An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation

Real-life use of the eutectic mixture lidocaine/prilocaine spray in men with premature ejaculation

Topical anaesthetics are considered a first-line therapy option in men with premature ejaculation (PE). A cross-sectional retrospective analysis was performed to evaluate the real-life use of the eutectic mixture of prilocaine/lidocaine spray (FORTACIN™) in a cohort of 198 white-European men who had been consecutively and prospectively seen at a single tertiary-referral andrology centre for self-reported PE and naive for previous PE treatments. Descriptive statistics was used to describe the whole cohort and the paired t-test was applied to investigate potential differences throughout a 12-month follow-up (baseline, 1, 3, 6 and 12 months). Overall, mean (SD) age was 37 (6.5) years. Of all, lifelong, acquired and subjective PE were reported in 101 (51%), 59 (29.8%) and 38 (19.2%) patients at baseline, respectively. FORTACIN™ use increased up to 6 months, with 184 (92.9%) and 128 (66.4%) men who had tried and regularly used the compound, respectively. At 12-month follow-up, 53 (26.8%) men reported a regular use of the compound. Mean Premature Ejaculation Diagnostic Tool score significantly decreased at 6 and 12 months compared to baseline (all p < 0.05). Conversely, mean IELT significantly improved at 6-month follow-up compared to baseline (all p ≤ 0.04). Overall, FORTACIN™ emerged to be a safe and effective treatment option in PE patients of various types, with almost one fourth of patients still under treatment after 12 months. Timing and dosing of the drug can deserve to be adjusted according to patient's needs and their sexual ecology.

Self-Reported Shorter Than Desired Ejaculation Latency and Related Distress-Prevalence and Clinical Correlates: Results From the European Male Ageing Study

BACKGROUND

Few data have looked at the occurrence and clinical correlates of self-reported shorter than desired ejaculation latency (rapid ejaculation, RE) and its related distress in the general population.

AIM

To determine the prevalence and clinical correlates of self-reported RE and RE- related distress in middle age and older European men.

METHODS

Subjects were recruited from population samples of men aged 40-79 years across 8 European centers.

OUTCOMES

Self-reported RE and its related distress were derived from the European male Aging Study (EMAS) sexual function questionnaire (EMAS-SFQ). Beck's depression Inventory (BDI) was used for the quantification of depressive symptoms, the Short Form 36 health survey (SF-36) for the assessment of the quality of life, the International Prostate Symptom Score (IPSS) for the evaluation of lower urinary tract symptoms.

RESULTS

About 2,888 community dwelling men aged 40-79 years old (mean 58.9 ± 10.8 years) were included in the analysis. Among the subjects included, 889 (30.8%) self-reported RE. Among them, 211 (7.3%) claimed to be distressed (5.9% and 1.4% reported mild or moderate-severe distress, respectively). Increasing levels of RE-related distress were associated with a progressive worse sexual functioning, higher risk of ED and with couple impairment, along with a higher prevalence of depressive symptoms (all P < 0.05). Furthermore, a worse quality of life and higher IPSS score were associated with RE-related distress (all P < 0.05). The aforementioned results were confirmed even when patients using drugs possibly interfering with ejaculation or those without a stable relationship were excluded from the analysis.

CLINICAL IMPLICATIONS

RE is a frequent condition in men from the general population; however, its related distress is relatively modest. Nonetheless, men with any degree of self-reported RE show increasing levels of depression, worse quality of life and worse couple satisfaction.

STRENGTHS & LIMITATIONS

This is the first study estimating the prevalence of self-reported RE and its related distress, along with their biological and psychological correlates, in a population sample of European middle age and older men. However, is should be recognized that the diagnosis of RE was derived from patient reports and not supported by Intra-ejaculatory-Latency-Time (IELT) measurements.

CONCLUSION

Self-reported RE is relatively common in European men aged more than 40 years. The reported limited RE-related distress may explain the relatively low number of medical consultations for RE. RE-related distress is associated with worse sexual function, couple impairment, and more LUTS resulting in a worse quality of life and mood disturbances. Corona G, Rastrelli G, Bartfai G, et al. Self-Reported Shorter Than Desired Ejaculation Latency and Related Distress-Prevalence and Clinical Correlates: Results From the European Male Ageing Study. J Sex Med Rev 2021;18:908-919.

Selective serotonin re-uptake inhibitors for premature ejaculation in adult men

BACKGROUND

Premature ejaculation (PE) is a common problem among men that occurs when ejaculation happens sooner than a man or his partner would like during sex; it may cause unhappiness and relationship problems. Selective serotonin re-uptake inhibitors (SSRIs), which are most commonly used as antidepressants are being used to treat this condition.

OBJECTIVES

To assess the effects of SSRIs in the treatment of PE in adult men.

SEARCH METHODS

We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, CINAHL), clinical trial registries, conference proceedings, and other sources of grey literature, up to 1 May 2020. We applied no restrictions on publication language or status.

SELECTION CRITERIA

We included only randomized controlled clinical trials (parallel group and cross-over trials) in which men with PE  were administered SSRIs or placebo. We also considered 'no treatment' to be an eligible comparator but did not find any relevant studies.

DATA COLLECTION AND ANALYSIS

Two review authors independently classified and abstracted data from the included studies. Primary outcomes were participant-perceived change with treatment, satisfaction with intercourse and study withdrawal due to adverse events. Secondary outcomes included self-perceived control over ejaculation, participant distress about PE, adverse events and intravaginal ejaculatory latency time (IELT). We performed statistical analyses using a random-effects model. We rated the certainty of evidence according to GRADE.

MAIN RESULTS

We identified 31 studies in which 8254 participants were randomized to receiving either SSRIs or placebo. Primary outcomes: SSRI treatment probably improves self-perceived PE symptoms (defined as a rating of 'better' or 'much better') compared to placebo (risk ratio (RR) 1.92, 95% confidence interval (CI) 1.66 to 2.23; moderate-certainty evidence). Based on 220 participants per 1000 reporting improvement with placebo, this corresponds to 202 more men per 1000 (95% CI 145 more to 270 more) with improved symptoms with SSRIs.  SSRI treatment probably improves satisfaction with intercourse compared to placebo (defined as a rating of 'good' or 'very good'; RR 1.63, 95% CI 1.42 to 1.87; moderate-certainty evidence). Based on 278 participants per 1000 reporting improved satisfaction with placebo, this corresponds to 175 more (117 more to 242 more) per 1000 men with greater satisfaction with intercourse with SSRIs. SSRI treatment may increase treatment cessations due to adverse events compared to placebo (RR 3.80, 95% CI 2.61 to 5.51; low-certainty evidence). Based 11 study withdrawals per 1000 participants with placebo, this corresponds to 30 more men per 1000 (95% CI 17 more to 49 more) ceasing treatment due to adverse events with SSRIs.  Secondary outcomes: SSRI treatment likely improve participants' self-perceived control over ejaculation (defined as rating of 'good' or 'very good') compared to placebo (RR 2.29, 95% CI 1.72 to 3.05; moderate-certainty evidence). Assuming 132 per 1000 participants perceived at least good control, this corresponds to 170 more (95 more to 270 more) reporting at least good control with SSRIs.  SSRI probably lessens distress (defined as rating of 'a little bit' or 'not at all') about PE (RR 1.54, 95% CI 1.26 to 1.88; moderate-certainty evidence). Based on 353 per 1000 participants reporting low levels of distress, this corresponds to 191 more men (92 more to 311 more) per 1000 reporting low levels of distress with SSRIs.  SSRI treatment probably increases adverse events compared to placebo (RR 1.71, 95% CI 1.48 to 1.99; moderate-certainty evidence). Based on 243 adverse events per 1000 among men receiving placebo, this corresponds to 173 more (117 more to 241 more) men having an adverse event with SSRIs.  SSRI treatment may increase IELT compared to placebo (mean difference (MD) 3.09 minutes longer, 95% CI 1.94 longer to 4.25 longer; low-certainty evidence).

