Erectile Function-Erectile Function Index (IIEF-EF) was used for the diagnosis of ED in the patients. The patients filled the Premature Ejaculation Diagnostic Tool (PEDT) questionnaire for the diagnosis of PE. Additionally, the Premature Ejaculation Profile (PEP) score was filled. A detailed medical history was taken from all patients and a complete physical examination was performed. After a fourweek follow-up period, patients were given 5 mg tadalafil and sertraline 50 mg tablets daily. The IELT durations of the patients were recorded after 12 weeks of treatment. Premature ejaculation profile and IIEF-EF questionnaires administered to the patients at the beginning were filled again. In addition, the Global Impression of Change (GIC) questionnaire was applied in terms of treatment satisfaction. RESULTS: A total of 71 patients were included in the study. Sixty-three patients completed the study (88.73%). As a result of 3-month daily tadalafil 5 mg + sertraline 50 mg combination therapy, the geometric mean IELT, PEP index scores and subgroup scores of the patients improved and a statistically significant increase in the IIEF-EF scores (p&lt;0.001). In addition, considering the GIC questionnaire, 81.69% (58/71) of the patients stated that they were satisfied with the treatment. CONCLUSION: In conclusion, daily administration of tadalafil and sertraline provides an effective and reliable objective and subjective improvement in the management of patients with ED and accompanying PE. Keywords: premature ejaculation, erectile dysfunction, sertraline, tadalafil, IELT

Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?

IntroductionThe role of bother/distress in the diagnosis of premature ejaculation (PE) has received minimal investigation compared with the 2 other diagnostic criteria, ejaculatory control and ejaculatory latency (EL).AimThis study assessed (i) the added variance explained by bother/distress to the diagnostic accuracy of PE and (ii) determined its overall contribution to a PE diagnosis.MethodsThe 3 diagnostic criteria for PE were assessed in 2,589 men (mean age = 38.2 years, SD = 13.5) in order to determine the contribution of each factor to a dysfunctional diagnosis. A series of regression and discriminant analyses were used to assess the value of bother/distress in explaining ejaculatory control and in predicting accuracy of PE group status. Commonality analysis was used to determine the relative contribution of each of these factors to the diagnosis of PE.Main Outcome MeasureThe major outcome was the quantified contribution of “bother/distress” to a PE diagnosis.ResultsBother/distress accounted for about 3–4% of the variation in ejaculatory control and added only minimally to the prediction accuracy of PE group status (no, probable, definite PE). Commonality analysis indicated that bother/distress comprised about 3.6% of the unique explained variation in the PE diagnosis, compared with ejaculatory control and EL which contributed 54.5% and 26.7%, respectively. Common variance among factors contributed the remaining 15.5% to the PE diagnosis.Clinical TranslationBother/distress contributes least to the determination of a PE diagnosis. Its contribution is largely redundant with the unique and combined contributions of ejaculatory control and EL.Strengths and LimitationsUsing a well-powered and multivariate analysis, this study parsed out the relative contributions of the 3 diagnostic criteria to a PE diagnosis. The study is limited by its use of estimated EL, a single item assessment of bother/distress, and the lack of differentiation of PE subtypes, lifelong and acquired.ConclusionBother/distress contributes minimally to the PE diagnosis, yet its assessment may be key to understanding the experiences of the patient/couple and to developing an effective treatment strategy.Rowland DL, McNabney SM, Hevesi K. Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?. Sex Med 2022;10:100548.

The Tenuous Role of Distress in the Diagnosis of Premature Ejaculation: A Narrative Review.

