1. 先明确：什么是早泄？
1.1 国际共识下的定义标准
想象一下，你正在和伴侣享受亲密时刻，突然，一切都结束了，而你和伴侣都还没准备好。这种“太快了”的感觉，如果只是偶尔发生，那倒没什么大不了。但如果它经常出现，让你感到沮丧、困扰，甚至因此避免性生活，那可能就触及到“早泄”这个医学概念了。
那么，究竟怎样才算得上是真正的“早泄”呢？医学界对于早泄的定义，可不是凭空想象的，而是经过了多年的研究和讨论，最终由国际性医学学会（ISSM）等权威机构给出了明确的判断标准 12。简单来说，早泄的诊断需要同时满足以下几个核心条件：
第一，射精时间“太短”。这里的“短”是有具体标准的：
- 终身型早泄：指的是从第一次性经历开始，就一直存在射精过快的情况。通常，指男性在阴道内抽动不到1分钟就射精了 134。
- 获得型早泄：则是在有过正常的性生活之后，才出现的射精时间明显缩短。这类情况，通常指男性在阴道内抽动约3分钟或更短的时间内射精 145。
当然，这个时间是“平均值”，并非每次都要拿秒表去精确测量。而且，这里特指的是“阴道内射精潜伏期”（IELT），也就是从阴茎插入阴道到射精的时间 36。虽然目前大多数研究和定义都集中在阴道性交上，但一些新的研究也开始探讨在其他性行为中如何应用这些诊断标准 78。
第二，缺乏控制感。这不仅仅是时间的问题，更重要的是，当事人会感到自己无法或很难控制射精，无论他多么想延迟射精，都力不从心 149。
第三，带来负面影响。早泄不仅仅是生理上的问题，它还会给当事人带来一系列不愉快的后果，比如感到沮丧、困扰、焦虑，甚至因此回避性亲密行为，严重影响了生活质量和伴侣关系 14910。
所以，这里要特别区分一下临床诊断和日常的误解。很多人觉得“射精快了点”就是早泄，但医学上讲的早泄，是需要同时满足“时间短”、“失控感”和“负面影响”这三个严苛条件的。只有当这些因素持续存在并造成困扰时，医生才会将其诊断为早泄。 occasional premature ejaculation is not a cause for concern 9。
1.2 常见误区：“时间短”≠早泄
在日常生活中，我们常常听到有人抱怨自己“时间短”，就觉得自己得了早泄。但在这里，我们必须纠正一个普遍存在的误区：偶尔的“时间短”并不等于医学上的“早泄”。
这就像感冒一样，你偶尔打个喷嚏，流点鼻涕，可能是因为天气变化或过敏，这不叫感冒；但如果持续高烧不退，浑身酸痛，那才是真正的感冒。早泄也一样，它是一种需要满足特定条件的“疾病”，而不是一次两次的“表现不佳”1112。
那么，两者的主要区别在哪里呢？
首先，“持续性”是关键。医学上诊断的早泄，指的是这种射精过快的情况是“持续存在或反复发生”的 13。也就是说，它不是偶尔发生一两次，而是每次性行为，或者绝大多数时候都这样。如果你只是在特定情境下（比如长时间没有性生活，或者压力特别大的时候）偶尔射精较快，那么这通常不被认为是早泄。
其次，“失控感”和“负面影响”是核心。就像前面提到的，真正的早泄患者会感到自己完全无法控制射精，并且因此感到极度困扰、焦虑，甚至影响到自信心和与伴侣的关系1415。这种心理上的痛苦和生活质量的下降，是判断早泄非常重要的标准1516。如果只是偶尔“快枪手”，但自己和伴侣都没有因此感到困扰，那也谈不上是病理性的早泄。例如，一项针对芬兰年轻男性的研究就发现，虽然有许多人报告射精过快，但只有当他们对射精速度感到担忧时，才与性困扰有显著关联11。
简单来说，你可以把这种情况想象成这样：
- 偶尔“时间短”：就像你开车时，偶尔会因为路况不熟或者急着赶路而开得快了点，但你依然掌控着方向盘，并且没有因此发生事故或者感到严重的焦虑。这只是一个正常的变化范围，通常不需要特别担心。
- 病理性早泄：这就好比你的车子刹车失灵了，你完全踩不住刹车，车速过快，而且因此感到极度恐慌，害怕发生事故，甚至不敢再开车出门了。这种失去控制感和随之而来的巨大负面影响，才是早泄的本质。
因此，如果你只是偶尔出现射精较快的情况，不必过于恐慌。但如果这种状况让你长期感到困扰，影响了你的性生活质量和心理健康，那么就应该寻求专业医生的帮助，进行科学的评估和诊断。不要自己下定论，更不要盲目相信网络上的各种“偏方”或“保健品”。
2. 为什么会早泄？多因素交织的“失控”
早泄的发生，并非单一因素在作祟，它更像是一场多米诺骨牌效应，由生理、心理、环境以及其他健康问题等多方面因素共同“导演”的“失控”戏码。想要真正理解早泄，我们就要把这些“幕后推手”一个个找出来。
2.1 生理基础：神经-内分泌系统的异常调节
我们的身体是一个精密的仪器，任何一个“零部件”出了问题，都可能影响整体运行。对于早泄来说，最核心的“零部件”之一就是我们的神经和内分泌系统。它们像身体里的“信息高速公路”和“化学信号塔”，调控着包括射精在内的各种生理活动。
首先，让我们来认识一位重要的“交通警察”——5-羟色胺（5-HT）。它是一种神经递质，可以简单理解为大脑和神经细胞之间传递信息的“信使”。研究发现，5-羟色胺在大脑中对射精过程有着非常重要的抑制作用 1718。你可以把射精想象成一辆疾驰的列车，5-羟色胺就是列车上的“刹车系统”。当5-羟色胺水平不足或者它的“刹车功能”出现异常时，射精这辆列车就容易“刹不住车”，过早地到达终点站 1719。许多研究都表明，5-羟色胺神经传递的紊乱，是导致终身型早泄的重要原因之一 1720。这也是为什么很多治疗早泄的药物会选择调节5-羟色胺的原因。
其次，睾酮等激素水平也可能与射精控制有关。睾酮是男性体内重要的雄性激素，它对性欲和性功能都有影响。虽然关于睾酮与早泄的直接关系，研究还在进行中，但一些初步的研究表明，睾酮水平的异常，尤其是游离睾酮的水平，可能与早泄患者的心理压力和躯体化分离症状有关 21。另外，一些研究发现，电针治疗早泄可以通过调节血清睾酮水平来改善症状 22。不过，这方面的机制还需要更深入的研究来明确。
最后，一个更直观的生理因素是阴茎头敏感度过高。你可以把阴茎头想象成一个高度灵敏的“传感器”。如果这个“传感器”过于灵敏，在轻微的刺激下就迅速达到兴奋阈值，那么射精自然就会来得更快。科学家们最近发现，一种名为 PIEZO2 的机械敏感离子通道，在阴茎头和脊髓神经节中含量较高，它就像一个“快速反应按钮”。在早泄患者中，这个“按钮”的数量可能会增加，或者变得过于活跃，导致对机械刺激的反应更加强烈，从而更容易触发射精反射 23。想象一下，正常情况下，你需要按压几次才能打开一个开关，但对于早泄患者来说，可能只是轻轻一碰，开关就弹开了。因此，降低这种“传感器”的敏感度，也成为了治疗早泄的一个思路。
2.2 心理与环境：焦虑与压力的“助推器”
除了生理上的“硬件配置”问题，早泄的另一个重要“推手”是心理和环境因素。我们的情绪、想法、甚至是过往的经历，都可能在无形中影响着身体的反应，让射精的“刹车”变得更不灵敏。可以说，早泄不仅是身体的反应，更是心理的投射。
而长期焦虑和压力，更是早泄的“助推器” 24。生活中的各种压力，比如工作压力、经济压力、人际关系压力，都会让人长期处于一种紧张状态。这种紧张感会影响神经系统，让身体更容易进入“应激模式”，从而对性刺激变得更加敏感。尤其是在性爱过程中，如果一个男性本身就对自己的性能力感到焦虑，担心自己会“不行”，这种“表现焦虑”就会进一步加剧早泄的发生。这形成了一个可怕的恶性循环：越是担心自己会早泄，就越容易早泄，而早泄又会加重这种担心和焦虑，形成“越担心越失控”的局面 25。
此外，伴侣关系紧张也扮演着不容忽视的角色。性是两个人之间亲密关系的体现。如果伴侣之间缺乏有效的沟通，或者一方对早泄问题表现出不满、指责甚至嘲讽，都会给早泄患者带来巨大的心理压力 26。这种关系上的压力，会进一步加重男性的焦虑感，让他觉得自己在性爱中“没有价值”，从而更加难以控制射精。有时，男性甚至会因为早泄而产生自责，把负面的性经历归咎于自己，而不是环境或伴侣，这又会进一步打击他们的自信心 27。
总结来说，心理和环境因素对早泄的影响是多方面的：
- 焦虑和压力：长期的高压生活和对性表现的担忧，会放大身体的敏感度。
- 伴侣关系：缺乏支持、充满压力的伴侣关系，会加剧心理负担。
这些因素交织在一起，就像一个复杂的网络，共同降低了射精的“控制力”，让原本可能只是一时的“小插曲”，演变成了持续的“大困扰”。因此，在治疗早泄时，仅仅关注生理层面是远远不够的，心理层面的干预同样重要，甚至可以说是治本的关键 28。
2.3 疾病与损伤：其他健康问题的“连锁反应”
早泄这个“麻烦”，有时还会牵扯到我们身体里的其他“病痛”。一些看似与性功能不相关的疾病或身体损伤，也可能通过复杂的“连锁反应”，间接或直接地导致早泄的发生。这就像一个复杂的机器，一个零件损坏，可能会影响其他零件的正常运作。
首先，糖尿病就是导致早泄的常见“幕后黑手”之一。糖尿病不仅仅是血糖高那么简单，它长期下来会对身体的血管和神经造成损害，这被称为“糖尿病并发症” 29。当负责控制射精的神经受到损伤时，射精反射的调节就会出现问题，使得射精变得难以控制 2930。此外，糖尿病还可能导致睾酮水平下降，这也会影响性欲和性功能 29。一项研究就指出，糖尿病患者中高达35%-50%的男性会出现射精功能障碍，其中包括早泄 30。即使是糖尿病前期，也与早泄存在关联 31。所以，如果被诊断出糖尿病或糖尿病前期，除了关注血糖，也要留意性功能的变化。
其次，前列腺炎和下尿路症状（LUTS）也常与早泄如影随形。前列腺炎，顾名思义就是前列腺发炎，它会引起骨盆区域的疼痛和不适 32。这种持续的炎症和疼痛，会影响到盆底肌肉和神经的功能，从而可能导致射精的过早发生 3233。一项针对中国男性的研究发现，慢性前列腺炎患者中早泄的患病率很高 34。而下尿路症状（LUTS）则是一系列与膀胱、前列腺和尿道相关的症状，比如尿频、尿急、排尿困难等 35。研究表明，LUTS与早泄之间存在显著关联，LUTS越严重，早泄的风险也越高 353637。有学者推测，这可能是因为LUTS带来的刺激或炎症，影响了神经功能或盆底肌肉的协调性，进而影响了射精控制 38。
最后，一些脊髓损伤或神经囊肿等器质性病变，也可能直接影响射精的神经通路，导致早泄。我们的射精过程是由复杂的神经反射控制的，涉及到脊髓的多个节段。如果脊髓受到损伤，特别是腰骶部的损伤，就可能干扰正常的射精反射。有些脊髓损伤患者会在受伤后突然出现严重的早泄，甚至只是轻微的性刺激或仅仅是性想法，就能触发射精 394041。这可能是因为损伤破坏了脊髓对射精的抑制通路，使得射精反射变得“过于敏感”和“不受控制” 4042。近期一项研究也证实，胸腰椎骨折合并不完全脊髓损伤可能导致勃起功能下降和早泄，且损伤程度和受损节段与性功能障碍的严重程度密切相关 43。
总之，早泄不仅仅是一个独立的性功能问题，它还可能像一个“信号灯”，提示我们身体内可能存在其他潜在的健康问题。因此，当出现早泄时，进行全面的身体检查，排除这些潜在的疾病或损伤，对于找到病因并进行有效治疗至关重要。
3. 科学治疗：从行为到药物的多维度干预
3.1 一线选择：行为训练与局部麻醉剂
面对早泄的困扰，我们首先要摒弃那种“病急乱投医”的心态，而应该选择科学、有效的方法。在众多治疗方案中，“行为训练”和“局部麻醉剂”就像是两位靠谱的“先锋官”，它们以其相对安全、易操作的特点，成为了早泄治疗的一线选择 44。
3.1.1 行为训练：重新掌握身体的“遥控器”
行为训练，顾名思义，就是通过一系列特定的练习，帮助患者重新认识自己的身体，并逐步学会控制射精反射。这就像学开车一样，一开始你可能手忙脚乱，但通过反复练习，就能熟练掌握油门和刹车。行为训练中最著名的两种方法就是“停-动法”和“挤压法” 45：
停-动法（Start-Stop Technique）：
- 操作步骤：想象你正在和伴侣进行性爱。当射精的冲动快要来临、感觉自己即将达到高潮时，立刻停止一切性刺激（包括抽动、爱抚等），等待射精冲动完全消退。等到感觉平静下来后，再重新开始性刺激。如此反复进行3-4次，最后一次再允许射精。这个过程可以在自慰时练习，也可以在伴侣的帮助下进行 4647。
- 核心原理：这种方法的核心在于让你学会识别射精前身体的“临界点”，并主动干预，让兴奋度下降。通过反复的“刹车”和“启动”，大脑会逐渐建立起对射精反射的控制能力，提高射精阈值。
- 注意事项：初期练习可能需要耐心和伴侣的理解与配合。关键是识别“高潮平台期”，即射精前的那一刻高度兴奋感。如果错过了这个时机，可能来不及“刹车”。
