Primary Premature Ejaculation Research Articles

The effect of local anesthetic on the hypersensitive and nonsensitive areas of the penis is different in primary premature ejaculation: a pilot study.

Penile hypersensitivity is not the whole penis, but rather only a part of the penis. Though local anesthetic can prolong intravaginal ejaculation latency time by reducing penile hypersensitivity, the effect on the hypersensitive and nonsensitive areas of penis is still unclear. The study aimed to explore whether the effect of local anesthetic on the hypersensitive and nonsensitive areas of the penis is different in premature ejaculation. Penile neurophysiological tests were performed on 290 patients with primary premature ejaculation. The sensory threshold, latency, and amplitude were recorded before and after the topical application of a local anesthetic (lidocaine cream) on the penis. Local anesthetics increased the sensory thresholds of hypersensitive and nonsensitive areas of the penis without difference but only prolonged the latency of the hypersensitive areas. According to the neurophysiological results, 149 of 290 patients with primary premature ejaculation had normal penile sensitivity and 141 had penile hypersensitivity. While penile hypersensitivity does not necessarily mean that the whole penis is hypersensitive, and may be that only a part of the penis is hypersensitive, and we examined the following hypersensitivities: glans hypersensitivity only (14 cases), shaft hypersensitivity only (77 cases), and whole penis hypersensitivity (50 cases). Local anesthetics (lidocaine cream) increased the sensory thresholds of hypersensitive and nonsensitive areas of the penis without difference (P < .001) but only prolonged the latency of the hypersensitive areas (P < .001), and the latency of the nonsensitive areas was not different (P > .05). The present discovery implies that it is possible to improve ejaculation by applying local anesthetics externally to the hypersensitive areas of the penis to reduce the afferent local sensory signals, and improve intravaginal ejaculation latency time through accurately decreasing penile sensibility. This is the first large-sample study to explore the difference of local anesthetics' effects on the hypersensitive and nonsensitive areas of the penis by means of neurophysiological methods in premature ejaculation. Our study exclusively examines alterations in penile evoked potential following electrical stimulation, which may not entirely encompass shifts in penile receptivity during sexual activity. The effects of local anesthetics on the same penis varied with penile sensitivity, and can only prolong the latency of hypersensitive area of the penis. The effect of local anesthetic on the hypersensitive and nonsensitive areas of the penis is different in premature ejaculation.

Correlation between serum tryptophan metabolism and treatment efficacy of dapoxetine in patients with premature ejaculation: A pilot study.

Primary premature ejaculation (PPE) is a common male neurobiological disorder. Currently, there is consensus that the impairment in central serotonin (5-HT) neurotransmission constitutes a key pathogenic factor in PPE. Selective serotonin reuptake inhibitors (SSRIs) serve as the primary pharmacological intervention; however, a comprehensive elucidation of their mechanism of action remains incomplete. Owing to significant individual variability in efficacy, SSRIs exhibit a high discontinuation rate. Hence, there is an urgent need to address the selection of SSRIs for PPE treatment. This study aims to investigate the characteristics of tryptophan (TRP) metabolism in patients with PPE and to assess its influence on the efficacy of SSRIs. The exploratory study included a total of 16 patients with PPE and 16 control subjects who were healthy men without any sexual dysfunction. Upon enrollment in the study, all participants underwent a thorough medical history review and physical examination. Subsequently, their serum levels of TRP, its metabolites, large neutral amino acids (LNAAs), and metabolite ratios were assessed using a liquid chromatography-mass spectrometry (LC-MS) assay. After a period of 4weeks of dapoxetine treatment, all patients with PPE underwent reassessment using the Premature Ejaculation Diagnostic Tool (PEDT) score and intravaginal ejaculatory latency time (IELT) test. The ratio of serum TRP to other LNAAs (TRP/LNAAs) in patients with PPE was found to be significantly lower compared to the control group (P<0.05). Conversely, the ratio of kynurenine to TRP (KYN/TRP) was observed to be significantly higher in the PPE patients compared to the control group (P<0.05). Including the serum TRP/LNAAs ratio and KYN/TRP ratio in the prediction model yielded the highest prediction efficiency for PPE. There was a significant negative correlation between the ratio of TRP/LNAAs before the treatment and the IELT after 4weeks of the treatment. Additionally, there was a significant positive correlation observed between the ratio of TRP/LNAAs before the treatment and the PEDT score after 4weeks of the treatment. This study demonstrates that the reduction in the TRP/LNAAs ratio and the elevation of the KYN/TRP ratio are significant characteristics associated with PPE. These findings suggest that diminished tryptophan availability in the brain and the activation of the kynurenine (KYN) pathway may play a role in the pathogenesis of PPE. The TRP/LNAAs ratio has potential as a reliable indicator of central serotonin (5-HT) levels. Considering the TRP/LNAAs ratio when selecting SSRIs for the treatment of PPE may enhance the response rate of this medication.