BackgroundUnlike the other 2 criteria for diagnosing premature ejaculation (PE), namely lack of ejaculatory control and short ejaculation latency (EL), the role of bother/distress has received only minimal consideration and investigation.AimThe specific aim was to determine both why distress is included in the PE diagnosis and whether such inclusion is advantageous to achieving better diagnostic outcomes. To this end, the review explored the historical and theoretical underpinnings of the inclusion of “bother/ distress” in the diagnosis of PE, with reference to the larger role that distress has played in the diagnosis of mental disorders, in an attempt to understand the utility (or lack thereof) of this construct in making a PE diagnosis.MethodsWe reviewed the role of bother/distress across current professional definitions for PE and then expanded this discussion to include the role of distress in other sexual dysfunctions. We then included a brief historical perspective regarding the role that distress has played in the diagnosis of PE. This discussion is followed by a deeper look at 2 nosological systems, namely DSM and ICD, to allow perspective on the inclusion of the bother/distress construct in the diagnosis of mental and behavioral disorders, including the assumptions/arguments put forward to include or exclude bother/distress as an important criterion underlying various professional assumptions.OutcomeDetermination of the value and/or need of including bother/distress as a necessary criterion for the diagnosis of PE.ResultsBased on the research literature, bother/distress does not appear to be as critical for a PE diagnosis as either the lack of ejaculatory control or short EL. It is the weakest of the differences among men with and without PE, and recent evidence suggests that its inclusion is generally redundant with the severity of the 2 other criteria for PE, ejaculatory control and EL.Clinical TranslationBother/distress appears to serve little purpose in the diagnosis of PE yet its assessment may be important for the treatment strategy and for assessing treatment effectiveness.Strengths and LimitationsThis review did not provide a critical analysis of the literature regarding the role of bother/distress in PE, but rather focused on its potential value in understanding and diagnosing PE.ConclusionAlthough bother/distress appears to add little to the improvement of accuracy for a PE diagnosis, understanding and assessing the man's or couple's experience of distress has important implications for the treatment strategy and focus, as well as for assessing treatment success.Rowland DL, Cooper SE. The Tenuous Role of Distress in the Diagnosis of Premature Ejaculation: A Narrative Review. Sex Med 2022;10:100546.

Assessing the nitric oxide and asymmetric dimethylarginine levels in lifelong premature ejaculation: A prospective study

ObjectiveTo evaluate nitric oxide (NO) and asymmetric dimethylarginine (ADMA) levels in men with premature ejaculation (PE), which is a common condition that adversely affects quality of life. Material and methodOf the 20–50-year old men presenting to the urology clinic, who were married or had regular sexual intercourse, 40 that were diagnosed with lifelong PE according to the Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculation latency time (IELT) measured by a stopwatch were included in the study. The results of the PE group were compared to those of the control group formed with 40 healthy hospital personnel. Venous blood samples were centrifuged and stored at −80°C. The NO and ADMA values were compared between the individuals with and without PE. ResultsThere was no statistically significant difference between the groups in terms of age, body mass index (BMI), and The International Erectile Dysfunction Index-5 (IIEF-5) questionnaire scores. The NO and ADMA values were significantly lower in the PE group than in the control group (29.76±13.26μmol/L vs. 48.27±22.71μmol/L; p<0.001 and 1.01±0.49nmol/ml vs. 1.83±1.06nmol/ml; p<0.001, respectively). There was a significant correlation between IELT and NO levels (r=0.407, p=0.001). ConclusionOur study can contribute to the explanation of the pathophysiology of PE having unclear etiology and treatment. Further studies on these molecules with larger case series are required for the diagnosis and treatment of PE.

Development and validation of holding time (HoT), a novel tool to measure the control over ejaculation in males