AUTHORS' CONCLUSIONS

SSRI 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. Undesirable effects are a small increase in treatment withdrawals due to adverse events as well as substantially increased adverse event rates. Issues affecting the certainty of evidence of outcomes were study limitations and imprecision.

Topical Treatment of Premature Ejaculation: The Rise of Anesthetic Spray Formulations?

Topical anesthetics are one of the first line therapeutical options for men with premature ejaculation (PE). Real-life PE management often involves a range of interventions including systemic drug treatments (such as off-label and on-label selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, phosphodiesterase-5 inhibitors (PDE5Is)), topical anesthetic creams and sprays, and behavioral approaches. Among them, on-demand dapoxetine and lidocaine/prilocaine spray formulations are the only approved treatment options for lifelong PE. The earliest strategy to treat PE was based on the use of topical anesthetic agents. The rationale behind the use of anesthetics is that by reducing the glans penis sensitivity, the spinal and cerebral input of sexual arousal impulses may also be reduced. Oral SSRI proved to be effective to treat PE, but their high rate of side effects limit treatment adherence and both short and long term follow up data are lacking. Conversely, topical anesthetics have proved to increase ejaculatory latency, control, and sexual satisfaction in couple affected by PE with limited rates of adverse events. In this context, we aimed to perform a narrative review to summarize the most recent findings regarding the use of topical treatments for PE.

Safety and Effectiveness of Dapoxetine On Demand in Chinese Men With Premature Ejaculation: Results of a Multicenter, Prospective, Open-Label Phase IV Study

INTRODUCTION

Dapoxetine on demand has been approved for premature ejaculation (PE) management in China; however, studies on the efficacy and safety of this treatment in the Chinese population are scarce.

AIM

The aim of this study was to evaluate the safety and effectiveness of dapoxetine 30 mg and 60 mg on demand in Chinese men with PE.

METHODS

Phase IV real-world study on 1,252 patients with PE. If men reported no response to dapoxetine 30 mg after 4 weeks treatment, dapoxetine has been uptitrated at 60 mg for 4 weeks more.

MAIN OUTCOME MEASURE

Self-reported data were collected for demographics, general and sexual health characteristics, PE severity, and treatment safety and effectiveness, as measured by the PE profile questionnaire.

RESULTS

Adverse events (AEs), such as nausea, thirst, headache, and dizziness, similarly to previous literature, were detected. The treatment-emergent AEs rate was higher in the patients treated with 30 and 60 mg (n = 192) compared with those treated with the dapoxetine 30 mg only (n = 1060) (34.4% vs 15.8%, respectively). No new safety concerns were observed. The overall effectiveness rates were 88.2% in subjects using 30 mg of dapoxetine, whereas a rescue from the previous failure was in 55.7% in the patients who received 60 mg after the initial 30 mg. Overall, 83.2% responded to dapoxetine at dosages equal to or lower than 60 mg.

CONCLUSION

The results in this study demonstrated in a large Chinese population that on-demand dapoxetine is a safe and effective symptomatic treatment in patients with PE. J Peng, L Yang, L Liu, et al. Safety and Effectiveness of Dapoxetine On Demand in Chinese Men With Premature Ejaculation: Results of a Multicenter, Prospective, Open-Label Phase IV Study. Sex Med 2021;9:100296.

Sexual Dysfunction Among Men Who Have Sex with Men: a Review Article

PURPOSE OF REVIEW

The goal of this review article is to evaluate sexual dysfunction among men who have sex with men (MSM).

RECENT FINDINGS

Men who have sex with men are commonly affected by sexual dysfunction. Often sexual dysfunction in MSM will significantly impact their psychological well-being perhaps even more than their heterosexual counterparts. Despite the frequency and high impact of sexual dysfunction in MSM, access to appropriate care may be limited. It is important for urologists, especially sexual medicine clinicians, to be aware of and comfortable with differences in sexual practices of MSM. Penile pathology in this patient population will negatively affect their quality of life and well-being. Therefore, it is important to properly assess and treat these patients.

Construction and internal validation of a prediction nomogram for acquired premature ejaculation (APE) in PE patients

Background

A predictive model for acquired premature ejaculation (APE) in PE patients has not yet been established.

Objectives

This study was aimed at determining which factors were independently associated with the possibility of predicting APE in PE patients, and whether an effective pre‐treatment nomogram for predicting their individual chances of being APE in PE patients can be developed.

Materials and methods

We analyzed the medical histories of 915 PE patients diagnosed at Xijing Hospital (Xi'an, China) and Northwest Women's and Children's Hospital (Xi'an, China) between May 2019 and May 2020. The diagnostic nomogram was developed using a multivariate logistic regression model by integrating selected significant variables determined through univariate analysis. Receiver operating characteristic curves were used to measure the predictive accuracy of the nomogram and its constituted variables, and calibrations were performed by making a comparison of nomogram‐predicted probability with actual rate of APE.

Results

The independent predictors for APE that were identified include Age, Intra‐vaginal Ejaculation Latency Time (IELT), Frequency of sexual desire (FSD), and Eysenck Personality Questionnaire‐Revised Short Scale for Chinese (psychoticism) [EPQ‐RSC(P)] scores. The predictive accuracy of the nomogram was 0.782 (95% CI: 0.723–0.841). Also, excellent agreement was demonstrated between the nomogram‐predicted probability and the actual rate of APE.

Discussion and conclusion

We identified 4 independent predictors for APE and demonstrated the potential significant differences in psychoticism between LPE and APE patients. This was the first internally validated predictive APE nomogram where good discrimination and calibration were applied, and it offers a promising role in clinical practice. More studies are necessary for verification of its universal applicability.

Glans penis augmentation using hyaluronic acid for the treatment of premature ejaculation: a narrative review

Premature ejaculation (PE) is the most common self-reported male sexual disorder estimated to occur in approximately 5% of men in the general community. Penile hypersensitivity is thought to be an etiologic factor of lifelong PE. The role of glans penis augmentation using injectable hyaluronic acid (HA) for the treatment of PE is debatable and remains to be confirmed. The creation of a barrier at the level of the glans, by the bulking agent blocking accessibility and inhibiting the tactile stimuli to reach the dorsal nerve of the penis (branch of the pudendal nerve) receptors, is the theory behind the effectiveness of HA in the field of PE. We reviewed the literature using PubMed and searched for the following keywords: premature ejaculation, glans penis and HA, over the last 20 years. Five studies were found. These studies showed that HA injection could significantly increase IELT (2.43- to 4.46-fold), and this increase could persist for long term (up to 5 years). No serious adverse reactions were reported besides transient discoloration and swelling of the glans that recovered to normal within 2 weeks. Many techniques were discussed, their effectiveness remains to be proved. However, proper patient selection and mastering the esthetics of the technique, by adequate surgical training, is necessary in order to achieve the optimal results.

