Premature Ejaculation Patients Research Articles

Aspects psychologiques de l’éjaculation prématurée

Historically, in order to explain and treat premature ejaculation (PE), a wholly psychoanalytical approach was used. Next, a wholly behavioural approach emerged. Then Helen Kaplan summarised the combined following concept: according to her sperm carries sadistic symbolism in PE; it sullies the woman and leaves her frustrated, due to an unresolved oedipal complex which is “awoken by” a conflict with the partner. The current consensus is that a psycho-physiological approach is appropriate (considering both the psychological state and history of the subject, as well as his neuro-biological condition). However, recent publications concerning the effectiveness of some anti-depressants and possible genetic differences in the period of time taken to ejaculate have caused many professionals to interpret PE as a primarily biological phenomenon. This is evidence of the absurd propensity that science has to separate psychological aetiologies from biological ones, although these causes are interlinked. In reality, demonstrating that there is a physiological vulnerability in PE patients does not mean that there is no central involvement. The current therapeutic approach, which is based on the idea that PE is a psycho-physiological phenomenon, should address, directly or indirectly, all levels of the ejaculatory process. Apart from the particular case of secondary PE, which responds to an individual psychodynamic approach and couple therapy before treatment with possible combined sex therapy, strategies in permanent primary PE involve an integrated cognitive-behavioural approach as well as physical techniques and pharmacological treatments that are appropriate to each case. The integrated nature of this approach seems to improve therapeutic effectiveness, not only in terms of time taken to ejaculate, but also on the subject’s relationships in general. An appropriate treatment for PE must go beyond simply extending the time it takes for a man to ejaculate, which is a very limited solution to a more complex problem. The question as to how permanent these results are remains unanswered.

Preliminary study of electric stimulation on premature ejaculation in patients with chronic pelvic pain syndrome or chronic prostatitis

To investigate the clinical efficacy of electric stimulation on the treatment of premature ejaculation (PE) in patients with chronic pelvic pain syndrome (CPPS) or chronic prostatitis (CP). Fourteen patients who complained with voiding syndromes, defecation disorder, pelvic pain and sexual problems were included in this prospective study. The white blood cells in prostatic expressed secretion of these patients were less than 10 per high-power field. In addition to the therapy of alpha-blocker, muscle relaxant and anti-cholinergics, six weekly cessions of electric stimulation were given on lithotomy position for specific group of patients. These patients whose PE scale scored as 4 or greater and the intra-vaginal ejaculation latency time (IVELT) as 2 or greater were noted. PE was graded on a scale of 0 to 8 (0 = almost never, 8 = almost always). The IVELT was graded on a scale of 0 to 3 (0 = longer than 5 min, 3 = shorter than 1 min). These scales were graded before the initiation and 6 weeks after the treatment. The mean age of 14 patients was 44 years old. The mean pre-treatment PE and IVELT scale was 5.78 ± 0.14 and 2.78 ± 0.18, respectively. The PE and IVELT scale after electric stimulation treatment was 4.0 ± 0.60 (P = 0.026) and 1.5 ± 0.35 (P = 0.006). Seven patients (50%) reported the improvement of PE after electric stimulation. The PE and IVELT scale after treatment was 2.2 ± 0.60 (P = 0.0022) and 0.14 ± 0.35 (P < 0.0001), respectively. Seven patients (50%) remained unchanged after treatment. The PE and IVELT scale after treatment was 5.71 ± 0.12 (P = 0.86) and 2.80 ± 0.38 (P = 0.55). Electric stimulation seems to have a benefit on improving PE in patients with CPPS/CP in our preliminary prospective study. Electric stimulation may be an important and encouraging part of the treatment modalities in PE. Examiner l'efficacité clinique de l'électrostimulation sur le traitement de l'éjaculation précoce (EP) chez des patients porteurs de douleur pelvienne (CPPS) ou de prostatite (PCF). Cette étude prospective concernait quatorze malades se plaignant de symptômes mictionnels, de troubles de la défécation, de douleur pelvienne et de problèmes sexuels. Les leucocytes retrouvés dans les sécrétions prostatiques de ces malades étaient inférieurs à dix par champ. On a pratiqué six séances d'électrostimulation, à raison d'une par semaine, en position de lithotomie pour un groupe spécifique de patients, en plus de la prescription d'alphabloquants, décontractants et anticholinergiques à visée musculaire. Ces patients ont été notés, leur échelle de EP était scorée à quatre ou plus, et le temps intravaginal de latence d'éjaculation (IVELT) scoré à deux ou plus. L'éjaculation précoce a été évaluée sur une échelle de zéro à huit (0 = presque jamais, 8 = presque toujours). L'IVELT a été évaluée sur une échelle de zéro à trois (0 = plus long que cinq minutes, 3 = plus court qu'une minute). Ces échelles ont été remplies avant le début des séances et six semaines après. L'âge moyen des 14 patients était de 44 ans. L'échelle moyenne de EP et de l'IVELT avant le traitement était de 5,78 ± 0,14 et 2,78 ± 0,18, respectivement. L'échelle moyenne de EP et de l'IVELT après le traitement de l'électrostimulation était de 4,0 ± 0,60 (p = 0,026) et 1,5 ± 0,35 (p = 0.006). Sept patients (soit 50 %) ont noté une amélioration de EP après l'électrostimulation. L'échelle de EP et d'IVELT après le traitement était de 2,2 ± 0,60 (p = 0,0022) et 0,14 ± 0,35 (p < 0,0001), respectivement. Chez sept patients (50 %), aucun changement n'a été noté après le traitement. L'échelle de EP et d'IVELT après le traitement a été de 5,71 ± 0,12 (p = 0,86) et 2,80 ± 0,38 (p = 0,55) respectivement. L'électrostimulation semble avoir un bénéfice sur l'amélioration de l'éjaculation précoce chez les patients porteurs de prostatite chronique ou de CPPS dans notre étude prospective préliminaire. L'électrostimulation peut avoir une part importante et encourageante dans les modalités du traitement de l'éjaculation précoce.

