Premature Ejaculation Symptoms Research Articles

High-intensity interval training (HIIT) and slow breathing interventions alleviate premature ejaculation (PE) symptoms

BackgroundPhysical exercise may alleviate premature ejaculation symptoms, a prevalent male sexual dysfunction linked to a series of negative outcomes for men and their partners. ObjectiveWe investigated the effectiveness of high-intensity interval training (HIIT) and slow breathing interventions on premature ejaculation symptoms and their relation to autonomic activity and attention regulation. MethodChinese adult men (N = 76, M = 21.89, SD = 3.32) with premature ejaculation completed one of the two-week interventions in their homes or as participants in a normal breathing control group; they reported their age, height, weight, physical activity level, premature ejaculation symptoms, and attention regulation. In the HIIT group, 26 participants engaged in a 7-minute HIIT each day. In the slow breathing group, 25 participants performed 7-minute slow breathing exercises per day while the 25 participants in the normal breathing group similarly performed normal breathing exercises. All participants measured their heart rate once before and five times (with one-minute intervals) after the intervention. When participants had penile-vaginal sex with their partners, they measured their heart rate once after ejaculation. ResultsTime × Intervention interaction was significant with lower levels of premature ejaculation symptoms on Days 12, 13, and 14 in the HIIT group (M ± SD = 16.19 ± 3.45, 15.96 ± 3.43, and 15.15 ± 3.62) compared to the normal breathing group (M ± SD = 17.68 ± 3.06, 17.68 ± 3.15, and 17.44 ± 3.25). Higher levels of attention regulation were associated with fewer premature ejaculation symptoms. We also found that a larger increase in heart rate from resting to after sex was associated with fewer premature ejaculation symptoms. ConclusionCompared to the control group, the efficacy of two weeks of HIIT exercise in mitigating PE symptoms suggests its potential as a novel treatment for PE.

Safety and efficacy of LibidUp-PE supplement on premature ejaculation: A randomized, placebo-controlled double-blind, crossover study

Premature ejaculation (PE) is the most common male sexual dysfunction. Selective serotonin reuptake inhibitors (SSRIs) are currently recommended for PE. However, the side effects of SSRIs, such as nausea, vomiting, and xerostomia, pose challenges to clinicians. Simultaneously, evidence indicates that psychological and behavioral treatments are often insufficient. LibidUp-PE is a nutraceutical designed to enhance sexual wellness and contains a combination of essential amino acids to boost stamina and vigor, addressing concerns like erectile dysfunction (ED). This study aimed to assess the safety and efficacy of LibidUp-PE in the treatment of PE. In this crossover, double-blind, placebo-controlled trial, 76 patients with PE were randomly divided into two groups. Group A received LibidUp-PE, whereas Group B received a placebo for 12 weeks. Following a 2-week wash-out period, the groups switched treatments for another 12 weeks. Intravaginal ejaculatory latency time (IELT) and post-ejaculatory refractory time (PERT) were measured as the primary outcomes to evaluate PE improvement. Plasma serotonin levels were measured as secondary parameters using enzyme-linked immunosorbent assay. The results showed that LibidUp-PE significantly improved the IELT score, increasing from 0.8 ± 0.2 min to 2.9 ± 1.1 min (p < 0.01). PERT scores also significantly decreased from 15.8 ± 1.7 min to 5.6 ± 0.6 min after 12 weeks of LibidUp-PE treatment. Plasma serotonin levels significant increased from 93.6 ± 7.8 ng/mL to 168.4 ± 12.8 ng/mL (p < 0.001) with LibidUp-PE treatment. In contrast, no significant improvements were observed in the placebo group. Notably, none of the participants withdrew their consent due to adverse reactions, which is indicative of the safety and tolerability of LibidUp-PE. In conclusion, 12-week treatment with LibidUp-PE demonstrated a beneficial effect in reducing PE symptoms, as reflected by improved IELT, reduced PERT, and increased plasma serotonin levels. Therefore, LibidUp-PE could be a promising solution for individuals with PE.