Relationship between atherogenic indices and acquired premature ejaculation

The aim of this study is to evaluate blood lipid parameters and level of atherogenic indices in acquired premature ejaculation (PE) patients. Between 2020 January and June 2020, 96 patients diagnosed with PE in our clinic and 84 control patients who applied to the urology outpatient clinic for other urological reasons were included in the study. Detailed medical and sexual histories of the patients were taken, and physical examination findings were recorded. In addition, 5-question premature ejaculation diagnostic tool (PEDT) was applied to patients and estimated intravaginal ejaculation latency times (IELT) were recorded. The mean values of lipid parameters; Risk Index of Castelli-1 (CRI-1 (Total cholesterol/ HDL)), CRI-2 (LDL/ HDL), Atherogenic Index of Plasma (AIP (log10 (triglyceride/ HDL)) and Atherogenic Coefficient (AC (HDL/ non-HDL)) were calculated. The average PEDT score was 7.68 + 5.05 (2-22), and the IELT arithmetic mean was 150.39 + 121.53 (5-900) seconds. In the APE group, triglyceride and AIP values were found to be higher than the control group (triglyceride: 188.75 + 76.39 versus 157.20 + 87.45; p = .049; AIP: 0.46 + 0.33 versus 0.35 + 0.35; p = .040). A fair positive correlation was found between PEDT scores and AIP values (r = .355, p < .001). AIP was found to be related to APE, and it was also found to be related to symptom severity.

Association between the serotonin transporter linked polymorphic region and lifelong premature ejaculation: An updated meta-analysis of case-control studies

Previous studies on the association between serotonin transporter linked polymorphic region (5-HTTLPR) polymorphism and premature ejaculation (PE) have led to inconsistent results. The purpose of the present meta-analysis was to examine whether 5-HTTLPR polymorphism is associated with PE susceptibility.All eligible studies were searched and acquired from PubMed, Embase, Science Direct, CNKI, and Wanfang databases according to inclusion and exclusion criteria. Odds ratios (ORs) with 95% confidence intervals (CIs) were computed to assess the strength of the association between 5-HTTLPR polymorphism and PE. In addition, heterogeneity test, publication bias and sensitivity analysis were also conducted.Firstly, the association were observed in 8 studies (L vs S: OR = 0.74, 95% CI = 0.63-0.87; LL vs SS: OR = 0.61, 95% CI = 0.44-0.83; SL vs SS: OR = 0.73, 95% CI = 0.55-0.96; LL + SL vs SS: OR = 0.67, 95% CI = 0.52-0.86; LL vs SL + SS: OR = 0.72, 95% CI = 0.55-0.92). When the 2 studies not in Hardy-Weinberg equilibrium (HWE) were omitted, a positive association could only be observed between the 5-HTTLPR polymorphism and PE in allele contrast model (L vs S: OR = 0.81, 95% CI = 0.67-0.98). In the stratified analysis by subgroup, significantly associations were also found between PE and 5-HTTLPR polymorphism in Caucasians but not Asians (L vs S: OR = 0.79, 95% CI = 0.63-0.98; LL + SL vs SS: OR = 0.67, 95% CI = 0.46-0.96).Our meta-analysis demonstrated that the 5-HTTLPR polymorphism was associated with the susceptibility to PE in the Caucasian population. Compared with S allele, L allele is likely to be less susceptible to PE.

Evaluation of Drug Abuse in Patients With Lifelong Premature Ejaculation: A Cross-Sectional Study

Introduction

Most studies investigate sexual dysfunction in drug abusers; however, there are no data available about the pattern of drug abuse in patients with lifelong premature ejaculation (PE).

Aim

To assess the pattern of drug abuse in patients with lifelong PE and to evaluate its potential effect on their hormonal profile.

Methods

A cross-sectional study included patients with lifelong PE (n = 76) with no prescribed medications for 1 month and age-matched control without PE (n = 48). Participants were evaluated by history, examination, Arabic index of PE, and hormonal profile. A urine sample was screened by dipstick kits for the following drug abuse tramadol, opiate, tetrahydrocannabinol (cannabis), amphetamine, barbiturate, cocaine, and benzodiazepines. Positive results were confirmed with a immunoassay drug analyzer.

Main outcome measures

The outcomes of this study are positive and negative drug abuse and hormonal profile changes.

Results

Control patients and patients with PE showed median (interquartile range) of age 43 (33–46.8) and 38.5 (31–45) years, respectively. Drug abuse testing results showed significantly high positive drug abuse in patients with PE, 26 of 76 (34.2%), in comparison with control, 9 of 48 (19.1%) (P = .05). The most commonly abused drug was tetrahydrocannabinol in control, 3 of 9 (33.3%), and tramadol, 12 of 26 (46.2%), in patients with PE. Control patients and patients with PE with positive drug abuse had significantly higher smoking percent (P < .0001) and higher positive drug abuse history (P < .0001). However, there was no relationship between drug abuse and PE severity, and there were no significant changes in their hormonal profile.

Conclusions

Drug abuse is high among patients with lifelong PE in Upper Egypt, with tramadol being the comment drug. Drug abuse is common among smokers. However, no hormonal disturbance could be shown in drug abuse patients. Drug abuse might be considered in the evaluation of patients with PE.

Mohammed SA, Abdelhamed A, El Sayed RM. Evaluation of Drug Abuse in Patients With Lifelong Premature Ejaculation: A Cross-Sectional Study. Sex Med 2020;8:608–614.

Premature ejaculation in couples using contraceptive withdrawal and associations with characteristics of its use: A cross-sectional study

This study aimed to investigate the Premature Ejaculation Profile (PEP) and its related factors in couples using contraceptive withdrawal (WD). The study sample was composed of 108 participants including 54 males and 54 females (their partners) who used WD. The data were collected via a questionnaire and the male and female forms of the PEP. The mean total PEP index score of the couples (female (F); 1.69 ± 0.55 and male (M); 1.65 ± 0.36) was below the average possible score. Although both males and their partners generally rated control over ejaculation (F; 57.4%, M; 61.1%) and satisfaction with sexual intercourse (F; 63%, M; 79.7%) as good/very good, they rate personal distress related to ejaculation (F; 64.8%, M; 83.4%) and interpersonal difficulty related to ejaculation (F; 81.5%, M; 92.6%) as 'extremely/quite a lot'. As the time of using WD increased, male control over ejaculation increased (p = .019); as the marriage duration (p = .045) and ages (F; p = .012, M; p = .045) of the couples increased, their problems related to ejaculation increased. According to the results, couples who use WD experience PE-related problems, and the problems they experience vary depending on the period of WD use, marriage duration and age.

Efficacy of microsurgical varicocelectomy in the treatment of premature ejaculation: A protocol for systematic review and meta-analysis

INTRODUCTION

Premature ejaculation (PE) is the most common type of sexual disorder among men which comprises a great of problems. Varicocele is defined as the dilation of the pampiniform venous plexus draining the testicle. At present, selective serotonin reuptake inhibitors antidepressants, topical anesthetics, tramadol, phosphodiesterase type 5 inhibitors are the common alternative strategy to improve PE. However, these therapeutic measures have several shortcomings and side effects. Recently, the correlation between varicocele and PE has attracted the attention of some researchers. A few studies consider microsurgical varicocelectomy can be a new remedy for PE. But it is still absent enough a great deal of convincing evidence. The study will assess the effectiveness and safety of the microsurgical varicocelectomy treatment in PE patients.

METHODS AND ANALYSIS

Electronic databases including English databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, China Biology Medicine Database, Wanfang Database, VIP Database) will be searched from their inception to December 2020 to recognize related studies. All the randomized controlled trials of microsurgical varicocelectomy for the management of PE patients will be included. The potential outcome will include intravaginal ejaculation latency time, Chinese index of sexual function for premature ejaculation-5, visual analogue score, premature ejaculation diagnostic tool, success treatment rate, serum testosterone levels. We will conduct this study strictly according to the Cochrane Handbook for systematic reviews of interventions.