ABSTRACT Introduction As per ISSM definition, premature ejaculation is based on the assessment of three constructs, namely, ejaculatory latency, control over ejaculation and its associated bother. There is an objective tool to measure ejaculatory latency. There are tools to measure bother as well. However, there is no objective tool to measure ejaculatory control in males. Objective To develop and validate a novel objective tool, namely, Holding Time (HoT) to measure control over ejaculation in males. Methods After obtaining ethical committee approval and written informed consent from the participants and their heterosexual partners, study was initiated. A group of sexually active heterosexual healthy male volunteers as controls and another group of voluntary sexually active heterosexual participants who reported premature ejaculation (PE) in our outpatient department were administered Premature Ejaculation Diagnostic Tool (PEDT). Each participant underwent sexual stimulation sessions in adequate privacy, wherein the audio-visual stimuli as well as stimulation by their heterosexual partner were used for sexual arousal. Following this, they masturbated, which began after reaching the level seven of Mosher's scale of genital sensations, which is the highest point of sexual arousal prior to reaching orgasm. Their heart rate was monitored throughout the session, which was recorded using digital pulse oxymeter. This was taken as additional objective biological evidence to record highest point of arousal. The heterosexual partner's opinion with regard to increase in size of glans as well as increased pulsations in penis was also taken into account to record the highest point of arousal, which was an additional crosscheck mechanism. The time from the highest point of sexual arousal to the point at which the study participant expressed inability to hold ejaculation to any further point of time was recorded using stopwatch by the investigator as the HoT. The test was repeated after 6 weeks to assess test-retest reliability, which was measured using Pearson's coefficient (r). Correlations between PEDT diagnosed PE and self-reported PE, with stopwatch measured HoT was assessed to validate HoT. Results Ten healthy controls (Mean age 30.3±4.64 years) and ten volunteers with self-reported PE (Mean age 29.6±4.25 years) participated in the study conducted from May 2020 to April 2021. The mean stopwatch measured HoT in seconds, recorded by healthy volunteers and self-reported PE were 119.6±33.6 and 32.4±12.8 respectively. Test-retest reliability was good for both the healthy volunteers (r =0.983) and volunteers with PE (r =0.839). It had a sensitivity of 90% and specificity of 91% for diagnosis of PE. The positive predictive value was 79.4% and negative predictive value was 95.5%. Excellent correlations between PEDT and HoT with respect to the diagnosis of PE demonstrated construct validity of HoT. Conclusions The development of an objective tool to evaluate the control over ejaculation helps to develop more objective definition and better management of ejaculatory dysfunctions in males. As per preliminary validation data, Holding Time (HoT) is a reliable objective tool to measure control over ejaculation in males. Disclosure Work supported by industry: no.

Are the Criteria for the Diagnosis of Premature Ejaculation Applicable to Gay Men or Sexual Activities Other than Penile-Vaginal Intercourse?

IntroductionThe criteria for premature ejaculation (PE) have generally been limited to the diagnosis of heterosexual men engaging in penile-vaginal intercourse and therefore the applicability of PE diagnostic criteria to gay men and to activities beyond penile-vaginal intercourse has yet to be explored in depth.AimTo compare the prevalence of PE in gay and straight men and to assess whether PE-related diagnostic measures (ejaculatory control, ejaculation latency [EL], and bother/distress) can be applied with confidence to gay men or to men engaging in sexual activities other than penile-vaginal intercourse.MethodsGay and straight participants (n = 3878) were recruited to take an online survey assessing sexual orientation, sexual function/dysfunction (including specific PE-related measures), sexual relationship satisfaction, and various other sexual behaviors during partnered sex or masturbation.OutcomesComparison of ejaculatory control, EL, and bother/distress across gay and straight men, as well as across different types of sexual activities.ResultsA slightly lower PE prevalence among gay men became undetectable when other predictors of prevalence were included in a multivariate analysis (aOR = 0.87 [95% CI: 0.60–1.22]). Gay men with PE reported longer typical ELs (zU = -3.35, P < .001) and lower distress (zU = 3.68, P < .001) relative to straight men, but longer ELs and lower distress were also associated with anal sex.Clinical TranslationClinicians can feel confident about using existing criteria for the diagnosis of PE in gay men but should be aware of potentially longer ELs and lower PE-related bother/distress—probably related to the practice of anal sex—compared with straight men.Strengths and LimitationsAlthough well-powered and international in scope, this study was limited by biases inherent to online surveys, the lack of a sizable sample of bisexual men, and a lack of differentiation between men with acquired vs lifelong PE.ConclusionsIrrespective of sexual orientation, gay and straight men with PE reported shorter ELs, lower satisfaction, and greater bother/distress than functional counterparts. While PE-related diagnostic criteria (ejaculatory control, EL, and bother/distress) are applicable to gay men, accommodation for longer ELs and lower bother/distress in gay men should be considered.McNabney SM, Weseman CE, Hevesi K, et al. Are the Criteria for the Diagnosis of Premature Ejaculation Applicable to Gay Men or Sexual Activities Other than Penile-Vaginal Intercourse?. Sex Med 2022;10:100516.

The Unfinished Business of Defining Premature Ejaculation: The Need for Targeted Research.