Effects of Transcranial Direct Current Stimulation and Behavior Therapy Using the Start-Stop Method on the Treatment of Men with Sexual Disorder Premature Ejaculation

Background: Men suffering from premature ejaculation often report emotional and relational problems, and some of them do not pursue sex due to embarrassment. This condition leads to mental disorders, e.g., anxiety and depression, and the couple's relationship may suffer. Objectives: The present study aimed to investigate the effectiveness of transcranial direct-current stimulation (tDCS) and behavior therapy using the start-stop method in improving premature ejaculation. Methods: This was a quasi-experimental study with two experimental groups and a control group. The statistical population comprised all men with premature ejaculation residing in Tehran (2021) who visited sexual health centers in this city. A sample of 45 men aged 25-65 was selected using convenience sampling and divided into three groups of 15. The research instrument included the International Index of Erectile Function (IIEF). The data were analyzed in SPSS-23 using the analysis of covariance. Results: The mean ± SD of the pretest of premature ejaculation in the tDCS, start-stop method, and control groups was 13.60 ± 5.45, 12.86 ± 3.24, and 15.68 ± 4.87, respectively; while in the posttest was 23.53 ± 9.65, 18.66 ± 5.25 and 17.53 ± 4.83, respectively. Based on the results, tDCS alleviated premature ejaculation (P &lt; 0.001). The start-stop method also decreased the symptoms of premature ejaculation, but this reduction was not significant. There was a significant difference between the two treatment methods, and tDCS proved more effective. Conclusions: tDCS demonstrated acceptable effectiveness in the treatment of premature ejaculation. Given its effectiveness in increasing marital satisfaction, it should be considered in the treatment of premature ejaculation.

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.

A 2-week high-intensity interval training intervention improves ejaculation control among men with premature ejaculation.

Premature ejaculation (PE), which leads to substantial distress in men and their partners, is a common male sexual dysfunction worldwide. However, there is still a lack of effective treatments without side effects. We investigated the effect of high-intensity interval training (HIIT) on PE symptoms. We recruited 92 Chinese men aged 18-36 to complete the experiment. There were 22 (13 in the control group; 9 in the HIIT group) men diagnosed with PE and 70 (41 in the control group; 29 in the HIIT group) men with normal ejaculatory function. In the HIIT group, participants completed HIIT exercises every morning for 14 days. Participants also completed surveys inquiring about demographic information, erectile function, PE symptoms, body image (including sexual body image), physical activity, and sexual desire. The heart rate was measured before and after each HIIT. In the control group, participants were instructed not to do HIIT, but other procedures were the same as in the HIIT group. Results indicated that the HIIT intervention alleviated PE symptoms in men with PE. In addition, in the HIIT group, men with PE who had a higher heart-rate increase during the HIIT intervention reported the greatest overall decrements in PE symptoms. In men with normal ejaculatory function, HIIT did not decrease PE symptoms. In addition, increments in the heart rate during the intervention were associated with more pronounced PE symptoms post-intervention in this group. Analyses of secondary outcome measures suggested that the HIIT intervention improved general and sexual body image satisfaction of men with PE compared to before the intervention. In summary, HIIT intervention may reduce PE symptoms in men with PE. The heart-rate increase during the intervention may be a key factor influencing the effect of the HIIT intervention on PE symptoms.

(327) The Masturbatory Premature Ejaculation Diagnostic Tool (MPEDT): A Novel Psychometric Tool to Evaluate Premature Ejaculation During Masturbation

Abstract Introduction Premature ejaculation (PE) is a highly prevalent male sexual dysfunction. Its current definition, together with the most used diagnostic tools, does not include non-vaginal sexual intercourse such as anal sex, self-masturbation and/or partnered-masturbation, and other forms of sexual stimulation. However, diagnostic psychometry currently available is exclusively evaluating PE in the vaginal coitus. Objective To validate a new tool, the Masturbatory Premature Ejaculation Diagnostic Tool (MPEDT), by assessing the control over ejaculation and its psychological effects during self-masturbation, rather than heterosexual vaginal intercourse. Methods We studied 135 male patients aging from 18 to 40 years seeking medical care for PE in the Infertility and Sexual Medicine Department from June to September 2020. All the participants were asked to fill the PEDT and MPEDT questionnaires to estimate the PE symptoms during, respectively, intercourse and self-masturbation. The reliability/validity, the factor analysis of the tool, and the diagnostic sensitivity/specificity of MPEDT were calculated. Results The overall Cronbach alpha was 0.884. In our adjusted model, both RMSEA (Root Mean Square Error of Approximation) and SRMR (Standardized Root Mean Square Residual) were lower than 0.08, while Goodness of Fit Index (GFI), Adjusted Goodness of Fit Index (AGFI), Non-Normed Fit Index (NNFI), and Comparative Fit Index (CFI) were higher than 0.9. The area under the ROC curve (AUC) is 0.943±0.015. The results suggest MPEDT points being ≤5 as “normal”, ≥7 as “PE during self-masturbation” and 6 as “suspected PE”, with the sensitivity of 91.9% and specificity of 88.1%. Conclusions An efficient diagnostic psychometric tool is needed for the individuals who, based on the impaired control over ejaculation during self-masturbation, may also suffer from PE during partnered intercourse. MPEDT is able to evaluate the existence of PE symptoms not necessarily during heterosexual intercourse but rather during self-masturbation, possibly aiding to the diagnosis, as well as planning and follow-up of a prompt therapeutical strategy. MPEDT could be considered a new, objective and reliable diagnostic tool for the evaluation of the existence of PE symptoms. Disclosure No