RESULTS

The current study is a protocol for systematic review and meta-analysis without results, and data analysis will be carried out after the protocol. We will share our findings in the February 28, 2021.

CONCLUSION

This systematic review will provide more evidence to assess whether microsurgical varicocelectomy is an effective intervention for patients with PE. The results will be published in a public issue journal and offer the urologists and andrologists help to make clinical decisions.

ETHICS AND DISSEMINATION

Formal ethical approval is not required in this protocol. We will collect and analyze data based on published studies, and since there are no patients involved in this study, individual privacy will not be under concerns. The results of this review will be disseminated to peer-reviewed journals or submit to related conferences.

PROTOCOL REGISTRATION NUMBER

INPLASY202060058.

Brain Cortical Complexity and Subcortical Morphometrics in Lifelong Premature Ejaculation

Premature ejaculation (PE) is the most common male sexual dysfunction. The brain disturbances that cause this disorder remain poorly understood. This study aimed to investigate how the morphology of cortical and subcortical brain structures differed in PE, how these morphologic differences were associated with severity measures of PE, such as intravaginal ejaculatory latency time (IELT), and how these cortical and subcortical structures were causally connected through mediation analysis. Anatomical MRI scans were acquired from 39 male participants, 23 with PE (28.78 ± 4.32 years), and 16 without PE (27.88 ± 3.65 years). We used a subcortical analysis package within FSL to perform subcortical shape segmentation and statistical analysis. The PE group was compared with the normal control (NC) group in the shapes of 15 subcortical structures with general linear models [p < 0.05, family-wise error (FWE)-corrected]. We analyzed the cortical complexity revealed by the gyrification index using the Computational Anatomy Toolbox (CAT12). Vertex-wise shape analyses revealed outward shape deformations (expansions) in the left hippocampus and bilateral thalamus. Gyrification index analyses revealed that the right orbital frontal cortex and the right nucleus accumbens had greater complexity in PE patients. The shape deformations were positively correlated with the IELTs in the NC group, while this relationship was interrupted in the PE group. PE is associated with outward deformations of the subcortical surfaces and more complexity of the cortical structures. These morphological differences may be the basis of the brain functional alterations underlying PE.

Association between 5-hydroxytryptamine transporter gene-linked promoter region polymorphism and the susceptibility of lifelong premature ejaculation: a meta-analysis involving 1,604 subjects

The relationship between 5-hydroxytryptamine transporter-linked promoter region (5-HTTLPR) gene and lifelong premature ejaculation (LPE) risk was discussed widely for the last few years, which was still controversial and remained to be explored. We performed the meta-analysis with 8 reliable research, which were searched in the following databases: PubMed, Embase and Cochrane Library. We also performed random and fixed effects models to evaluate the odds ratios (ORs) and 95% confidence intervals respectively. By pooling all included studies, we found that SS genotype of 5-HTTLPR polymorphism was linked with significantly higher PE risk in Caucasian population (OR =0.635, 95% CI: 0.417–0.958, I²=0.311, P=0.035), and S-allele of 5-HTTLPR polymorphism increased the risk of LPE significantly in Asian population (OR =0.656, 95% CI: 0.539–0.799, I²=0.435, P<0.001). However, no significant was observed between 5-HTTLPR gene polymorphism and LPE risk in overall studies. Further studies were anticipated to be done.

Can low serum brain-derived neurotrophic factor levels be associated with lifelong premature ejaculation?; A pilot study

This study aimed to present the association between the serum level of brain-derived neurotrophic factor (BDNF) and the lifelong pre-mature ejaculation (PE). The data of 40 patients with lifelong PE and 40 healthy controls were evaluated prospectively. PE diagnostic tool and patient-reported outcome measures were performed to the participants. The serum BDNF level measurement was made after the collecting of blood samples in both groups. The mean ± SD age of the PE and control group was 34.43 ± 5.71 and 33.03 ± 3.97 years respectively (p = .228). Only the participant who has been married included in the study, and there was no difference in the mean marriage duration. In both groups, smoking status, alcohol use and body mass index were similar. The median PE diagnostic tool scores were 15 (11-20), and serum BDNF levels were 225.3 (26.1-689.6) ng/ml in the PE group, 5 (0-9) and 540.9 (102.9-769.2) ng/ml in the control group respectively (p < .001 for both). The patients with PE had significantly lower serum BDNF levels. Our study suggests that lower serum BDNF levels may be directly related to lifelong PE.

Trends in reported male sexual dysfunction over the past decade: an evolving landscape

We investigated changes in patterns of reported male SDs at a single academic centre over a 10-year time frame. Comprehensive data of 2013 patients consecutively assessed for the first time by a single Sexual Medicine expert between 2006 and 2019 has been analysed. All patients were assessed with a thorough sexual and medical history. Primary reason for seeking medical help at first assessment was recorded for all patients and categorized as: erectile dysfunction (ED), premature ejaculation (PE), low/reduced sexual desire/interest (LSD/I), Peyronie's disease (PD), and other SDs. Linear and logistic regression models tested the association between different reasons for seeking medical help and the time at first evaluation. Local polynomial regression model explored the probability of reporting different SDs over the analysed time frame. Median (IQR) age at first clinical assessment was 50 (38-61) years. Overall, most patients were assessed for ED (824; 41%), followed by PD (369; 18%), PE (322; 16%), LSD/I (204; 10%) and other SDs (294; 15%). Significant changes in terms of reported SD over the analysed time frame were observed. The likelihood of assessing patients for ED significantly increased up to 2013, with a decrease in the past 5 years (p < 0.001). PE assessment at presentation linearly decreased over time (OR: 0.94; 95% CI: 0.91-0.96; p < 0.001). Patients assessed during the past few years were more likely to report PD (OR: 1.20; 95% CI: 1.15-1.25; p < 0.001) and LSD/I (OR: 1.21; 95% CI: 1.16-1.26; p < 0.001), with a linear increase over the evaluated time frame. Likewise, patients were also more likely to report other SDs (Coeff: 1.06; 95% CI: 1.02-1.10; p = 0.004), with a linear increase over time. These results may reflect real changes in SD incidence, increased public awareness towards different SDs and the possible impact of novel treatments available on the market throughout the same time frame.

Vibrator-Assisted Start-Stop 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.

Ejaculatory Dysfunction in Patients Presenting to a Men's Health Clinic: A Retrospective Cohort Study

Introduction

Prevalence and bother of ejaculatory dysfunction (EjD) has yet to be evaluated in a men's health referral population.

Aim

To evaluate the prevalence and associated risk factors of EjD in men presenting to a men's health clinic.

Methods

A retrospective review examined patients presenting to an outpatient men's health clinic who completed the Sexual Health Inventory for Men and the Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD) Short Form. Patient factors including demographics, comorbidities, and medication were examined. Descriptive statistics and multivariable logistic regression were used.

Main Outcome Measures

The main outcomes of this study are Sexual Health Inventory for Men and MSHQ-EjD scores.

Results

A total of 63 (24%) of patients presenting to the urology clinic were characterized as having EjD based on questionnaire responses. The mean age for men with EjD was 53.8 years, while those without was 42.6 years (P < .001). Of men with EjD, 74.6% were at least moderately bothered (MSHQ-EjD ≥3). Men with EjD were more likely to have erectile dysfunction (77.8%) compared with those without (21%, P < .001) as well as a history of a pelvic cancer (20.6% vs 6%, P = .001). On multivariable regression, erectile dysfunction (odds ratio: 15.04, 95% confidence interval: 6.76–35.92, P < .0001) and alpha inhibitor prescription (odds ratio: 6.82, 95% confidence interval: 1.57–30.16, P = .01) were associated with a higher odds of EjD. ED was found to be a mediator of the relationship between EjD and age, as the age association was lost in the ED population on multivariable regression compared with the non-ED population where it remained significant.

