Premature Ejaculation Patients Research Articles

Repeated sexual intercourse as a coping strategy for men with premature ejaculation.

Patients with premature ejaculation (PE) are often concerned and distressed about their sexual performance. Hence, they may be more willing to exploit their refractory period to employ sexual coping strategies in order to improve their unsatisfactory sexual intercourse compared with patients without PE. The study sought to verify the sexual coping strategies of patients with PE in the daily sexual activities. We included both patients with PE and individuals without PE and analyzed their sexual behaviors and attitudes by means of detailed interviews and questionnaires. The main outcomes were perceived intravaginal ejaculatory latency time recording, Premature Ejaculation Diagnostic Tool score, and sexual frequency, attitudes, and behavior log. A total of 182 young patients with PE (age 31.2 ± 6.2 years) and 92 individuals without PE (age 30.7 ± 5.1 years) were included in the study. A total of 53.3% of patients with PE vs 17.4% of individuals without PE reported engaging in multiple sexual intercourse sessions within a single day in the past 4 weeks. PE patients who engaged in multiple intercourse sessions displayed better performance during the second attempt but performed poorly compared with individuals without PE. Scores for the first attempt in PE vs second attempt in individuals with PE vs without PE were the following: intravaginal ejaculatory latency time, 2.4 ± 1.6 vs 4.8 ± 5.7 vs 9.9 ± 9.4 (P < .001); Premature Ejaculation Diagnostic Tool, 14.9 ± 3.1 vs 12.7 ± 4.8 vs 5.2 ± 2.5 (P < .001); satisfaction, 2.9 ± 1.0 vs 3.1 ± 0.8 vs 3.7 ± 1.4 (P < .001). A total of 57.1% of patients held a negative attitude toward precoital masturbation, for reasons such as a reduced sexual desire (21.2%), the belief that masturbation is harmful (17.6%), concerns about erectile function (15.7%), fatigue (9.8%), and other mixed reasons (35.3%). Engaging in multiple intercourse sessions within a day is more common among the young PE population, and using precoital masturbation as a coping strategy is not universally applicable among patients with PE. This is the first study to explore symptom-coping strategies in patients with PE compared with individuals without PE. However, the conclusions cannot be generalized to the entire male population. Patients with PE, compared with individuals without PE, are more inclined to engage in multiple sexual intercourse sessions within a single sexual session, likely in an attempt to compensate for their first unsatisfactory sexual encounter. Moreover, the majority of patients with PE here studied hold a negative attitude toward using precoital masturbation as a coping strategy for symptoms.

New technologies developed for treatment of premature ejaculation.

Premature ejaculation (PE), lifelong and acquired, is the most common male sexual disorder, with serious impacts on the patient and his partner's quality of life, sexual well-being, and psychosocial health. The most popular treatment options are on-demand topical anesthetics and off-label daily or on-demand selective serotonin reuptake inhibitors (SSRIs), followed by behavioral therapy. While SSRI treatments are reportedly safe, they are associated with limited efficacy and provide only a temporary delay in ejaculation latency time. The majority of PE patients are dissatisfied with SSRIs; thus, adherence to on-demand or daily SSRI treatments is low. In this article, we review studies on currently available technologies that are not pharmacological, surgical, cognitive or behavioral therapies. Recent data from studies of newly developed medical devices used in PE treatment are encouraging as they provide drug-free spontaneity during coitus, without severe adverse effects.

(218) The Intimometer: A Brief Psychometric Self-Report Questionnaire

Abstract Introduction Erectile dysfunction (ED) or premature ejaculation (PE) can severely affect the quality of life and wellbeing of both couple members. Sexual health care providers, including andrologists and sexologists, should perceive ED/PE as a collaborative health issue for men and their sexual partners. Thus, this study was designed to better understand the contribution of sexual partners in the treatment of men with ED/PE. Objective We aimed to evaluate the advisability of female (or male, in the case of homosexual patient) partner involvement in the prescription of specific pharmacological therapies in ED/PE patients. Methods We developed a brief psychometric self-report questionnaire tool, Intimometer. This tool consists of two modules (patient and partner versions) for each sexual dysfunction (ED and PE). Each module has 6 items that evaluate the degree of comfort/discomfort about communication, sharing, and partner involvement during the process of drug prescription and intake. The tool can be administered during the first andrological visit to either a single individual (only patient version) or to both members of the couple. The single module can be administered in less than 3 minutes. Each item scores from 0 (extremely unlikely) to 4 (extremely likely), and the total score is computed by the sum of the modules’ items. The total score ranges from 0 to 24, with higher scores endorsing the partner's comfort during treatment of ED/PE. Also, color codes were assigned for responses, low scores (red light) and high scores (green light) or combination of single results (couple administration). Results We hypothesize one cut-off score to identify two categories of responses. A low score signifies that the patient feels uncomfortable sharing drug information, choice, and intake and the involvement of the partner could potentially be harmful during medical treatment. On the contrary, a high score shows the involvement of the partner could improve the treatment’s efficacy and/or compliance, with a high chance of success. The combination of the single results (red, yellow and green) helps to identify the best treatment choice. The red light indicates that prior to medical prescription, the couple undergoes a psycho-sexological assessment to unveil conditions to continue with medical treatment. Yellow light indicates contemporary to medical prescription, psycho-sexological assessment might manage relational issues that could worsen pharmacological treatment. And green light denotes that the instrument could be re-administered after 4 weeks since the first administration, to verify any changes in patient/partner’s perception of medical treatment. Moreover, a re-test is highly recommended in patients whose scores are low or medium. Nevertheless, patients and couples who are classified as “red” or “yellow” light could present any other psychological complications (performance anxiety, fear of rejection, anger towards partner) which can be evaluated by psycho-sexologists. Conclusions This instrument could be beneficial to physicians while prescribing medical therapy and prevent any possible patient dropout and resultant therapy failure, especially in PE and ED patients. The involvement of sexual partners in the diagnostic process, education, counseling, and treatment choice is pivotal in improving the overall quality of life and sexual experiences for couples. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: 2Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.