(215) Investigating if Hormonal Dysfunctions are Risk Factors in Men Complaining of Premature Ejaculation

Abstract Introduction Most epidemiological studies suggest that premature ejaculation (PE), also referred to as early ejaculation and rapid ejaculation, may be the most common male sexual disorder. The exact etiology of PE is unknown. Psychological/behavioristic and biogenic etiologies have been proposed. Objective Initial reports indicate that there are hormone differences between men with primary (lifelong) and secondary (acquired) PE. This study was designed to investigate hormone profiles of these two subgroups. Methods Men who presented to our outpatient clinic with PE were enrolled in this study. The diagnosis and classification (primary or secondary) of PE was based on patient medical and sexual history according to guidelines of international society of sexual medicine (ISSM) and European association of urology (EAU). Complete physical examination was done and we measured thyroid stimulating hormone (TSH), testosterone (T), and prolactin (P) for all patients. Statistical analyses included descriptive statistics and independent-measures t-test for univariate analyses. Analysis of covariance was used for multivariable analyses. Results 506 men were included in this analysis. The average age of these men was 44±12 years old and the mean body mass index (BMI) was 26.7±5.5. The mean levels of T, TSH, and P for the entire sample was 4.38±1.69, 2.31±3.56, and 10.56±11.04, respectively. There were 267 men in the primary PE group and 239 men in the secondary PE group. The men with primary PE were significantly younger than those with secondary PE (37±11 vs. 52±12, p=0.001). There were no significant differences in BMI between the groups. On univariate analyses, there was no differences between the primary PE and secondary PE groups in T (4.39±1.66 vs. 4.38±1.84, p=0.94), TSH (2.31±4.89 vs. 2.20±2.07, p=0.76), and P (10.65±8.13 vs. 10.46±13.46, p=0.86). When controlling for age in multivariable analyses, there continued to be no differences between the two groups (p values ranging from p=0.56 to 0.81). Conclusions hormonal profile including T, TSH and P seem to be in the normal range in men with PE and there is no statistical difference in these hormones between primary and secondary PE Disclosure No.

(074) The Sensitivity Difference Between the Glans Penis and Penile Shaft in Primary Premature Ejaculation

Abstract Introduction The penis is a vital organ of perception that transmits perceived signals to ejaculation-related centers. The penis consists of the glans penis and penile shaft, which differ considerably in both histology and innervation. Objective This paper aims to investigate whether the glans penis or the penile shaft is the main source of sensory signals from the penis and whether penile hypersensitivity affects the whole organ or only part of it. Methods The thresholds, latencies, and amplitudes of somatosensory evoked potentials (SSEPs) were recorded in 290 individuals with primary premature ejaculation using the glans penis and penile shaft as the sensory areas. Results The thresholds, latencies, and amplitudes of SSEPs from the glans penis and penile shaft in patients were significantly different (all P &amp;lt; 0.0001). The latency of the glans penis or penile shaft was shorter than average (indicating hypersensitivity) in 141 (48.6%) cases, of which 50 (35.5%) cases were sensitive in both the glans penis and penile shaft, 14 (9.9%) cases were sensitive in the glans penis only, and 77 (54.6%) cases were sensitive in the penile shaft only (P &amp;lt; 0.0001). Conclusions There are statistical differences in the signals perceived through the glans penis and the penile shaft. Penile hypersensitivity does not necessarily mean that the whole penis is hypersensitive. We classify penile hypersensitivity into three categories, namely, glans penis, penile shaft, and whole-penis hypersensitivity, and we propose the new concept of penile hypersensitive zone. Disclosure No.