MP45-05 A VALIDATED PATIENT REPORTED OUTCOME FOR PREMATURE EJACULATION

You have accessJournal of UrologyCME1 Apr 2023MP45-05 A VALIDATED PATIENT REPORTED OUTCOME FOR PREMATURE EJACULATION Michael Wyllie Michael WyllieMichael Wyllie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A major stumbling block for the approval of drugs for the treatment of premature ejaculation (PE) in the USA has been the lack of a patient reported outcome (PRO) validated to FDA standards. Under FDA guidance a PRO, the premature ejaculation bothersome evaluation questionnaire (PEBEQ) has been developed and run in a 16 centre US validation study. A comparison was to be made with other questionnaires used in clinical research in premature ejaculation. METHODS: Over the last 3 years, following FDA guidance and input, the PEBEQ has undergone the required validation sequence and has been run in a 16-centre clinical study. In addition to the PEBEQ, data were captured using the domains of the index of premature ejaculation (IPE) and a per event anchor i.e. the classical IELT measured via a stopwatch. A time stamper was also used to ensure protocol adherence. The patients were double-blind randomised to either active or placebo. In the validation study the active comparator used was PSD502, the metered dose aerosolized eutectic mixture of lidocaine and prilocaine. RESULTS: Clinically significant IELT changes from baseline (<0.7min) were noted for active, representing an 8-9-fold increase for active but only 2-3-fold for placebo. These changes were associated with corresponding increases in control, sexual satisfaction and decreases in distress in the domains of the IPE. Likewise changes in PEBEQ were observed for the active from both baseline and placebo (p< 0.0008 in the case of the latter). Concordance between the domains of the IPE and PEBEQ were in the range 0.79 to 0.89. Compliance was good with 92% of patients completing the study and side effects were minimal. CONCLUSIONS: FDA has been critical of other PROs in so far as the focus has been on "distress" rather than "bother". Under FDA guidance this has been addressed withe the development of the PEBEQ. The data presented show that patients do not necessarily differentiate between distress and bother, in terms of the presenting symptoms of premature ejaculation. Hopefully, the acceptance of the PEBEQ will expedite approval of drugs for premature ejaculation in the USA. Source of Funding: Funding for the validation exercise was provided to Health Research Associates (Evidera) and a US based CRO by Plethora Solutions Ltd © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e622 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Wyllie More articles by this author Expand All Advertisement PDF downloadLoading ...

The Effectiveness of a Mindfulness Program in Treating Premature Ejaculation

The aim of the paper is to identify the effectiveness of an intervention program based on minfulness techniques in treating premature ejaculation. Method: In a randomized controlled clinical trial (RCT), the participants, 500 men aged 18 to 60 in Romania with premature ejaculation, randomly divided into two groups: experimental group, who will benefit from 60 days of training of mindfulness techniques and the control group that will perform the same measurements of premature ejaculation (PEDT and IELT) but without intervention. The intervention will consist of learning and practicing mindfulness techniques (breathing exercises, meditation, body scanning). Expected results: According to studies and literature, we expect to improve the symptoms of premature ejaculation and increase the interval from the appearance of erection to ejaculation in the experimental group as a result of the techniques learned. Conclusions: interventions based on mindfulness techniques are effective in relieving premature ejaculation. The isolation of effective techniques and the mechanisms involved requires further research.

Study on the Efficacy of Electric Acupuncture in the Treatment of Premature Ejaculation Based on Testosterone Level.

