Lifelong premature ejaculation (PE) is a commonly reported male sexual dysfunction. However, investigations focusing on the glymphatic system of lifelong PE are still limited. To investigate alterations of glymphatic function and potential correlation between the diffusion tensor image analysis along the perivascular space (DTI-ALPS) index and clinical symptoms of lifelong PE patients. Our study enrolled 36 lifelong PE patients and 30 matched healthy controls (HCs). DTI-ALPS index was calculated through diffusion tensor imaging sequence. Statistical analysis was performed, including intergroup comparisons, correlation assessments, and subgroup analyses. The results comprised 2 sample t-tests comparing intergroup DTI-ALPS values and their correlations with clinical scales, in addition to 2 sample t-test results comparing lifelong PE patients with high depressive states and those with low depressive states. The results demonstrated that lifelong PE patients exhibited a significantly lower DTI-ALPS index compared to HCs. The decreased DTI-ALPS index was negatively correlated with the severity of lifelong PE. Furthermore, lifelong PE patients with high depressive states had significantly lower DTI-ALPS index than those with low depressive states. This study offers a potential neurobiological explanation for the condition, which could inspire the development of new diagnostic tools or therapies targeting the glymphatic system. The major strength of this research is the innovative use of the DTI-ALPS index to objectively evaluate glymphatic function in lifelong PE, providing novel insights into its neuropathophysiology. However, the study is limited by its small sample size. To ensure robust generalizability, future work will involve the acquisition of larger-scale cohorts. These findings provide further evidence for the existence of intracranial waste clearance efficiency abnormalities in lifelong PE patients and suggest that the decreased glymphatic system activity in patients may be implicated in emotional state and the disease severity. These findings may offer new perspectives for understanding the pathophysiology of lifelong PE.

This study aimed to compare the effectiveness of gum-chewing therapy (GCT) and biofeedback therapy (BFT) in patients with lifelong premature ejaculation (LPE). Between April and October 2025, 84 patients presenting to the urology outpatient clinic were evaluated. Inclusion criteria were a Premature Ejaculation Diagnostic Tool (PEDT) score >11 and an intravaginal ejaculatory latency time (IELT) <60 seconds. After exclusions, 75 patients were randomly assigned to the GCT (n = 39) or BFT group (n = 36). Patients in the GCT group performed rhythmic gum chewing starting 20 minutes before intercourse and continuing until ejaculation, while patients in the BFT group were evaluated after completing therapy sessions. IELT and PEDT scores were assessed at 1 and 3 months. Data from 61 patients (GCT:33, BFT:28) who completed the study were analyzed. The groups were comparable in age and baseline IELT and PEDT scores. Both groups demonstrated significant improvements in IELT and PEDT outcomes at follow-up (p < 0.001). Although numerical improvements were greater in the GCT group, intergroup differences were not statistically significant. Gum-chewing therapy may represent a simple, discreet, low-cost, non-pharmacological treatment option for LPE.

Premature ejaculation (PE) is one of the common male sexual dysfunctions with high prevalence rates varying in different studies, while Personality disorders (PDs) occur significantly in the general population, acting as a predisposing factor for other psychiatric disorders. This study was conducted with aims to find the proportion and type of PDs among patients with PE attending in tertiary care hospitals as well as observing any additional variation according to the socio-demographic variables. This observational, cross-sectional study was conducted in the Psychiatric sex clinic (PSC) of the outpatient Department of Bangladesh Medical University (BMU) from May 2017 to September 2019. The assessment of PE was done by applying Premature Ejaculation Diagnostic Tool (PEDT) from consenting male patients. Cases scoring more than or equal to 11 in PEDT and met the inclusion criteria, were accepted. Different types of PDs were determined by using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II questionnaire). PDs were found to be present in 37.1% of patients with PE, Cluster C being predominant among them. Within Cluster C, OCPD (Obsessive-Compulsive Personality Disorder) was the most prevalent type (63.6%), followed by Avoidant (39.4%). Co-occurrence of more than one PD in the same individual was found as 9.1%; 66.3% patients had lifelong premature ejaculation, among which 41.0% of patients with Lifelong PE had PD. There is no significant difference between mean age of the PE patients with PD (35.0±7.9) and without PD (36.0±8.03). Current study reveals almost 97.0% of patients with PE belong to cluster C PD and 41.0% of lifelong PE has PD. There are significant proportions of Personality Disorder among patients who are suffering from Premature Ejaculation, particularly of Cluster C Disorders. OCPD is the commonest among all types of PD, but further study is needed to explore whether there is any direct relationship between PD and PE.