(260) Effects of Surface Delay Agents on Penile Sensibility in Premature Ejaculation

Abstract Introduction The penis is an important sensory organ during sexual intercourse, transforming the sensations experienced from intercourse into neural impulses and transmitting them to the central nervous system. Our previous research has found that the sensitivity of the penis varies due to histological and neuroanatomical differences between the penile shaft and glans. We have identified hypersensitivity zones within the penis, classifying them into three subtypes，namely, glans penis, penile shaft, and whole-penis hypersensitivity. However, it remains unknown whether there are differences in sensitivity after the application of surface anesthetics to these subtypes. Objective As the hypersensitivity of the penis is not uniform throughout, with specific sensitive zones, this study aims to investigate whether there are differences in sensitivity after surface delay agents are applied to the hypersensitive and hyposensitive areas. This will aid in the precise use of surface delay agents and reduce their side effects. Methods Based on the neurophysiological results, 290 patients with primary premature ejaculation were categorized into the group with single glans penis hypersensitivity, the group with single penile shaft hypersensitivity, the group with the whole penis hypersensitivity, and the group with the whole penis being hyposensitivity. Differences in sensory thresholds, latencies, and amplitudes between the hypersensitive and hyposensitive areas of the penis were compared between patients before and after the use of delaying agents on the surface of the penis. Results The surface delay agent can indiscriminately increase the sensory threshold of both the hypersensitive and hyposensitive areas of the penis (P&amp;lt;0.001), but it only prolongs the latency of the hypersensitive area (P&amp;lt;0.001), without affecting the latency of the hyposensitive area of the penis. Conclusions The effects of the surface delay agent on the hypersensitive and hyposensitive areas of the penis are different. The delay agent only extends the latency of the hypersensitive area, suggesting that there may be differences in receptors, sensory cells, and synaptic transmission of sensory nerve fibers between the hypersensitive and hyposensitive areas of the penis. Disclosure No.

Combined on-demand sildenafil citrate and tramadol hydrochloride is an effective and safe treatment for premature ejaculation: A randomized placebo-controlled double-blind clinical trial

ABSTRACT Background Premature ejaculation (PE) is a common sexual dysfunction that harms both sex partners. Aim To evaluate the safety, efficacy and impact on sexual satisfaction scores of the combined use of tramadol HCl and sildenafil citrate for the treatment of PE. Methods One hundred and sixty otherwise healthy males complaining of PE (primary/secondary) were enrolled in this randomized, double-blind, placebo-controlled study. Only 155 patients (age range 22–48 years) completed the study. Of them, 81 patients had primary PE, and 74 had secondary PE. The comparative groups included the placebo group (n = 34), sildenafil citrate 50 mg group (n = 39), tramadol HCl 100 mg group (n = 40), and the combination therapy group (n = 42). The treatment duration for all groups was 10 weeks. Outcomes This combination is safe and effective. Results Five patients discontinued the study, all from the placebo group, due to a lack of improvement over the treatment course. No significant differences were reported between groups before treatment as regards Intravaginal ejaculatory Latency Time (p = 0.8), satisfaction score (p = 0.7), age (p = 0.9), or duration of marriage (p = 0.9). There was a significant improvement in IELT after treatment with a placebo (p = 0.0001), associated with an insignificant improvement in satisfaction score (p = 1.0). In the other three groups, there was a significant improvement in IELT after treatment (p = 0.0001 for all), which coincided with a significant improvement in satisfaction scores in all three groups (p = 0.0001 for all). Clinical Implications We recommend this combination in the treatment of premature ejaculation. Strengths It is a prospective randomized double-blind placebo-controlled clinical trial. Limitations Limited number of participants. Conclusion Combined therapy of PE, whether primary or secondary, with sildenafil citrate 50 mg and tramadol HCl 100 mg is safe and effective; and its therapeutic effect is superior to the utilization of either agent alone.