Efficacy of Tramadol V/S Paroxetine for the Management of Premature Ejaculation Patients

Background: Premature ejaculation (PE) is a common sexual dysfunction in men, impacting relationships and quality of life. Current treatments include selective serotonin reuptake inhibitors (SSRIs) and opioid receptor agonists, but their comparative efficacy is not well-established. Objective: To compare the efficacy of tramadol (an opioid receptor agonist) with paroxetine (an SSRI) in the treatment of PE. Methods: This randomized control trial was conducted at Jinnah Postgraduate Medical Center, Karachi, from October 2020 to April 2021. Male patients aged 18-55 years, diagnosed with PE, were included. Exclusion criteria were erectile dysfunction, substance abuse, psychiatric illnesses, and ongoing PE treatment. Participants were divided into two groups: one receiving tramadol and the other paroxetine, taken 2-4 hours before intercourse. Efficacy was measured using Intravaginal Ejaculation Latency Time (IELT) over a six-week period. Data were analyzed using SPSS version 21, with a p-value of &lt;0.05 considered significant. Results: 200 participants were included, with 100 in each treatment group. Tramadol showed a higher efficacy (89% efficacy) compared to paroxetine (73% efficacy), with a significant p-value of 0.004. Stratified analyses by age, BMI, and duration of relationship also indicated higher efficacy for tramadol across different subgroups. Conclusion: Tramadol demonstrated superior efficacy in delaying ejaculation compared to paroxetine in the treatment of PE. These findings suggest that tramadol may be a more effective alternative for PE management, although further research is needed to confirm these results and explore long-term outcomes.

Regular penis-root masturbation: A promising behavioral treatment method for lifelong premature ejaculation.

We aimed to determine the effectiveness of penis-root masturbation (PRM), a newly defined behavioral therapy (BT) technique, in patients with unsuccessful medical treatment due to premature ejaculation (PE). The study included 35 patients aged 25-43 years, who were diagnosed with lifelong PE. Patients and their partners were informed about the PRM technique and asked to practice PRM three times a week for three months, with or without sexual intercourse. The patients' Premature Ejaculation Diagnostic Tool (PEDT) scores and intravaginal ejaculatory latency time (IELT) were recorded and compared before PRM training (T0) and at the third (T3) month after the start of PRM training. The mean±SD PEDT scores were 16.26±1.94 at T0, 10.63±1.14 at T3. When compared to T0, the PEDT values at T3 were significantly lower (P=0.021). In terms of IELT, the mean T3 values (192.43±56.71) were significantly longer (P=0.035) than at T0 (50.43±13.84seconds). PRM BT shows promise for lifelong PE patients who do not benefit from or discontinue to pharmacotherapy. Larger prospective trials are required to confirm these findings.

Retracted: Evaluation and Correlation Analysis of Mental and Psychological Factors and Premature Ejaculation in Patients with Benign Prostatic Hyperplasia in Mobile Medical System.

[This retracts the article DOI: 10.1155/2022/8260640.].

Decreased grey matter volume in dorsolateral prefrontal cortex and thalamus accompanied by compensatory increases in middle cingulate gyrus of premature ejaculation patients.