ANOTATION. One of the most common sexual dysfunctions in men is premature ejaculation, which negatively affects interpersonal relationships and, consequently, the quality of life not only of the patient but also of his sexual partner. AIM. To evaluate the diagnostic aspects of the severity of premature ejaculation. MATERIALS AND METHODS. The study included 89 men with premature ejaculation. The mean age of the patients was 32.6±4.2 years. The mean duration of the condition was 4.6±2.4 years. Twenty-two patients (24.7%) had secondary (acquired) premature ejaculation against a background of chronic prostatitis or prostatovesiculitis. The majority of the remaining men—67 (75.3%)—had the primary (congenital) form of premature ejaculation, which began at the onset of sexual activity. To determine the severity of premature ejaculation, the Premature Ejaculation Diagnostic Tool (PEDT) was used. Penile sensitivity was assessed using biotensiometry. RESULTS AND DISCUSSION. When evaluating the results of the PEDT diagnostic test based on symptom severity, men were classified as having mild (50.5%), moderate (31.5%), or severe (18%) symptoms. According to biotensiometry data, hypersensitivity of the glans penis was observed in men with premature ejaculation, compared to data in the control group of men without sexual dysfunctions, at 4.2±1.6 volts and 12.4±2.6 volts, respectively (p&lt;0.05). More pronounced indicators of penile hypersensitivity were observed in men with premature ejaculation with severe clinical manifestations, showing a statistically significant difference compared to the indicators in the group of men with mild premature ejaculation manifestations (p&lt;0.05) and no significant difference compared to the group of men with moderate premature ejaculation (p&gt;0.05). Slightly more pronounced indicators of penile hypersensitivity were observed in men with premature ejaculation aged under 30 years. Increased penile sensitivity is associated with more severe clinical manifestations of premature ejaculation, as evidenced by a higher total score on the PEDT questionnaire, a finding confirmed by a strong correlation (Spearman’s r = –0.972; p&lt;0.01). CONCLUSIONS. The diagnostic aspect, which involves determining the severity of premature ejaculation, will make it possible to improve the management of such patients.

Male sexual dysfunction, with specific reference to erectile malfunction and premature ejaculation, interferes with both physical and social health of individuals. Erectile dysfunction is seen as the inability to obtain a construction that is rigid enough for successful sexual intercourse, while premature ejaculation is defined as the premature discharge that triggers discomfort. Botulinum toxin, a neurotoxin that blocks acetylcholine release, is thought to lower SMH tone and alter neurotransmitter substrates presumed to be involved in these disorders. Here, we present a systematic review and metaanalysis to determine the efficacy of Botulinum toxin injections in the treatment of erectile dysfunction and premature ejaculation. A comprehensive literature review was executed across various databases, including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus, to identify relevant randomized controlled trials evaluating the efficacy of botulinum toxin injections for sexual dysfunction disorders. Subsequently, a meticulous extraction of pertinent information was performed, followed by the extraction of outcomes of interest. A meta-analysis was conducted employing a random effects model using RevMan software. This systematic review and meta-analysis included eight clinical trials (n = 742 patients) evaluating the efficacy of botulinum toxin (BoTN) in sexual dysfunction. For premature ejaculation, BoTN significantly increased intravaginal ejaculatory latency time (IELT) compared to control (MD = 17.63 seconds, 95% CI [6.69, 28.57], p = 0.02). In erectile dysfunction, BoTN demonstrated significant improvements in the Sexual Health Inventory for Men (SHIM) score at both 2 weeks (MD = 3.25 points, 95% CI [1.10, 5.40], p = 0.03) and 3 months (MD = 5.30 points, 95% CI [2.60, 8.00], p = 0.0001). Botulinum toxin (BoTN) demonstrates significant therapeutic potential for treating both premature ejaculation, by effectively increasing ejaculatory latency, and erectile dysfunction, by improving key indicators like erection hardness and penile blood flow. Its novel mechanism, which involves relaxing hypertonic smooth muscle and modulating peripheral neurotransmission, offers a valuable approach for patients who do not respond to traditional treatments. While the evidence is promising, the findings are tempered by limitations, such as heterogeneity among the included studies and an inability to analyze all relevant outcomes due to limited data. BoTN was significantly correlated with increases in IELT and the SHIM, enhancements in EHS and PSV. These studies report that BoTN has potential as a treatment approach for male sexual dysfunction, and its further application should be investigated.