(192) The Perceptibility Difference between Glans Penis and Penile Shaft in Primary Premature Ejaculation

Abstract Introduction The penis is a vital perceptor that transmits perceived signals to ejaculation-related centers. The penis consists of the glans and the shaft, and histology and innervation differ considerably. Does this difference affect their perceptibility? Objective This paper aims to investigate whether perceived signals are different using the glans penis or penile shaft as the perceptor zone and whether hypersensitivity of the penis is the whole or the part. Methods Through somatosensory evoked potentials, thresholds, latencies, and amplitudes were recorded in 290 cases of primary premature ejaculation, using the penis and penile shaft as the perceptor areas, respectively. Results (1) Thresholds, latency, and amplitude of the glans penis and penile shaft in patients were significant differences (P&amp;lt; 0.05) (2) The latency of the glans penis or penile shaft was shorter than average (hypersensitivity) in 141 cases (48.62%), of which 50 cases (35.5%) were sensitive to both the glans and shaft of the penis, 14 cases (9.93%) were sensitive to the glans only and 77 cases (54.6%) were sensitive to the shaft only. (P &amp;lt;0.05) Conclusions There are differences in the signals perceived with the glans penis and the penile shaft as the perceptive zone. Penile hypersensitivity does not necessarily mean that the whole penis is hypersensitive. We classify the penile hypersensitivity into three categories: the glans, the shaft, or the whole penile hypersensitivity, and we put forward the new penis high sensitivity zone concept. Disclosure No

The role of selective serotonin re-uptake inhibitors in themanagement of premature ejaculation

A prospective, randomized, placebo-conlrolled study was designed to investigate the efticacy and side effects of the selective serotonin re-uptake inhibitor, fluoxetine hydrochloride, on postponing ejaculation in patients with premature ejaculation (PE). A total of 55 men with PE were scheduled to begin this study, but 5 of them have been dropped out for unknown reason, so tbc study was completed with a total number of 50 patients. The ages of these patients (who experienced primary premature ejaculation (lifelong rapid ejaculation)) ranging between 19 to 65 years. The patients were asked to detennine the time in seconds between vaginal penet.ration and ejaculation (latency time), by using a clock for four weeks before starting the trcatment,and a baseline mean ejaculatory latency time was measured. Then the patients were given either flouxetine hydrochloride or placebo for aditiomal 8 weeks. All patients were interviewed before and 8 weeks after beginning the treatment.Baseline mean ejaculatory latency time was 60.6 s; 20 mg/day of lluoxetine increased it to 199.3 s, while in patient using placebo it was 68. 15 s (p &lt; 0.001). This resulted in significantly greater sexual satisfaction for men: 73% (p &lt; 0.001). Generally. fluoxetine was well tolerated and there were no major side effects. None of the patients discontinued thempy due to adverse effects. Fluoxetinae hydrochloride may be regarded as a safe and effective option in the treatment of premature ejaculation.

