Premature Ejaculation Patients Research Articles

Efficacy and Safety of Extracorporeal Shock Wave Therapy in the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Acquired Premature Ejaculation Patients

Introduction: The aim of this study was to evaluate the efficacy and safety of extracorporeal shock wave therapy (ESWT) in patients with acquired premature ejaculation (APE) due to chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Method: Patients with APE due to CP/CPPS between January 2020 and June 2022 were included in the study. Demographic data of the patients were recorded, and the degree of their symptoms was evaluated with the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), premature ejaculation diagnostic tool (PEDT), and Premature Ejaculation Profile (PEP). The international prostate symptom index (IPSS) was also used for lower urinary tract symptoms (LUTS), and the international erectile function index-erectile function (IIEF-EF) was used to evaluate erectile functions. All patients received treatment with the Medispec Bold Li-ESWT device without using any anesthesia method (12 sessions). The changes in the symptom scores of the patients were evaluated before the treatment and at the 3rd month after the treatment. Results: A total of 42 patients were included in the study. The mean age of the patients was 43.75 ± 12.03 (20–55), and the mean BMI was 23.58 ± 7.61 (18.03–35.98) kg/m². The patients’ estimated mean intravaginal ejaculation latency time (IELT) before ESWT was 37.98 ± 21.87 s. After a total of 12 sessions of ESWT, the IIEF-EF, IPSS, NIH-CPSI, and PEP index scores of the patients showed significant improvements (p < 0.001 for each). The IELT mean increased to 74.81 ± 46.79 s (p < 0.001). Posttreatment IELT fold increase was determined as 3.25 ± 1.72 fold. A highly significant positive correlation (p = 0.032; r = 0.839) was found between the CPSI score difference and the posttreatment PEP index score. Conclusion: Li-ESWT treatment is an effective and safe treatment with positive effects on both LUTS and premature ejaculation in patients with APE symptoms due to CP/CPPS. Patients who benefit from CP treatment also have longer IELT times.

A novel tool for improving the accuracy of major depressive disorder screening: A prospective study on andrology with external validation

Patient Health Questionnaire-9 (PHQ-9) is the most widely used tool for screening for major depressive disorder (MDD). Although its reliability and validity have been proven, missed or misjudged cases during MDD screening are often encountered. A nomogram that considers the weights of depressive symptoms was developed using data from premature ejaculation patients to improve screening accuracy. During a 33-month prospective study, a training cohort comprising 605 participants from Xijing Hospital was used to develop and internally validate the nomogram. A validation cohort comprising 461 patients from Xi'an Daxing Hospital was also used to externally test the nomogram. The nomogram was established by integrating the LASSO regression-based optimal predictors of MDD according to their coefficients in a multivariate logistic regression model. The nomogram was well-calibrated during internal and external validations. Moreover, it showed a better discriminatory capacity and yielded more net benefits in both validations than PHQ-9. With better performance, the nomogram may help reduce the number of missed or misjudged cases during MDD screening. This study is the first to weigh the direct indicators of MDD under the DSM-5 criteria, presenting a fresh concept that can be applied to other populations to enhance screening accuracy.

(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

(399) Effect of Bulbospongiosus Muscles Cutting with Frenular Delta Excision for Treatment Premature Ejaculation ( Alaa Aglan Operation)