Premature ejaculation is a prevalent male sexual dysfunction, yet real-world clinical practices in China remain poorly characterized. To evaluate current premature ejaculation management practices among Chinese physicians. A nationwide cross-sectional survey of 1000 physicians was conducted using a structured, self-administered questionnaire exploring diagnostic practices, treatment modalities, and perceived therapeutic effectiveness. Associations between physician characteristics and treatment choices were analyzed using chi-square tests. Diagnostic reliance on clinical history (67.4%) exceeded that on standardized tools (32.6%). Around 46.5% of physicians reported treating intravaginal ejaculation latency time <1min without distress, while 32.6% reported treating intravaginal ejaculation latency time >10min with distress. Oral dapoxetine (59.7%) and psychotherapy (92.1%) were preferred first-line therapies, followed by long-acting selective serotonin reuptake inhibitors (13.7%). Prescriptions for long-acting selective serotonin reuptake inhibitors were primarily driven by guideline adherence (25.95%), anxiety/depression comorbidity (17.56%), dapoxetine inefficacy (6.11%), and clinician experience (6.11%). Combination therapy was common (52.1%), whereas surgical interventions remained rare (14.7%) but more prevalent among andrologists than among non-andrologists (p<0.001). Compared with non-andrologists, andrologists demonstrated greater use of behavioral therapy (p = 0.001) and topical agents (p = 0.006) than non-andrologists. Drug selection (54.5%) and psychological factors (16.6%) were identified as key efficacy determinants. Chinese physicians commonly use combined pharmacological and psychological approaches for premature ejaculation treatment, but significant challenges persist, including inappropriate treatment of non-premature ejaculation cases, unwarranted surgical interventions, and insufficient utilization of evidence-based selective serotonin reuptake inhibitors, highlighting the need for standardized diagnostic criteria and enhanced physician education on guideline-recommended therapies.

Background Paraphilic interests are common in nonclinical populations, yet their relationship with sexual dysfunction remains underresearched. Understanding this association may support clinical assessment and treatment planning in sexual health settings. Aim To examine the associations between paraphilic interests/disorders and DSM-5 sexual dysfunctions in a large nonclinical adult sample, using sociodemographic matching. Methods An online survey of 8,282 participants (aged 18–35) classified individuals into paraphilic disorder, paraphilic interest, and control groups based on DSM-5 criteria. A 1:1 manual sociodemographic matching procedure was applied. Sexual dysfunctions were assessed according to DSM-5 criteria A–C. Results Compared with matched controls, paraphilic interests were associated with higher rates of erectile dysfunction (OR = 3.10), premature ejaculation (OR = 1.60), and female orgasmic disorder (OR = 1.59) (all p < .05). Paraphilic disorders showed even higher likelihoods of erectile dysfunction (OR = 4.47), premature ejaculation (OR = 4.47), male hypoactive sexual desire disorder, and female sexual interest/arousal disorder (all p < .05). These associations were independent of sociodemographic factors. Clinical Implications Screening for sexual dysfunction may be warranted when paraphilic interests or related distress are disclosed in clinical contexts. Awareness of potential comorbidities may support earlier recognition. Conclusion Paraphilic interests and disorders were significantly associated with multiple sexual dysfunctions in a nonclinical population. These findings highlight clinically relevant comorbid patterns.