Fifteen years have passed since the International Society of Sexual Medicine first established the 3-pronged criteria for premature ejaculation (PE): a short ejaculation latency, lack of ejaculatory control, and bother/distress. Although the process of establishing valid criteria for any condition or disorder is an ongoing one, a dearth of targeted research on these criteria has hindered professional societies from updating and revising them. To review and critique existing criteria used in the diagnosis of PE, to identify specific problems with them, and to recommend studies that will address shortcomings. Each of the PE criteria was evaluated and compared against standard procedures for establishing validated measures. Following each analysis, targeted research to address the gaps has been recommended. Each PE criterion has shortcomings and each can be improved by using standard validation procedures, as noted by the targeted research outcomes. Professional societies can play an important role by encouraging broad participation in research that generates new and relevant data supporting, validating, or challenging the existing criteria. The concepts underlying the diagnostic criteria for PE have both broad consensus and functional utility. Nevertheless, much of the research investigating PE has uncritically adopted these criteria without concomitantly recognizing their limitations. These limitations prevent determining accurate prevalence rates, interpreting research findings with confidence, and establishing efficacious treatment outcomes. Rowland DL, Althof SE, McMahon CG. The Unfinished Business of Defining Premature Ejaculation: The Need for Targeted Research. Sex Med Rev 2022;10:323-340.

A Cross-Sectional Observational Study on the Coexistence of Erectile Dysfunction and Premature Ejaculation.

IntroductionThe interplay between erectile dysfunction (ED) and premature ejaculation (PE) needs more studies to clarify.AimTo evaluate the risk factors and temporal relationship for the coexistence of ED and PE.MethodsThe data were derived from clinical history.Main Outcome MeasureThe diagnosis of ED and PE was based on self-report and validated questionnaires.ResultsBased on the chief complaint, 1,893 participants were recruited as ED group and 483 participants as PE group from 2014 to 2020. One third of ED and PE groups reported comorbid PE and ED. Of the ED group, 4.1% (n = 77) had lifelong PE, 18.0% (n = 341) had acquired PE and 9.7% (n = 184) had subjective or natural variable PE. Of the PE group, ED was reported in 22.0% (n = 40) of lifelong PE, 33.9% (n = 65) of acquired PE, and 37.6% (n = 41) of subjective or natural variable PE, P < .01. With adjustment of potential confounders, the ED severity was associated with increased risk of acquired PE, while acquired PE was associated with higher risk of ED than lifelong PE. In cases of comorbid lifelong PE and ED (n = 117), 22.2% reported the onset of both dysfunctions being about the same time, whereas 77.8% reported ED occurred behind PE with an average 23.3 years lag. In cases of comorbid acquired PE and ED (n = 406), 52.2% reported the onset of both dysfunctions being about the same time, 34.2% reported ED happened behind PE and 13.5% reported PE emerged behind ED.ConclusionOrganic pathogenesis was least likely to be responsible for the link between PE and ED. When acquired PE and ED coexist, treating ED first or concomitantly according to their temporal order is an appropriate management algorithm.Chieh‑Wen Chin, Chia Mu Tsai, Jen-Tai Lin, et al. A Cross-Sectional Observational Study on the Coexistence of Erectile Dysfunction and Premature Ejaculation. Sex Med 2021;9:100438.

Efficacy of Sphincter Control Training and medical device in the treatment of premature ejaculation: A multicenter randomized controlled clinical trial

A new line of treatment for premature ejaculation (PE) based on the use of masturbation aid device in combination with behavioral techniques has emerged in recent years. We report a multicenter randomized clinical trial with a parallel group design to determine the effectiveness of an electronic device called Myhixel I© in the treatment of PE. Forty patients who met the criteria for the diagnosis of lifelong PE, were assigned to two treatment groups completed the Sphincter control training (SCT) program in eight weeks. The only difference between groups was the use of the device. The main measure was the “fold increase” (FI) of the intravaginal ejaculatory latency time (IELT). The geometric means of IELT show, at the end of the treatment at week 8, a superiority of the device group. The mean FI 4.27 (SD 2.59) at the end of treatment for the device group was clearly higher than obtained in the previous clinical trial, in which a specific medical device was not used. No side effects were observed and it required little therapeutic input and no partner involvement. The SCT program in combination with the Myhixel I© is an effective treatment for PE.