Abstract Introduction Alaa aglan operation is a new procedure consists of two parts. First part is cutting bulbospongiosus muscles bilaterally, And 2nd part is cutting of elliptical part of frenular delta. it is the most sensitive area in penis and excision of its central part decreases penis sensitivity. The operation has it's own prediction test that allows us to know the expected time post operatively and if the operation is option or not. It is easy just spraying local anesthesia (procomail 10%®) at coronal ridge (inhibits glans-bulbospongiosus reflex) and at frenular delta (temporary excision) 30 minutes before having sex. The operation could be reversed by repairing the muscle again. Objective presentation of a simple, easy permanent solution for treatment of premature ejaculation with less side effects in comparison with all other treatments. Methods 1050 Cases were operated between 1/1/2015 and 3/10/2015 follow up was done at 1, 3,6,12 months intervals then yearly (5 years duration). 47 Cases didn't complete the 5 years duration but none of them have any complain. Results There are two types of patients: First type (non-psychic causes patients) the gained time was approximately as prediction test of each. Second type (secondary psychic or mixed causes patients) the results were much better than prediction tests after 3 months. The non- psychic premature ejaculation patients improved quickly. we calculate the time (IVEL) from the second intercourse as patient usually be congested unless he masturbated or had wet dreams so we avoid the 1st intercourse and calculate the time from 2nd time .clinically we noticed that all patients gets the final result after 1 month approximately from day of surgery. And the result still constant without change or with minimal positive change in few cases but in second type patients the results after 3 weeks resembles the prediction test results but improves gradually till the 3rd month with final constant result. Satisfaction was rate 99.6% this is due to prediction test application, in our early trials beyond this study Satisfaction rate was 71% (without prediction test). Side effects were minimal, No regression in results in any patient during the following up period. Only 4 patients were not satisfied although the operation was successful. 1st patient complained from neuroma due to adhesion (post operative), Adhesiolysis was done, total relief of pain reported by the patient immediately post operative, 2nd patient reported that the distance of expulsion of semen from penile orifice decreased in comparison to that before surgery. 3rd patient reported hematoma, Evacuation was done without complications. 4th patient reported that he lost the sensation of repetitive contraction of muscles at peno-scrotal area during ejaculation. Many patients reported absence or decrease in number of wet dreams post operative other side effects were minimal. Conclusions Alaa aglan operation is safe, Immediate, Curative technique for premature ejaculation provided that prediction test shows good response. Disclosure No

Retrospective evaluation of the efficacy of daily paroxetine/tadalafil combination in patients with premature ejaculation and erectile dysfunction.

Premature ejaculation (PE) and erectile dysfunction (ED) are sexual dysfunction diseases affecting males. The phosphodiesterase type 5 (PDE5) inhibitors such as tadalafil are used to treat ED whereas selective serotonin reuptake inhibitors (SSRIs) are preferred for PE. Most of the patients with ED also suffer from PE simultaneously. The combined drug therapies are commonly preferred as they favor elevated intra-vaginal ejaculation latency time (IELT) scores and improved sexual function. The study aimed to evaluate the efficacy and safety of daily paroxetine and tadalafil combination therapy in patients with PE and ED. A total of 81 PE patients with ED were enrolled in the study. Patients were treated with daily paroxetine 20 mg and tadalafil 5 mg for 4 weeks. Pre- and post-treatment IELT, premature ejaculation profile (PEP), and International Index of Erectile Function-Erectile Function (IIEF-EF) scores of the patients were analyzed. The mean IELT and PEP index scores, and mean IIEF-EF values improved after combination therapy (p<0.001 for each). When lifelong and acquired PE+ED patients were compared, significant improvements were observed in IELT, PEP, and IIEF-EF scores in both groups (p<0.001). Even though the treatment methods are different, combined therapies to treat simultaneous PE and ED presence are effective compared to monotherapies. However, there is still no definitive treatment that can cure all subtypes of PE or ED.

The relationship between four types of premature ejaculation patients and the quality of residential environment

BackgroundWe investigated the association between premature ejaculation (PE) and the quality of residential environment from a new perspective to explore the influencing factors of PE, especially in four PE subtypes. We selected 499 adult males to participate in this study from September 2021 to September 2022. The satisfaction of residential environment was assessed by the Perceived Residential Environment Quality Indicators (PREQIs) scale, the control ability over ejaculation was assessed using the premature ejaculation diagnostic tool (PEDT), and their depression was assessed using the self-rating depression scale (SDS).ResultsThe Architectural and Town-planning Spaces (ATS), Green Spaces (GS), and Commercial Services (CS) of PE patients (N = 346) were compared with those of control group (N = 153), showed a significant difference (p < .05), for PE patients, the score of ATS was 44.30 ± 12.38, the score of GS was 18.60 ± 6.24, and the score of CS was 20.82 ± 8.20; for control group, which were 40.46 ± 16.21, 20.69 ± 5.71 and 22.90 ± 7.03 respectively. After age was taken into account, ATS had a positive correlation with PEDT score (r = 0.76), whereas GS and CS had a negative correlation (r = -0.87, -0.90); ATS had a positive correlation with SDS (r = 0.96), whereas GS and CS had a negative correlation (r = -0.74, -0.81).ConclusionsWe discovered that PE patients more likely resided in high-density areas with little green space and subpar commercial services, which might have an adverse effect on their mental health. This study offered a new viewpoint about the influence of residential environment on PE.