Intravaginal ejaculation latency time (IELT) is traditionally considered a stable parameter in premature ejaculation (PE), although recent findings suggest that physiological, behavioural and contextual factors may influence it. This cross-sectional study assessed intraindividual variations in self-reported IELT among 119 men with PE, examining the effects of time of day, sexual position, alcohol consumption, condom use and foreplay duration. Participants completed validated questionnaires and provided IELT estimates across multiple conditions. Masturbation latency (MELT) was significantly longer than vaginal IELT (Z = 7.53, p = 3.0 × 10⁻¹⁴). Daily longest and morning IELT were significantly higher than the "average" IELT (Z = 4.06, p = 4 × 10⁻⁵; Z = 3.95, p = 8 × 10⁻⁵), whereas the shortest IELT did not differ significantly (Z = -1.26, p = 0.206). No sexual position emerged as significantly more likely to be associated with the longest or shortest IELT, although position-related IELT differences were reported (longest IELT: Z = 4.97, p = 6.7 × 10⁻⁷; shortest IELT: Z = -6.00, p = 2.0 × 10⁻⁹). IELT increased significantly after alcohol consumption (Z = 4.84, p = 1.3 × 10⁻⁶) and condom use (Z = 4.56, p = 5.1 × 10⁻⁶), while foreplay duration showed minimal impact (p = 9.3 × 10⁻⁸). These findings challenge the assumption of IELT as a fixed diagnostic parameter and highlight the influence of contextual and behavioural factors.

Premature ejaculation (PE) accompanied by anxiety or depression is a complex clinical condition at the intersection of male reproductive dysfunction and emotional disorders. Increasing evidence suggests that serotonin (5-HT) and brain-derived neurotrophic factor (BDNF) play central and interrelated roles in its pathogenesis. In this review we examine the bidirectional functions of 5-HT and BDNF in both the reproductive and nervous systems, highlighting their importance in regulating ejaculation, emotional stability, and synaptic plasticity. A comprehensive literature search (2010-2025) was conducted across multiple databases using relevant Medical Subject Headings (MeSH) terms, including pertinent original research and review articles, to synthesize the roles and regulatory pathways of 5-HT and BDNF in PE with comorbid anxiety or depression. We summarize the shared and distinct roles of 5-HT and BDNF in maintaining physiological balance across these systems and focus on their involvement in the major pathological processes underlying PE with anxiety or depression, including neurotransmitter imbalance, neuroendocrine dysregulation, inflammation, and oxidative stress. Furthermore, we outline the related signaling pathways through which 5-HT and BDNF exert their effects and interact. We also evaluate current pharmacological and non-pharmacological interventions targeting these molecules, demonstrating their potential to improve both ejaculatory control and emotional symptoms, and critically appraise selective serotonin reuptake inhibitor (SSRI)-related risks and highlighted the need for individualized dosing and monitoring. Emerging evidence suggests that Traditional Chinese Medicine formulations can extend intravaginal ejaculatory latency and mitigate mood symptoms and may serve as stand-alone or adjunctive options to reduce reliance on selective serotonin reuptake inhibitors (SSRIs). Overall, 5-HT and BDNF are not only deeply involved in the biological mechanisms of PE with comorbid psychological disorders, but also represent promising biomarkers and therapeutic targets, and their integrative neuro-reproductive regulatory functions provide new insights into the diagnosis and treatment of this multifaceted condition.

S100 calcium-binding protein B ameliorates premature ejaculation in rats via regulation of the BDNF/5-HT pathway.

