Treatment Of Primary Premature Ejaculation Research Articles

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.

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

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

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.

Comparison of the Efficacy of Tramadol and Paroxetine in the Management of Premature Ejaculation.

ObjectiveThe goal of this study was to compare the efficacy of tramadol and paroxetine in the treatment of primary premature ejaculation (PE).Study designThis study was a randomized controlled trial performed in the outpatient department of Nishtar Hospital, Multan, from January 2017 to January 2018.MethodologyOne hundred six patients were diagnosed with PE and included in the study. The patients were categorized into two groups receiving either tramadol or paroxetine through a lottery randomization method. The main variables were baseline PE, baseline satisfaction after intercourse, baseline intravaginal ejaculatory latency time (IELT), ejaculation control, difficulty in ejaculation, and after-treatment satisfaction with sexual intercourse and IELT. We used IBM SPSS Statistics for Windows, Version 23.0 (Armonk, NY: IBM Corp.) for data analysis, and p≤0.05 was considered statistically significant.ResultsEjaculation control, difficulty in ejaculation, and distress due to ejaculation in patients in the tramadol group was noted as 24.5%, 7.5%, and 7.5%, respectively. Ejaculation control, difficulty in ejaculation, and distress due to ejaculation in the paroxetine group was noted as 49.1%, 17%, and 24.5%, respectively. The differences were statistically significant within the groups at baseline and after treatment of PE (p<0.001).ConclusionTramadol is an effective and useful drug as compared to paroxetine for the treatment of PE. Tramadol can be used as an alternative to other medications for the treatment of lifelong PE.

The efficacy of regular penis-root masturbation, versus Kegel exercise in the treatment of primary premature ejaculation: A quasi-randomised controlled trial.

To explore the efficacy of regular penis-root masturbation (PRM) versus Kegel exercise (KE) in the treatment of primary premature ejaculation (PPE). This study was a prospective quasi-randomised controlled trial. Thirty-seven heterosexual males with PPE were selected according to the time sequence of outpatient consultations and the preliminary results of a pre-experiment and were assigned to an PRM group and a KE group. Differences in intravaginal ejaculatory latency times (IELTs) and premature ejaculation diagnostic tool (PEDT) scores were compared between the two groups. The study was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University. Among the 37 PPE patients, 18 performed PRM and 19 patients performed KE. The IELTs of patients who performed PRM and KE were significantly prolonged before treatment, and the difference after treatment was statistically significant (p<.05). Compared with the KE group, the IELT prolongation effect in the PRM group was more significant PRM (p<.05). The PEDT scores of patients after performing PRM and KE were significantly lower than those before performing these exercises (p<.05). Compared with the KE group, the PEDT scores of the PRM group exhibited a greater decrease (p<.05). Thus, both PRM and KE have therapeutic effects on PPE. Compared with KE, PRM is more effective in the treatment of PPE.

Effect of premature ejaculation desensitisation therapy combined with dapoxetine hydrochloride on the treatment of primary premature ejaculation.

To evaluate the overall treatment benefits of premature ejaculation desensitisation therapy combined with 30mg dapoxetine hydrochloride treatment on patients with primary premature ejaculation (PPE). Ninety-nine PPE patients were randomly divided into two groups at the ratio of 2:1. Sixty-six PPE patients received premature ejaculation desensitisation therapy accomplished by Weili Automatic Semen Collection-Penis Erection Detection and Analysis workstation (WLJY-2008) combined with 30mg dapoxetine hydrochloride treatment (DTCD group), and another 33 patients received 30mg dapoxetine hydrochloride-only treatment (DO group). Intravaginal ejaculation latency time (IELT) and premature ejaculation profile (PEP) were recorded before and during the treatment, and clinical global impression of change (CGIC) in PPE was recorded at the fourth week and the end of the treatment and the items. In both groups were significantly improved (p<0.0001) in IELT, PEP and CGIC for premature ejaculation compared with baseline, and DTCD treatment showed a more significant improvement on PPE patients in the items compared with DO treatment (p<0.05). Thus, premature ejaculation desensitisation combined with dapoxetine therapy may be a better choice for improving premature ejaculation with PPE.

No effect of abstinence time on nerve electrophysiological test in premature ejaculation patients.