MP45-06 THE CLINICAL PROFILE OF MEN WITH PREMATURE EJACULATION AT PRESENTATION HAS CHANGED OVER THE LAST FIFTEEN YEARS: ANALYSIS FROM A LONGITUDINAL STUDY

You have accessJournal of UrologyCME1 Apr 2023MP45-06 THE CLINICAL PROFILE OF MEN WITH PREMATURE EJACULATION AT PRESENTATION HAS CHANGED OVER THE LAST FIFTEEN YEARS: ANALYSIS FROM A LONGITUDINAL STUDY Luca Boeri, Edoardo Pozzi, Federico Belladelli, Giuseppe Fallara, Simone Cilio, Alessandro Bertini, Francesco Lanzaro, Luigi Candela, Christian Corsini, Massimiliano Raffo, Fausto Negri, Ludovica Cella, Margherita Fantin, Paolo Capogrosso, Francesco Montorsi, and Andrea Salonia Luca BoeriLuca Boeri More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Simone CilioSimone Cilio More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Francesco LanzaroFrancesco Lanzaro More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Fausto NegriFausto Negri More articles by this author , Ludovica CellaLudovica Cella More articles by this author , Margherita FantinMargherita Fantin More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patient’s characteristics at first medical evaluation for a specific sexual dysfunction (SD) are correlated to the public awareness towards the specific disease and the availability of novel treatments. We aimed to assess the clinical characteristics of patients presenting for premature ejaculation (PE) as their primary medical complaint over a 15-year time frame. METHODS: Data from 257 sexually active, heterosexual men seeking first medical help for primary PE at a single sexual medicine academic clinic between 2008 and 2022 were analysed. Clinical data and serum hormones were collected. At baseline all patients completed the International Index of Erectile Function (IIEF), the Beck Inventory for Depression (BDI), and the Premature Ejaculation Diagnostic Tool (PEDT). Relationship status was categorized as: single vs. stable sexual relationship. Descriptive statistics and linear regression analyses were used to describe the whole cohort. RESULTS: Median (IQR) age at presentation was 32 years. Of all, 182 patients reported some degree of erectile dysfunction (ED) according to IIEF-EF scores. Median baseline PEDT and BDI score were 14 and 7, respectively. Median total testosterone and TSH values were 5.2 ng/ml and 1.6 mUI/L, respectively. Across the 15-year time frame, patient’s age at presentation significantly decreased over time (p<0.001). Furthermore, depressive symptoms at BDI (p<0.001) and PE severity as scored with the PEDT (p<0.001) linearly decreased overtime. When segregating the whole cohort into 5-year groups, age at presentation decreased from 2008-2012 to 2013-2017 (p=0.04) and further decreased between 2018-2022 (p=0.01). Similarly, baseline BDI scores decreased from 2008-2012 to 2018-2022 (all p<0.001). PE severity at first assessment was stable between 2008-2012 to 2013-2017 but decreased thereafter. Patients in a stable couple relationship more frequently asked for medical attention for PE between 2018-2022 compared to 2013-2017 and 2008-2012. CONCLUSIONS: Findings from this study showed that PE patients characteristic at first presentation has changed throughout the last 15 years. Of note, age, PE severity and depressive symptoms showed a significant decline overtime. Men in a stable sexual relationship were more likely to seek medical attention for PE in recent years. These results probably reflect the increased public awareness of PE; therefore, patients request PE consultation at younger age, with initial symptoms and with fewer psychological bother related to this condition. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e623 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Boeri More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Giuseppe Fallara More articles by this author Simone Cilio More articles by this author Alessandro Bertini More articles by this author Francesco Lanzaro More articles by this author Luigi Candela More articles by this author Christian Corsini More articles by this author Massimiliano Raffo More articles by this author Fausto Negri More articles by this author Ludovica Cella More articles by this author Margherita Fantin More articles by this author Paolo Capogrosso More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF downloadLoading ...