Background: Unconsummated marriage (UCM) is a significant yet underreported sexual health problem in South Asia, with a limited number of studies revealing limited information. Objective: To synthesize available literature on UCM in South Asia, focusing on risk factors, management strategies, clinical outcomes, and research gaps. Methods: A narrative review was conducted using PubMed, Scopus, Google Scholar, BanglaJOL, NepJOL, and Google. Original peer-reviewed studies published in English reporting on UCM in eight South Asian countries were included. Data on sample characteristics, etiologies, therapeutic interventions, and outcomes were extracted and analyzed descriptively. Results: Seven studies from India, Bangladesh, Pakistan, and Sri Lanka were included, with sample sizes ranging from single cases to 769 couples. Genito-pelvic pain emerged as the most common factor, followed by erectile dysfunction, premature ejaculation, and psychosocial factors such as fear, anxiety, and depression. Management strategies included psychosexual counseling and cognitive-behavioral therapy. Delays in seeking medical care ranged from days to over two decades, reflecting cultural taboos, lack of knowledge about sexual health, and social stigma. Conclusions: UCM in South Asia is an under-researched issue reflected by the number and designs of studies. Prospective studies with large sample and cross-cultural comparisons are essential to develop evidence-based management and improve sexual health outcomes for couples in the region.

Clinical significance of serum Nesfatin-1 as a novel biomarker in premature ejaculation: its association with the serotonergic system and diagnostic value.

BackgroundType 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder and erectile dysfunction (ED) is a common complication among male patients with T2DM. Although T2DM is a well-established independent risk factor for ED the clinical characteristics and associated psychosocial burden of ED in this population remain inadequately characterized. This study aimed to comprehensively assess the prevalence, severity, clinical correlates, and emotional comorbidities of ED in male patients with T2DM.ObjectiveThe incidence and related factors of T2DM patients with ED (T2DMED) were investigated by clinical symptom collection and related scale evaluation. The emotional abnormalities of T2DMED patients and their relationships with clinical features were evaluated by the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD).MethodsA total of 208 male patients with T2DM who presented to the Department of Endocrinology in Jiangsu Provincial People’s Hospital from July 2020 to March 2021 were selected. The demographic information and T2DM related clinical data were collected. The scales of HAMA, HAMD, and sexual function questionnaires including International Erectile Function Index (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT) and Arizona Sexual Experience Scale (ASEX) were evaluated. Statistical analysis was conducted based on the patient’s demographic information, clinical indicators, and scale data.ResultsThe prevalence of ED in male patients with T2DM was 67.8%. The prevalences of mild, moderate and severe ED were 57.2%, 5.3%, 5.3%, respectively. Compared with the group of T2DM, higher age, lower IIEF score, higher PEDT score, higher ASEX score, increased left and right pulse wave velocity (PWV) were detected in the T2DMED group. In addition, age and fasting insulin had positive impacts on the development of ED in T2DM patients. HbA1C, age and educational level had impacts on the severity of ED. The severity of ED was positively correlated with low-density lipoprotein (LDL) level, age, left ankle brachial index (ABI), left and right PWV. There were negative correlations between IIEF-5 scores and HAMA, HAMD scores in T2DM patients. PEDT scores were positively correlated with HAMA and HAMD scores while ASEX scores were positively correlated with HAMA scores. The HAMA scores were positively correlated with the duration of T2DM and HAMA scores had negative effects on IIEF scores.ConclusionMild ED is more common in T2DM patients with more serious sexual dysfunction and higher risk of diabetic vasculopathy. Higher age and fasting insulin level are associated with the development of T2DMED while HbA1C, age and education level affect the severity of ED, with higher levels of low-density lipoprotein (LDL) and age, high risk of diabetic vasculopathy indicating more severe ED. The sexual dysfunction was positively associated with both anxiety and depression, especially in patients with higher age.

P0503 A digital health application to reduce premature ejaculation symptoms: Final results of the German CLIMACS study

P0501 Dual-site botulinum toxin injection for lifelong premature ejaculation: A prospective randomized controlled trial

P0025 Effect of a silicone patch applied to the penile frenulum for premature ejaculation: A prospective, randomised controlled trial assessing functional outcomes, safety, and satisfaction

P0502 Effectiveness of tramadol vs. SSRI in the treatment of premature ejaculation.