- 长期效果：研究显示，停-动法能够显著延长射精时间，并改善患者对射精的控制感 4648。一些研究还发现，结合盆底肌训练（如括约肌控制训练）的停-动法，比单独使用停-动法效果更好 46。
挤压法（Squeeze Technique）：
虽然行为疗法历史悠久，效果也相对肯定，但值得注意的是，一些早期研究报告的高成功率（如Masters和Johnson宣称的97.8%）在后续研究中并未能完全复制 4950。这可能与研究设计、患者依从性等多种因素有关。但总的来说，行为训练仍然是治疗早泄不可或缺的一部分，尤其对于那些不愿意或不适合药物治疗的患者。
3.1.2 局部麻醉剂：“给敏感区打个‘麻药’”
如果说行为训练是让你学会“踩刹车”，那么局部麻醉剂就是直接“给油门减敏感度”。局部麻醉剂通过降低阴茎头的敏感度，从而延长射精潜伏期 51。
- 作用机制：这类药物通常含有利多卡因和/或丙胺卡因等麻醉成分 5152。它们涂抹在阴茎头上后，会被皮肤吸收，局部麻醉阴茎头的神经末梢，从而降低其对性刺激的敏感性。当阴茎头不再那么“兴奋”时，射精反射的触发阈值就会升高，射精时间自然就延长了。
- 正确使用方法：常见的局部麻醉剂有乳膏、凝胶或喷雾剂等形式。通常建议在性生活前5-30分钟涂抹或喷洒于阴茎头，待药物吸收后，可以擦掉多余的药物或使用避孕套，以避免伴侣接触后产生麻木感 445153。
- 避免伴侣麻木的注意事项：这是使用局部麻醉剂时需要特别注意的一点。如果药物残留过多，或者在没有防护的情况下进行性行为，伴侣可能会感受到麻木，影响性体验。因此，建议在药物吸收后用湿巾擦拭阴茎头，或者全程使用避孕套，这样可以有效隔离药物，保护伴侣的感受。
- 优势与局限性：局部麻醉剂的优点是起效快，按需使用，且全身性副作用较少 4451。然而，它们的缺点是可能影响性爱自发性，操作起来可能有些麻烦，并且如果处理不当，确实可能导致伴侣的生殖器麻木 51。
总而言之，行为训练和局部麻醉剂作为早泄治疗的一线方案，各有优势。行为训练更侧重于患者自身对身体的控制力培养，而局部麻醉剂则通过外部干预降低敏感度。在实际应用中，医生往往会根据患者的具体情况，建议单独使用或两者联合使用，以达到最佳的治疗效果。
3.2 药物核心：SSRIs类药物的“精准调节”
当行为疗法和局部麻醉剂的效果不尽如人意，或者早泄的程度比较严重时，医生就会考虑引入药物治疗。在众多药物中，选择性5-羟色胺再摄取抑制剂（SSRIs）是目前治疗早泄最核心、也是最有效的药物类型。它们就像是身体内部的“高级调节器”，通过精准地干预神经递质，帮助男性重新找回射精的控制感。
还记得我们前面提到的“交通警察”5-羟色胺吗？它在大脑中扮演着射精“刹车系统”的角色。SSRIs类药物的作用原理，就是通过抑制5-羟色胺在神经细胞间的再摄取，从而增加突触间隙中5-羟色胺的浓度，简单来说，就是让更多的5-羟色胺停留在“工作岗位”上，延长它发挥“刹车”作用的时间。这样一来，射精反射的触发阈值就会升高，射精时间自然也就延长了。
SSRIs家族里有几位重要的成员，它们在治疗早泄上各有特点：
达泊西汀（Dapoxetine）：早泄的“专属解药”
达泊西汀是目前全球范围内唯一一个专门被批准用于治疗早泄的口服药物 5556。它最大的特点就是“按需服用”，也就是说，你不需要每天都吃，而是在预计进行性生活前，提前1-3小时服用即可 57。这种用药方式非常灵活，大大减少了长期服药可能带来的顾虑和副作用。
- 效果显著：多项临床研究表明，达泊西汀能够显著延长男性的阴道内射精潜伏期（IELT）。例如，有研究显示，服用达泊西汀后，IELT平均可以延长2-3倍，甚至更高 5557。对于服用达泊西汀的患者，其射精时间从基线的不到1分钟，可以延长至2.84分钟或3.8分钟以上 5758。患者的性生活满意度、对射精的控制感以及与早泄相关的困扰也都有明显改善 5759。
- 安全性：达泊西汀通常被认为是安全且耐受性良好的药物 5558。最常见的副作用包括恶心、头晕、头痛和腹泻等，这些通常是轻度到中度的，并且是短暂的，随着身体适应药物会逐渐减轻 555758。值得注意的是，达泊西汀可能引起血管迷走神经性晕厥（一种神经心源性晕厥），但发生率较低 55。
帕罗西汀（Paroxetine）等其他SSRIs：强效但“非标签”
除了达泊西汀，其他一些SSRIs类药物，如帕罗西汀（Paroxetine）、舍曲林（Sertraline）、氟西汀（Fluoxetine）和氯米帕明（Clomipramine），也被广泛用于治疗早泄 606162。它们在延长射精时间方面表现出强大的效果，尤其是帕罗西汀，被认为对射精延迟效果最强 6364。然而，这些药物并非专门为早泄设计，而是作为抗抑郁药使用，因此它们在早泄治疗上属于“超说明书用药”（off-label use） 5665。
- 服用方式：与达泊西汀不同，这些药物通常需要每日服用，以维持体内的稳定药效。虽然也有“按需服用”的研究，但普遍认为每日服用效果更佳 62。
- 效果对比：帕罗西汀被认为在延长IELT方面优于安慰剂、氟西汀和艾司西酞普兰 63。与达泊西汀相比，一些研究表明它们的效果可能不相上下，但在长期使用和副作用方面需要更全面的考虑 6366。
- 常见副作用：由于需要每日服用，这些药物的副作用可能会更明显或持续时间更长。常见的副作用包括恶心、口干、疲劳、嗜睡、头晕、出汗增多以及性功能障碍（如性欲减退或勃起功能障碍）等 5859。与达泊西汀相比，舍曲林（另一种SSRI）每日服用可能导致疲劳、嗜睡和口干的发生率更高 58。此外，长期使用SSRIs还需警惕一些更严重的风险，如出血增加、低钠血症、肝毒性以及停药后的戒断症状等 65。
小结与选择建议：
| 特点 | 达泊西汀（Dapoxetine） | 其他SSRIs（如帕罗西汀） |
|---|---|---|
| 批准情况 | 唯一获批的早泄专用药 | “超说明书用药” |
| 服用方式 | 按需服用（性生活前1-3小时） | 通常每日服用 |
| 起效速度 | 快，服药后1-3小时达峰 | 相对较慢，需持续服药积累药效 |
| 射精延迟效果 | 显著，延长IELT 2-3倍及以上 | 显著，帕罗西汀效果被认为最强 |
| 常见副作用 | 恶心、头晕、头痛、腹泻，通常短暂 | 恶心、口干、疲劳、嗜睡、性功能障碍，可能持续 |
| 对性欲影响 | 较小 | 可能引起性欲减退或勃起功能障碍 |
在选择药物时，医生会根据患者的具体情况、对药物的耐受性以及个人偏好来综合评估。对于希望保持性爱自发性且对副作用敏感的患者，达泊西汀通常是首选。而对于追求更强效果或对达泊西汀效果不佳的患者，医生可能会考虑在充分告知风险和监测的前提下，使用其他每日服用的SSRIs。无论选择哪种药物，都必须在专业医生的指导下进行，切勿自行购药服用。
3.3 联合与升级：综合方案提升效果
在早泄的治疗上，单打独斗往往不如“协同作战”效果更佳。当单一的治疗方法效果不理想，或者患者希望获得更显著的改善时，医生通常会建议采取“组合拳”——也就是联合治疗。这就像组建一支特种部队，将不同的专业人员（不同的治疗方法）汇集在一起，共同应对挑战，从而提升整体的“战斗力”。
3.3.1 行为疗法 + 药物：1+1>2的智慧
想象一下，你学会了开车的技巧（行为疗法），同时你的车子也配备了更灵敏的刹车系统（药物）。这样一来，你对车辆的掌控力自然就大大增强了。在早泄治疗中，将行为疗法与药物治疗结合起来，正是这个道理。
- 联合优势：这种组合的优势在于，行为疗法能帮助患者建立对射精的心理控制和技巧，而药物则从生理层面提供“刹车”的辅助。两者相互补充，可以达到延长射精时间、减少复发的协同效果。例如,研究表明，局部麻醉剂（如利多卡因凝胶）配合行为疗法，能显著改善终身型早泄患者的射精时间。磷酸二酯酶-5抑制剂（PDE5-Is，通常用于治疗勃起功能障碍的药物，有时也用于早泄的辅助治疗）与行为疗法结合，也比单独使用行为疗法更有效 67。
- 心理与生理的双重提升：药物能快速带来生理上的改善，帮助患者重拾信心，而行为疗法则能让患者在药物辅助下更好地掌握控制技巧。当药物停用后，行为训练所获得的控制能力往往能持续更久，从而降低复发的可能性。
3.3.2 中药联合SSRIs：东西方智慧的结合
近年来，随着中医药研究的深入，一些研究开始探索将中药与西药SSRIs联合应用于早泄治疗。这就像中西医合璧，希望能发挥各自的优势。
- 联合优势：有证据表明，中药（如某些传统中药配方或提取物）与SSRIs联合使用，在延长射精时间、改善射精控制能力、提高性生活满意度方面，比单独使用SSRIs效果更好 68。一些研究发现，中药联合达泊西汀治疗早泄，不仅疗效更好，而且安全性良好，能显著改善患者的性生活满意度 69。例如，一项研究表明，柴胡疏肝散与帕罗西汀联合治疗后天性早泄，可能具有协同效应 70。
- 副作用平衡：中药可能还能在一定程度上缓解SSRIs的副作用，提高患者的依从性。研究显示，中药联合SSRIs的方案，在不良反应发生率上与单独使用SSRIs没有显著差异 68。
- 未来前景：虽然还需要更多大规模、高质量的研究来证实其确切疗效和安全性，但这种中西医结合的尝试，为早泄患者提供了新的治疗思路。
3.3.3 新兴非药物技术：生物反馈与盆底肌训练
除了传统的行为疗法和药物，一些新兴的非药物技术也逐渐走入人们的视野，它们主要通过训练患者对身体的感知和控制能力来改善早泄。
生物反馈（Biofeedback）：
盆底肌训练（Pelvic Floor Muscle Training, PFMT）：
- 原理：盆底肌是位于骨盆底部的一组肌肉群，它们支撑着盆腔器官，并参与排尿、排便和性功能。有力的盆底肌能够帮助男性更好地控制射精反射。你可以把盆底肌想象成一个“闸门”，学会控制这个“闸门”的开启和关闭，就能更好地掌控射精。
- 方法：盆底肌训练通常包括识别和收缩盆底肌（就像憋尿或中断排尿的动作），然后逐渐增加收缩的时长和次数。这些训练可以在专业理疗师的指导下进行，也可以在家中自主练习。
- 案例与效果：多项研究证实了盆底肌训练对早泄的有效性。有研究显示，经过8周的盆底肌训练，获得型早泄患者的射精时间中位数从120秒增加到180秒，终身型早泄患者的射精时间中位数从30秒增加到60秒 74。另一项长达5年的经验表明，54%的早泄患者在经过盆底肌训练后能够“治愈”，将射精时间从不到2分钟延长到超过10分钟，尤其对35岁以下的年轻男性效果更佳 75。甚至有研究发现，经过12周的盆底肌康复训练，82.5%的终身型早泄患者获得了射精控制，平均射精时间显著延长，并且这种效果在6个月的随访中依然保持 76。
这些联合和升级的治疗方案，为早泄患者提供了更广阔的选择空间。重要的是，无论采取何种治疗，都应在专业医生的评估和指导下进行，根据个人情况量身定制最合适的方案。
3.4 谨慎对待：手术与器械的“双刃剑”
在早泄治疗的探索之路上，总有一些方法听起来很诱人，似乎能“一劳永逸”，但实际上却隐藏着不小的风险，就像一把“双刃剑”，既可能带来益处，也可能造成伤害。手术和某些新兴的辅助器械就属于这一类，需要我们格外谨慎地对待。
3.4.1 手术干预：阴茎背神经阻断术的“高风险”与“不推荐”
有一种手术叫做阴茎背神经阻断术（Selective Dorsal Neurectomy, SDN），它的想法听起来很简单：既然早泄是因为阴茎头敏感度过高，那我就把一部分神经切断，让它不那么敏感不就好了吗？这种手术的目的，就是通过切断或冷消融部分阴茎背神经，来降低阴茎头的敏感度，从而达到延长射精时间的目的 77。
然而，尽管这种手术在一些地方被推广，但主流的医学界对其态度是高度警惕和不推荐的。为什么呢？
- 高风险性：阴茎背神经阻断术最大的风险在于，它可能导致永久性的感觉丧失或麻木。一旦神经被切断，就很难恢复。想象一下，如果你的手指神经被切断，会发生什么？你会失去触觉。同样，如果阴茎头的神经被切断过多，可能会导致阴茎头麻木，这不仅会严重影响性快感，甚至可能导致勃起功能障碍。一些研究显示，手术后可能会出现疼痛、麻木、感觉减退等不良反应 77。
- 疗效不确定：尽管一些小型研究报告了该手术能改善射精时间，但这些研究往往样本量小、缺乏严格的对照，且长期效果和安全性数据不足 77。例如，有研究指出，SDN可以显著改善阴道内射精潜伏时间（IELT），平均延长147.47秒，并改善性满意度和射精控制，但同时也伴随着11.17%的不良事件发生率 77。然而，这些研究的异质性很高，随访期也较短，因此其可靠性仍需进一步验证。