Vital function of DRD4 in dapoxetine medicated premature ejaculation treatment.

Recently, dapoxetine has been widely accepted to treat premature ejaculation by fast-inhibiting 5-hydroxytryptamine reuptake. However, dapoxetine is not suitable for all premature ejaculation patients in clinical treatment. We need to investigate and reveal the mechanism deeply to solve this problem. To investigate and reveal the function of dopamine D4 receptor in dapoxetine medicated premature ejaculation treatment. A rat model was used to screen rapid ejaculators. The molecular mechanisms of histone serotonylation-mediated regulation of dopamine D4 receptor were demonstrated by chromatin immunoprecipitation, DNA pull-down, mass spectrometry analysis, and coimmunoprecipitation experiments. The biological function of dopamine D4 receptor was investigated through in vivo experiments by intrathecal injection of shDRD4 to knockdown dopamine D4 receptor. In this study, we found that dapoxetine increased expression of 5-hydroxytryptamine and dopamine D4 receptor. We demonstrated that dapoxetine increased levels of 5-hydroxytryptamine, which promoted histone serotonylation (H3K4me3Q5ser) and transcription factor myeloid zinc-finger 1 complex binding on the dopamine D4 receptor promoter, upregulated the expression of dopamine D4 receptor and thus delayed ejaculation. In this study, we demonstrated that dapoxetine increased the levels of 5-hydroxytryptamine, which promoted histone serotonylation and myeloid zinc-finger 1 complex binding to the dopamine D4 receptor promoter and upregulated the expression of dopamine D4 receptor, thus delaying ejaculation. It is a novel mechanism that dapoxetine take effect of premature ejaculation treatment through upregulating the dopamine D4 receptor, which indicated that upregulated dopamine D4 receptor would enhance the dapoxetine effect in premature ejaculation treatment. This may lead to the development of novel therapeutic interventions for premature ejaculation.

Erectile dysfunction, anxiety, perceived stress, and insomnia are more common among acquired premature ejaculation patients compared to other premature ejaculation syndromes.

Premature ejaculation (PE) is the most common ejaculatory function disorder. To date, four types of PE have been identified depending on the severity, onset, and course of the problem. The aim of this study was to investigate whether or not there is a difference between these types in respect of anxiety, perceived stress, insomnia severity, and sleep chronotype. The study included 112 patients diagnosed with PE in our clinic between October 2021 and May 2022. The patients were separated into groups according to PE types of lifelong (LPE, n = 39), acquired (APE, n = 45), variable (VPE, n = 10), and subjective (SPE, n = 18). In addition to the demographic and clinical data, the scores were recorded of all participants in the International Index of Erectile Function-5, Hospital Anxiety and Depression Scale, Premature Ejaculation Diagnostic Tool (PEDT), Insomnia Severity Index (ISI), Perceived Stress Scale (PSS), and Morningness Eveningness Questionnaire (MEQ). SPE was determined more in university graduate patients (42.1% vs. LPE, 21.1%; APE, 36.8%; VPE, 0%; p = 0.01). In patients with APE, erectile dysfunction was more severe (80.0% vs. LPE, 8.0%; SPE, 12.0%; VPE, 0%; p < 0.001). The median (IQR) PEDT score was determined to be higher in APE than in LPE and SPE (16(5), 13(7), 11(5), p = 0.001, respectively). Patients with APE were determined to have higher median (IQR) ISI (21(9) vs. LPE, 8(7); SPE, 5(8); VPE 8(4), p < 0.001) and PSS scores (35(12) vs. LPE, 22 (7); SPE,22(5); VPE 21(6), p < 0.001), the sleep chronotype was more eveningness according to the MEQ (80.8% vs. LPE, 19.2%; VPE, 0%; SPE, 0%; p < 0.001), and there were seen be more anxiety symptoms (75.5% vs. LPE,12.2%; VPE, 0%; SPE, 12.2%; p < 0.001). Psychological status and sleep health were concluded to be important factors for PE patients, and the patients with acquired PE were the group most affected by these factors.