Evaluation of the Sexual Assessment Monitor, a diagnostic device used to electronically quantify ejaculatory latency time: findings from three studies

To validate the Sexual Assessment Monitor (SAM), a novel apparatus designed to collect electronic data on ejaculatory latency time (ELT) for diagnosing premature ejaculation (PE), and for accurately measuring treatment outcomes in clinical trials. Men with PE, and healthy volunteers aged 18-75 years, were enrolled in three open-label studies, conducted in the UK. The SAM, which consists of a control box with two front attachments, a vibrator and sensor, was attached to the penis. The vibrator, which provides stimulation, was positioned at the frenulum using a soft cuff; the vibrator intensity was set at 80 units for most subjects. The sensor is an indium-gallium elasticated loop, which was positioned around the base of the penis to detect ejaculatory pulses. These pulses were transmitted to a data recorder in the control box. The data, which are displayed graphically as traces, were automatically classified by a computer-generated algorithm to quantify ELT. In all, 53 healthy volunteers and 58 men with PE provided 213 and 195 evaluable records, respectively. Most were complete records (99% and 96%). The pooled data showed that the ELT was much higher for healthy volunteers than for men with PE (geometric means: 687 vs 169 s, respectively), with a healthy volunteer to PE patient ratio of 2.87 (P < 0.001). Only 6.3% of subjects reported mild adverse events, which were unrelated to the SAM. These open-label studies show that the SAM can consistently and safely measure times to erection (from the start of vibration) and ejaculation, and ELT in healthy volunteers and men with PE. These findings show that the SAM has the potential to become the 'gold standard' in the diagnosis of PE and in clinical trials design.