Association of sexual behaviours and premature ejaculation

Premature ejaculation (PE) is the most common reported sexual complaint in men. It is believed that PE is associated with sexual behavior such as early sexual experience, novelty of partners or frequencies of intercourse. Therefore, to examine the association of PE and sexual behaviors in men, a case-control study was conducted with a total of 418 clients Subjects were interviewed for general health status, sexual behaviors, IELT and requested to complete the premature ejaculation diagnostic tool (PEDT). DSM-IV-TR criteria were applied for the diagnosis of PE. Those who diagnosed with PE(+) and PEDT score ≥ 11 belonged to the PE group; those diagnosed with PE(-) and PEDT &lt; 11 belonged to the non-PE group. The results indicated that no significant difference was noted regarding demographic features in the 2 groups. Normal men had a more frequent sexual life compared with PE patients (9.71 ± 6.09 and 6.62 ± 5.44 episodes of sexual intercourses per month, respectively with p &lt; 0.001. Subjects who were single or circumcised had higher prevalence of PE than married or uncircumcised men. Multivariable logistic analysis elucidated that circumcision, number of lifetime sexual partners and sexual frequencies were associated factors of PE. In conclusion, PE is a common sexual dysfunction in men. It was found to be significantly associated with circumcision and frequencies of sexual intercourse. Medical history taking of PE patients should include these sexual behavior factors.

A Study of Differences in Penile Dorsal Nerve Somatosensory Evoked Potential Testing Among Healthy Controls and Patients With Primary and Secondary Premature Ejaculation

BackgroundPenile dorsal nerve somatosensory evoked potential (DNSEP) is a scientific and objective technique that provides effective and objective data to establish the diagnosis of premature ejaculation (PE). AimTo explore differences in DNSEP between patients with primary premature ejaculation (PPE) and those with secondary premature ejaculation (SPE), in order to investigate the clinical value of DNSEP in the diagnosis of PE. MethodsThe participants were divided into a PPE group (34 cases), an SPE group (25 cases) and a healthy control group (18 cases). All participants underwent DNSEP testing, and the latencies and amplitudes of DNSEP were recorded. OutcomesDifferences in the latencies and amplitudes of DNSEP were compared among the PPE, SPE, and healthy control groups. ResultsThe latencies of DNSEP in the PPE and SPE groups were shorter than those in the healthy control group, and these differences were statistically significant (P < 0.01). However, there was no statistically significant difference between the PPE and SPE groups (P > 0.05). The amplitudes of DNSEP in the PPE group were significantly higher than those in the healthy control group (P < 0.01). However, the amplitudes of DNSEP in the SPE group were significantly lower than those in the healthy control group (P < 0.05). Clinical ImplicationsPPE and SPE can be differentiated based on differences in the amplitudes of DNSEP, providing an objective basis for treatments and follow-up examinations. Strengths and LimitationsWe evaluated differences in the amplitudes of DNSEP between PPE and SPE patients, which were rare in the published literature. However, specific causes of these differences are still unclear. SEP only reflects afferent pathways in the ejaculatory reflex arc, and role of the brain as a higher center should not be ignored. ConclusionBoth PPE and SPE patients are characterized by an increased excitability of the penile sensory nerves. Sun Z, Liao Z, Zheng Q, et al. A Study of Differences in Penile Dorsal Nerve Somatosensory Evoked Potential Testing Among Healthy Controls and Patients With Primary and Secondary Premature Ejaculation. J Sex Med Rev 2021;18:732–736.

Premature ejaculation in OSAS: Does it improve with CPAP treatment?

Premature ejaculation (PE) is a common problem in male sexual health that significantly affects the quality of life. We aimed to evaluate the association of PE with obstructive sleep apnoea syndrome (OSAS), which is characterised by chronic oxidative stress, and to assess the effects of continuous positive airway pressure (CPAP) therapy on PE. Sexually active men between the ages of 20 and 50 who were newly diagnosed with PE, and diagnosed with moderate or severe OSAS were included in the study. Arabic Premature Ejaculation Index (AIPE) and Intravaginal Ejection Delay Time (IELT) were questioned for the diagnosis of PE. Patients with OSAS who accepted to participate in the study were given 1year of CPAP treatment, and AIPE and IELT were questioned again, after the treatment. The results are compared with the results of the control group. In total, 80 control subjects without OSAS, 85 patients with moderate OSAS and 82 patients with severe OSAS were included in the study. There were no significant differences between the groups in terms of age, BMI or thyroid function test results. Initial IELT and AIPE scores were significantly higher in the control group compared with the OSAS groups (for the IELT, 155.63±98.78 vs 96.23±60.60 and 62.86±40.49; for the AIPE 26.18±3.88 vs 18.71±3.43 and 17.85±3.83). Compared with initial (pretreatment) values, both scores improved significantly in both OSAS groups after 1year of CPAP therapy (in moderate OSAS group, 96.23±60.60 vs 134.17±83.43 and 18.71±3.43 vs 23.25±3.43 and severe OSAS group 62.86±40.49 vs 112.25±71.58 and 17.85±3.83 vs 24.18±3.53). For the first time in literature, we determined that the presence of OSAS was associated with significantly worse IELT and AIPE scores in males with PE, and the treatment of OSAS was related to the significant improvements in both scores, in the absence of any specific treatments for PE.