MP45-13 CAN DELAYED EJACULATION HAVE AN IMPACT ON PSYCHOLOGICAL HEALTH? FINDINGS FROM A CROSS SECTIONAL STUDY

You have accessJournal of UrologyCME1 Apr 2023MP45-13 CAN DELAYED EJACULATION HAVE AN IMPACT ON PSYCHOLOGICAL HEALTH? FINDINGS FROM A CROSS SECTIONAL STUDY Christian Corsini, Federico Belladelli, Edoardo Pozzi, Giuseppe Fallara, Simone Cilio, Massimiliano Raffo, Alessandro Bertini, Francesco Lanzaro, Donato Cannoletta, Fausto Negri, Ludovica Cella, Margherita Fantin, Luigi Candela, Paolo Capogrosso, Luca Boeri, Alessia D'Arma, Francesco Montorsi, and Andrea Salonia Christian CorsiniChristian Corsini More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Simone CilioSimone Cilio More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Francesco LanzaroFrancesco Lanzaro More articles by this author , Donato CannolettaDonato Cannoletta 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 , Luigi CandelaLuigi Candela More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Luca BoeriLuca Boeri More articles by this author , Alessia D'ArmaAlessia D'Arma 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.0000000000003291.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Delayed Ejaculation (DE) is among the most challenging male sexual dysfunctions. We aimed to explore and compare the sociodemographic and clinical characteristics of men with DE with those complaining of primary premature ejaculation (PE) METHODS: Data from 555 consecutive men seeking first medical help for DE and/or primary PE between 2005 and 2022 at a single tertiary-referral center were retrospectively analyzed. Complete socio-demographic, clinical and laboratory data were collected for all patients. All patients completed the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI) at baseline. We excluded men with known or potential causes responsible for ejaculatory disorders (n= 52). Descriptive statistics was used to detail and compare clinical and sociodemographic characteristics between the two groups (DE vs. PE). Linear regression models tested the association between depressive symptoms (BDI) and baseline IIEF domains scores among men with DE. RESULTS: Of 555 patients, 479 (86.3%) and 76 (13.7%) primary PE and DE, respectively. Men with DE were significantly older (44 vs. 47, p=0.01) than patients with PE. Conversely, the two groups did not differ in terms of educational/relational status, BMI, comorbidities, and hormonal milieu. At psychosexual interview, men with DE report more frequently symptoms referable to anxiety and depression (9.4% and 12,7%) along with higher median baseline BDI scores (8 vs. 6), all p<0.01. DE patients reported lower median IIEF-OF, -SD domains (6 vs. 9) and (7 vs. 8) than patients with PE only, all p<0.05. At linear regression analysis, among DE patients, a higher BDI score was associated with lower IIEF-OS (coeff. -1.57 p=0.004), and IIEF-IS (coeff. -0.72 p=0.01) domains (Figure 1). No association between BDI and IIEF-OF, -EF, -SD domains was found. CONCLUSIONS: Among men complaining of ejaculatory disorders, one out of ten reports DE. These patients have higher chances to report clinically significant depression significantly impacting on their overall satisfactory sexual life. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e626 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Corsini More articles by this author Federico Belladelli More articles by this author Edoardo Pozzi More articles by this author Giuseppe Fallara More articles by this author Simone Cilio More articles by this author Massimiliano Raffo More articles by this author Alessandro Bertini More articles by this author Francesco Lanzaro More articles by this author Donato Cannoletta 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 Luigi Candela More articles by this author Paolo Capogrosso More articles by this author Luca Boeri More articles by this author Alessia D'Arma More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF downloadLoading ...

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 ...

Clinical value of penile sympathetic skin response to assess the efficacy of sertraline in the treatment of patients with sympathetic hyperexcitability in primary premature ejaculation.

The pathogenesis of primary premature ejaculation (PPE) is complex, and the pathologic basis may be an overactive sympathetic nervous system. To investigate sertraline efficacy in patients with sympathetic hyperexcitability in PPE and clarify the value of penile sympathetic skin response (PSSR) in assessing the efficacy of sertraline for PPE treatment. Sixty-three patients with PPE were recruited in the outpatient clinic and asked to take 50mg of oral sertraline daily for a 4-week treatment period. Changes in intravaginal ejaculation latency time (IELT), Premature Ejaculation Diagnostic Tool, International Index of Erectile Function (IIEF-5), and PSSR latency and wave amplitude were compared before and after treatment. The principal aim was to determine the relationships among sertraline efficacy, IELT, and PSSR latency and amplitude. After sertraline treatment, patients with PPE demonstrated a significant decrease in Premature Ejaculation Diagnostic Tool scores (P < .001); a significant increase in IELT, PSSR latency, and wave amplitude (P < .001); and no significant change in International Index of Erectile Function scores (P > .05). Moreover, the latency changes of PSSR were positively correlated with the increment of IELT (r = 0.550, P < .001). In addition, there was some degree of improvement vs pretreatment, although IELT and PSSR latencies were significantly shorter after drug discontinuation when compared with posttreatment (both P < .001). We aimed to find an objective test that accurately reflects the efficacy of treatment for sympathetic hyperexcitability in PPE. The strengths include a well-powered study, use of validated instruments, and self-assessment of treatment benefit. The limitations include the single-center design, relatively short-term follow-up, and lack of more comprehensive monitoring between treatment and drug discontinuation. These findings suggest that sertraline is effective for PPE treatment, that its efficacy can be partially maintained even after drug discontinuation, and that PSSR may be reliable for evaluating treatment success in patients with PPE.