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.

An observational, national and multicentric study to describe the detection, diagnosis and treatment of erectile dysfunction and premature ejaculation from the patient's perspective

Introduction and objectivesTo examine the opinions, attitudes and perceptions of patients regarding the diagnosis and treatment protocols of erectile dysfunction (ED) and premature ejaculation (PE) and their interaction with the urology specialists. Material and methodsObservational, national and multicentric study based on a self-designed online questionnaire in which ED and PE patients described their perception of ED and PE at diagnosis and during treatment and monitoring, the patient-physician relationship and the role of the patient's partner in the course of the disease. Results306 ED and 70 PE participants were recruited. After the occurrence of the first symptoms, the time elapsed until the patient decided to go to the doctor was 28.6 months for PE and 14.0 months for ED (p<0.001). ED patients saw physicians more frequently (especially those aged between 60 and 69 years: 60.7%, p<0.001) than PE patients (52.1% vs 36.8%, respectively; p<0.001) and discussed this problem with their partner more (34.0% vs 22.8%, p<0.001). These disorders were mainly diagnosed at the urologist's office (ED: 74.8% vs 42.5%; PE: 75.7% vs 34.3%; diagnosis vs detection). One third of all participants reported that the sexual problem was not the main reason for the visit. The time elapsed between the first consultation for related symptoms and therapy was 8.7 months (oral drugs) and 7.6 months (dapoxetine) for ED and PE, respectively. ED patients and their partners felt particularly better once treatment had started (p<0.001). PE patients presented the highest degree of sexual dissatisfaction (78%). 50% of the patients agreed with the statement that initiating a discussion about sexual concerns was regarded as taboo and most of them did not say that their partner had encouraged them to seek medical advice. ConclusionA concerted effort is called for to expand ED and PE patients’ proactivity in taking care of their own and their partner's sexual health. Current therapies would appear to have a benefit in couples’ sexual relationships.

Do Psychogenic Erectile Dysfunction and Premature Ejaculation Share a Neural Circuit? Evidence from a fMRI Systematic Review and Meta-Analysis

Background: Several functional magnetic resonance imaging (fMRI) studies investigated the brain correlates of psychogenic erectile dysfunction (PED) and premature ejaculation (PE), representing the most common sexual dysfunctions in men. These studies allowed a wide set of brain regions in PED and PE patients when compared to healthy men. In the present meta-analysis, we aim at assessing the presence of homogeneity in the cerebral underpinnings of PED and PE. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and after the electronic search, duplicate removal and the application of pre-exclusion criteria, nine PED and ten PE studies were considered eligible with a Cohen’s k of 0.84 and 0.75, respectively. The effect sizes of the sociodemographic and psychological/urological dimensions were calculated. We extracted brain clusters from the retrieved studies, comparing patients and controls, and we calculated brain maps with Seed-Based D Mapping software. Results: We found a homogenous involvement of the frontal gyrus and insula in both dysfunctions, suggesting a common network. Conclusions: The anterior insula plays a key role in the processing of emotional features of stimuli, while the posterior insula in interoceptive information is relevant for sexual response. The prefrontal and inferior frontal cortices are important for sexual inhibition/disinhibition.