Psychosocial stress, somatoform dissociative symptoms and free testosterone in premature ejaculation.

One of the most common sexual dysfunctional diseases in adult males is premature ejaculation. So far, there is no evidence of how premature ejaculation is associated with psychosocial stress. We tested the relationship between neuroendocrine changes in patients with premature ejaculation and indicators of stress experience as a new psychosomatic hypothesis where psychosocial stress may significantly contribute to the aetiology of premature ejaculation. A total of 55 patients with premature ejaculation were included in the study. The control group consisted of 55 healthy men. The diagnosis of premature ejaculation was confirmed by a sexology examination, a history of patients and the values of the premature ejaculation diagnostic tool questionnaire. Comprehensive biochemical serum analysis was focused on the values of total testosterone, free testosterone, luteinising hormone, thyroid-stimulating hormone, dehydroepiandrosterone sulphate, sex hormone-binding globulin and a premature ejaculation diagnostic tool score with trauma symptom checklist and somatoform dissociation questionnaire. The results show significant Spearman correlations of trauma symptom checklist with the premature ejaculation diagnostic tool score (R=0.84) and free testosterone (R=0.62) and somatoform dissociation questionnaire with the premature ejaculation diagnostic tool score (R=0.53) and free testosterone (R=0.57). Spearman correlations of trauma symptom checklist with somatoform dissociation questionnaire show significant correlation (R=0.54).

Estimations of Typical, Ideal, Premature Ejaculation, and Actual Latencies by Men and Female Sexual Partners of Men During Partnered Sex

BackgroundThe ejaculation latency (ELT) criterion for men with premature ejaculation (PE), including its 2 major subtypes of lifelong and acquired, relies heavily on expert opinion, yet such information represents only one source of data for this determination; furthermore, information regarding ELTs for PE within specific subgroups of men (eg, gay, bisexual) has been lacking. AimTo obtain data regarding men's lived experiences and expectations regarding typical ejaculation, ideal ejaculation, and PE and (for men) self-reported ejaculatory latencies during partnered sex across a variety a groups, including men vs women (ie, sexual partners of men), men with and without PE, and straight vs gay/bisexual men. MethodsWe recruited 1,065 men and sexual partners of men, asking them to estimate typical ejaculation, ideal ejaculation, and PE and (for men) self-latencies through an online survey posted on social media. Demographics, sexual identity, and sexual response data were also collected. ResultsTypical and self-reported ELTs were closely aligned with those reported in the literature, with ideal ELTs generally longer than typical ELTs. Median PE ELTs were consistently estimated around 1.5 min, with nearly all subgroups—men vs women; straight vs gay; PE and non-PE men—showing alignment on this criterion. Men with lifelong PE did not differ from men with acquired PE in either their PE ELT estimation or their self-reported ELT. Clinical ImplicationsThe data support the idea of extending the latency cutoff for establishing a PE diagnosis beyond the current 1-minute threshold. Strengths & LimitationsA large sample size drawn from a multinational population powered the study, whereas the use of social media for recruitment and lack of inclusion of lesbian and asexual individuals may have missed relevant data from some who have had sexual experience with men. ConclusionStraight and nonstraight men do not differ in their ELT estimations. In addition, the use of different ELT criteria for lifelong vs acquired PE may be unnecessary.Côté-Léger P, Rowland DL. Estimations of Typical, Ideal,Premature Ejaculation,and Actual Latencies by Men and Female Sexual Partners of Men During Partnered Sex. J Sex Med 2020;17:1448–1456.

Advantages and limitations of current premature ejaculation assessment and diagnostic methods: a review.