Conclusions

EjD is common among patients presenting to a men's health clinic and may present at varying ages, though it is more common in those aged 50 years or older; it is independent of age and race. EjD is associated with erectile dysfunction, pelvic cancer history, and use of alpha inhibitors, presenting a population that could be considered for screening.

Kasman AM, Bhambhvani HP, Eisenberg ML. Ejaculatory Dysfunction in Patients Presenting to a Men's Health Clinic: A Retrospective Cohort Study. J Sex Med 2020;8:454–460.

Clinical effect of computed guided pudendal nerve block for patients with premature ejaculation: a pilot study

Background: Premature ejaculation has a complex etiology, and its pathophysiology is still unclear, with penile hypersensitivity being the most accepted hypothesis. The aim was to investigate the efficacy and safety of a computed tomography-guided pudendal nerve block at the level of the sacrospinous ligament and the Alcock's canal in patients with premature ejaculation refractory to conventional pharmacological treatment.Methods: This is a prospective pilot study involving five patients suffering from premature ejaculation refractory to standard treatment and clinical features of pudendal nerve entrapment. A CT-guided infiltration of ropivacaine and methylprednisone was done at the levels of sacrospinous ligament and Alcock's canal. Intra-vaginal ejaculatory latency time (IELT) was recorded several times for each patient before and after infiltration. International Index of Erectile Function (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT) and Sexual Quality of Life-Male version (SQoL-M) questionnaire were also evaluated before and after infiltration.Results: Overall IELT differed significantly before and after treatment (21.94 vs 215.42 s; p = 0.039). IIEF-5, PEDT and SQoL-M also differed significantly before and after treatment. No complications for the CT-guided infiltration were recorded.Conclusion: CT-guided pudendal nerve block at the sacrospinous ligament and the Alcock's canal was effective in improving premature ejaculation. Therefore, pudendal nerve entrapment may be a curable cause of sensory premature ejaculation.

Premature ejaculation in patients with lower urinary tract symptoms: a systematic review

Lower urinary tract symptoms (LUTS) refer to a group of symptoms related to bladder, prostate, and urethra. LUTS are common in men and the severity increases with age. LUTS are frequently associated with sexual dysfunction, such as premature ejaculation (PE), standing as the most common sexual dysfunction in men. Both LUTS and PE cause distress and dissatisfaction for the patient and his partner. This systematic review aims to determine the relationship between LUTS and PE in men. Two reviewers independently conduct a literature search in five online databases (PubMed, Scopus, Proquest, ClinicalKey, and ScienceDirect). In addition, reviewers also reviewed the reference list of chosen articles to identify additional relevant studies. Twelve articles were included in this systematic review that consists of one cohort study and 11 cross-sectional studies. The total scores of each identified study ranged from "poor" to "good." The prevalence of PE in LUTS ranged from 12 to 77%. Most of the studies showed a significant relationship between LUTS and PE. PE is more common in older age with the peak prevalence in age of 60-69 years old. There is a possible association between PE and LUTS. Further research using cohort or case-control study design on this topic is needed.

The heart rate recovery is impaired in participants with premature ejaculation

Premature ejaculation (PE) is one of the most common sexual disorders in men. Excessive activity of the sympathetic nervous system is considered as one of the pathological mechanisms of PE. Heart rate recovery (HRR) is a noninvasive and easily applicable method for evaluating autonomic functions. We aimed to investigate the relationship between PE and HRR. This cross-sectional study included 42 consecutive patients with lifelong PE and 98 healthy volunteers. All participants underwent stress tests according to age-dependent target heart rates outlined in the Bruce protocol. When the maximal heart rate was reached in the stress test, intensive exercise was terminated and electrocardiographic records were obtained for 3 min in the cool-down period. The HRR indices were calculated by subtracting the heart rate at first, second and third minutes from the maximal HR. The two groups were similar in terms of age, body mass index, serum glucose and lipid parameters. HRR indices were significantly lower in the PE group compared with the control group (p < .05 for all). Common factors that affect equilibrium of sympathetic and parasympathetic nervous systems may be involved in the PE and abnormal HRR etiopathogenesis. The cause-and-effect relationship can be more clearly demonstrated with large-scale, prospective studies.

Editorial for "Altered Functional Connectivity of Hypothalamus in Lifelong Premature Ejaculation Patients"

LEVEL OF EVIDENCE

5 TECHNICAL EFFICACY: Stage 3 J. Magn. Reson. Imaging 2020;52:785-786.

Which of available selective serotonin reuptake inhibitors (SSRIs) is more effective in treatment of premature ejaculation? A randomized clinical trial

Purpose:

To compare the efficacy and safety of available selective serotonin reuptake inhibitors (SSRIs) in order to find the most effective drug with the least number of side effects in treatment of premature ejaculation (PE).

Materials and Methods:

This study was a randomized clinical trial. Four hundred and eighty patients with PE in the 4 groups referred to Imam Reza hospital Tehran, Iran from July 2018 to February 2019 were enrolled in the study. The patients received sertraline 50mg, fluoxetine 20mg, paroxetine 20mg and citalopram 20mg, every 12 hours daily. The intravaginal ejaculatory latency time (IELT) before treatment, fourth and eighth weeks after treatment was recorded by the patient's wife with a stopwatch.

Results:

Mean IELT before, 4 and 8 weeks after treatment in four groups were: sertraline 69.4±54.3, 353.5±190.4, 376.3±143.5; fluoxetine 75.5±64.3, 255.4±168.2, 314.8±190.4; paroxetine 71.5±69.1, 320.7±198.3, 379.9±154.3; citalopram 90.39±79.3, 279.9±192.1, 282.5±171.1 seconds, respectively. The ejaculation time significantly increased in all groups (p <0.05), but there was no significant difference between the groups (P=0.75). Also, there was no significant difference in drugs side effects between groups (p >0.05). The most common side effects were drowsiness and dyspepsia, which were not severe enough to cause discontinuation of the drug.

Conclusions:

All available SSRIs were effective and usually had no serious complications. In patients who did not respond to any of these drugs, other SSRI drugs could be used as a salvage therapy.

A bibliometric analysis of international publication trends in premature ejaculation research (2008-2018)

The incidence of premature ejaculation (PE) has been on the rise over the years. Thus, significant research efforts have been directed toward understanding the pathogenesis and hence treatment of PE. Here, we performed a comprehensive analysis of the worldwide trends in research outputs in the field of PE. This study investigated the universal findings of previous PE studies and the trending issues surrounding the condition. We employed the Web of Science Core Collection for data collection. The Excel (2016) and CiteSpace IV were used for information analysis. The information was categorized using journal names, institutions, research frontiers, citation reports, regions/countries, and authors. A sum of 886 publications concerning PE between 2008 and 2018 were identified as of July 6, 2019. The highest number of publications was identified in the Journal of Sexual Medicine published. The United States of America (USA) had the highest number of publications and H-index value. The highest co-citations were from Waldinger MD. The most common keyword was 'drug treatment'. A steady pattern was observed for PE publications done between the period of 2008-2018. Thus, the USA is at the forefront of research on PE research. The interesting advanced research frontiers were drug treatment, circumcision, and sertraline.