A novel, on-demand therapy for premature ejaculation using a miniature trans-perineal electrical stimulator: a randomized-controlled trial

<h3>Objectives</h3> To assess the feasibility, safety, and efficacy of a miniaturized on-demand perineal Transcutaneous Electrical Stimulation (TES) Using the vPatch device, for the treatment of premature ejaculation (PE). <h3>Methods</h3> We designed a bi-center, international, prospective, randomized, double-blind, sham-controlled, clinical study. A total of 59 lifelong PE patients were included. After the screening visit (Visit 1), patients measured their intravaginal ejaculatory latency time (IELT) for a 2-week run-in period and complete the Premature Ejaculation Profile (PEP) questionnaire. At Visit 2, eligible patients tried vPatch to determine the individualized sensory and motor activation thresholds. Patients were randomized into active and sham arms in a 2:1 ratio. At Visit 3, the IELT values and PEP outcomes were recorded again. Clinical Global Impression of Change (CGIC) scores were noted. <h3>Results</h3> Of the patients, 51 completed the study, 34 in the active and 17 in the sham arm. In the active arm the Baseline Geometric Mean IELT (BGMI) was 67 seconds (s) and significantly increased by 56s (standard error (SE) 9s) to 123s (p<.0001). However, in the sham arm the BGMI was 63s and increased insignificantly by 17s (SE 12s) to 80s (p=0.1653). The increase in IELT from base line was 3.22-fold greater in favor of the active arm (p=0.0047). In the active arm 91% (31/34) of the subjects significantly improved their IELT due to treatment compared to baseline. The mean geometric time-fold in IELT, in those positive responders was 2.04 (CI 95% 1.68-2.4). According to the CGIC, patients in the active group were significantly more satisfied with the treatment (74% vs. 41%, p=0.0274). The subjects in the active arm reported significant improvement in all 4 PEP parameters (P<0.05). <h3>Conclusions</h3> IELT values and patient-reported outcome measures can be improved with TES using vPatch. This treatment may become an on-demand, noninvasive, and drug-free therapeutic option for lifelong PE. <h3>Conflicts of Interest</h3> This study was sponsored by Virility Medical Ltd

Is there any relationship between premature ejaculation and the age of first sexual intercourse in men?

There are few studies on the association between male sexual health and the age at first sexual experience (FSE), and the results are mixed. Furthermore, there is no research regarding premature ejaculation (PE) on this topic. In this study, we aimed to evaluate the relationship between PE and the age at FSE in men. The study consisted of a total of 136 males, including 66 PE patients and 70 control groups. The age, body mass index (BMI), duration of education, marital status, age at circumcision, age of FSE, and estimated intravaginal ejaculation latent time (eIELT) of the individuals were all recorded. All participants completed the Premature Ejaculation Diagnostic Tool (PEDT), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). The mean age of the PE and control groups was 38.27 ± 8.47 and 33.66 ± 8.04 years, respectively (p<0.05). The mean BMI values of the groups were comparable (p>0.05). The education duration of the control group was substantially longer than the PE group (p<0.001). The marriage rate was 57/66 (86.36%) in the PE group, while it was 49/70 (70%) in the control group (p<0.05). The mean eIELT for the PE and control groups was 64.89 ± 41.91sec and 608.64 ± 369.04 sec, respectively (p<0.001). The PE group had significantly higher PEDT, BDI, and BAI scores than the control group (p<0.001; p<0.01; p<0.01, respectively). In terms of circumcision age and age of FSE, there was no significant difference between the groups (p>0.05). According to our findings, there was no link between PE and the age of FSE. Future large-scale studies on the subject could provide more exact and reliable knowledge. All authors declare no conflict of interest.