The 46,XX testicular difference of sex development is a rare genetic condition linked to primary hypogonadism and male infertility. However, research on how this condition affects male sexual functioning is lacking. Here, we describe the several dimensions of sexual function and its related associates in a 27-year-old Egyptian male man who has the disease but did not initially disclose any sexual dysfunction. Using self-administered validated questionnaires, the man demonstrated a reduction in erectile function, sexual desire, and intercourse satisfaction, along with premature ejaculation. Additionally, he had varying degrees of mental disorders, including depression, anxiety, and perceived stress. The hormonal assay revealed hypergonadotropic hypogonadism. The quality of life was poor. To the best of our knowledge, this is the first case report that used validated measuring instruments to show detrimental alterations in mood, numerous facets of sexual function, and quality of life in a man with 46,XX testicular difference of sex development. Men with this syndrome should receive a multidisciplinary strategy, which includes coping with hypogonadism and psychological support, in addition to sexual dysfunction treatment. This can help patients enhance their quality of life.

Vitamin B12 plays a key role in the serotonergic pathway; we predicted that B12 replacement could be beneficial in the treatment of premature ejaculation (PE) in patients with B12 deficiency. We aimed to investigate the response to vitamin B12 replacement in PE patients with vitamin B12 deficiency. Between January 2025 and June 2025, a total of 152 individuals were included in this study, comprising 92 patients aged 18–45 who were diagnosed with PE and 60 healthy controls. The blood vitamin B12 levels of all participants were examined. Thirty-four patients with PE who presented with vitamin B12 deficiency were re-evaluated for ejaculation time after vitamin B12 replacement. The mean blood vitamin B12 level was 237.8 ± 91.4 ng/L in the PE group and 297 ± 141.7 ng/L in the control group (p = 0.002). Following vitamin B12 replacement in the PE group with vitamin B12 deficiency, there was a statistically significant decrease in Premature Ejaculation Diagnostic Tool (PEDT) scores, a significant increase in Premature Ejaculation Profile (PEP) scores, and an increase in intravaginal latency time (p < 0.001). Of the patients diagnosed with PE who received B12 replacement therapy, 25 (73.5%) were satisfied with the treatment, while 9 (26.5%) were dissatisfied. Treatment satisfaction rates were 87.5% in those with lifelong PE and 61.1% in those with acquired PE (p = 0.082). In PE patients with B12 deficiency, normalizing blood B12 levels may be a viable treatment option. This is the first study to assess the effect of B12 replacement in PE patients with vitamin B12 deficiency.

This cross-sectional study aimed to validate the male version of the Orgasmometer in Mandarin and to examine whether Chinese men with premature ejaculation (PE) experience reduced orgasmic intensity. From September 2020 to January 2023, a group of 230 men with PE (mean age=28.2 ± 4.8) and 107 men without sexual dysfunction (mean age= 35.1 ± 6.7), who were seeking help from the Department of Infertility and Sexual Medicine, underwent a detailed assessment from the andrologist and completed a questionnaire that included the Mandarin Orgasmometer(Orgasmometer-m), the Premature Ejaculation Diagnostic Tool (PEDT), and the erectile function domain of the International Index of Erectile Function (IIEF-6). Orgasmometer-m scores were 5.0 (4.0) in the PE group and 8.0 (3.0) in the non-PE group; PEDT scores were 14.8 ± 2.5 and 3.3 ± 2.4, and IIEF-6 scores were 27.9 ± 1.6 and 29.1 ± 1.2, respectively (p < 0.001). The Orgasmometer demonstrated good discriminative validity, with an area under the curve (AUC) of 0.8296 (95% CI: 0.7873-0.8719, p < 0.0001). A score of ≤6 was identified as the optimal cutoff for distinguishing low from high orgasm intensity, yielding 66.1% sensitivity and 86.9% specificity. These findings support the reliability of the Orgasmometer-m and suggest that men with PE report diminished orgasmic experiences.