Objective To investigate the clinical efficacy and possible mechanism of electroacupuncture in the treatment of premature ejaculation. Methods 50 cases of premature ejaculation patients who met the diagnostic criteria were randomly divided into 2 groups with 25 cases in each group. The observation group was treated with electroacupuncture, and the control group was treated with Longdan Xiegan decoction. The treatment period was 4 weeks. Ejaculation latency (IELT), sexual satisfaction score of patients, sexual satisfaction score of partners, testosterone test, and drug safety assessment were performed in all 4 groups before and after treatment. Results IELT was prolonged in all groups after treatment, the difference was statistically significant (P < 0.05). At the same time, the IELT of the observation group was significantly higher than that of the control group after treatment. Life satisfaction scores of patients and spouses in 2 groups were improved after treatment compared with before treatment, the difference was statistically significant (P < 0.05). After treatment, the satisfaction scores of patients and spouses in the observation group were higher than those in the control group, and the difference was statistically significant (P < 0.05). Before treatment, there was no significant difference in serum testosterone levels among all groups (P > 0.05). Serum testosterone levels in all groups were decreased after treatment compared with before treatment, with statistical significance (P < 0.05). After treatment, the serum testosterone level of the observation group was lower than that of the control group, and the difference was statistically significant (P < 0.05). During the treatment, the adverse reactions in each group disappeared after treatment, and no obvious abnormality was observed in the safety indicators. Conclusion Electroacupuncture can improve the symptoms of premature ejaculation, which may be related to the regulation of serum testosterone by acupuncture.

Selective Serotonin Re-Uptake Inhibitors for Premature Ejaculation in Adult Men: A Cochrane Systematic Review.

PurposeSelective serotonin re-uptake inhibitors (SSRIs) are frequently used to treat premature ejaculation (PE) in men. We performed a Cochrane review to assess the efficacy of SSRI treatment for PE.Materials and MethodsWe extensively searched a range of databases up to May 2020 and only included randomized controlled trials.ResultsA total of 31 studies with 8,254 men were included in this analysis. We found that SSRI treatment probably improves self-perceived PE symptoms (defined as a rating of ‘better’ or ‘much better’; risk ratio [RR], 1.92; 95% confidence interval [CI], 1.66–2.23; moderate-certainty evidence) and satisfaction with intercourse (defined as a rating of ‘good’ or ‘very good’; RR, 1.63; 95% CI, 1.42–1.87; moderate-certainty evidence) compared to placebo. Furthermore, SSRI treatment likely improve participants’ self-perceived control over ejaculation (defined as rating of ‘good’ or ‘very good’; RR, 2.29; 95% CI, 1.72–3.05; moderate-certainty evidence) and probably lessens distress (defined as rating of ‘a little bit’ or ‘not at all’) about PE (RR, 1.54; 95% CI, 1.26–1.88; moderate-certainty evidence). SSRI treatment may increase IELT compared to placebo (mean difference, 3.09 minutes higher; 95% CI, 1.94 higher to 4.25 higher; low-certainty evidence). However, SSRIs may increase treatment cessations due to adverse events compared to placebo (RR, 3.80; 95% CI, 2.61–5.51; low-certainty evidence).ConclusionsSSRI treatment for PE appears to substantially improve a number of outcomes of direct patient importance such as symptom improvement, satisfaction with intercourse and perceived control over ejaculation when compared to placebo.

The masturbatory premature ejaculation diagnostic tool (MPEDT): A novel psychometric tool to evaluate premature ejaculation during masturbation.