Effects of CYP24A1 polymorphisms on premature ejaculation: a case–control study

Premature ejaculation (PE) is a common male sexual dysfunction disorder, and is considered to have the genetic predisposition. However, the internal regulation mechanisms is still unclear. Hence, this study intended to explore the effects of genetic polymorphisms of CYP24A1 on the risk of PE. This case-control study genotyped three SNPs of CYP24A1 (rs2762934, rs1570669 and rs6068816) from 139 PE patients and 372 healthy men using Agena MassARRAY platform. Collected data was then processed in SPSS 18.0. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in logistic regression analysis to evaluate the associations between CYP24A1 polymorphisms and the PE risk. The results suggested that allele A of rs1570669 was significantly associated with the increased PE risk (OR=1.38, 95% CI=1.04-1.84, P=0.026). Meanwhile, we also identified rs1570669 as a risk factor of PE under the additive model (OR=1.47, 95% CI=1.02-2.11, P=0.039) by comparing the genotypic distributions between cases and controls, and genotype AA of rs1570669 was detected to be significantly related with an increased risk of PE under the codominant model (OR=2.26, 95% CI=1.06-4.83, P=0.036). This study is the first to proved that the genetic variants of CYP24A1 played essential role in affecting the susceptibility to PE in Chinese Han.

Evaluation of the quality of life of patients with premature ejaculation (lifelong and acquired).

SUMMARYOBJECTIVE:The aim of this study was to evaluate the quality of life of patients with lifelong and acquired premature ejaculation and to examine its relationship with depression and anxiety.METHODS:Between February 2017 and January 2018, a total of 175 patients with premature ejaculation and 132 control men who applied to the urology department of the training and research hospital with the complaint of Premature Ejaculation were included. Patients were divided into three groups according to International Society for Sexual Medicine (ISSM) criteria as follows: Group 1, lifelong premature ejaculation; Group 2, acquired premature ejaculation, and Group 3, control group without premature ejaculation. A detailed medical history of patients was obtained and physical examinations were performed. Intravaginal ejaculation latency time (IELT) was recorded and patients were administered International Erectile Function Index-5 (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT), Sexual Health Inventory for Men (SHIM), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI)-1 and STAI-2, and Short Form-36 (SF-36).RESULTS:The mean mental component score (MCS) of the SF-36 was 51.65±6.57 in the lifelong premature ejaculation group, 49.33±8.65 in the acquired premature ejaculation group, and 61.12±11.09 in the control group (p<0.0001). The mean physical component score (PCS) was 50.99±7.43 in the lifelong premature ejaculation group, 48.32±11.58 in the acquired premature ejaculation group, and 55.17±8.10 in the control group (p<0.0001). Quality of life of premature ejaculation patients as assessed by SF-36 was lower in the subscales of physical functioning, general health perception, vitality, and role limitations due to emotional functioning, compared to the control group.CONCLUSIONS:Lifelong and acquired premature ejaculation patients deteriorate their quality of life: the deterioration in these patients’ quality of life also negatively affects their depression and anxiety states.

Levosulpiride for Premature Ejaculation: A Systematic Review and Meta-Analysis.

Premature ejaculation (PE) is one of the major causes of sexual dysfunction. Levosulpiride is an off-label medicine used to treat PE, but no review on its efficacy exists. A systematic review and meta-analysis was performed to determine the efficacy of levosulpiride in treating PE. Databases PubMed, Science Direct, and Google Scholar were searched. Randomized control trials (RCTs) comparing levosulpiride with placebo or other medicine were selected. Odds ratio (OR) of improved intravaginal ejaculation latency time (IELT) was calculated. A total of 97 articles were retrieved from database search, of which only four RCTs containing 203 men met the selection criteria. All four RCTs were included in systematic review while only two were included in meta-analysis. A high selection and detection bias was found in both of these studies. Meta-analysis also showed the odds of improving IELT in PE patients using levosulpiride to be significantly higher (p < .05) compared with those who used placebo, OR: 100.81, 95% confidence interval (CI) [13.12–774.90], I2 = 0%. Odds of improving IELT for > 5 min (500% improvement) were also significantly higher (p < .05) compared with the placebo groups (OR: 38.88, 95% CI [5.12–295.29], I2 = 0%). The odds of improving IELT for > 1 min, but < 5 min were also significantly higher (p < .05) than placebo groups (OR: 32.84, 95% CI [4.15–259.75], I2 = 0%). Levosulpiride improved IELT, but even so, limited studies are available on this topic. Additional research is thus required to support the present review’s findings.