The sensitivity difference between the glans penis and penile shaft in primary premature ejaculation.

The penis is a vital organ of perception that transmits perceived signals to ejaculation-related centers. The penis consists of the glans penis and penile shaft, which differ considerably in both histology and innervation. This paper aims to investigate whether the glans penis or the penile shaft is the main source of sensory signals from the penis and whether penile hypersensitivity affects the whole organ or only part of it. The thresholds, latencies, and amplitudes of somatosensory evoked potentials (SSEPs) were recorded in 290 individuals with primary premature ejaculation using the glans penis and penile shaft as the sensory areas. The thresholds, latencies, and amplitudes of SSEPs from the glans penis and penile shaft in patients were significantly different (all P < 0.0001). The latency of the glans penis or penile shaft was shorter than average (indicating hypersensitivity) in 141 (48.6%) cases, of which 50 (35.5%) cases were sensitive in both the glans penis and penile shaft, 14 (9.9%) cases were sensitive in the glans penis only, and 77 (54.6%) cases were sensitive in the penile shaft only (P < 0.0001). There are statistical differences in the signals perceived through the glans penis and the penile shaft. Penile hypersensitivity does not necessarily mean that the whole penis is hypersensitive. We classify penile hypersensitivity into three categories, namely, glans penis, penile shaft, and whole-penis hypersensitivity, and we propose the new concept of penile hypersensitive zone.

Does the Hypothetical Aetiology Affect the Response to Serotonin Reuptake Inhibitors and Local Anesthetics Therapies in Patients with Primary Premature Ejaculation? A Prospective, Placebo-Controlled, Crossover Study

Does the Hypothetical Aetiology Affect the Response to Serotonin Reuptake Inhibitors and Local Anesthetics Therapies in Patients with Primary Premature Ejaculation? A Prospective, Placebo-Controlled, Crossover Study

Efficacy of Sildenafil Citrate in Treatment of Primary Premature Ejaculation in Men

Efficacy of Sildenafil Citrate in Treatment of Primary Premature Ejaculation in Men

Prematür ejakülasyona güncel yaklaşım

Premature ejaculation (PE) is the most common ejaculation disorder affecting all age groups. It is a clinical condition that causes psychological stress and loss of self-confidence in the patient and has a negative effect on quality of life. While the main treatment of primary PE is pharmacotherapy, treatment of the underlying secondary causes may be more important in acquired PE. Behavioral treatments should be used in the initial phase and accompany pharmacological treatments. Pharmacological agents that can be used in the treatment of PE are selective serotonin reuptake inhibitors (SSRI), topical anesthetics, tramadol, tricyclic antidepressants (TCA), phosphodiesterase-5 inhibitors (PDE5i), α-1 blockers and some combinations of these. Invasive interventions are experimental and not recommended by the guidelines. Patient and partner compatibility can be said to be the most important factor that brings success in treatment. Keywords: men, premature ejaculation, treatment

Efficacy and safety assessment of glandular augmentation with hyaluronic acid for premature ejaculation.