The prefrontal-cingulate-thalamic areas are associated with ejaculation control. Functionalabnormalities of these areas and decreased grey matter volume (GMV) in the subcortical areas have been confirmed in premature ejaculation (PE) patients. However, no study has explored the corresponding GMVchanges in the prefrontal-cingulate-thalamic areas, which are considered as the important basis for functionalabnormalities. This study aimed to investigated whether PE patients exhibited impaired GMV in the brain, especially the prefrontal-cingulate-thalamic areas, and whether these structural deficits were associated with declined ejaculatory control. T1-weighted structural magnetic resonance imaging (MRI) data were acquired from 50 lifelong PE patients and 50 age-, and education-matched healthy controls (HCs). The PE diagnostic tool (PEDT) was applied to assess the subjective symptoms of PE. Based on the method of voxel-based morphometry (VBM), GMV were measured and compared between groups. In addition, the correlations between GMV of brain regions showed differences between groups and PEDT scores were evaluated in the patient group. PE patients showed decreased GMV in the right dorsolateral superior frontal gyrus (clusters=13, peak T-values=-4.30) and left thalamus (clusters=47, T=-4.33), and increased GMV in the left middle cingulate gyrus (clusters=12, T=4.02) when compared with HCs. In the patient group, GMV of the left thalamus were negatively associated with PEDT scores (r=-0.35; P=0.01). Receiver operating characteristic (ROC) analysis showed that GMV of the right dorsolateral superior frontal gyrus (AUC=0.71, P<0.01, sensitivity=60%, specificity=78%), left thalamus (AUC=0.72, P<0.01, sensitivity=92%, specificity=46%) and middle cingulate gyrus (AUC=0.69, P<0.01, sensitivity=50%, specificity=90%), and the combined model (AUC=0.84, P<0.01, sensitivity=78%, specificity=80%) all had theability to distinguish PE patients from HCs. Disturbances in GMV were revealed in the prefrontal-cingulate-thalamic areas of PE patients. The findings implied that decreased GMV in the dorsolateral prefrontal cortex and thalamus might be associated with the central pathological neural mechanism underlying the declined ejaculatory control while increased GMV in the middle cingulate gyrus might be the compensatory mechanism underlying PE.

Surgical treatment of premature ejaculation: a narrative review.

Recurrence after drug cessation is the biggest drawback of medical premature ejaculation (PE) treatments. Although these treatments are demonstrated to be safe and effective, most of the PE patients are interested in a more permanent solution. Despite the fact that currently available guidelines do not recommend surgical treatment for PE, some surgical interventions have been commonly performed for many years, especially in the Asian countries. The main purpose of these surgical treatments is to decrease the sensitivity of the glans penis. However, they are associated with irreversible complications such as penile deformity, sensory loss and erectile dysfunction. The aim of this narrative review is to summarize the advantages and disadvantages of various surgical interventions introduced for the treatment of PE. PubMed, Scopus and Web of Science have been utilized to search articles about glans penis augmentation and penile dorsal nerve interventions. A total of 11 articles were included, three articles excluded because they were in non-English languages. Glans penis augmentation offered a less invasive treatment that avoids severe side effects but requires retreatment in time. Selective dorsal neurectomy provided a more invasive but curative treatment alternative. However, more clinical data are necessary before surgical treatment options can be recommended to patients with PE.

Abnormal cortical surface-based spontaneous and functional connectivity in the whole brain in lifelong premature ejaculation patients.

Recent research has highlighted structural and functional abnormalities in the cerebral cortex of patients with premature ejaculation (PE). These anomalies could play a pivotal role in the physiological mechanisms underlying PE. This study leveraged functional magnetic resonance imaging (fMRI), a noninvasive technique, to explore these neural mechanisms. We conducted resting-state fMRI scans on 36 PE patients and 22 healthy controls (HC), and collected data on Premature Ejaculation Diagnostic Tool (PEDT) scores and intravaginal ejaculation latency time (IELT). Employing a surface-based regional homogeneity (ReHo) approach, we analyzed local neural synchronous spontaneous activity, diverging from previous studies that utilized a volume-based ReHo method. Areas with significant ReHo differences between PE and HC groups underwent surface-based functional connectivity (FC) analysis. Significant discrepancies in ReHo and FC across the cortical surface were observed in the PE cohort. Notably, PE patients exhibited decreased ReHo in the left triangular inferior frontal gyrus and enhanced ReHo in the right middle frontal gyrus. The latter showed heightened connectivity with the left lingual gyrus and the right orbital superior frontal gyrus. Furthermore, a correlation between ReHo and FC values with PEDT scores and IELT was found in the PE group. Our findings, derived from surface-based fMRI data, underscore specific brain regions linked to the neurobiological underpinnings of PE.

The efficacy of hyaluronic acid in treating premature ejaculation: A systematic review and single-armed meta-analysis

Aim: To evaluate the efficacy of hyaluronic acid (HA) injection in treating patients with premature ejaculation (PE). Methods: Matching interventional studies from MEDLINE, CENTRAL, and CINAHL. Outcomes were intravaginal estimated latency time (IELT), glandular circumference, satisfaction score, and adverse event rate. Data were assessed with Open Meta Analyst, DerSimonian and Laird random-effects model. Results: Ten interventional studies, three double-armed, with low to moderate bias risk, revealed significant differences in baseline IELT and 1, 3, and 6-month post-hyaluronic acid injection, with mean differences of 217.035 (95% CI, 89.330–344.739), 161.513 (95% CI, 37.262–285.764), and 196.350 (95% CI, 142.314–250.386) seconds. Glandular circumference increased by 10.956 mm (95% CI, 3.314–18.598) after six months. Conclusion: Hyaluronic acid successfully extended IELT in premature ejaculation patients at one, three, and six months post-treatment with no severe side effects. It also enhanced glandular size and sexual satisfaction for patients and their partners.

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.

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.