Study of the role of microRNAs 16 and 135a in patients with lifelong premature ejaculation receiving fluoxetine daily for 3months: A prospective case control study.

We aimed to determine the level of miRNAs 16 and 135a in lifelong premature ejaculation (LPE) patients versus controls. Moreover, we evaluated the potential interplay between the studied miRNAs and fluoxetine in these patients after utilizing fluoxetine daily for 3months. The study involved 60 consecutive LPE patients and 20 healthy age matched individuals as controls. The median miRNA16 was significantly higher in the controls (1.02) compared to the patients (0.31) (p <0.001). Moreover, the median miRNA-135a was significantly higher in the controls compared to the patients 1.02 and 0.35, p <0.001, respectively. In addition, the median pre-treatment miRNA16 in the responders was 0.29 that significantly increased to 0.66 (p <0.001). The median pre-treatment miRNA-135a in the responders was 0.27 that significantly increased to 0.65 (p <0.001). Furthermore, considering EXP(β) for the odds ratio evaluation, with a 95% degree of confidence, a 1 fold increase in pre-treatment miRNA 135a fold change decreases the odds for being responsive to SSRI by 0.028. Meanwhile, there was non-significant association between fluoxetine responsiveness and age, pre-treatment miRNA 16, pre-treatment PEDT and pre-treatment IELT. The current study had shown that a lower pre-treatment miRNA 135a was significantly associated with response to fluoxetine.

Premature ejaculation among men with erectile dysfunction-findings from a real-life cross-sectional study.

Concomitant sexual disorders have progressively shown increased prevalence in men at first outpatient presentation. We sought to i) estimate the prevalence of unreported premature ejaculation (PE) in a homogenous cohort of 1258 men seeking first medical help for erectile dysfunction (ED) as their primary compliant; ii) compare the baseline sociodemographic and clinical characteristics of men with only ED(ED-only) compared to those with ED and PE(ED + PE); and, iii) investigate the likelihood of detecting PE among men self-reporting only ED over a 16-year period at a single tertiary-referral centre. Descriptive statistics compared sociodemographic and clinical characteristics between ED-only patients and those with unreported concomitant primary/secondary PE(ED + PE). Logistic regression models predicted the risk of having ED + PE at baseline. Local polynomial regression models graphically explored the probability of reporting PE among ED men with ≤40 vs. 41-60 vs. >60 years over the analysed timeframe. Of all, 932 (74.1%) were ED-only and 326 (25.9%) ED + PE patients, respectively. ED + PE patients were younger, presented with fewer comorbidities, and lower rates of severe ED (all p ≤ 0.04). At multivariable logistic regression analysis, younger age (OR:0.98) and low sexual desire/interest (OR:1.54) were independently associated with ED + PE at first clinical assessment (all p = 0.03). The likelihood of detecting unreported concomitant primary/secondary PE among patients complaining of only ED at first presentation worrisomely increased among younger and middle-aged men over the last 16 years.

Role of vitamin D supplementation in lifelong premature ejaculation

Background: Premature ejaculation (PE) is defined as persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before the person wishes it. Aim and objectives: The aim of this study was to measure the serum level of 25-hydroxyvitamin D (25 (OH) D) in lifelong premature ejaculation patients and evaluate the role of 25-hydroxyvitamin D (25 (OH) D) supplementation in these patients with low or in sufficient level of 25-hydroxyvitamin D (25 (OH) D). Subjects and methods: A total of 80 consecutive men who presented with lifelong PE. Results: The mean PEDT showed a statistically significant decrease after treatment. The mean IELT in the included cases before treatment with vitamin D is 31.14 ± 20.511 and the mean IELT in the included cases after treatment is 48.86 ± 26.432. The mean IELT showed a statistically significant increase after treatment. Conclusion: This study demonstrates that lower vitamin D levels are associated with the acquired PE. The result of our study showed that the role of serum vitamin D levels should be investigated in the etiology of acquired PE. Perhaps supplementation of vitamin D in men with acquired PE will ameliorate the sexual health of these patients.