- 指南不推荐：基于其不可逆的风险和不确定的长期疗效，国际上绝大多数权威的早泄诊疗指南，包括欧洲泌尿外科学会（EAU）和美国泌尿外科学会（AUA）的指南，都明确不推荐将阴茎背神经阻断术作为治疗早泄的方法。它们认为，在有多种安全有效、非侵入性或微创治疗方案的情况下，不应冒这种巨大的风险。
因此，如果你听到有人推荐这种手术，务必擦亮眼睛，寻求多个权威医生的意见，切勿盲目尝试。对于早泄的治疗，我们始终应该优先选择那些经过充分验证、风险可控的方法。
3.4.2 新型辅助训练器械：希望与局限并存
随着科技的发展，一些旨在辅助早泄治疗的新型器械也开始出现。它们大多是非侵入性的，通过物理刺激或训练来帮助患者改善射精控制。
经皮电刺激器（Transcutaneous Electrical Stimulation, TES）：
- 原理：这种器械通过向特定部位（如会阴部）传递微弱的电流，来刺激神经或肌肉，以期调节射精反射。你可以想象它像是一种温和的电脉冲按摩，希望能“唤醒”或“训练”控制射精的神经回路。
- 研究进展：一项小型概念验证研究发现，经皮电刺激（TES）可以显著延长终身型早泄患者的自慰射精潜伏期（MELT），平均延长3.5倍，且安全性良好 78。另一项针对“vPatch”这种微型经皮电刺激设备的初步临床研究也显示，该设备在性交时按需使用，能使终身型早泄患者的IELT从平均67秒延长到123秒，效果显著优于安慰剂组，且没有严重不良事件 79。
- 局限性：尽管初步结果令人鼓舞，但这些研究大多样本量较小，随访时间也较短，且有些研究只观察了自慰时的效果，其在实际性生活中的长期疗效和安全性仍需更大规模、更严谨的临床试验来证实。目前，这类设备还处于研究阶段，尚未广泛推荐用于临床。
机械自慰装置（Mechanical Masturbation Device）：
总而言之，对于手术和这些新兴的辅助器械，我们需要保持一种既开放又谨慎的态度。手术（如阴茎背神经阻断术）由于其高风险和不可逆性，目前并不推荐。而新型器械虽然前景可期，但大多仍处于研究阶段，在获得充分的临床证据之前，不应将其视为常规治疗方案。在选择治疗时，始终应以科学证据为基础，在专业医生的指导下，权衡利弊，选择最适合自己的安全有效的方法。
4. 患者自我管理：从治疗到康复的全程配合
早泄的治疗不仅仅是医生的事情，患者自身的积极参与和配合也至关重要。这就像一场马拉松，医生为你制定了跑道和补给方案，但最终能不能跑到终点，还需要你自己迈开双腿，持之以恒。所以，除了专业的医学干预，患者的“自我管理”同样是治疗成功的关键，它能为“控制感”打下坚实的基础，并帮助巩固治疗效果，实现长期的康复。
4.1 生活方式调整：为“控制感”打基础
你可能已经发现，我们身体的各个系统都是相互关联的。一种疾病往往不是孤立存在的，它可能与其他健康问题有着千丝万缕的联系。早泄也是如此。通过调整生活方式，改善整体的健康状况，往往能对早泄的治疗起到意想不到的积极作用。这就像是在给你的身体系统做一次全面的“升级维护”，让它运行得更顺畅，从而提升对射精的控制力。
规律作息：给身体和大脑“充电”
长期熬夜、睡眠不足，会导致身体疲惫、精神紧张，这些都会影响神经内分泌系统的稳定，让大脑对射精的“刹车”功能变得迟钝。想象一下，一个人长期疲劳，反应都会变慢，更何况是精密的生理反射呢？有研究表明，睡眠质量差是获得型早泄的一个独立风险因素 81。更深入的研究也发现，不同类型的早泄（如获得型早泄和终身型早泄）患者，其睡眠参数确实存在显著差异，特别是获得型早泄患者往往睡眠质量更差 82。所以，保证充足、高质量的睡眠，让身体得到充分休息，大脑得到有效“充电”，对于稳定情绪、调节神经功能，从而间接改善射精控制，都是非常重要的。适度运动：让“身体机器”更灵活
运动不仅能增强体质，还能改善情绪，减轻压力。对于早泄患者来说，适度运动，尤其是针对性的盆底肌锻炼，更是重中之重。- 盆底肌锻炼（凯格尔运动）：前面我们提到过盆底肌对于射精控制的重要性。规律的盆底肌锻炼，能够增强这部分肌肉的力量和耐力，帮助男性更好地感知并控制射精前的“临界点”，从而延长射精时间 83848586。多项研究证实，盆底肌训练对早泄患者非常有效 7175。甚至有研究认为，盆底肌训练可能对早泄具有治疗作用，尽管仍需更多高质量的研究来证实其作为一线疗法的普遍适用性 87。你可以像憋尿一样收缩盆底肌肉，每次收缩并保持几秒钟，然后放松，每天重复多次。贵在坚持，效果才会逐渐显现。
- 全身性运动：除了盆底肌锻炼，像瑜伽、跑步和高强度间歇训练等全身性运动，也可能对缓解早泄症状有帮助 88。这些运动有助于改善心血管健康，减轻压力，提升整体的身体素质，从而间接支持性功能的改善。
戒烟限酒：清除“健康障碍”
吸烟和过量饮酒是多种疾病的危险因素，也与性功能障碍密切相关。
通过这些生活方式的调整，你不仅能改善早泄症状，还能提升整体的健康水平和生活质量。这是一个积极的循环，当你感觉身体更健康、精神更饱满时，对射精的控制感自然也会随之增强。
4.2 伴侣协同：沟通与支持的重要性
性生活从来就不是一个人的事，它是两个人亲密关系的体现。因此，当一方出现早泄问题时，伴侣的角色和态度，对于治疗的成败和患者的康复，起着举足轻重的作用。可以说，伴侣的协同作战，是早泄治疗中不可或缺的“催化剂”和“稳定剂”。
设想一下，如果患者独自面对早泄的困扰，不仅要承受生理上的不适，还要应对心理上的焦虑和自责。这时，伴侣如果能给予理解和支持，就像在患者最需要的时候递上了“定心丸”；反之，如果伴侣表现出指责、不满，甚至因此而疏远，那无疑是雪上加霜，会让患者的焦虑感倍增，甚至彻底放弃治疗。研究表明，夫妻双方的心理症状和性功能都会影响到性功能障碍的治疗效果 92。
那么，伴侣应该如何有效地参与到早泄的治疗中来呢？
积极沟通，打开心结：
早泄常常是难以启齿的“隐疾”，患者可能会因为羞耻感而选择隐瞒或逃避。伴侣应该主动创造一个开放、坦诚的沟通环境，让对方感到安全，能够自由地表达自己的感受和担忧。- 避免指责和抱怨：请记住，早泄不是患者的“错”，它是一种生理或心理功能障碍。指责和抱怨只会增加患者的心理负担，让他们的表现焦虑加剧，形成恶性循环。
- 表达理解和支持：告诉你的伴侣，你理解他的痛苦，愿意和他一起面对。例如，你可以说：“亲爱的，我知道你现在很困扰，我在这里支持你，我们会一起想办法解决的。”这种肯定的态度，本身就是一种强大的心理疗愈。
- 分享感受，共同探索：伴侣也可以分享自己在性生活中的感受，但重点应放在“我们如何能让彼此的体验更好”，而不是“你做得不够好”。通过共同探讨性生活的节奏、方式，可以帮助患者减轻压力，找到更适合双方的性爱模式。
共同学习，参与治疗：
早泄的治疗，特别是行为疗法，往往需要伴侣的积极参与。- 学习行为疗法：例如，在前面提到的“停-动法”和“挤压法”中，伴侣的配合至关重要。伴侣需要了解这些方法的原理和操作步骤，并在性生活中给予患者恰当的反馈和帮助。这不仅能提高治疗效果，也能增强夫妻之间的互动和默契。
- 了解药物知识：如果患者需要药物治疗，伴侣可以一起了解药物的作用机制、服用方法和可能的副作用。这种共同面对疾病的态度，会让患者感到不那么孤独，从而提高治疗的依从性。
减轻压力，提供心理支持：
性生活中的压力往往是早泄的“元凶”之一。伴侣可以通过多种方式帮助患者减轻这种压力。- 降低“性表现”的期望：有时，男性会将性能力与自己的价值划等号。伴侣可以帮助患者认识到，亲密关系远不止性爱本身，还有情感连接、互相扶持等更多层面。让患者放松下来，减少对“必须表现完美”的执念。
- 创造轻松愉悦的氛围：性爱前可以通过爱抚、亲吻等方式增加前戏，营造轻松浪漫的氛围，而不是直接进入主题，这有助于减轻患者的紧张感。
- 肯定患者的努力：无论治疗进展如何，都要肯定患者为改善问题所做的努力，哪怕只是很小的进步，也值得鼓励。这种正向的反馈，会给患者带来巨大的信心。
共同面对，避免“性生活黑洞”：
有些夫妻在早泄问题出现后，可能会逐渐减少性生活，甚至完全回避。这种“性生活黑洞”不仅无助于解决问题，反而会加剧夫妻间的隔阂。- 保持亲密接触：即使暂时无法进行满意的性交，也可以通过拥抱、亲吻、按摩等非性交方式来保持亲密接触，维系情感连接。
- 探索新的亲密方式：性爱的方式有很多种，不一定非要局限于插入式性交。夫妻可以共同探索其他能带来愉悦和满足感的亲密方式，这有助于减轻患者的心理负担，同时也能增进彼此的了解。
总之，伴侣的支持和参与，是早泄治疗过程中一笔宝贵的财富。它不仅能帮助患者更好地应对疾病，提高治疗效果，更能加深夫妻之间的理解与情感，让亲密关系在共同面对挑战中变得更加坚固。
4.3 避免误区：不盲目用药或迷信“偏方”
在治疗早泄的道路上，有一种诱惑常常摆在患者面前，那就是各种“速效壮阳药”、“祖传秘方”以及网络上流传的“神奇疗法”。面对性功能的困扰，许多人抱着“死马当活马医”的心态，急于尝试，希望能快速解决问题。然而，这往往是治疗过程中的一大误区，就像走入了一条布满陷阱的羊肠小道，不仅可能延误病情，甚至会给身体带来新的伤害。
自行服用未经验证药物的风险：
市面上充斥着大量宣称能“延长性爱时间”的药物，包括一些所谓的“保健品”和从非正规渠道获得的“特效药”。这些产品往往缺乏严格的临床验证，成分不明，或者可能含有未经申报的处方药成分。- 成分不明的危害：许多“壮阳药”可能非法添加了PDE5抑制剂（如西地那非、他达拉非），如果患者本身有心血管疾病，或正在服用硝酸酯类药物，盲目使用可能导致血压骤降，引发严重的心脏事件，甚至危及生命。例如，一些产品可能混合了多种化学成分，其相互作用尚不明确，对肝肾功能造成损害的风险不容忽视。
- 延误正规治疗：当患者花费大量时间和金钱在这些无效或有害的产品上时，就错过了接受科学、规范治疗的最佳时机，导致病情迁延不愈，甚至加重心理负担。
- 虚假承诺与经济损失：这些产品往往通过夸大宣传、虚假承诺来吸引消费者，最终不仅没有效果，反而让患者蒙受经济损失。
迷信“偏方”的潜在危险：
在民间，关于治疗早泄的“偏方”也五花八门，比如服用某些草药、食物，或者进行一些特殊的物理刺激。- 缺乏科学依据：绝大多数“偏方”都没有经过严格的科学研究和临床试验验证，其疗效和安全性都无法保证。有些偏方甚至可能采用具有毒副作用的物质，对人体造成损害。例如，一些传统草药可能含有肝毒性成分，长期服用可能导致肝功能损伤。
- 可能导致意外伤害：除了口服药物，一些物理“偏方”也可能存在风险。例如，有人尝试用刺激性物质涂抹阴茎以降低敏感度，这可能导致皮肤过敏、炎症甚至溃疡。极端情况下，一些未经许可的“侵入性”操作，如自行购买所谓的“治疗器械”进行不当操作，甚至可能造成永久性损伤，甚至危及生命（尽管极端，但需警示）。甚至有案例报告，不当的针灸治疗可能导致致命的肺部脂肪栓塞 93。
强调在医生指导下规范治疗，定期随访：
早泄的治疗是一个科学、严谨的过程，必须遵循医学指南，并在专业医生的指导下进行。- 专业诊断是前提：医生会根据患者的具体情况，进行全面的评估和诊断，排除其他潜在的健康问题（如糖尿病、前列腺炎等），并确定早泄的类型和严重程度。只有明确了病因，才能对症下药。
- 个体化治疗方案：医生会根据患者的身体状况、心理因素、伴侣关系以及对治疗的期望，制定个性化的治疗方案，这可能包括行为疗法、药物治疗、心理咨询或多种方法的联合应用。
- 定期随访与调整：治疗并非一劳永逸。患者需要定期复诊，向医生反馈治疗效果和遇到的问题。医生会根据随访结果，及时调整治疗方案，确保达到最佳的治疗效果，并最大程度地减少副作用。这种动态的、持续的医学指导，是确保治疗成功和长期康复的关键。
总之，面对早泄问题，患者最明智的选择是寻求正规医院泌尿科或男科医生的帮助。相信科学，拒绝盲从，才能真正摆脱困扰，重获健康和自信。
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参考文献
1Premature Ejaculation: Aetiology and Treatment Strategies.PubMed
Nicholas Gillman, Michael Gillman
Med Sci (Basel). 2019 Oct 25;7(11):102. doi: 10.3390/medsci7110102.