Premature ejaculation (PE) is a highly prevalent male sexual dysfunction. Its current definition, together with the most used diagnostic tools, does not include nonvaginal sexual intercourse such as anal sex, self-masturbation and/or partnered-masturbation, and other forms of sexual stimulation. However, diagnostic psychometry currently available is exclusively evaluating PE in the vaginal coitus. To validate a new tool, the masturbatory premature ejaculation diagnostic tool (MPEDT), by assessing the control over ejaculation and its psychological effects during self-masturbation, rather than heterosexual vaginal intercourse. We studied 135 male patients aging from 18 to 40 years seeking medical care for PE in the Infertility and Sexual Medicine Department from June to September 2020. All the participants were asked to fill the premature ejaculation diagnostic tool PEDT and MPEDT questionnaires to estimate the PE symptoms during, respectively, intercourse and self-masturbation. The reliability/validity, the factor analysis of the tool, and the diagnostic sensitivity/specificity of MPEDT were calculated. The overall Cronbach alpha was 0.884. In our adjusted model, both root mean square error of approximation (RMSEA) and standardized root mean square residual (SRMR) were lower than 0.08, while goodness of fit index, adjusted goodness of fit index, non-normed fit index (NNFI), and comparative fit index (CFI) were higher than 0.9. The area under the ROC curve (AUC) is 0.943 ± 0.015. The results suggest MPEDT points being ≤5 as "normal," ≥7 as "PE during self-masturbation," and 6 as "suspected PE," with the sensitivity of 91.9% and specificity of 88.1%. An efficient diagnostic psychometric tool is needed for the individuals who, based on the impaired control over ejaculation during self-masturbation, may also suffer from PE during partnered intercourse. MPEDT is able to evaluate the existence of PE symptoms not necessarily during heterosexual intercourse but rather during self-masturbation, possibly aiding to the diagnosis, as well as planning and follow-up of a prompt therapeutical strategy. MPEDT could be considered a new, objective, and reliable diagnostic tool for the evaluation of the existence of PE symptoms.

Premature Ejaculation Symptoms Are Associated with Sexual Excitability: Empirical Support for the Hyperarousability Model

Premature ejaculation (PE) is a common sexual complaint among men, but its etiology is poorly understood. Previous studies on the dual control model of sexuality has revealed that propensities for sexual excitation and inhibition can contribute to sexual dysfunctions, but few studies have included a measure of premature ejaculation. We sought to explore whether PE is associated with sexual excitation or inhibition. We applied structural equation models to data from a large population-based sample of Finnish adult men. The analyses supported a four-factor solution for the sexual inhibition/sexual excitation short-form scale. The clearest result was that increased symptoms of PE were associated with a greater propensity for sexual excitation (β = 151, p &lt; 001, n = 2953). Importantly, this excitation was intrapersonal, as opposed to stemming from social activities. The results imply that men with PE may have stronger and more rapid reactions to sexual stimuli, which in turn may lead to ejaculating earlier than desired.

Randomized Clinical Trial Between Fluoxetine and Dapoxetine for Premature Ejaculation and Its Effect on Marital Relationship

INTRODUCTION: Premature ejaculation(PE) decreases sexual pleasure and quality of life, and both Fluoxetine and Dapoxetine were used in PE therapy. Dapoxetine is the first SSRI with a short half-life and fewer side effects, primarily designed for PE therapy. The aim is to evaluate and compare the effects of Fluoxetine and Dapoxetine on PE symptoms and marital satisfaction. MATERIALS AND METHODS: 44 participants aged between 18 and 64 with a PEDT score of ≥9 from Hospital USM's Primary-Care-Clinic, Kelantan Malaysia were selected and randomized into two groups: Fluoxetine(FG) and Dapoxetine Group(DG), and administered for 8 weeks with either regular Fluoxetine(20mg) or Dapoxetine (30mg) on-demand at least once a week. Premature Ejaculation Diagnostics Tool(PEDT) score was used to assess PE symptoms and Dyadic Satisfaction-Dyadic Adjustment Scale (DS-DAS) used to evaluate marital satisfaction at baseline and the 8th week. RESULT: 22 and 21 participants in FG and DG completed the study. For both groups, PEDT scores decreased substantially [from 11.41 to 5.45(P&lt; 0.001) among FG, from 13.43 to 3.10(P&lt;0.001) among DG]. After adjustment of the baseline PEDT score, PEDT scores in DG(6.03 vs 2.49, P&gt;&lt;0.001) were lower at the 8th week. All groups showed significantly improved DS-DAS scores [from 34.50 to 40.68(P&gt;&lt;0.001) in FG, from 36.57 to 44.33(P&gt;&lt;0.001) in DG]. No marked difference in DS-DAS was scored after adjustment of the baseline DS-DAS score(41.13 vs 43.86, P=0.055) at the end of the assessment. CONCLUSION: Treatment of PE with either Fluoxetine or Dapoxetine decreases PE symptoms and increases marital satisfaction. &gt;&lt;0.001) among DG]. After adjustment of the baseline PEDT score, PEDT scores in DG (6.03 vs 2.49, P&lt; 0.001) were lower at the 8th week. All groups showed significantly improved DS-DAS scores [from 34.50 to 40.68(P&lt; 0.001) in FG, from 36.57 to 44.33(P&lt; 0.001) in DG]. No marked difference in DS-DAS was scored after adjustment of the baseline DS-DAS score (41.13 vs 43.86, P=0.055) at the end of the assessment. CONCLUSION: Treatment of PE with either Fluoxetine or Dapoxetine decreases PE symptoms and increases marital satisfaction.