Compliance With Fluoxetine Use in Men With Primary Premature Ejaculation

BACKGROUND

Premature ejaculation (PE) is a common sexual dysfunction for which selective serotonin reuptake inhibitors (SSRIs) have been used effectively for treatment. However, compliance with therapy and predictors of long-term SSRI use in the treatment of PE are not well known.

AIM

To analyze our experience with drop-out rates with fluoxetine in the primary PE population and to identify predictors of continued use of this agent.

METHODS

Men with primary PE constituted who used fluoxetine and had at least 12 months follow-up constituted the study population. Subjects underwent a comprehensive interview to ascertain self-reported (non-stopwatch) intravaginal ejaculatory latency time (IELT), self-rated control over ejaculation, and personal and patient-reported partner distress due to PE. Patients were treated with fluoxetine 20 mg daily, with the possibility of dose titration up or down based on efficacy and side effects.

OUTCOMES

The PE parameters of interest included self-reported IELT, self-rated control over ejaculation, personal and partner distress due to PE, and medication adherence.

RESULTS

130 men were included in the study. Dropout rates at 6 and 12 months were 56% and 72%. Self-rated "poor" ejaculatory control decreased from 98%-41% (P < .01), high personal distress from 47%-11% (P < .01), and high partner distress rates from 72%-27% (P < .01). Predictors of continued use at 12 months included high partner distress, being unpartnered, and having a post-treatment IELT ≥5 minutes (P < .01). Overall side effects included headache (5%), dizziness (4%), nausea (5%), nervousness (5%), and sleepiness (8%); however, moderate to severe side effects reported included nausea (2%), sleepiness (2%), headache (2%), and dizziness (2%).

CLINICAL IMPLICATIONS

Compliance with SSRIs is a well-described problem in the depression literature, but data are sparse regarding continued use of SSRIs in the treatment of PE.

STRENGTHS AND LIMITATIONS

We report on 12-month compliance with SSRIs for the treatment of PE. Our early compliance rates were more encouraging than what has been reported in the past. However, IELT was self-reported and not measured objectively, and we did not use validated patient-reported outcomes but rather self-reported ejaculatory control and distress levels, which have limitations.

CONCLUSIONS

Fluoxetine is an effective agent for the treatment of PE with significant improvement realized in IELT, ejaculatory control, and distress levels for both men and their partners. Despite its efficacy, continued use of fluoxetine beyond 6 months is poor. Jenkins LC, Gonzalez J, Tal R, et al. Compliance with Fluoxetine Use in Men with Primary Premature Ejaculation. J Sex Med 2020;16:1895-1899.

Premature Ejaculation: Aetiology and Treatment Strategies

Premature ejaculation (PE) is a highly prevalent male sexual dysfunction that is often neglected, presenting a currently unmet therapeutic need. The classification of PE has historically been varied and at times ambiguous, contributing to inaccurate prevalence estimates. This review uses the International Society for Sexual Medicine (ISSM) definition of PE, which includes reduced ejaculatory latency, lack of control and associated negative personal consequences. Patient assessment and management options differ depending on the classification of PE and it is the role of the clinician to appropriately classify patients and be aware of the correct management strategies. This review provides an overall background of PE in terms of classification and underlying physiology, patient assessment and management strategies along with the scientific rationale for treatment. Patients with lifelong and acquired PE are most likely to benefit from combination therapy of pharmacological treatment in the form of selective serotonin re-uptake inhibitor dapoxetine, psychosexual behavioural therapy and psychological therapy.

Comparative study of on-demand and daily use of sertraline in treatment of premature ejaculation: A randomized clinical trial

Objective

The intravaginal ejaculatory latency time (IELT) may increase less in on-demand compared to daily intake, but may fulfill a suitable treatment for specific patients. We decided to compare the efficacy and safety of on-demand and daily use of sertraline in order to find the most effective and least complicated method in treatment of premature ejaculation (PE).

Methods

This study was parallel or concurrent control randomized clinical trial. Two hundred and forty patients with PE diagnosed by urologist in the two groups of 120 from July 2017 to February 2019 enrolled in the study. In the first group, it is prescribed 50 mg sertraline each 12 h daily and the second group received 50 mg 4 h before coitus for 4 and 8 weeks. The IELT before treatment and during all coitus after treatment were recorded by the patient's wife with a stopwatch.

Results

Mean IELT before, 4 and 8 weeks after treatment in two groups were: On-demand group 101.62±65.44 s, 208.75±128.02 s and 265.87±145.70 s; daily use group 102.50±81.22 s, 276.87±181.08 s and 353.75±176.45 s, respectively. The ejaculation time increased significantly in both groups (p<0.05). However, increase in ejaculation time in daily use group was significantly higher than the on-demand group in 4 weeks (p=0.036), especially in 8 weeks (p=0.009). The percent of side effects in daily use group (26.7%) was higher than on-demand group (20%) (p<0.05). Drowsiness, diarrhea and vertigo were significantly higher in the daily use than on-demand (p<0.05).

Conclusions

On-demand and daily use of sertraline are effective and usually have no serious complications, but the on-demand method is considerably more tolerable. In patients who did not tolerate to daily use of this drug, on-demand could be used as a salvage therapy.

The Comorbidity Between Premature Ejaculation and Erectile Dysfunction-A Cross-Sectional Internet Survey

Introduction

The comorbidity between premature ejaculation (PE) and erectile dysfunction (ED) has not yet been clarified.

Aim

To assess the comorbidity between PE and ED.

Methods

Male members of a shopping club in Taiwan aged 20–60 years with stable sexual relationships were invited to complete an online questionnaire.

Main Outcome Measures

Self-estimated intravaginal ejaculatory latency time (IELT), Premature Ejaculation Diagnostic Tool, Sexual Health Inventory for Men, Self-Esteem and Relationship, and Hospital Anxiety and Depression Scale results were used.

Results

A total of 937 participants with a mean age of 41.1 ± 10.2 years were enrolled. The prevalence rates of ED (Sexual Health Inventory for Men ≤ 21), PE (Premature Ejaculation Diagnostic Tool ≥11), and IELT ≤1 minute were 24.7%, 6.3%, and 6.4%, respectively. Prevalence of acquired PE and IELT ≤1 minute increased marginally with age. Participants with ED had a greater prevalence of PE than those without ED (19.5% vs 2.0%, P < .001), and participants with PE had a greater prevalence of ED than those without PE (76.3% vs 19.4%, P < .001). Compared with participants without PE, participants with PE had greater adjusted odds of ED (odds ratio [OR] = 12.7, 95% CI = 6.7–24.2). Relative to participants without ED, participants with ED had increased adjusted odds of PE (OR = 7.2, 95% CI = 3.5–14.6 with mild ED and OR = 36.7, 95% CI = 16.2–83.0 with ED severity greater than a mild degree). Poor sexual relationships and self-esteem, depression, and anxiety were reported more frequently in those with PE or ED, especially in those with both problems compared with those without PE and ED.

Conclusions

This study confirmed a high prevalence of PE and ED coexistence, indicating a complicated relationship between the 2 conditions and the importance of screening for their co-occurrence in practice.

Tsai W-K, Chiang P-K, Lu C-C, et al. The Comorbidity Between Premature Ejaculation and Erectile Dysfunction—A Cross-Sectional Internet Survey. Sex Med 2019;7:451–458

Comparison of the treatment efficacies of paroxetine, fluoxetine and dapoxetine in low socioeconomic status patients with lifelong premature ejaculation

Introduction

To assess the treatment efficacies of paroxetine, fluoxetine and dapoxetine in patients with lifelong premature ejaculation (PE).