Phosphodiesterase 5 inhibitors in the treatment of premature ejaculation

To date, there is no FDA-approved therapy for premature ejaculation (PE). Recently, phosphodiesterase 5 inhibitors (PDE5-Is) have been demonstrated to have encouraging results in the treatment of PE by a few studies. The aim of this review was to assess the updated manuscripts and thereafter present the practical recommendations and possible mechanisms concerning PDE5-Is for treating PE. Using MEDLINE, we searched and assessed the peer manuscripts published from 1 January 1996 to 1 September 2005 about PDE5-Is for treating PE. The results show that the number of patients in all the reports is very few and most of the studies do not employ double-blinded and placebo-controlled tests, though they are prospective and randomized. Therefore, the results and conclusions might be biased. PDE5-Is are suggested to be used in PE with old age or associated with erectile dysfunction (ED), or to be employed alone or in combination with selective-serotonin reuptake inhibitors (SSRIs) when SSRIs fail to treat PE; behavioural therapy is proposed to be used for preventing the recurrence of PE following withdrawal of PDE5-Is. In addition, for the PE patient with a definite aetiological cause, the aetiology should be cured first, if PE still exists, followed by PDE-Is prescription. Possible mechanisms that are involved include relaxing the smooth muscles of vas deferens, seminal vesicle, prostate and urethra; decreasing the central sympathetic output; inducing peripheral analgesia; prolonging the duration of erection; and increasing confidence, the perception of ejaculatory control, overall sexual satisfaction, and decreasing the post-orgasmic refractory time to achieve a second erection after ejaculation. Well-designed multicentre studies are urgently warranted to further elucidate the efficacies and safety as well as mechanisms of PDE5-Is in the treatment of PE.

ORIGINAL RESEARCH—EJACULATORY DISORDERS: A Qualitative Pilot Study of Islamic Men with Lifelong Premature (Rapid) Ejaculation

Premature ejaculation is a common sexual problem in men. Although the etiology is unclear, there is emerging evidence that men from different ethnic backgrounds may be more at risk. The aim of this study was to generate themes and hypotheses around the etiology of premature ejaculation with particular reference to men from Islamic backgrounds. This is an explorative qualitative study using semi-structured interviews with 10 male volunteers with a clinical diagnosis of premature ejaculation. Interviews were tape-recorded and transcribed. Transcriptions were then hand-coded and analyzed using grounded theory. Anxious first sexual experience (with subtheme: fear of being discovered and wanting to finish early); sex before marriage; sex outside of marriage; religion; "stress;" exposure to Western images; living in the United Kingdom; and the subsequent feeling of freedom were themes that emerged from the transcripts. We have identified factors associated with premature ejaculation in patients with Islamic backgrounds attending our unit. This may have useful therapeutic implications when consulting Islamic men with premature ejaculation.

Comorbidity between Social Phobia and Premature Ejaculation: Study on 242 Males Affected by Sexual Disorders

Several studies have reported high comorbidity between psychiatric and sexual disorders, particularly between anxiety and mood disorders and sexual dysfunction. The goal of the present study is to examine the comorbidity between premature ejaculation and Axis I psychiatric disorders. Of 242 males referred to an outpatient clinic of sexology between November 2000 and July 2003, 52 were diagnosed with premature ejaculation (PE). These patients were also administered the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID; First, Spitzer, Gibbon, & Williams, 1995) for the evaluation of Axis I psychiatric disorders and a modified SCID based on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 2000) criteria for the evaluation of sexual disorders. We also determined the age of onset of the disorders. We found that 21.5% of the overall clinical population was affected by PE, and 64.4% of PE patients were affected by at least one Axis I psychiatric disorder. PE was highly associated (p = 0.015) with social phobia (SP), with an odds ratio of 2.55. The debut of SP preceded the onset of PE. Social phobia may represent risk factor for the development of PE, and adrenergic hyperactivity may represent a pathophysiology common to both disorders.

Cognitive and partner-related factors in rapid ejaculation: Differences between dysfunctional and functional men.