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.
2Comparison of Current International Guidelines on Premature Ejaculation: 2024 Update.PubMed
Lorenzo Romano, Davide Arcaniolo, Lorenzo Spirito, et al.
Diagnostics (Basel). 2024 Aug 21;14(16):1819. doi: 10.3390/diagnostics14161819.
Premature ejaculation (PE) is a common male sexual dysfunction that can cause significant distress in the patient and partner. This study aimed to compare the current international guidelines on PE to highlight their similarities and differences. We examined the latest guidelines from the European Association of Urology (EAU), American Urological Association/Sexual Medicine Society of North America (AUA/SMSNA), and International Society of Sexual Medicine (ISSM) by comparing definitions, classifications, epidemiology, pathophysiology, and recommendations on diagnosis and therapy. The quality of guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) Global Rating Scale (GRS). We found significant variations in the definitions of PE and recommendations on management of patients. The EAU guidelines were the most recent, the AUA/SMSNA guidelines lacked detail in some areas, and the ISSM guidelines were the most complete but also the least updated. The search for a unified definition and the development of standardized diagnostic and therapeutic pathways remain concrete issues to improve the management of patients with PE worldwide.
3Oral agents for the treatment of premature ejaculation: review of efficacy and safety in the context of the recent International Society for Sexual Medicine criteria for lifelong premature ejaculation.PubMed
Chris G McMahon, Hartmut Porst
J Sex Med. 2011 Oct;8(10):2707-25. doi: 10.1111/j.1743-6109.2011.02386.x. Epub 2011 Jul 19.
INTRODUCTION: New diagnostic criteria for lifelong premature ejaculation (PE) have been proposed by the International Society of Sexual Medicine (ISSM), including an intravaginal ejaculatory latency time (IELT) of less than about 1 minute, lack of control over ejaculation, and PE-related distress or bother. AIM: The aim of this study was to review evidence supporting the efficacy and safety of oral agents for the treatment of PE in the context of the new ISSM criteria. METHODS: The PubMed database was searched for randomized, double-blind, placebo-controlled studies of oral agents in PE that included stopwatch measurements of IELT. MAIN OUTCOME MEASURES: The main outcome measure used for this study was a review of the efficacy and safety data of oral agents for PE aligned with ISSM criteria. RESULTS: Since the latest meta-analyses using similar criteria (conducted in 2004 and 2005 for selective serotonin reuptake inhibitors [SSRIs] and phosphodiesterase type 5 [PDE-5] inhibitors, respectively), eight studies evaluated SSRIs vs. placebo, one compared SSRIs, two evaluated PDE-5 inhibitors, and one evaluated an SSRI/PDE-5 inhibitor combination. New agents included dapoxetine (five studies) and tramadol (one study). Six studies enrolled men who met an approximation of the ISSM criteria. Although evidence suggests that most SSRIs, tramadol, and dapoxetine increase IELT to varying degrees, few studies included control over ejaculation and PE-related distress or bother as enrollment criteria or used validated patient-reported outcome instruments to evaluate these parameters. Among studies that provided comprehensive adverse event data, safety and tolerability observations in men with PE were generally similar to those observed in other populations; however, with the exception of dapoxetine, known SSRI-class effects (e.g., withdrawal syndrome) were not evaluated in men with PE. CONCLUSIONS: This systematic review of well-controlled clinical trials in PE has demonstrated that while many oral agents, particularly SSRIs, tramadol, and dapoxetine, have proven effective and safe for the treatment of men with PE, few have been evaluated for their effects on the specific elements of the ISSM criteria.
4Male Sexual Disorders: Ejaculatory Disorders.PubMed
Michael Partin, Roderick Clark, Roland Newman, et al.
FP Essent. 2025 May;552:21-28.
Disorders of ejaculation include premature ejaculation, delayed ejaculation, retrograde ejaculation, and hematospermia. Lifelong premature ejaculation is defined as ejaculation always or nearly always within 1 minute of vaginal penetration that has been present since the first sexual encounter. Acquired premature ejaculation typically begins after a period of normal function, with ejaculation occurring within 3 minutes of penetration. Treatment options include medications and behavioral techniques. Selective serotonin reuptake inhibitors and tricyclic antidepressants are first-line drugs. Delayed ejaculation applies to a range of issues, from delay to complete absence of ejaculation. Guidelines suggest use of an ejaculatory latency time greater than 25 to 30 minutes for diagnosis. Etiologies include psychological and organic factors, such as adverse effects of medications. Treatment focuses on causal medication discontinuation, psychological interventions, and use of off-label drug therapy. Retrograde ejaculation occurs when semen enters the bladder due to an anatomic, neurogenic, or pharmacologic cause. Treatment options include sympathomimetic medications and surgical correction of anatomic abnormalities. Hematospermia, or blood in the semen, is generally benign and self-limited. However, underlying malignancy is possible and should be considered based on patient age and risk factors. Treatment ranges from reassurance to management of the underlying cause.
5The pathophysiology of acquired premature ejaculation.PubMed
Chris G McMahon, Emmanuele A Jannini, Ege C Serefoglu, et al.
Transl Androl Urol. 2016 Aug;5(4):434-49. doi: 10.21037/tau.2016.07.06.
The second Ad Hoc International Society for Sexual Medicine (ISSM) Committee for the Definition of Premature Ejaculation defined acquired premature ejaculation (PE) as a male sexual dysfunction characterized by a the development of a clinically significant and bothersome reduction in ejaculation latency time in men with previous normal ejaculatory experiences, often to about 3 minutes or less, the inability to delay ejaculation on all or nearly all vaginal penetrations, and the presence of negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy. The literature contains a diverse range of biological and psychological etiological theories. Acquired PE is commonly due to sexual performance anxiety, psychological or relationship problems, erectile dysfunction (ED), and occasionally prostatitis and hyperthyroidism, consistent with the predominant organic etiology of acquired PE, men with this complaint are usually older, have a higher mean BMI and a greater incidence of comorbid disease including hypertension, sexual desire disorder, diabetes mellitus, chronic prostatitis, and ED compared to lifelong, variable and subjective PE.
6A multinational population survey of intravaginal ejaculation latency time.PubMed
Marcel D Waldinger, Paul Quinn, Maria Dilleen, et al.
J Sex Med. 2005 Jul;2(4):492-7. doi: 10.1111/j.1743-6109.2005.00070.x.
INTRODUCTION: Intravaginal ejaculation latency time (IELT), defined as the time between the start of vaginal intromission and the start of intravaginal ejaculation, is increasingly used in clinical trials to assess the amount of selective serotonin reuptake inhibitor-induced ejaculation delay in men with premature ejaculation. Prospectively, stopwatch assessment of IELTs has superior accuracy compared with retrospective questionnaire and spontaneous reported latency. However, the IELT distribution in the general male population has not been previously assessed. AIM: To determine the stopwatch assessed-IELT distribution in large random male cohorts of different countries. METHODS: A total of 500 couples were recruited from five countries: the Netherlands, United Kingdom, Spain, Turkey, and the United States. Enrolled men were aged 18 years or older, had a stable heterosexual relationship for at least 6 months, with regular sexual intercourse. The surveyed population were not included or excluded by their ejaculatory status and comorbidities. This survey was performed on a "normal" general population. Sexual events and stopwatch-timed IELTs during a 4-week period were recorded, as well as circumcision status and condom use. MAIN OUTCOME MEASURES: The IELT, circumcision status, and condom use. RESULTS: The distribution of the IELT in all the five countries was positively skewed, with a median IELT of 5.4 minutes (range, 0.55-44.1 minutes). The median IELT decreased significantly with age, from 6.5 minutes in the 18-30 years group, to 4.3 minutes in the group older than 51 years (P<0.0001). The median IELT varied between countries, with the median value for Turkey being the lowest, i.e., 3.7 minutes (0.9-30.4 minutes), which was significantly different from each of the other countries. Comparison of circumcised (N=98) and not-circumcised (N=261) men in countries excluding Turkey resulted in median IELT values of 6.7 minutes (0.7-44.1 minutes) in circumcised compared with 6.0 minutes (0.5-37.4 minutes) in not-circumcised men (not significant). The median IELT value was not affected by condom use. CONCLUSION: The IELT distribution is positively skewed. The overall median value was 5.4 minutes but with differences between countries. For all five countries, median IELT values were independent of condom usage. In countries excluding Turkey, the median IELT values were independent of circumcision status.
7Are the Criteria for the Diagnosis of Premature Ejaculation Applicable to Gay Men or Sexual Activities Other than Penile-Vaginal Intercourse?PubMed
Sean M McNabney, Claire E Weseman, Kriszta Hevesi, et al.
Sex Med. 2022 Jun;10(3):100516. doi: 10.1016/j.esxm.2022.100516. Epub 2022 Apr 25.
INTRODUCTION: The criteria for premature ejaculation (PE) have generally been limited to the diagnosis of heterosexual men engaging in penile-vaginal intercourse and therefore the applicability of PE diagnostic criteria to gay men and to activities beyond penile-vaginal intercourse has yet to be explored in depth. AIM: To compare the prevalence of PE in gay and straight men and to assess whether PE-related diagnostic measures (ejaculatory control, ejaculation latency [EL], and bother/distress) can be applied with confidence to gay men or to men engaging in sexual activities other than penile-vaginal intercourse. METHODS: Gay and straight participants (n = 3878) were recruited to take an online survey assessing sexual orientation, sexual function/dysfunction (including specific PE-related measures), sexual relationship satisfaction, and various other sexual behaviors during partnered sex or masturbation. OUTCOMES: Comparison of ejaculatory control, EL, and bother/distress across gay and straight men, as well as across different types of sexual activities. RESULTS: A slightly lower PE prevalence among gay men became undetectable when other predictors of prevalence were included in a multivariate analysis (aOR = 0.87 [95% CI: 0.60-1.22]). Gay men with PE reported longer typical ELs (z = -3.35, P < .001) and lower distress (z = 3.68, P < .001) relative to straight men, but longer ELs and lower distress were also associated with anal sex. CLINICAL TRANSLATION: Clinicians can feel confident about using existing criteria for the diagnosis of PE in gay men but should be aware of potentially longer ELs and lower PE-related bother/distress-probably related to the practice of anal sex-compared with straight men. STRENGTHS AND LIMITATIONS: Although well-powered and international in scope, this study was limited by biases inherent to online surveys, the lack of a sizable sample of bisexual men, and a lack of differentiation between men with acquired vs lifelong PE. CONCLUSIONS: Irrespective of sexual orientation, gay and straight men with PE reported shorter ELs, lower satisfaction, and greater bother/distress than functional counterparts. While PE-related diagnostic criteria (ejaculatory control, EL, and bother/distress) are applicable to gay men, accommodation for longer ELs and lower bother/distress in gay men should be considered. McNabney SM, Weseman CE, Hevesi K, et al. Are the Criteria for the Diagnosis of Premature Ejaculation Applicable to Gay Men or Sexual Activities Other than Penile-Vaginal Intercourse?. Sex Med 2022;10:100516.