Erectile Dysfunction in Young Men: Testosterone, Androgenic Polymorphisms, and Comorbidity With Premature Ejaculation Symptoms

BackgroundThe association between erectile dysfunction (ED), free testosterone (T), and androgenic genetic polymorphisms is still unclear. As most studies in the field have focused on older (>40 y.o.) men, data from young men is scarce. In addition, the clinically observed comorbidity between ED and premature ejaculation (PE) has not been explained. AimThe aim of the present study was 3-fold: to assess in a sample of young men (1) the association between ED and T; (2) the role of androgenic genetic polymorphisms in the aforementioned association; and (3) comorbidity between ED and PE symptoms. MethodsStatistical analyses were performed on a population-based sample of 2,302 Finnish men, (Mage = 26.8 years). Hormone samples were available from 317 men, and genotype information was available from a minimum of 1,144 men depending on genetic locus. For twin analyses, the sample contained 533 male individuals from opposite-sex fraternal twin pairs, 491 identical male individuals (110 complete pairs), 493 male individuals from male fraternal twin pairs (92 complete pairs), and 658 siblings of twins. OutcomesThe main outcome measure includes association between levels of salivary T and ED, main effects of the androgen-related genetic polymorphisms on ED scores. Bivariate twin models of PE and ED were fitted to elucidate possible shared etiology. ResultsWe found no significant association between T levels and ED and no significant main effects of the androgenic genetic polymorphisms on ED. We found no evidence suggesting that any of the genetic polymorphisms would moderate the association between T and ED symptoms. We found shared unique environmental influences between PE and ED (rE = .28). Clinical TranslationObtained data suggest that ED has T-independent causes and that any comorbidity between PE and ED is not explained by a set of genes affecting both phenotypes. Strengths & LimitationsFirst, the sample size for both parts of the study was relatively small, which may make some statistical analyses underpowered. Furthermore, as the sample was a population-based sample of relatively young men, the number of clinically relevant ED cases was low. Second, some concerns about T derived from saliva exist because saliva sampling comes with increased risks of error particularly because saliva samples are more vulnerable to contamination. ConclusionWe found no significant association between free T levels, androgenic genetic polymorphisms, and ED in the younger age cohort. Twin analysis suggested a common nonshared environmental component in PE and ED.Zhuravleva1 ZD, Johansson A, Jern P. Erectile Dysfunction in Young Men: Testosterone, Androgenic Polymorphisms, and Comorbidity With Premature Ejaculation Symptoms. J Sex Med 2021;18:265–274.

Upregulated expression of NMDA receptor in the paraventricular nucleus shortens ejaculation latency in rats with experimental autoimmune prostatitis.

Estimated 30%-40% of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) suffer from premature ejaculation (PE), which is difficult to cure, but the mechanism is still unknown. Based on the results of our previous clinical studies and animal experiments, we propose that the glutamatergic system dysfunction in the paraventricular nucleus (PVN) may be involved. To test this hypothesis, we used experimental autoimmune prostatitis (EAP) rats to investigate the effects of CP/CPPS on ejaculation behavior through integrating copulatory behavior testing, neuroelectrophysiologic experiments, and molecular biology technologies. Histological examination of prostate tissue in EAP rats exhibited consistent pathological findings with that in CP/CPPS patients. Behavior testing showed that ejaculation latency (EL) of EAP rats significantly shortened compared with the controls (5.1±1.8 vs 9.1±2.4min, P<.001). Sympathetic nervous system (SNS) activity testing revealed that EAP rats displayed significantly higher plasma norepinephrine (NE) level (1780±493 vs 1421±453pg/mL, P=.043) and SNS sensitivity (67.8±9.6 vs 44.6±8.7%, P<.001). Immunohistochemical detection and Western blot analysis both displayed that NR1 subunit expression of N-methyl-D-aspartic acid (NMDA) receptors in the PVN of EAP rats was significantly upregulated (P=.007 and P<.001). Furthermore, the expression of NMDA NR1 subunit positively correlated both with SNS sensitivity (r=.917, P<.001) and prostatic inflammation scores (r=.964, P<.001). This study shows that EAP rats suffer from the same PE symptom as CP/CPPS patients. CP/CPPS-induced inflammatory-immune response can significantly upregulate the expression of NMDA receptors in the PVN, which shortening the EL by enhancing SNS sensitivity. However, the exact mechanism of chronic inflammation in the prostate causing the upregulated expression of NMDA receptors needs to be further studied.