Glandular augmentation (GA) with hyaluronic acid (HA) is a newly developed, minimally invasive therapy for patients with premature ejaculation (PE); however, evidence supporting its efficacy is scarce. To provide a comprehensive profile of GA with HA gel in managing PE, 184 patients with PE who received GA with HA gel therapy from October 2017 to November 2019 were included and followed up for 1 year. The Fan technique was applied. Intravaginal Ejaculation Latency Time (IELT), Chinese Index of Premature Ejaculation-5(CIPE-5) and Visualised Satisfaction Index (VSI) of sexual experience were assessed at initial and 1-, 3-, 6- and 12-month post injection. A total of 71 patients with primary PE (pPE, 38.6%) and 113 patients with acquired PE (aPE, 61.4%) were enrolled. The mean IELT increased to 100.7 ± 43.2s(p < .05) for pPE patients and 359.2 ± 87.1s (p < .05) for aPE patients 1-month post injection and remained significantly higher at the end point with acceptable attenuation. The mean CIPE-5 score increased to 17.6 ± 6.4 (p < .05) in the 1st month and remained steady. The VSI scores increased to 6.6 ± 1.0 (p < .05) for patients with pPE and 7.7 ± 1.2 (p < .01) for patients with aPE. Increments in VSI in patients with aPE were significantly higher than those in patients with pPE (p < .01). No severe complications were noted. GA with HA may be an effective and safe method to treat PE. Patients with acquired PE were also more satisfied post treatment.

Correlation between age and curative effects of selective dorsal neurectomy for primary premature ejaculation.

The use of selective dorsal neurectomy (SDN) as a surgical treatment of premature ejaculation (PE) has increased for many years in Asian countries. To investigate the correlation between age and curative effects of SDN in primary premature ejaculation (PPE) in mainland China. From September 2016 to September 2020, 65 patients with PPE treated with SDN were selected for study. All of the patients were followed up from 12 to 56 (30.07 ±13.48) months. They were divided into 3 groups according to age: group A (22-30 years, n = 23), group B (31-37 years, n = 20) and group C (38-45 years, n = 22). The 5-item version of the International Index of Erectile Function (IIEF-5) and Premature Ejaculation Diagnostic Tool (PEDT) results, erectile rigidity grade, intravaginal ejaculation latency time (IELT), ejaculation control abilities (ECA) scores, and sexual intercourse satisfaction (SIS) scores were assessed in the 3 groups before and after operation to evaluate the clinical efficacy of surgery. Fifty-nine patients were finally followed up. The IIEF-5 scores and erectile rigidity grade of group A was significantly higher than that of groups B and C, both before and after surgery. The change of PEDT scores in group A was significantly higher than in groups B and C; the difference was statistically significant (p < 0.05). The IELT, ECA and SIS scores in group A were significantly higher than in groups B and C (p < 0.05). Operational efficiency ratio in groups B and C (65%, 70%) was significantly lower than in group A (95.24%). The SDN as a treatment of PPE in different age groups allowed to achieve certain results. The highest surgical efficiency (95.24%) was observed in the 22-30 years age group and the lowest (65%) in the 38-45 years age group. Therefore, we believe that the best time for surgery is between 22 and 30 years of age.

Оценка эффективности дапоксетина при первичной и вторичной формах преждевременной эякуляции

to compare the efficacy of dapoxetine in treatment of primary and secondary premature ejaculation.The study included 60 patients with premature ejaculation (PE). Depending on the form of premature ejaculation they were divided into two groups: 27 patients with primary PE (group 1) and 33 patients with secondary PE (group 2). Patients were recommended to take dapoxetine 30 mg 1 hour before intercourse. A follow-up visit was scheduled on day 30 after receiving the drug. The intravaginal ejaculation latency time (IELT) and the Premature ejaculation diagnostic tool (PEDT) score were evaluated before dapoxetine was given and after 30 days from the start of the study. The significance of differences between baseline and follow-up values were compared using Wilcoxons test. In both groups, the proportion of patients with an incomplete response (IELT less than 2 minutes, PEDT more than 10) to symptomatic therapy with dapoxetine was evaluated. The proportion of patients with incomplete response to therapy was compared using the chi-square test.The median IELT among all patients before starting therapy was 63 seconds (interquartile interval [IQR]: 28.75-94). After one month of therapy median IELT increased to 119 seconds (IQR: 58.75-321.75). Median PEDT score was 16 (IQR: 13-19) at baseline and 7 (IQR: 4-12) at follow-up. In group 1, the median IELT increased from 57 to 83 seconds (p = 0.02088), and in group 2, the median IELT increased from 70 to 173 seconds (p<0.00001). The mean PEDT score decreased to 7 in both groups (p<0.00001). Incomplete response to therapy was observed in 66.7% of patients in group 1 and in 39.4% of patients in group 2. The difference between two groups was statistically significant (p=0.035456).Symptomatic therapy with dapoxetine has a positive effect on the intravaginal ejaculation latency time and patient satisfaction in both primary and secondary premature ejaculation. However, the incidence of incomplete response to therapy is higher in patients with primary premature ejaculation, which may be due to characteristic differences in the pathogenesis of primary and secondary premature ejaculation.