8Advances and Missteps in Diagnosing Premature Ejaculation: Analysis and Future Directions.PubMed
Stanley E Althof, Chris G McMahon, David L Rowland
J Sex Med. 2022 Jan;19(1):64-73. doi: 10.1016/j.jsxm.2021.10.010. Epub 2021 Dec 8.
BACKGROUND: There are several problems with diagnostic criteria for premature ejaculation (PE) that lack objectivity, clarity and precision. They hamper accurate determination of PE prevalence estimates, investigations into the etiology of the dysfunction, impact on partners, development of validated Patient Reported Outcomes, regulatory authority oversight, and which men might benefit from specific treatment interventions. AIM: We sought to review, analyze and comment on the evolution of the definitions of PE and offer suggestions for future directions for PE definitions. Our goal is to propose strategies whereby the criterion sets are useful to researchers, clinicians and governmental oversight agencies alike and bring harmony and scientific rigor among the conflicting and confusing definitions. METHODS: There are several premature ejaculation definitions published in the peer reviewed medical literature. The PUBMED electronic database from 1970 to 2021 was searched for published definitions. Search terms included the medical subject headings of premature ejaculation, definition and diagnosis. In chronological order, Table 1 lists the various diagnosis and criteria sets for PE. We discuss the process by which constructs, which make up diagnostic criteria sets, are operationalized and validated. RESULTS: We review definitions of PE beginning with Masters and Johnson's focus on partner orgasmic attainment and move through the nebulous and subjective criterion sets found in the early Diagnostic and Statistical Manuals and International Classification of Disease series, to the more evidenced-based definitions found in International Society of Sexual Medicine, Diagnostic and Statistical Manuals-5 and the American Urological Association (AUA) definitions. Additionally, we discuss how constructs and criteria sets have been adopted to minimize errors of inclusion and exclusion in defining disease/dysfunction. STRENGTHS AND LIMITATIONS: This manuscript offers a careful chronological analysis of the published definitions of PE. This historical lens allows the reader to perceive the shifting science underlying the development of PE definitions. The manuscript is limited regarding our comments on acquired PE as evidenced-based research is incomplete. CONCLUSION: Over the past 50 years there has been considerable forward momentum in defining PE based on well conducted scientific studies. We support the American Urological Association's modification in Intravaginal ejaculatory latency time to 2-minutes for lifelong PE, concur with the 11th revision of the International Classification of Diseases recommendation for changing the terminology from premature ejaculation to early ejaculation. We also recommend ongoing validation of definitions, moving away from the current heterosexist definition of PE based on penile-vaginal sex and urge further population based research into acquired PE to develop stronger evidenced-based criterion sets for this subtype. Althof SE, McMahon CG, Rowland DL. Advances and Missteps in Diagnosing Premature Ejaculation: Analysis and Future Directions. J Sex Med 2022;19:64-73.
9Premature EjaculationPubMed
Marissa Crowdis, Stephen W. Leslie, Saad Nazir
Ejaculation occurs when semen is released and externally expressed from the male reproductive system. The term premature ejaculation describes the phenomenon which occurs when ejaculation happens persistently sooner than a man or his partner would like during sexual activity. About 30% of men are affected but possibly up to 75% in some reviews. It is considered to be the most common male sexual disorder. There are several different definitions of premature ejaculation. It has been defined simply as an inability to exert voluntary control over the ejaculatory reflex or as the condition where a man reaches orgasm and ejaculates before he desires to do so. Masters and Johnson defined it as "the inability of the male to control ejaculation sufficiently to satisfy his female partner in more than 50% of coital episodes provided that she is not anorgasmic," while Strassberg et al. define it as "the condition where the male has little voluntary control over ejaculation and ejaculates within 2 minutes or less after intromission in at least 50% of coital attempts." The World Health Organization (WHO) describes premature ejaculation as "the inability to delay ejaculation sufficient to enjoy lovemaking, which is manifested by either an occurrence of ejaculation before or very soon after the beginning of intercourse or ejaculation occurring in the absence of sufficient erection to make intercourse possible." Some have suggested that any ejaculation which occurs less than 1 minute after vaginal penetration is automatically "premature" while others suggest that this intravaginal time should normally be at least 4 minutes long with anything less considered pathological. The International Society for Sexual Medicine defines premature ejaculation as the following: 1. Ejaculation that always or nearly always occurs before, or within about 1 minute, of vaginal penetration from the first sexual experience (lifelong premature ejaculation) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired premature ejaculation). 2. Inability to delay ejaculation on all or nearly all vaginal penetrations. 3. Negative personal consequences include distress, bother, frustration, and avoidance of sexual intimacy. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association defines premature ejaculation as follows: Ejaculation occurs during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it, during all or almost all sexual activity (75% to 100% of the time). . Symptoms must persist for at minimum six months and cause clinically significant distress to the individual. The dysfunction is not explainable by a nonsexual mental disorder, medical condition, drug side effects, severe relationship distress, or other significant stressors. Many women may have a severely delayed climax with vaginal intercourse. This is defined as delayed female orgasm rather than premature ejaculation. Occasional premature ejaculation is not a cause for concern; however, for those individuals who chronically meet the diagnostic criteria, the condition can cause significant anxiety, distress, depression, psychological pain, and marital discord as sexual activity becomes much less enjoyable and relationships suffer significant negative consequences. Premature ejaculation that has been present for one year or more has a significant effect on the couple and tends to lead to clinical depression, relationship issues, and other problems. Approximately 30% of men ages 18 to 59 years old have problems with premature ejaculation; however, shame and embarrassment prevent many from discussing this sensitive topic with their physicians.
10Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?PubMed
David L Rowland, Sean M McNabney, Krisztina Hevesi
Sex Med. 2022 Oct;10(5):100548. doi: 10.1016/j.esxm.2022.100548. Epub 2022 Aug 8.
INTRODUCTION: The role of bother/distress in the diagnosis of premature ejaculation (PE) has received minimal investigation compared with the 2 other diagnostic criteria, ejaculatory control and ejaculatory latency (EL). AIM: This study assessed (i) the added variance explained by bother/distress to the diagnostic accuracy of PE and (ii) determined its overall contribution to a PE diagnosis. METHODS: The 3 diagnostic criteria for PE were assessed in 2,589 men (mean age = 38.2 years, SD = 13.5) in order to determine the contribution of each factor to a dysfunctional diagnosis. A series of regression and discriminant analyses were used to assess the value of bother/distress in explaining ejaculatory control and in predicting accuracy of PE group status. Commonality analysis was used to determine the relative contribution of each of these factors to the diagnosis of PE. MAIN OUTCOME MEASURE: The major outcome was the quantified contribution of "bother/distress" to a PE diagnosis. RESULTS: Bother/distress accounted for about 3-4% of the variation in ejaculatory control and added only minimally to the prediction accuracy of PE group status (no, probable, definite PE). Commonality analysis indicated that bother/distress comprised about 3.6% of the unique explained variation in the PE diagnosis, compared with ejaculatory control and EL which contributed 54.5% and 26.7%, respectively. Common variance among factors contributed the remaining 15.5% to the PE diagnosis. CLINICAL TRANSLATION: Bother/distress contributes least to the determination of a PE diagnosis. Its contribution is largely redundant with the unique and combined contributions of ejaculatory control and EL. STRENGTHS AND LIMITATIONS: Using a well-powered and multivariate analysis, this study parsed out the relative contributions of the 3 diagnostic criteria to a PE diagnosis. The study is limited by its use of estimated EL, a single item assessment of bother/distress, and the lack of differentiation of PE subtypes, lifelong and acquired. CONCLUSION: Bother/distress contributes minimally to the PE diagnosis, yet its assessment may be key to understanding the experiences of the patient/couple and to developing an effective treatment strategy. Rowland DL, McNabney SM, Hevesi K. Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?. Sex Med 2022;10:100548.
11Indicators of premature ejaculation and their associations with sexual distress in a population-based sample of young twins and their siblings.PubMed
Patrick Jern, Pekka Santtila, Ada Johansson, et al.
J Sex Med. 2008 Sep;5(9):2191-201. doi: 10.1111/j.1743-6109.2008.00863.x. Epub 2008 May 20.
INTRODUCTION: Recently, in anticipation of the Diagnostic and Statistical Manual of Mental Disorders V, much consideration has been given to the diagnostic criteria for premature ejaculation (PE). The scientific community is yet to agree not only on the etiology of PE, but also on the most suitable diagnosis and forms of treatment. It has been suggested that the diagnostic criteria of PE should be strictly empirical and rely on intravaginal latency time alone, whereas others stress the need to also include psychological and personal factors. AIM: To examine different indicators of PE and their relationship with and ability to predict sexual distress. MAIN OUTCOME MEASURES: Statistical analyses of data on sexual distress and different measures of ejaculatory function on a population-based sample of 3,332 Finnish men. METHODS: The present study involved a population-based sample of 3,332 males, of which 2,328 were twins aged 18-33, and 1,004 were over 18-year-old siblings to the aforementioned (M = 26.17 years of age). The individual contributions of different PE-indicator variables to experienced sexual distress were investigated by calculating correlations and performing a regression analysis. RESULTS: All included indicators of PE were significantly associated with sexual distress, and significant and logical differences in sexual distress were found between intravariable levels for several of the indicator variables. Only variables relating to subjective experience (e.g., worrying about PE) were uniquely related to sexual distress when other indicators were controlled for. CONCLUSIONS: The results suggest that variables measuring subjective experience may be useful when considering diagnostic criteria if indicators that are related to sexual distress are considered useful. However, overall, the association between PE and sexual distress is not especially strong, emphasizing the fact that more objective indicators of PE may not necessarily be associated with significant distress.
12The use of old and recent DSM definitions of premature ejaculation in observational studies: a contribution to the present debate for a new classification of PE in the DSM-V.PubMed
Marcel D Waldinger, Dave H Schweitzer
J Sex Med. 2008 May;5(5):1079-1087. doi: 10.1111/j.1743-6109.2008.00789.x. Epub 2008 Mar 4.
INTRODUCTION: The DSM-III definition of premature ejaculation (PE) contains the criterion "control" but not that of "ejaculation time." In contrast, the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) (DSM-IV-TR) contains the criterion "short ejaculation time," while it lacks "control." AIM: To review the adequacy and consequent use of all criteria of the DSM-IV-TR definition in previously published PE Internet surveys. METHODS: Reviewing all published cohort studies on PE from 2004 to 2007. MEDLINE and EMBASE computer bibliographies were used. MAIN OUTCOME MEASURE: Definitions of DSM-III, DSM-IV-TR, and International Classification of Diseases. RESULTS: Five papers, of which three are original studies, reported inclusion of men with PE according to DSM-IV-TR definition but omitted to apply the required "short ejaculation time" criterion. These studies, which have defined PE according to subjective criteria such as control, actually referred to the DSM-III definition. Using DSM-III-like definitions in three different studies revealed a highly variable prevalence of PE (32.5%, 27.6%, and 13.0%). In contrast, based on studies using a 1-minute cutoff point, being the time that is required to call ejaculation time "short" or using the criterion "persistent occurrence," PE revealed to be far less prevalent (5-6%). CONCLUSIONS: Unacceptable discrepancies of PE definitions according to DSM-III (abandoned but still used) and DSM-IV-TR argue strongly in favor of a multidimensional new classification of PE for the DSM-V.
13Recommendations for the diagnosis and evaluation of premature ejaculation.PubMed
Eric Huyghe, Laure Grellet, Antoine Faix, et al.
Fr J Urol. 2024 Sep;34(9):102697. doi: 10.1016/j.fjurol.2024.102697. Epub 2024 Jul 11.