Do women’s Relationship Satisfaction and Sexual Functioning Vary as a Function of Their Male Partners’ Premature Ejaculation Symptoms?

The present study investigated how women’s sexual functioning and relationship satisfaction are associated with their partner’s premature ejaculation (PE) symptoms, and whether prevalence rates of PE differ when women report on their male partners compared to male self-report. The sample comprised of responses from 1,779 Finnish women (mean age 33.3 years) and a control group of 1,024 Finnish men. Women who reported that their male partners had symptoms of PE were less satisfied with their relationships, and reported lower levels of arousal, orgasm, satisfaction, lubrication, and pain, but not desire. Effect sizes of these associations were small. Men and women report similar base rates of PE, suggesting that on a population level prevalence estimates are remarkably similar irrespective of whether men report on PE symptoms themselves, or women report on their partners.

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

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

Vibrator-Assisted Start\u2013Stop Exercises Improve Premature Ejaculation Symptoms: A Randomized Controlled Trial

Premature ejaculation (PE) is associated with decreased quality of life, lower confidence and self-esteem, and higher levels of depression, anxiety, and interpersonal difficulties. Here we investigated the effectiveness of vibrator-assisted start–stop exercises for treatment of PE, and whether the treatment effect could be enhanced by an additional psychobehavioral intervention. Fifty participants with a mean age of 41.7 years were included and randomized into two treatment groups and a waiting list control group. Participants were instructed to perform start–stop exercises while stimulating the penis with a purpose-made vibrator, 3 times a week for 6 weeks. Additionally, participants in one of the treatment groups received additional psychoeducation and performed mindfulness meditation-based body scan exercises three times a week. Data were gathered through online questionnaires before and after treatment, as well as 3 and 6 months after treatment. The interventions reduced PE symptoms with large effect sizes (partial η2 = .20 across the three groups, d [95% CI] = 1.05 [.27, 1.82] and 1.07 [.32, 1.82] for treatment groups compared to waiting list control group). The additional psychobehavioral intervention did not further reduce PE symptoms, but did decrease PE-associated negative symptoms such as levels of sexual distress, anxiety, and depression. No side effects were reported. Vibrator-assisted start–stop exercises can be offered as an adequate treatment option for PE.

The Oxytocin Antagonist Cligosiban Prolongs Intravaginal Ejaculatory Latency and Improves Patient-Reported Outcomes in Men with Lifelong Premature Ejaculation: Results of a Randomized, Double-Blind, Placebo-Controlled Proof-of-Concept Trial (PEPIX)