The nerve electrophysiological tests may differentiate the treatment of primary premature ejaculation (PPE) in our previous studies. However, no study verifies if the results will be affected by abstinence time. From January to December in 2016, fifty PPE patients ejaculated within 2 min and 28 control subjects were enrolled. The nerve electrophysiological tests, including dorsal nerve somatosensory evoked potential (DNSEP), glans penis somatosensory evoked potential (GPSEP), and penile sympathetic skin response (PSSR), were recorded before and immediately after ejaculation. The abstinence day was not correlated with the latencies of SEPs or PSSR neither in PE group (P = 0.170, 0.064, and 0.122, respectively) nor in control group (P = 0.996, 0.475, and 0.904, respectively). No statistically differences were found in the latencies of SEPs and PSSR before and after ejaculation in PE patients (P = 0.439, 0.537, and 0.576, respectively) or control subjects (P = 0.102, 0.198, and 0.363, respectively). Thus, abstinence time does not interfere with the nerve electrophysiological test, which is stable in determining the nerve function of PPE patients.

Efficacy of combined traditional Chinese medicine spray with premature ejaculation desensitization therapy for the treatment of primary premature ejaculation

We recommend a new kind of spray made from eight kinds of traditional Chinese medicine, we aimed to investigate the safety and clinical efficacy of combined traditional Chinese medicine spray (TCMS) with premature ejaculation desensitization therapy (PEDT) for the treatment of primary premature ejaculation (PPE). A total of 90 patients with PPE were randomly assigned to receive TCMS, PEDT monotherapy or TCMS plus PEDT combination therapy for 6 weeks. Intravaginal ejaculation latency time (IELT) and Chinese index of sexual function for premature ejaculation (CIPE-5) were measured to evaluate the effect of each treatment. Eighty six (86) participants completed the study voluntarily. Both IELT and CIPE-5 in these three groups increased after treatment when compared with baseline levels (p< 0.01). IELT and CIPE-5 after treatment in TCMS plus PEDT group were significantly higher than those in the other two groups (both p <0.05). Additionally, clinical efficacy in TCMS plus PEDT group (89.7%) was significantly higher than in TCMS (65.5%) and PEDT group (67.9%) (p< 0.01). The self-made TCMS was safe and effective for the treatment of PPE, a combination of TCMS and PEDT therapy was more effective than the TCMS or PEDT monotherapy.

Lidocaine/prilocaine spray for premature ejaculation

Although premature ejaculation is the most common ejaculation problem, it is poorly understood and currently has no standard definition.1 Typically, it involves reduced time to ejaculation, inability to control or...

Evaluation of dapoxetine hydrochloride in treatment of primary premature ejaculation

Objective: The aim of the study was to evaluate the role of dapoxetine in treatment of primary premature ejaculation (PE). Background: PE is regarded as the most common male sexual disorder. To date, there is no accurate and objective diagnostic test or specific treatment for PE. Dapoxetine hydrochloride is recently developed for treatment of primary PE. It is a short-acting selective serotonin reuptake inhibitor. Although it was refused by the food and drug administration (FDA) in 2005, it is now available in many countries, including Egypt, for treatment of PE. Its efficacy and side effects are not fully studied and few studies exist in this regard with controversial results. Materials and methods: This was a double-blind, placebo-controlled, cross-over study. It included 24 patients with primary PE, selected according to the International Society of Sexual Medicine definition of primary PE with intravaginal ejaculatory latency time (IELT) less than 1 min. The patients received dapoxetine 60 mg and placebo for 6 weeks, each with 2 weeks in between as a washout period. The drug and placebo were received on demand 1–3 h before the sexual activity. Efficacy and tolerability were evaluated by IELT and Arabic index of premature ejaculation (AIPE) mean score changes, and the side effects were reported upon at baseline and at 1, 3, and 6 weeks. Results: Dapoxetine significantly increased IELT by first, third, and sixth week and the geometric mean by 5.15 ± 0.17 folds, and with dapoxetine (60 mg) the AIPE became normal in 88.9% of patients by the sixth week, whereas placebo failed to give any change. Conclusion: Dapoxetine is a promise drug for PE as on-demand treatment. Dapoxetine significantly improved the IELT and AIPE, and it is well tolerated.

AB151. Clinical study on the treatment of lifelong premature ejaculation with paroxetine hydrochloride and tamsulosin