OBJECTIVES: The Association Interdisciplinaire Post-Universitaire de Sexologie (AIUS) has brought together a panel of experts to draw up French recommendations for the management of premature ejaculation. This article presents the recommendations for the diagnosis and evaluation of premature ejaculation. METHODS: Systematic review of the literature between 01/1995 and 02/2022. Using the method of recommendations for clinical practice (RPC). RESULTS: We recommend using the SIAMS definition for everyday clinical practice. PE is defined as: (i) a persistent and recurrent subjective perception of loss of control (management) of the ejaculatory mechanism in the presence of appropriate erotic stimuli; (ii) subjective, PE-related distress induced in the patient and sexual dissatisfaction or PE-related anorgamy in the partner; (iii) a short intravaginal ejaculatory latency time, whether subjectively perceived by the patient and the partner or objectively measured as less than 180seconds (generally). We suggest that the same definition be applied to practices other than vaginal penetration, such as masturbation, oral or anal intercourse, as well as to non-heterosexual contexts. We suggest using information reported by the patient, possibly supplemented by assessment tests/questionnaires (IPE, PEP, PEDT). We recommend investigating the presence of other sexual dysfunctions, in particular erectile dysfunction (ED), as well as any sexual dysfunctions of partners. We recommend taking a medical and psychosexological history, and carrying out a targeted physical examination in patients complaining of PE. CONCLUSION: These recommendations should help to improve the management of PE.
14Impact of premature ejaculation: the psychological, quality of life, and sexual relationship consequences.PubMed
Raymond C Rosen, Stanley Althof
J Sex Med. 2008 Jun;5(6):1296-307. doi: 10.1111/j.1743-6109.2008.00825.x. Epub 2008 Apr 14.
INTRODUCTION: Premature ejaculation (PE) has been associated with a range of negative psychological effects, including anxiety, depression, and distress in men and their female partners. AIM: To review evidence of the psychosocial concomitants of premature ejaculation in recent observational studies, and to consider the psychosocial and quality of life outcomes associated with PE, including effects on the partner relationship. MAIN OUTCOME MEASURE: Psychosocial and quality of life consequences related to premature ejaculation. METHODS: A literature search was performed to retrieve publications relating to management or treatment of PE or male sexual dysfunction. Publications were included if they reported the impact of PE on the man, his partner or relationship, or the impact of male sexual dysfunction and included PE in the analysis. RESULTS: Eleven observational studies were selected. All these studies found evidence for an association between PE and adverse psychosocial and quality of life consequences, including detrimental effects on the partner relationship. Comparative analyses were restricted by major differences across the studies. CONCLUSIONS: PE significantly negatively impacts men and their partners and may prevent single men forming new partner relationships. Men are reluctant to seek treatment from their physicians, although they may be more encouraged to do so through their partner's support and the availability of effective treatments. There is a need for validated diagnostic screening criteria and validated, reliable, brief patient-reported outcome measures that can be used to assess men with PE and their partners. These factors would allow further studies with more complete and accurate assessment of the impact of PE.
15Dapoxetine for premature ejaculation.PubMed
A M Feige, M R Pinsky, W J G Hellstrom
Clin Pharmacol Ther. 2011 Jan;89(1):125-8. doi: 10.1038/clpt.2010.215. Epub 2010 Nov 17.
Premature ejaculation (PE) is the most common form of male sexual dysfunction, with an estimated worldwide prevalence of 20–30%.1 Although PE is not life threatening, it has significant impact on quality of life. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)defines PE as “persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it” that “causes marked distress or interpersonal difficulty” and “is not due exclusively to the direct effects of a substance.”2 The International Society for Sexual Medicine, which recently modified the definition to include the threshold ejaculatory latency time, defines PEas “male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within 1 min of vaginal penetration; the inability to delay ejaculation on all or nearly all vaginal penetrations; and negative personal consequences such as distress, bother, frustration, and/or the avoidance of sexual intimacy.”3 The lack of ejaculatory control is consistent among all clinical definitions of PE and is a highly sensitive predictor of the condition.
16Evaluation of the quality of life of patients with premature ejaculation (lifelong and acquired).PubMed
Bahadır Ermeç, Uğur Yucetas, Haydar Güler, et al.
Rev Assoc Med Bras (1992). 2022 Sep;68(9):1303-1307. doi: 10.1590/1806-9282.20220421.
OBJECTIVE: The aim of this study was to evaluate the quality of life of patients with lifelong and acquired premature ejaculation and to examine its relationship with depression and anxiety. METHODS: Between February 2017 and January 2018, a total of 175 patients with premature ejaculation and 132 control men who applied to the urology department of the training and research hospital with the complaint of Premature Ejaculation were included. Patients were divided into three groups according to International Society for Sexual Medicine (ISSM) criteria as follows: Group 1, lifelong premature ejaculation; Group 2, acquired premature ejaculation, and Group 3, control group without premature ejaculation. A detailed medical history of patients was obtained and physical examinations were performed. Intravaginal ejaculation latency time (IELT) was recorded and patients were administered International Erectile Function Index-5 (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT), Sexual Health Inventory for Men (SHIM), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI)-1 and STAI-2, and Short Form-36 (SF-36). RESULTS: The mean mental component score (MCS) of the SF-36 was 51.65±6.57 in the lifelong premature ejaculation group, 49.33±8.65 in the acquired premature ejaculation group, and 61.12±11.09 in the control group (p<0.0001). The mean physical component score (PCS) was 50.99±7.43 in the lifelong premature ejaculation group, 48.32±11.58 in the acquired premature ejaculation group, and 55.17±8.10 in the control group (p<0.0001). Quality of life of premature ejaculation patients as assessed by SF-36 was lower in the subscales of physical functioning, general health perception, vitality, and role limitations due to emotional functioning, compared to the control group. CONCLUSIONS: Lifelong and acquired premature ejaculation patients deteriorate their quality of life: the deterioration in these patients' quality of life also negatively affects their depression and anxiety states.
17Emerging drugs for premature ejaculation.PubMed
Marcel D Waldinger
Expert Opin Emerg Drugs. 2006 Mar;11(1):99-109. doi: 10.1517/14728214.11.1.99.
Lifelong premature ejaculation (PE) is a frequent male sexual dysfunction and is thought to be mediated in part by disturbances of serotonergic (5-hydroxytryptamine; 5-HT) neurotransmission and ejaculation-mediating 5-HT receptors in the CNS. The aetiology of the dysfunction is unclear, but probably includes neurobiological and environmental factors. Lifelong PE is a syndrome characterised by a cluster of symptoms. Rapid ejaculations become manifest around the first sexual encounters in puberty or adolescence. Intravaginal ejaculation latency time usually occurs within 30-60 s, or maximally within 2 min after vaginal penetration, is present with nearly every sexual partner, and remains similar throughout life or may aggravate during ageing. The syndrome may lead to secondary psychological, sexual and relationship problems. Daily treatment with some selective serotonin re-uptake inhibitors (SSRIs) leads to strong ejaculation delay, but may be accompanied by side effects. New treatment with SSRIs with a short half-life (if approved) for on-demand use 1-2 h prior to coitus exerts less ejaculation-delaying effects than daily SSRI strategies. Animal studies have shown that strong, immediate ejaculation delay may be induced by the combination of an SSRI with a 5-HT(1A) receptor antagonist. The combination of an SSRI and any other compound that immediately strongly raises 5-HT neurotransmission may form the basis for the development of new on-demand drugs to treat PE.
18Serotonin and premature ejaculation: from physiology to patient management.PubMed
François Giuliano, Pierre Clément
Eur Urol. 2006 Sep;50(3):454-66. doi: 10.1016/j.eururo.2006.05.055. Epub 2006 Jun 19.
INTRODUCTION: Premature ejaculation (PE), whose pathophysiology is still not clearly identified, is the most common male sexual dysfunction, yet it remains underdiagnosed and undertreated. The aims of this paper are to provide a scientific and pharmacologic rationale, and to discuss to what extent selective serotonin reuptake inhibitors (SSRIs) can help patients with PE. MATERIALS AND METHODS: A comprehensive evaluation of available published data included analysis of published full-length papers that were identified with Medline and Cancerlit from January 1981 to January 2006. Official proceedings of internationally known scientific societies held in the same time period were also assessed. RESULTS: The central ejaculatory neural circuit comprises spinal and cerebral areas that form a highly interconnected network. The sympathetic, parasympathetic, and somatic spinal centers, under the influence of sensory genital and cerebral stimuli integrated and processed at the spinal cord level, act in synergy to command physiologic events occurring during ejaculation. Experimental evidence indicates that serotonin (5-HT), throughout brain descending pathways, exerts an inhibitory role on ejaculation. To date, three 5-HT receptor subtypes (5-HT1A, 5-HT1B, and 5-HT2C) have been postulated to mediate 5-HT's modulating activity on ejaculation. Pharmacologic manipulation of the serotonergic system has been performed in rats, with the antidepressant selective serotonin reuptake inhibitors (SSRIs) exhibiting the greatest efficacy in delaying ejaculation. The mechanism of action by which SSRIs modulate central 5-HT tone has been studied in depth, but gaps in this knowledge prevent an explanation of the efficacy of acute treatment in delaying ejaculation. Emerging clinical evidence indicates chronic and on-demand dosing of SSRIs has a beneficial effect for the treatment of men with PE, at least for paroxetine. On-demand dapoxetine, and SSRI with a short half-life, recently has been shown to significantly increase intravaginal latency time and PE patient-related outcomes in phase 3 clinical trials. CONCLUSIONS: Nowadays there is no doubt that PE can be treated effectively by SSRIs. Nevertheless their mechanism of action is not yet well understood and deserves more research. In particular it is not understood why all the SSRIs are not equal in terms of their ability to delay ejaculation. Therefore, there is a need for more research to better characterize the mechanism of action of SSRIs as well their clinical benefit in patients affected by PE.
19Lifelong premature ejaculation: definition, serotonergic neurotransmission and drug treatment.PubMed
Marcel D Waldinger
World J Urol. 2005 Jun;23(2):102-8. doi: 10.1007/s00345-004-0491-z. Epub 2005 Jun 2.
The ejaculation distribution theory (EDT) postulates a biological continuum of the intravaginal ejaculation latency time (IELT) in men. Such an continuum has recently been found in two epidemiological stopwatch studies. In addition, a continuum of ejaculation latency time has also been demonstrated in laboratory rats. It is suggested that the invariable parts of ejaculation, i.e. premature and retarded ejaculation are highly influenced by genetic and neurobiological factors. In contrast, superimposed on biological roots, ejaculation of men, in the middle part of the continuum, is probably more easily influenced by environmental and psychological factors. A meta-analysis of 35 daily SSRI and clomipramine treatment studies demonstrated a similar efficacy for paroxetine, clomipramine, sertraline and fluoxetine, with paroxetine exerting the strongest effect on ejaculation. Based on fundamental insights into serotonergic neurotransmission, it is suggested that on-demand conventional SSRI treatment will not lead to similarly impressive ejaculation delay as that found after daily conventional SSRI treatment. Future studies with SSRIs with short half-lives, short T(max) and high C(max )should elucidate whether these pharmacokinetic properties are able to affect the pharmacodynamics of 5-HT neurons in such a way that immediate clinically relevant ejaculation delay occurs.
20Premature ejaculation: old story, new insights.PubMed
Emmanuele A Jannini, Giacomo Ciocca, Erika Limoncin, et al.
Fertil Steril. 2015 Nov;104(5):1061-73. doi: 10.1016/j.fertnstert.2015.08.035. Epub 2015 Sep 26.
Conventional theories and therapies for premature ejaculation (PE) are based on assumptions not always supported by evidence. This review of the current literature on the physiology of the ejaculatory control, pathogenesis of PE, and available therapies shows that PE is still far from being fully understood. However, several interesting hypotheses have been formulated, and solid, evidence-based clinical data are currently available for dapoxetine, the unique, first-line, officially approved pharmacotherapy for PE. Further growth in the field of PE will occur only when we shift from opinion-based classifications, definitions, and hypotheses to robust, noncontroversial data grounded on evidence.
21Psychosocial stress, somatoform dissociative symptoms and free testosterone in premature ejaculation.PubMed
Ludek Fiala, Jiri Lenz
Andrologia. 2020 Dec;52(11):e13828. doi: 10.1111/and.13828. Epub 2020 Sep 29.
One of the most common sexual dysfunctional diseases in adult males is premature ejaculation. So far, there is no evidence of how premature ejaculation is associated with psychosocial stress. We tested the relationship between neuroendocrine changes in patients with premature ejaculation and indicators of stress experience as a new psychosomatic hypothesis where psychosocial stress may significantly contribute to the aetiology of premature ejaculation. A total of 55 patients with premature ejaculation were included in the study. The control group consisted of 55 healthy men. The diagnosis of premature ejaculation was confirmed by a sexology examination, a history of patients and the values of the premature ejaculation diagnostic tool questionnaire. Comprehensive biochemical serum analysis was focused on the values of total testosterone, free testosterone, luteinising hormone, thyroid-stimulating hormone, dehydroepiandrosterone sulphate, sex hormone-binding globulin and a premature ejaculation diagnostic tool score with trauma symptom checklist and somatoform dissociation questionnaire. The results show significant Spearman correlations of trauma symptom checklist with the premature ejaculation diagnostic tool score (R = 0.84) and free testosterone (R = 0.62) and somatoform dissociation questionnaire with the premature ejaculation diagnostic tool score (R = 0.53) and free testosterone (R = 0.57). Spearman correlations of trauma symptom checklist with somatoform dissociation questionnaire show significant correlation (R = 0.54).