Is There A Role for Dihydrotestosterone/ Estradiol Ratio in Premature Ejaculation?

Background: The association between endocrine control and ejaculatory reflex is still not completely elucidated. Serum dihydrotestosterone (DHT) concentrations have been reported to be lower in premature ejaculation (PE) patients. We hypothesized that homeostasis between testosterone (T) and their metabolites; dihydrotestosterone (DHT) and estradiol (E2); could be involved in orchestration of the ejaculatory process. Aim: To test this hypothesis, we aimed to investigate any possible relationship between DHT/ E2 ratio and T/E2 ratio in a cohort of patients consulting for premature ejaculation (PE). Methods: This prospective hospital-based cross-sectional case-control study has been carried on 104 PE patients (30 patients with primary lifelong PE and 74 patients with acquired PE) compared to 90 healthy men as controls. Results: DHT levels were significantly higher in secondary PE compared to primary PE group (p = 0.011). Besides, serum E2 showed significant higher level among both primary and secondary PE groups compared to the control group (p=0.001). Moreover, both total testosterone (TT)/E2 and DHT/E2 ratios were significantly lower in both primary and secondary PE compared to the control group (p=0.001 for both). Furthermore, DHT/E2 ratio showed fair discriminating ability between PE and healthy controls (AUC = 0.749, p=0.001). Conclusions: Both TT/E2 and DHT/E2 ratios were significantly lower in both primary and secondary PE subjects suggesting a role of hormonal imbalance in this context. Although this link seems likely, large-scale studies are needed to confirm these findings.

A Study of Differences in Penile Dorsal Nerve Somatosensory Evoked Potential Testing Among Healthy Controls and Patients With Primary and Secondary Premature Ejaculation

BackgroundPenile dorsal nerve somatosensory evoked potential (DNSEP) is a scientific and objective technique that provides effective and objective data to establish the diagnosis of premature ejaculation (PE). AimTo explore differences in DNSEP between patients with primary premature ejaculation (PPE) and those with secondary premature ejaculation (SPE), in order to investigate the clinical value of DNSEP in the diagnosis of PE. MethodsThe participants were divided into a PPE group (34 cases), an SPE group (25 cases) and a healthy control group (18 cases). All participants underwent DNSEP testing, and the latencies and amplitudes of DNSEP were recorded. OutcomesDifferences in the latencies and amplitudes of DNSEP were compared among the PPE, SPE, and healthy control groups. ResultsThe latencies of DNSEP in the PPE and SPE groups were shorter than those in the healthy control group, and these differences were statistically significant (P < 0.01). However, there was no statistically significant difference between the PPE and SPE groups (P > 0.05). The amplitudes of DNSEP in the PPE group were significantly higher than those in the healthy control group (P < 0.01). However, the amplitudes of DNSEP in the SPE group were significantly lower than those in the healthy control group (P < 0.05). Clinical ImplicationsPPE and SPE can be differentiated based on differences in the amplitudes of DNSEP, providing an objective basis for treatments and follow-up examinations. Strengths and LimitationsWe evaluated differences in the amplitudes of DNSEP between PPE and SPE patients, which were rare in the published literature. However, specific causes of these differences are still unclear. SEP only reflects afferent pathways in the ejaculatory reflex arc, and role of the brain as a higher center should not be ignored. ConclusionBoth PPE and SPE patients are characterized by an increased excitability of the penile sensory nerves. Sun Z, Liao Z, Zheng Q, et al. A Study of Differences in Penile Dorsal Nerve Somatosensory Evoked Potential Testing Among Healthy Controls and Patients With Primary and Secondary Premature Ejaculation. J Sex Med Rev 2021;18:732–736.