Premature ejaculation (PE) is the most common male sexual dysfunction worldwide. Characteristic symptoms of PE are unexpected, rapid, complete ejaculation, which negatively impacts the sexual act for both sexual partners. Despite the existence of a definitive PE classification system and various diagnostic tools, diagnosing PE is still challenging due to the limitations associated with the assessment of this condition. Hence, it is necessary to review the diagnostic methods and processes of the physical examination that are currently performed in the medical setting. It is also important to analyze any controversial results of each main PE assessment method and propose novel diagnostic and assessment methods. To date, it is important to verify the accuracy of the PE evaluation method due to the ambiguity of previous definitions and proven invalidity of current examining techniques. Clinical diagnosis is based mainly on the patient history, patient-reported outcome scores, and diagnostic tools. Introduction of intravaginal ejaculatory latency time, penile biothesiometry, and the electrophysiological test provided objective means of evaluating PE. Due to the controversial and inconclusive findings in PE psychogenic and neurogenic etiology, utilizing a single parameter to describe and qualify PE using the aforementioned diagnostic methods provides valuable, but insufficient information for PE diagnosis. There is still a lack of a feasible and plausible means of objective measurement to evaluate the ejaculatory latency and control over ejaculation. Consequently, a comprehensive penile stimulation that simulates sexual intercourse could be useful to record intensity and duration parameters before the ejaculatory threshold, providing a more accurate method of describing and diagnosing PE versus a single chronological observation.

Psycho-social factors associated with premature ejaculation among the patients attending in a tertiary level psychiatric hospital, Dhaka, Bangladesh

Premature ejaculation (PE) has been considered as the most common male sexual dysfunction affecting men and their partners. The objective of the study was to find out the proportion of PE, associated psycho-social factors and psychiatric co- morbidities among the patients attended in the Sexual Dysfunction Clinic of National Institute of Mental Health, Dhaka, Bangladesh. This was a cross-sectional study conducted from August 2017 to June 2018. For this purpose 280 male patients with complaints of sexual dysfunction aged from 18 to 60 years were selected by convenient sampling technique. A semi-structured, self-administered questionnaire containing socio-demographic variables, Bangla version of the premature ejaculation diagnostic tool (PEDT), Bangla version of the depression anxiety stress scales (DASS 21-BV) were applied to assess their PE and associated depression, anxiety and stress respectively. The results showed that, mean (+SD) age of the respondents was 38.8 (+8.44) years and 26.4% of the respondents were found to have PE. Presence of PE was slightly higher (55.4%) among the older age group (aged 41-60 years) than the younger age group (aged 18-40 years). Chi-square test showed significant association with religion, smoking status and psychiatric co-morbidities with presence of PE (p&lt;0.05 for all comparisons). This high prevalence and associated psycho- social factors illustrate the need for promoting awareness and development of standardized methods for diagnosis, assessment and treatment of PE.&#x0D; Bang J Psychiatry December 2017; 31(2): 27-31

142 Predictors of Intravaginal Ejaculatory Latency Time Among a Cohort of Men Presenting to a Sexual Medicine Clinic

Premature ejaculation (PE) is a common male sexual dysfunction and is associated with significant psychological distress. Intravaginal ejaculatory latency time (IELT) is one objective measure utilized in the diagnosis of PE. The objective of this study was to identify factors associated with IELT in a cohort of men presenting to a male sexual dysfunction clinic. A prospective database is maintained of all men presenting to a sexual dysfunction clinic since January 2014. Patients complete an 89-item intake questionnaire that includes information on erectile dysfunction, Peyronie’s Disease, low testosterone symptoms, orgasmic dysfunction, and ejaculatory dysfunction, with one question asking to estimate IELT. Comparative analyses with t-test and linear regression models were used to compare IELT to other patient demographic and pathophysiologic characteristics. A total of 1,406 men completed the intake questionnaire, with 550 responding to the question on IELT. Mean IELT was 8.4 minutes (standard deviation 10.1 minutes). Factors associated with higher IELT included frequency of intercourse (p<0.0001), erection sustainability (p<0.0001), presence of nocturnal erections (p=0.039), IIEF-5 score (p<0.001), and overall satisfaction with sexual relationship (p=0.02). Factors associated with lower IELT included longer duration of relationship (p<0.01) and current alcohol use (p=0.03).