22Study on the Efficacy of Electric Acupuncture in the Treatment of Premature Ejaculation Based on Testosterone Level.PubMed
Xiangpeng Lu, Hao Han, Zhibiao Zhang, et al.
J Healthc Eng. 2022 Mar 22;2022:8331688. doi: 10.1155/2022/8331688. eCollection 2022.
OBJECTIVE: To investigate the clinical efficacy and possible mechanism of electroacupuncture in the treatment of premature ejaculation. METHODS: 50 cases of premature ejaculation patients who met the diagnostic criteria were randomly divided into 2 groups with 25 cases in each group. The observation group was treated with electroacupuncture, and the control group was treated with Longdan Xiegan decoction. The treatment period was 4 weeks. Ejaculation latency (IELT), sexual satisfaction score of patients, sexual satisfaction score of partners, testosterone test, and drug safety assessment were performed in all 4 groups before and after treatment. RESULTS: IELT was prolonged in all groups after treatment, the difference was statistically significant ( < 0.05). At the same time, the IELT of the observation group was significantly higher than that of the control group after treatment. Life satisfaction scores of patients and spouses in 2 groups were improved after treatment compared with before treatment, the difference was statistically significant ( < 0.05). After treatment, the satisfaction scores of patients and spouses in the observation group were higher than those in the control group, and the difference was statistically significant ( < 0.05). Before treatment, there was no significant difference in serum testosterone levels among all groups ( > 0.05). Serum testosterone levels in all groups were decreased after treatment compared with before treatment, with statistical significance ( < 0.05). After treatment, the serum testosterone level of the observation group was lower than that of the control group, and the difference was statistically significant ( < 0.05). During the treatment, the adverse reactions in each group disappeared after treatment, and no obvious abnormality was observed in the safety indicators. CONCLUSION: Electroacupuncture can improve the symptoms of premature ejaculation, which may be related to the regulation of serum testosterone by acupuncture.
23Significance of piezo-type mechanosensitive ion channel component 2 in premature ejaculation: An animal study.PubMed
Zhenghao Chen, Mingzhen Yuan, Zhen Ma, et al.
Andrology. 2020 Sep;8(5):1347-1359. doi: 10.1111/andr.12779. Epub 2020 Mar 12.
BACKGROUND: Penile hypersensitivity is one of the main pathological mechanisms of premature ejaculation. However, little is known about the neurophysiological mechanism of penile peripheral nerve sensitization. Piezo Type Mechanosensitive Ion Channel Component 2 (PIEZO2), was recently identified as a mechanically sensitive channel. OBJECTIVES: This study explored the possible neural mechanisms of PIEZO2 action in the mechanisms of premature ejaculation using molecular biology and electrophysiology approaches. MATERIALS AND METHODS: One hundred seventy male rats and 85 female rats were recruited. The females were induced estrus by injection of estradiol benzoate and progesterone followed by surgically castrated. Subsequently, the copulatory behaviors were record by a video camera six times, once a week. The last three mating processes of 134 male rats were successfully recorded. The males were divided into three groups according to ejaculation frequency value. Immunocytochemical and molecular methods as well as whole-cell patch clamp recording were used to show the difference between premature ejaculation rats and control rats. To further clarify the involvement of PIEZO2 in premature ejaculation, we constructed a PIEZO2 knockdown model in rats by intrathecal injection of PIEZO2 antisense oligodeoxynucleotides. RESULTS: We showed that PIEZO2 in the penis head and in the dorsal root ganglia(DRG) were significantly increased in premature ejaculation rats. Whole-cell patch clamp recording demonstrated that mechanical stimulation evoked a higher inward current density in premature ejaculation rats compared with control rats, which could be inhibited by the PIEZO2-specific antagonist, FM1-43. PIEZO2 knockdown experiments revealed that the inward current density induced by mechanical stimulation was significantly decreased in PIEZO2 knockdown rats, and that the mount frequency and ejaculation latency and frequency were significantly improved in PIEZO2 knockdown rats. DISCUSSION AND CONCLUSION: Our data demonstrate PIEZO2 involvement in peripheral nerve sensitization, indicating that pharmacological antagonism of PIEZO2 may be a useful strategy for treating premature ejaculation.
24Premature ejaculation and stress.PubMed
Ludek Fiala, Jiri Lenz, Petra Konecna, et al.
Andrologia. 2021 Aug;53(7):e14093. doi: 10.1111/and.14093. Epub 2021 May 1.
Recent findings indicate that men with premature ejaculation report more frequent sexual problems associated with increased anxiety and interpersonal difficulties. Bearing this in mind, the neuroendocrine changes were examined in men with premature ejaculation and compared to other indicators of stressful experiences to see whether there can be any correlation which could indicate how these factors may contribute to the aetiology of premature ejaculation. Our study comprised 60 male outpatients diagnosed as having secondary premature ejaculation. Clinical examinations were focused on biochemical analysis of cortisol and psychometric scoring using a diagnostic tool for premature ejaculation, traumatic stress and somatoform dissociation. The control group consisted of a 60 healthy men. The results showed significant Spearman correlations of the Premature Ejaculation Diagnostic Tool score with Trauma Symptom Checklist score (R = .86), cortisol level (R = .47) and Somatoform Dissociation Questionnaire score (R = .61). In the control group, the results did not reach statistical significance. Spearman correlations of the Premature Ejaculation Diagnostic Tool score with Trauma symptoms checklist score was (R = .21), cortisol (R = .27) and with Somatoform dissociation questionnaire score (R = .25). These results represent the first reported findings documenting the relationship of traumatic stress indicators with the experience of secondary premature ejaculation and cortisol levels.
25The impact of ejaculatory dysfunction upon the sufferer and his partner.PubMed
Carmita Helena Najjar Abdo
Transl Androl Urol. 2016 Aug;5(4):460-9. doi: 10.21037/tau.2016.05.08.
Ejaculatory function cannot be evaluated outside the dyadic process and without taking into account the men's and women's cognition of the condition and how their subjective perception impacts on the evaluation of the relationship and sexual quality. Although the distress of the sufferer and his partner has been a motivating factor in leading men with ejaculatory dysfunction to seek medical help, few objective or prospective evaluations of the effects on the couple have been reported. Specialized literature has been dealing with ejaculatory disorders in a heterogeneous manner. Comparatively, there are far more studies on premature ejaculation (PE) than on delayed ejaculation (DE) and even fewer studies on other male orgasm disorders. Therefore, the review focuses on the literature of the two most studied ejaculatory disorders. The matter presented in this article can also be considered for other ejaculatory disorders, since all of them relate to a failure of control, changing the intravaginal ejaculatory latency time (IELT), with consequences for men and their partners. There are multiple psychological explanations as to why a man develops PE or DE. Unfortunately, none of the theories evolve from evidence-based studies. The common final pathway of these factors is the irrational fear of ejaculating intravaginally. These sexual disorders may also cause personal distress for the sexual partner and decreased sexual satisfaction for the couple. An association between pre-existing anxiety disorders and sexual performance anxiety has been found in men and couples with ejaculatory dysfunction. This could reflect a process in which pre-existing anxiety triggers sexual dysfunction, causing performance anxiety and leading to a vicious cycle: anxiety, sexual dysfunction, more anxiety. Men with DE are similar to men with other sexual dysfunctions. They show the same elevated level of sexual dissatisfaction and they also show lower levels of coital frequency. To a lower extent, they use more masturbatory activity relative to controls. The burden of PE for the patient is revealed in three different levels: the emotional burden, the health burden, and the burden on the relationship. In terms of the emotional burden, there is often a sense of embarrassment and shame at not being able to satisfy their partner, and patients often have low self-esteem, feelings of inferiority, anxiety, anger, and disappointment. Men feel frustrated about their PE and how it affects their intimacy with their partners and the sexual relationship. In conclusion, ejaculatory dysfunction has a negative impact on both the man and his female partner and, consequently, it has implications for the couple as a whole. Additionally, ejaculatory dysfunction extending beyond a year elevates the risk of depression in these patients. Although partner perceptions of PE generally indicated less dysfunction than those of subjects, partner outcomes measures play a part in the assessment of PE. Ejaculatory dysfunction involves the integration of physiological, psychobehavioral, cultural, and relationship dimensions. All these elements need to be considered in the treatment.
26What does premature ejaculation mean to the man, the woman, and the couple?PubMed
Alessandra Graziottin, Stanley Althof
J Sex Med. 2011 Oct;8 Suppl 4:304-9. doi: 10.1111/j.1743-6109.2011.02426.x.
INTRODUCTION: The relational impact of male and female sexual dysfunction, and specifically premature ejaculation (PE), is an important consideration. Published findings are consistent in identifying the negative psychosocial impact of PE on the man. However, the effect of PE on the female partner, especially in relation to her sexual functioning, has been less well studied. AIM: Provide an overview of the impact of PE on the man, the woman, and the couple. METHODS: Review of relevant literature. RESULTS: Female partners of men with PE report significantly greater sexual problems, with reduced satisfaction, increased distress and interpersonal difficulty, and more orgasmic problems than partners of non-PE men. Both men with PE and their partners feel control over ejaculation is the central issue in PE. For both, the lack of control leads to dissatisfaction, a feeling that something is missing from the relationship, and an impaired sense of intimacy. If left untreated, the situation can lead to increased irritability, interpersonal difficulties, and deepening of an emotional divide. CONCLUSIONS: When treating a man with PE, the partner's participation should be encouraged to enable the physician to fully understand the extent of the problem, and consider other relevant factors, from her perspective. Identifying the best approach for the couple requires consultation with each person individually and together. In clinical practice, treatments for PE are likely to include a combination of pharmacological, psychological, sexological, and/or behavioral approaches for both the man and his partner. It is important that physicians regard PE as the couple's problem and endeavor to include the partner in its management where possible.
27Attribution Patterns in Men Who Ejaculate Before They Desire: An Internet Survey.PubMed
David L Rowland, Laura C Mikolajczyk, Devin M Pinkston, et al.
J Sex Marital Ther. 2016 Jul 3;42(5):462-73. doi: 10.1080/0092623X.2015.1069432. Epub 2015 Jul 13.
Men with erectile problems tend to attribute negative sexual experiences to themselves, in contrast with sexually functional individuals who tend to attribute negative experiences to external factors such as the circumstance or relationship. In this study, we investigated attribution patterns in men with premature ejaculation (PE) symptoms-a group not yet investigated in this regard-to determine whether they follow patterns similar to men with erectile problems. Using an Internet-based approach, we compared attribution responses of 289 men with PE symptoms with 433 sexually functional men on a series of five sexual scenarios (two presenting a positive experience and three presenting a negative experience). Men with PE symptoms were more likely to take blame for any negative sexual experience, including ones unrelated to ejaculating quickly, whereas functional men were more likely to attribute blame to the partner, circumstance, or relationship. Men with PE symptoms also took less credit for positive sexual experiences than functional counterparts, attributing them to the partner or circumstance. These results point out similarities across men with a variety of sexual problems, but also raise questions regarding differences between men with erectile problems and men with problems of ejaculating before desired. Several therapeutic strategies are offered.
28Practical tips for sexual counseling and psychotherapy in premature ejaculation.PubMed
David Rowland, Stewart Cooper
J Sex Med. 2011 Oct;8 Suppl 4:342-52. doi: 10.1111/j.1743-6109.2011.02367.x. Epub 2011 Jun 23.
INTRODUCTION: A number of milestones in the treatment of premature ejaculation (PE) have occurred over the past five decades, including the development of various behavioral and cognitive techniques as well as pharmacotherapies that modify neurophysiological processes involved in ejaculation. Nevertheless, the notion that sexual responses such as PE are influenced by physiological, psychobehavioral, cultural, and relationship factors is as valid now as it was 50 years ago, and therefore, interventions should consider all such domains in the development of effective treatment strategies. AIM: Provide an overview of which patients with PE are suitable to receive psychosexual treatment and the psychological approaches for managing this disorder. METHODS: Review of the literature. MAIN OUTCOME MEASURE: Psychosexual treatments that integrate behavioral, psychological, and relationship functioning. RESULTS: PE is typically a couple's problem and, therefore, psychotherapy is best when the partner is involved. Before embarking on psychotherapy, the clinician should obtain a medical history pertaining to sexual-, psychological-, and relationship-related factors, so that the treatment strategy can be tailored to the needs of the individual. General strategies underpinning integrative, "process-oriented" elements of psychotherapy most relevant to PE are: developing the therapist-patient relationship; expressing empathy, genuineness, and positive regard; motivational interviewing, i.e., developing motivation to change; developing discrepancy; working through resistance; identifying PE-related affect, cognitions, and behaviors (including interaction with partners); and supporting self-efficacy. The four main domains that encompass psychotherapy techniques specific to the treatment of PE are: behavioral; cognitive; affective; and relational. Sustained positive outcomes in PE may be obtained using a combination treatment strategy that addresses all elements of PE, including psychological and biological factors. CONCLUSIONS: Psychosexual treatments may help the patient with PE and his partner to address their sexual problems and improve their overall relationship. The effects of psychosexual therapy may be augmented by combining this intervention with pharmacotherapy.