IntroductionCligosiban is an orally administered oxytocin receptor antagonist being developed to treat premature ejaculation (PE). AimTo determine the safety and efficacy of cligosiban capsules (dose range 400–800 mg) to improve intravaginal ejaculation latency time (IELT) and patient-reported outcomes in men with severe lifelong PE. MethodsPatients recorded details of at least 4 sexual intercourse events during a 4-week run-in period, after which they underwent baseline assessments. Patients were eligible for the study if they rated their control of ejaculation as poor/very poor and their stopwatch-assessed IELT was ≤1 minute in ≥75% of intercourse attempts. Eligible patients were randomized to an 8-week treatment period with double-blind cligosiban or placebo (to be taken 1 to 6 hours prior to sexual activity). The starting dose was 400 mg (not more than 1 dose per day) which could be increased to 800 mg after 2 and/or 4 weeks of treatment. Assessments were conducted at 2, 4, and 8 weeks. Main Outcome MeasureEfficacy measures were comprised of IELT, self-rating of ejaculation control and ejaculation-related distress (recorded in an electronic diary after each intercourse attempt), premature ejaculation profile, and the Clinical Global Impression of Change. ResultsThe mean ratio of fold change from baseline in IELT to the last 4 weeks of treatment (cligosiban/placebo) was 1.9 compared to a baseline of 1.0 (P = .0079). The mean increase in IELT from baseline to the last 4 weeks of treatment was 61.0 seconds for cligosiban, which was significantly different from (and 3.6-fold greater than) the mean increase of 16.4 seconds for placebo (P = .0086). Statistically significant improvements in ejaculation control and ejaculation-related personal distress scores were also observed for cligosiban compared to little or no change with placebo. Cligosiban was generally well tolerated, with no serious or severe adverse events or other safety parameters. Clinical ImplicationsThis proof-of-concept study demonstrated the potential for cligosiban, an oxytocin antagonist, to successfully treat symptoms of severe lifelong PE. Strengths and LimitationsThis was a Phase II, randomized, double-blind, placebo-controlled study that was adequately powered to detect a clinically meaningful difference in change in IELT between cligosiban and placebo. Larger studies will be needed to confirm these findings, determine the optimal dose of cligosiban and assess efficacy in men with acquired PE. ConclusionsCligosiban was well tolerated, and resulted in significant benefits in both objective and subjective measures of ejaculatory control in men with lifelong PE and therefore offers significant potential as an on-demand, orally administered agent for the treatment of PE.McMahon C, Althof S, Rosen R, et al. The Oxytocin Antagonist Cligosiban Prolongs Intravaginal Ejaculatory Latency and Improves Patient-Reported Outcomes in Men with Lifelong Premature Ejaculation: Results of a Randomized, Double-Blind, Placebo-Controlled Proof-of-Concept Trial (PEPIX). J Sex Med 2019; 16:1178–1187.

The Oxytocin Antagonist Cligosiban Fails to Prolong Intravaginal Ejaculatory Latency in Men with Lifelong Premature Ejaculation: Results of a Randomized, Double-Blind, Placebo-Controlled Phase IIb trial (PEDRIX)

IntroductionCligosiban is an orally administered, centrally penetrant oxytocin receptor antagonist being developed to treat premature ejaculation (PE). AimTo determine the efficacy of 3 dose levels of cligosiban caplets to prolong intravaginal ejaculation latency time (IELT) and improve patient-reported outcomes in men with lifelong PE. MethodsPatients recorded details of at least 4 sexual intercourse events during a 4-week run-in period, after which they underwent baseline assessments. Patients were eligible for the study if their stopwatch-assessed IELT was ≤1 minute in ≥75% of intercourse attempts and if they met other diagnostic criteria for lifelong PE. Eligible patients (target 220 evaluable) were randomized to double-blind cligosiban 400, 800, or 1200 mg or matching placebo caplets (to be taken 1 to 6 hours prior to sexual activity). Assessments were conducted at 2, 4, and 8 weeks. Main Outcome MeasureEfficacy measures were comprised of IELT, self-rating of ejaculation control and ejaculation-related distress (recorded in an electronic diary after each intercourse attempt), premature ejaculation profile, Patient’s Global Impression of Severity, and the Clinical Global Impression of Change. ResultsThere were no clinically or statistically significant differences between cligosiban (at any dose level) and placebo for the primary endpoint (change in geometric IELT) or any of the secondary endpoints. Cligosiban was well tolerated with a side-effect profile similar to placebo. Clinical ImplicationsThis Phase IIb study failed to demonstrate the potential for cligosiban, an oxytocin antagonist, to successfully treat symptoms of severe lifelong PE at doses up to 1200 mg. Strengths and LimitationsThis was a Phase IIb, randomized, double-blind, placebo-controlled study that was adequately powered but failed to detect a clinically meaningful or statistical difference in change in IELT between cligosiban at 3 dose levels and placebo. This is in contrast to a similarly designed proof-of-concept study where cligosiban was flexibly dosed at doses up to 800 mg and did demonstrate clinically meaningful and statistically significant changes in efficacy parameters. The reasons for this disparity are not known. ConclusionsCligosiban was well tolerated but failed to demonstrate efficacy for the treatment of men with lifelong PE at doses up to 1200 mg.Althof S, Osterloh IH, Muirhead GJ, et al. The Oxytocin Antagonist Cligosiban Fails to Prolong Intravaginal Ejaculatory Latency in Men with Lifelong Premature Ejaculation: Results of a Randomized, Double-Blind, Placebo-Controlled Phase IIb trial (PEDRIX). J Sex Med 2019; 16:1188–1198.