Background and objectiveThere are some methods for the treatment of primary premature ejaculation (PE) at present, but its efficacy and safety is not very good and the effectiveness of some treatment method remains to be further confirmed. Psychotherapy and behavior training therapy has a poor adherence for patients. The surgical treatment to PE has not been widely recognized by experts because its effect of uncertainty and may cause irreversible damage. So, pharmaceutical drug therapy is usually recommended as the first priority selection for the treatment of PE. At present, only the dapoxetine was specifically developed for the treatment of PE worldwide. Other off-label selective serum reuptake inhibitor substance (SSRIs) such as paroxetine, fluoxetine; local anesthetics such as lidocaine, prilocaine cream; PDE5 inhibitor such as tadalafil, sildenafil and vardenafil; selective alpha-adrenergic receptor blockers such as tamsulosin, silodosin was also used for the treatment of PE. Owing to the individual differences and the different causes of PE, the efficacies of one medicine in different patients are different. So, individual-based treatment could be the trend for the treatment of PE according to the specific causes and its classification. There is quite a few researches focus on the combination treatment of SSRIs and α-receptor blockers to PE. In this study, the efficacy and safety using paroxetine and hydrochloric tamsulosin for the treatment of PE were evaluated, the serum concentration of 5-HT in the PE patients before and after treatment were assessed, and the mechanism of SSRIs for the treatment of PE were discussed.MethodsA total of 225 cases of men with 18-65 years of age, a history of lifelong PE and an intra-vaginal ejaculation latency time (IELT) <120 sec were included in this study. The patients were randomized divided into three groups. Group A were given paroxetine hydrochloride 20 mg/d for 8 weeks; group B were given tamsulosin 0.2 mg/d for 8 weeks; group C were given paroxetine hydrochloride and tamsulosin at the same dosage as above for 8 weeks. The effects and adverse events were evaluated by the overall change and folds increase in average IELT and the mean change in all four measures of the premature ejaculation profile (PEP). Blood sample was got from the candidates before and after treatment. The plasma concentration of 5-HT was measured by ELISA. All the data were statistically analyzed.ResultsThe reliable data from 198 patients were achieved. The mean IELT in group A was increased from 1.23 to 8.52 min and increased for 7.29 min after treatment; the mean IELT in group B was increased from 1.16 to 2.30 min and increased for 1.14 min after treatment; the mean IELT in group C was increased from 1.16 to 9.31 min and increased for 8.15 min after treatment; the mean IELT after treatment were significantly improved in all groups than that of before treatment (group B: P<0.01; group A,C: P<0.001). The increased folds of mean IELT in group C (8.02 folds) was significantly higher than that in group B (1.98 folds) and group A (6.92 folds) (P<0.001). The mean PEP scores that include measures of perceived control over ejaculation, satisfaction with sexual intercourse, ejaculation-related personal distress, and ejaculation-related interpersonal difficulty were significantly improved in all groups after treatment. The mean PEP scores in group C have more significant improvements than that in group A and B. The prevalence of adverse events in group A,B,C were 13.3% (10 cases), 2.6% (2 cases) and 12.0% (9 cases), respectively. The mean plasma concentration of 5-HT in group A,B,C before treatment was significant lower than that in normal control group (P<0.001). The mean plasma concentration of 5-HT in group A and C was significant improved (P<0.001) and there is no significant difference between group A and C after treatment (P>0.05). The plasma concentration of 5-HT in group B did not change after treatment (P>0.05).ConclusionsParoxetine hydrochloride combined with tamsulosin produce more better therapeutic effects and could be a priority selection for the treatment of primary PE. The plasma concentration of 5-HT can be used as the objective diagnostic index of primary PE, and to some extent, it is meaningful for the assessment of treatment effect of SSRIs.

Can sildenafil treat primary premature ejaculation? A prospective clinical study

Recently, sildenafil has been demonstrated to be effective in treating premature ejaculation (PE). However, these studies ignored female factors and could not exclude the probability of drug interaction when combined with paroxetine. Therefore, the aim of this study was to evaluate the efficacy and safety of sildenafil alone in the treatment of primary PE, taking female factors into consideration. One hundred and eighty potent men with primary PE were randomly divided into three groups and followed up for 6 months. Group A were treated with 50 mg sildenafil as needed, group B with 20 mg paroxetine daily and group C with squeeze technique daily. Intravaginal ejaculatory latency time (IELT), PE grade, intercourse satisfactory score (ISS), frequency of intercourse, and adverse effects of drugs were recorded before treatment, and 3 and 6 months after treatment. Compared with pretreatment, the three groups had significant differences in all the parameters after 3 or 6 months treatment, except the frequency of intercourse in Group C (all P = 0.00). However, there were no significant differences between 3 and 6 months. Compared with paroxetine and squeeze technique, after 3 or 6 months, sildenafil had significant differences in all the parameters (all P = 0.00). After 6 months, 1.7%, 18.3% and 36.7% patients in groups A, B and C, respectively, withdrew from the study and 86.7%, 60.0% and 45.0% patients, respectively, wanted to be treated further with the original administration, and this was statistically significant (both P = 0.00). Sildenafil is very effective and safe to treat PE, and has much higher efficacy than paroxetine and squeeze technique.