Material and methods

One hundred and seventy male patients with lifelong PE were included in our study. Premature ejaculation profile (PEP) and Intravaginal ejaculation latency times (IELT) were recorded. Paroxetine 20 mg/d was given in Group 1 (n = 64), fluoxetine 20 mg/d was given in Group 2 (n = 47) and dapoxetine 30 mg on demand (at least two times/week) was given in Group 3 (n = 59) patients. After 1 month of treatment, the patients' IELT, PEP and patient reported clinical global impression of change (CGIC) were completed.

Results

The mean age was 36 ±9.2 years. There was no difference between the groups' age, PEP and IELT before treatment (p >0.05). PEP and IELT improved in all three groups (p <0.001). The changes in the 1^st and 3^rd questions of PEP was significantly higher in group 1 than in the other groups (pPEP-1 = 0.042, pPEP-3 = 0.001). The changes in the 2^nd and 4^th questions of PEP were similar between groups (pPEP-2 = 0.444, pPEP-4 = 0.442). In group 1 and 3 IELT changes were better than group 2 (pIIEL1-3 = 0.297, pIIEL1-2 = 0.017, pIIEL2-3 = 0.100). There was no difference between CGIC scores (p = 0.087). The treatment was terminated by 8 patients in Group 1 and 9 patients in Group 2 because of side effects.

Conclusions

While paroxetine treatment seemed to be better than the other medications, dapoxetine 30 mg treatment has less side effects than the two others and its' on demand usage makes it more prominent than the others.

Premature Ejaculation and Erectile Dysfunction in Male Partners of Infertile Couples: Prevalence and Correlation

Objectives: The frequency of, and relationship between, the various manifestations of male sexual dysfunction in infertile couples have been poorly investigated, especially in Vietnam. Our study aims to assess the prevalence of premature ejaculation and erectile dysfunction in infertile couples using validated instruments, and the relationship between these disorders.

Method: Cross-sectional descriptive study, using validated questionnaires including the Premature Ejaculation Diagnostic Tool (PEDT) and the International Index of Erectile Function-15 (IIEF-15), to measure the incidence of these problems in 255 male partners of infertile couples who were examined from January through December 2017, at the Center for Reproductive Endocrinology & Infertility, Hue University Hospital.

Results: The prevalence of overt premature ejaculation was 4.7%, probable premature ejaculation was 7.1%, and erectile dysfunction was 26.3% (mild: 19.3%, mild-to-moderate: 3.9%, moderate: 2.7%, and severe: 0.4%). The PEDT total score was negatively correlated to IIEF-15-EFD and IIEF-15 total scores (r [Formula: see text]0.322 and r [Formula: see text]0.348, respectively).

Conclusions:In light of the identified prevalence of premature ejaculation and erectile dysfunction in the studied population, screening for these conditions should be included in the evaluation of infertile couples. These two disorders could negatively reciprocal effect on each other.

Validity of premature ejaculation diagnostic tool and its association with International Index of Erectile Function-15 in Chinese men with evidence-based-defined premature ejaculation

The premature ejaculation diagnostic tool (PEDT) is a brief diagnostic measure to assess premature ejaculation (PE). However, there is insufficient evidence regarding its validity in the new evidence-based-defined PE. This study was performed to evaluate the validity of PEDT and its association with IIEF-15 in different types of evidence-based-defined PE. From June 2015 to January 2016, a total of 260 men complaining of PE and defined as lifelong PE (LPE)/acquired PE (APE) according to the evidence-based definition from Andrology Clinic of the First Affiliated Hospital of Anhui Medical University, along with 104 male healthy controls without PE from a medical examination center, were enrolled in this study. All individuals completed questionnaires including demographics, medical and sexual history, as well as PEDT and IIEF-15. After statistical analysis, it was found that men with PE reported higher PEDT scores (14.28 ± 3.05) and lower IIEF-15 (41.26 ± 8.20) than men without PE (PEDT: 5.32 ± 3.42, IIEF-15: 52.66 ± 6.86, P < 0.001 for both). It was suggested that a score of ≥9 indicated PE in both LPE and APE by sensitivity and specificity analyses (sensitivity: 0.875, 0.913; specificity: 0.865, 0.865, respectively). In addition, IIEF-15 were higher in men with LPE (42.64 ± 8.11) than APE (39.43 ± 7.84, P < 0.001). After adjusting for age, IIEF-15 was negatively related to PEDT in men with LPE (adjust r = -0.225, P < 0.001) and APE (adjust r = -0.378, P < 0.001). In this study, we concluded that PEDT was valid in the diagnosis of evidenced-based-defined PE. Furthermore, IIEF-15 was negatively related to PEDT in men with different types of PE.

Sexuality in Males With Congenital Adrenal Hyperplasia Resulting From 21-Hydroxylase Deficiency

Purpose

Although sexuality has been reported to be impaired in females with congenital adrenal hyperplasia (CAH) resulting from 21-hydroxylase deficiency, sexuality in males with CAH so far has remained largely unconsidered.

Patients

One of the largest European male cohorts of patients with CAH in which sexuality in male patients with CAH was assessed.

Methods

Sexuality was evaluated in 91 sexually active male patients with CAH using questionnaires investigating sexual orientation, age at sexual initiation, sexual activity, satisfaction with sex life, and sexual problems, such as fears or dislike of sexual activity, lack or excessive sexual desire, difficulties getting aroused or reaching an orgasm, premature ejaculation, and no or incomplete erection.

Results

Sexuality in male patients with CAH was similar to European reference populations. If sexuality problems were present, they were less frequently reported by the most severely affected CAH males. Adducing a holistic perspective, sexual problems showed substantial association to psychological problems, such as anxiety and depression.

Conclusions

Sexuality in male patients with CAH in general was unaffected and sexuality problems seemed to be associated in particular with psychological problems. Because sexual health is a key factor of general health, we recommend that sexuality as well as psychological issues explicitly should be addressed in health care of patients with a CAH diagnosis, independent of sex.

Effectiveness and safety of fluoxetine for premature ejaculation: Protocol for a systematic review

BACKGROUND

Premature ejaculation (PE) is one of the most common male sexual dysfunctions, which can directly harm men's self-esteem and affect the stability of the relationship between husband and wife. To some extent, PE even affects the harmony and stability of society. So, men's health has gained more and more attention. As one of the long-acting selective serotonin reuptake inhibitors (SSRIs), fluoxetine has been proven to be effective in the treatment of PE by many trails. In this study, we aim to evaluate the effectiveness and safety of fluoxetine for PE to provide the newest evidence for clinical use.

METHODS AND ANALYSIS

Literature research will be divided into 2 parts: electronic search and manual search. We will search PubMed, EMBASE, The Cochrane Library, the China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), the China Science and Technology Journal database (VIP), and the Wanfang database online. We will select the eligible studies published up to December 31, 2018. Manual searches mainly retrieve dissertations, ongoing trails, internal reports, and so on. We use intravaginal ejaculatory latency time (IELT) as the primary outcome of PE and we also care about the following indexes: PE Diagnostic Tool (PEDT); Arabic index of PE (AIPE); Index of PE (IPE). In addition, we will carefully observe the patient's adverse reactions during the medication. Two reviewers will read the articles, extract the data information, and assess the risk of bias independently. Data analysis will be used the software such as RevMan V.5.3.5; EndNote X7 and Stata 13.0.

RESULTS

This study will provide a high-quality synthesis of current evidence of fluoxetine for PE from several aspects, including IELT, PEDT, AIPE, IPE, and adverse events.