Despite the high prevalence of rapid ejaculation in community samples, there is still a paucity of data on cognitive and other relevant aspects of the subjective experience of premature ejaculation (PE) patients and their functional counterparts. Therefore, the main aim of this study was to expand our understanding of the complex nature of rapid ejaculation disorders by providing a detailed characterization of ejaculatory patterns, behavioral aspects, cognitive, and partner-related factors in a sample of unselected PE patients compared to a group of functional men. To explore the areas that might differentiate PE men from their sexually functional counterparts, a multidimensional self-administered questionnaire, the PEQuest, was created. This 36-item instrument addresses a number of domains relevant to ejaculatory function and dysfunction such as ejaculatory latencies and ejaculatory control, cognitions and feelings during sexual intercourse, factors interfering with ejaculatory control, techniques to delay ejaculation, and partnership factors. A total of 45 PE patients (mean age: 41.8 years) and 72 non-patients (mean age: 37.1 years) were included. The results show significant group differences in the majority of PEQuest domains. In the functional group, an average intravaginal latency time of 12.8 min (median: 10 min) was reported compared to 3.7 min (median: 2 min) in the patient group with 87% of PE patients ejaculating within 2 min and 100% within 5 min after penetration. In their subjective experience in sexual situations, PE patients were totally preoccupied with thoughts about controlling their orgasm, with the anxious anticipation of a possible failure, and thoughts about keeping their erection while the inner experience of functional men is focused on sexual arousal and sexual satisfaction. The factors that maximally impede the control of ejaculation are similar for both groups, but functional men normally succeed in adapting their sexual behavior to these factors whereas PE men fail in their efforts. Regarding partner-related factors, PE patients felt less secure and experienced with respect to female sexuality than their functional counterparts, and more often reported a discrepancy between their own limited experience and the more extensive sexual experience of their partner. In conclusion, a number of salient differences in ejaculatory behavior, cognitive-affective patterns, and partner-related factors between PE patients and functional men could be delineated in this study, indicating that chronic rapid ejaculation is a serious disorder with a profound impact on the man's life and his partnership.

Diagnosis and Treatment of Premature Ejaculation: The Physician's Perspective

Premature ejaculation (PE) is a common condition associated with significant adverse effects on the sexual and overall quality of life of men with this condition. Behavioral therapies, such as the "squeeze" and "stop-start" techniques, and psychotherapy, have been the mainstay of PE management for many years. However, evidence of their short-term efficacy is limited while support for their long-term benefit is lacking. There are currently no medications licensed specifically for the treatment of PE. This paucity of pharmacological treatment may, in turn, contribute to the absence of systematic procedures for the identification, evaluation, and treatment of PE patients. Current "off-label" pharmacotherapeutic approaches include topical anesthetics, phosphodiesterase-5 inhibitors, and serotonin reuptake inhibitors. Of these, the serotonin reuptake inhibitors show the greatest efficacy and an increasing body of evidence is illuminating their mode of action. Nevertheless, all current "off-label" pharmacotherapeutic approaches fall short of the ideal therapy for PE. In the absence of a cure, such a treatment should be tolerable, inconspicuously used, effective from first dose, rapid in onset of action, and available as a prn-dosing regimen. It is anticipated that agents in development for the specific indication of PE will come closer to this ideal than existing pharmacotherapeutic approaches.

Extensive Neurophisyological Evaluation in Primary Premature Ejaculation Patients

Pudendal nerve somatosensory evoked potentials (PN-SEPs), bulbo-cavernosus reflex (BC reflex) and perineal motor evoked potentials (BC MEPs) following transcranial magnetic cortical stimulation (TMS) were performed in patients with primary premature ejaculation (PPE), to investigate the somatic sensory and motor function of the genital area. Methods Fourteen patients with PPE underwent psychological counseling, urologic physical and trasnrectal ultrasound examination, laboratory data and Stamey test. Spinal and cortical PN-SEPs were recorded by dorsal nerve stimulaiton at penile shaft (DN-SEPs) in all patients, and at glans penis (GP-SEPs) in 3 of them. BC reflex was obtained by stimulating the basis of penis. Results Mean sensory thresold did not significantly differ between patients and normal subjects. Cortical DN-SEPs were normal in alla patients. Sensory central conduction was significantly smaller in patients than controls. In 3 patients and in 3 controls undergone both DN-SEPs and GP-SEPs, glans penis sensory threshold was lower than dorsal nerve one, and cortical GP-SEP latency longer than cortical DN-SEP latency. BC reflex was normal in most patients. BC MEPs were normal in all patients, but one. Conclusions We did not confirm either a faster conduction along the pudendal sensory pathway, or a greater cortical representation of the sensory stimuli from the genital area in oue patients. Moreover, we did not confirm an hyperexcitability of BC reflex in them. Our results suggest that the electrophysiological approach is probably not sufficient to clariphy the causes of PPE and more integrated investigation are requested.