CONCLUSION

This systematic review will provide evidence to assess the effectiveness and safety of fluoxetine in the treatment of PE.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42018109722.

Method and design of drug treatment research of subjective premature ejaculation in men differs from that of lifelong premature ejaculation in males: proposal for a new objective measure (part 1)

As lifelong premature ejaculation (PE) and subjective PE are two different PE subtypes, the measurement of their characteristic features requires different objective measures. In this article, we address the differences between lifelong PE and subjective PE, in terms of the extent of variation of sexual performance and propose a new objective measure for research of subjective PE. By considering lifelong PE as a mainly "male" sex disorder and subjective PE as a mainly "man" sex disorder, we show that stopwatch-mediated intravaginal ejaculation latency time (IELT) measurement is most adequate for research of lifelong PE, but inadequate for research of subjective PE. Subjective PE needs another objective measure to capture its key characteristics. Arguments are provided to show that the characteristics of subjective PE are different from the key features of lifelong PE. The core issue in lifelong PE is the very short IELT with a very small variation in sexual performance. Subjective PE is characterized by a higher variation of sexual performance. Stopwatch-mediated IELT measurement is essential in case of small variation of sexual performance. In contrast, measurement of various parameters of penile intravaginal thrusting is suggested to be more appropriate in case of high variation of sexual performance observed in subjective PE. In conclusion, research of lifelong PE should be performed by stopwatch measurement of the IELT whereas research of subjective PE should be performed by movement tracker devices, designed to be bound to the males body and/or inserted into the women's vagina with robust software to measure intravaginal thrusting variation performance. Future studies are warranted to provide scientific data to support this hypothesis.

Hyaluronic acid injection in glans penis for treatment of premature ejaculation: a randomized controlled cross-over study

This randomized controlled cross-over study aimed to assess the efficacy and safety of glans penis injection with hyaluronic acid (HA) in treating premature ejaculation (PE). A total of 30 patients with PE were randomly allocated into two groups: group 1 (n = 15) which was subjected to glans penis HA injection and group 2 (n = 15) which was injected with saline as a control then both groups were subjected to follow-up at 1 week and 1 month after injection. These subjects were evaluated by intra-vaginal ejaculation latency time (IELT) and the Arabic validated index of premature ejaculation (AIPE). After a wash-out period, cross-over and re-evaluation of both groups were carried. Additionally, patients with reported improvement after 1 month of HA injection (n = 20) were subjected to extended evaluation by IELT at 3, 6, and 9 months intervals. Two-way repeated measures ANOVA indicated significant improvement after HA in comparison with saline across the follow-up periods (F(1.66: 91.37) = 24.85, p = 0.001). Post-hoc Bonferroni test indicated no significant difference after 1 week period in comparison with baseline IELT, but a significant difference after 1 month of injection in comparison with baseline IELT (p < 0.001) and after 1 week (p < 0.001). After 1 month of HA, IELT increased by a median of 2.6 folds while 1.1 folds increase was observed after 1 month of saline injection. Total AIPE scores improved significantly after HA injection compared with baseline (p = 0.003) and saline scores (p = 0.002). Reported adverse effects were minimal and self-limited. It could be concluded that glans penis injection with HA for treatment of PE is a safe method that ensures a modest but significant increase in IELT and improves couple sexual satisfaction.

Metabolic Syndrome Is an Independent Risk Factor for Acquired Premature Ejaculation

Purpose

To determine the role of metabolic syndrome (MetS) as a risk factor for acquired premature ejaculation (PE) after considering the various risk factors, such as lower urinary tract symptoms, erectile dysfunction, hypogonadism, and prostatitis.

Materials and Methods

From January 2012 to January 2017, records of 1,029 men were analyzed. We performed multivariate analysis to identify risk factors for PE, including the covariate of age, marital status, International Prostate Symptom Score, International Index of Erectile Function (IIEF) score, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score, serum testosterone levels, and all components of MetS. Acquired PE was defined as self-reported intravaginal ejaculation latency time ≤3 minutes, and MetS was diagnosed using the modified National Cholesterol Education Program Adult Treatment Panel III criteria.

Results

Of 1,029 men, 74 subjects (7.2%) had acquired PE and 111 (10.8%) had MetS. Multivariate analysis showed that the IIEF overall satisfaction score (odds ratio [OR]=0.67, p<0.001), NIH-CPSI pain score (OR=1.07, p=0.035), NIH-CPSI voiding score (OR=1.17, p=0.032), and presence of MetS (OR=2.20, p=0.022) were significantly correlated with the prevalence of acquired PE. In addition, the Male Sexual Health Questionnaire for Ejaculatory Dysfunction scores and ejaculation anxiety scores progressively decreased as the number of components of MetS increased.

Conclusions

MetS may be an independent predisposing factor for the development of acquired PE. Effective prevention and treatment of MetS could also be important for the prevention and treatment of acquired PE.

Clinical correlation between erectile function and ejaculatory function in the Czech male population

Introduction

This study explores the relationship between erectile function and ejaculatory function, to inform the clinical psychosexological and sexual medicine practice treatment protocols.

Materials and methods

A total of 1,004 Czech males aged between 15 and 84 years (m = 42.8 yrs; sd = 17.6 years) completed a sexual behavior questionnaire. A cross-sectional design was adopted. Erectile function was measured with the International Index of Erectile Function (IIEF-5) and ejaculatory function measured using self-report intravaginal ejaculation latency time and the Index of Premature Ejaculation (IPE). Linear regression analyses were used to explore the relationships between premature ejaculation and erectile dysfunction.

Results

The sample mean self-reported intravaginal ejaculatory latency time was 9.34 minutes. The overall mean on the IPE was 19.44 (sd = 2.368). The Control domain mean was 81.13 (sd = 17.22); Sexual Satisfaction domain mean 78.60 (sd = 20.59); and the Distress domain mean was 86.86 (sd = 18.32). The mean score on the IIEF-5 was 19.28 (sd = 2.53). The results indicate a relationship between premature ejaculation and erectile dysfunction. With age significantly associated with all measures.

Conclusions

Higher levels of erectile function are associated with a better control and sexual satisfaction, and less distress about ejaculation. This association supports the consideration of this relationship in the development of new clinical practice guidelines for erectile dysfunction and premature ejaculation.

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.

Pharmacological interventions for premature ejaculation: a mixed-treatment comparison network meta-analysis of randomized clinical trials

Premature ejaculation (PE) is the most common sexual dysfunction in men. The present study is a network meta-analysis of drugs used for treating PE. Electronic databases were searched for randomized controlled trials comparing medical interventions with either placebo or with other active drugs in patients with PE. Inverse variance heterogeneity model was used for mixed-treatment comparisons. Intravaginal ejaculatory latency time (IELT) and adverse events were the main outcome measures. A total of 44 studies were included in the meta-analysis. Dapoxetine 30 and 60 mg, tadalafil, sildenafil, paroxetine with sildenafil, topical lidocaine, dapoxetine 30 mg with mirodenafil, vardenafil, fluoxetine, and tadalafil, pindolol with paroxetine, tramadol, topical lidocaine with tadalafil, paroxetine with tadalafil, and topical eutectic mixture of local anesthetics were associated with a significant increase in IELT. Similarly, dapoxetine 60 mg, venlafaxine, fluoxetine, tramadol at 25, 50, and 100 mg, and combined fluoxetine and tadalafil were associated with an increased risk of adverse events. Dapoxetine 30 mg has a high likelihood of being the "best" in the interventional pool. Dapoxetine at 30 mg could be used as the first-line agent in the management of PE.