29Diabetes and Sexuality.PubMed
Fuat Kizilay, Helena Elizabeth Gali, Ege Can Serefoglu
Sex Med Rev. 2017 Jan;5(1):45-51. doi: 10.1016/j.sxmr.2016.07.002. Epub 2016 Aug 17.
INTRODUCTION: Deterioration in sexual functioning is one of the major and serious complications of diabetes. This common metabolic disorder not only affects sexuality through microvascular and nerve damage but also has psychological aspects. In men, the primary complications are erectile dysfunction, ejaculatory dysfunction, and loss of libido. Women similarly experience sexual problems, including decreased libido and painful intercourse. AIM: To summarize the effects of diabetes on sexuality, evaluate the impact of diabetes on sexual function, and assess the conventional and novel treatment approaches based on recent studies. METHODS: A literature review of peer-reviewed journal articles and guidelines was performed. MAIN OUTCOME MEASURES: To assess the effects of diabetes on sexuality and to focus on treatment approaches. RESULTS: Male and female sexual dysfunctions are a significant complication of diabetes. Tight glycemic control seems to be beneficial in delaying the onset of sexual problems and ameliorating them when they are present. Erectile dysfunction occurs as one of the first problems. The current mainstay of treatment for erectile dysfunction is therapy with phosphodiesterase type 5 inhibitors and then a stepwise approach of management. Men also can experience ejaculation problems and loss of libido. Diabetes also can decrease testosterone levels, which further decreases libido. Hypogonadal men with diabetes might benefit from testosterone replacement therapy. Diabetic women also can have sexual problems. These problems mainly include loss of libido, decrease in arousal and lubrication resulting in painful intercourse, and loss of orgasm. All these challenges require a multidisciplinary approach. CONCLUSION: Diabetes has detrimental effects on the sexual function of patients. Diabetologists who primarily care for the patient should not only focus on the glycemic control of their patients but also address their sexual complaints, because these problems can significantly impair their quality of life. Urologists, gynecologists, endocrinologists, and psychiatrists should work in a multidisciplinary manner for the treatment of decreased sexual functioning as a result of diabetes.
30Understanding and treating ejaculatory dysfunction in men with diabetes mellitus.PubMed
Ankit Desai, Runzhi Chen, Axel Cayetano, et al.
Andrology. 2023 Feb;11(2):379-398. doi: 10.1111/andr.13262. Epub 2022 Aug 26.
Diabetes mellitus is a rapidly rising metabolic disorder with important systemic complications. Global figures have demonstrated the prevalence of diabetes mellitus has almost quadrupled from 108 million in 1980 to 422 million in 2014, with a current prevalence of over 525 million. Of the male sexual dysfunction resulting from diabetes mellitus, significant focus is afforded to erectile dysfunction. Nevertheless, ejaculatory dysfunction constitutes important sexual sequelae in diabetic men, with up to 35%-50% of men with diabetes mellitus suffering from ejaculatory dysfunction. Despite this, aspects of its pathophysiology and treatment are less well understood than erectile dysfunction. The main disorders of ejaculation include premature ejaculation, delayed ejaculation, anejaculation and retrograde ejaculation. Although ejaculatory dysfunction in diabetes mellitus can have complex multifactorial aetiology, understanding its pathophysiological mechanisms has facilitated the development of therapies in the management of ejaculatory dysfunction. Most of our understanding of its pathophysiology is derived from diabetic animal models; however, observational studies in humans have also provided useful information in elucidating important associative factors potentially contributing to ejaculatory dysfunction in diabetic men. These have provided the potential for more tailored treatment regimens in patients depending on the ejaculatory disorder, other co-existing sequelae of diabetes mellitus, specific metabolic factors as well as the need for fertility treatment. However, evidence for treatment of ejaculatory dysfunction, especially delayed ejaculation and retrograde ejaculation, is based on low-level evidence comprising small sample-size series and retrospective or cross-sectional studies. Whilst promising findings from large randomised controlled trials have provided strong evidence for the licensed treatment of premature ejaculation, similar robust studies are needed to accurately elucidate factors predicting ejaculatory dysfunction in diabetes mellitus, as well as for the development of pharmacotherapies for delayed ejaculation and retrograde ejaculation. Similarly, more contemporary robust data are required for fertility outcomes in these patients, including methods of sperm retrieval and assisted reproductive techniques in retrograde ejaculation.
31Sexual Dysfunction in Men with Prediabetes.PubMed
Luca Boeri, Paolo Capogrosso, Eugenio Ventimiglia, et al.
Sex Med Rev. 2020 Oct;8(4):622-634. doi: 10.1016/j.sxmr.2018.11.008. Epub 2019 Mar 7.
INTRODUCTION: Previous studies have shown a strong association between diabetes mellitus (DM) and the frequency and severity of some aspects of male sexual dysfunction (SD). The same relationship with prediabetes (preDM) has been less well investigated. AIM: To systematically review the current literature on the association between preDM and SD, focusing on erectile dysfunction (ED), sex steroid hormone alterations, and premature ejaculation (PE). METHODS: The present review was conducted in accordance with the PRISMA declaration standards for systematic reviews. A systematic search for the terms "male sexual dysfunction," "prediabetes," "IFG or IGT," "glycemia," "ED," "ejaculation," and "hypoactive sexual desire disorder" was carried out in the PubMed and Embase databases. MAIN OUTCOME MEASURE: Prevalence of SD in men with preDM and severity of ED, PE, and hormone alterations in men with preDM compared with controls. RESULTS: 12 studies reporting data on the association between SD and preDM were found in the literature. According to these studies, ED is more prevalent in men with preDM compared with controls, the severity of ED increases progressively as a function of impaired glucose metabolism, testosterone values and preDM are strongly correlated, men with preDM are at increased risk of testosterone deficiency and hypogonadism, men with hypogonadism have a higher prevalence of preDM, and the association between PE and preDM is controversial. CONCLUSION: PreDM is a common and underdiagnosed clinical condition that is strongly associated with male SD. A detailed glucose metabolism investigation should be performed in every patient with SD to screen for glucose abnormalities and eventually to implement prevention program to decrease their chances of developing life-changing chronic illnesses. Boeri L, Capogrosso P, Ventimiglia E, et al. Sexual Dysfunction in Men with Prediabetes. Sex Med Rev 2019;8:622-634.
32Relationship between premature ejaculation and chronic prostatitis/chronic pelvic pain syndrome.PubMed
Jun Ho Lee, Sung Won Lee
J Sex Med. 2015 Mar;12(3):697-704. doi: 10.1111/jsm.12796. Epub 2014 Dec 5.
INTRODUCTION: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common etiology of premature ejaculation (PE). However, the current data are insufficient to explain this relationship and to support routine screening of men with PE. AIMS: This study aims to evaluate the relationship between PE and CP/CPPS. METHODS: A cross-sectional study was conducted that included 8,261 men who had participated in a health examination. The Premature Ejaculation Diagnostic Tool (PEDT), the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), and the International Index of Erectile Function-5 (IIEF) were used for assessment of symptoms. A full metabolic work-up and serum testosterone level checks were also performed. We then investigated the relationship using the Spearman correlation test, multiple linear regression, and logistic regression analyses. MAIN OUTCOME MEASURES: Associations of PEDT with NIH-CPSI. RESULTS: The mean age was 50.4 ± 5.5 years. In total, 2,205 (24.9%) men had prostatitis-like symptoms (NIH-CPSI pain score of ≥4 and perineal or ejaculatory pain), and 618 (7.0%) men had moderate to severe symptoms (NIH-CPSI pain score of ≥8). Additionally, 2,144 men (24.2%) were classified as demonstrating PE (PEDT > 10). The PEDT score was found to have a significant positive correlation with the NIH-CPSI pain domain score (correlation coefficient = 0.206; P < 0.001). After adjusting for age, metabolic syndrome status, testosterone level, and IIEF score, there was no change in the positive correlation between the NIH-CPSI pain domain score and PEDT score (Beta = 0.175; P < 0.001). After adjusting for age, testosterone level, metabolic syndrome, and IIEF score, the odds ratio (OR) for PE significantly increased with the severity of pelvic pain (mild prostatitis-like symptoms, OR for PE: 1.269, 95% confidence interval: 1.113-1.447; moderate to severe symptoms, OR for PE: 2.134: 95% confidence interval: 1.782-2.557). CONCLUSIONS: Our data showed a significant correlation between the PEDT score and the NIH-CPSI score. We suggest routine screening for CP/CPPS in men with PE and PE in men with CP/CPPS.
33The association between varicocele, premature ejaculation and prostatitis symptoms: possible mechanisms.PubMed
Francesco Lotti, Giovanni Corona, Mario Mancini, et al.
J Sex Med. 2009 Oct;6(10):2878-87. doi: 10.1111/j.1743-6109.2009.01417.x. Epub 2009 Aug 11.
INTRODUCTION: No study has ever systematically evaluated the impact of varicocele on sexual function. AIM: Two cross-sectional studies were performed in patients attending an andrology unit either for male sexual dysfunction (study 1) or couple infertility (study 2). In study 1, we evaluated the impact of varicocele on sexual function. In study 2, we retrospectively evaluated a possible association between varicocele and prostatitis signs and symptoms. METHODS: Study 1 refers to a consecutive series of 2,448 (mean age 52.0 +/- 12.9 years) subjects. Study 2 consists of a consecutive series of 139 male subjects (mean age 37.3 +/- 6.3). MAIN OUTCOME MEASURES: In study 1, varicocele was clinically classified into three grades according to Dubin criteria. Different hormonal parameters were also evaluated. All the patients of study 2 underwent simultaneous scrotal and transrectal color-Doppler ultrasonography (CDU) along with seminal characteristics and interleukin-8, a surrogate marker of prostatitis. RESULTS: After adjusting for age, subjects with severe varicocele (N = 284, 11.6%; Dubin grade 2 and 3) showed a reduction of testicular volume (P < 0.01), higher luteinizing hormone (LH) (P < 0.05), follicle stimulating hormone (FSH) (P < 0.0001) and prolactin (P < 0.05) levels, and also an enlarged or tender prostate at digito-rectal examination (P < 0.05). Premature ejaculation was the only sexual symptoms significantly associated with varicocele (29.2% vs. 24.9% in subjects with or without varicocele, respectively; P < 0.05). In study 2, subjects with severe echographic-defined varicocele (basal venous reflux increasing or not after Valsalva's maneuver; N = 28, 20.1%) showed CDU features of prostatitis and higher seminal inteleukin-8 levels. The presence of any degree of varicocele (N = 40, 28.8%) was also associated with prostatitis symptoms, as measured by the National Institutes of Health Chronic Prostatitis Symptom Index scoring (P < 0.05), and in particular with the pain domain (P < 0.05). CONCLUSIONS: In conclusion, signs and symptoms of prostatitis are more common in varicocele patients, who more often complain of premature ejaculation.
34Prevalence of premature ejaculation and its correlation with chronic prostatitis in Chinese men.PubMed
Chao-Zhao Liang, Zong-Yao Hao, Hong-Jun Li, et al.
Urology. 2010 Oct;76(4):962-6. doi: 10.1016/j.urology.2010.01.061. Epub 2010 Apr 9.
OBJECTIVES: Chronic pelvic pain syndrome is a common and serious health problem affecting the quality of life of men. We evaluated the prevalence of premature ejaculation (PE) in Chinese men with chronic pelvic pain syndrome and studied its correlation to chronic prostatitis. METHODS: A total of 15,000 men (aged 15-60 years) were randomly recruited to take part in a survey to provide questionnaire-elicited information for sociodemographics, sexual function, National Institutes of Health-Chronic Prostatitis Symptom Index, and International Index of Erectile Function 5-item questionnaire. The eligible subjects of the present investigation were married with sexual activity. RESULTS: Responses were collected from 12 743 men (84.95%). Of these men, 1071 (8.4%) reported having prostatitis-like symptoms. The incidence of chronic prostatitis was 4.5% (n = 571) for the entire group. Of the 7372 eligible men, the incidence of prostatitis-like symptoms, chronic prostatitis, and PE was 10.5% (n = 771), 5.0% (n = 370), and 15.3% (n = 1127), respectively. The group with PE had worse National Institutes of Health-Chronic Prostatitis Symptom Index scores (P < .05) and lower International Index of Erectile Function 5-item questionnaire scores (P < .05) than the patients without PE. Also, the percentage of prostatitis-like symptoms in the PE group was greater than that in the non-PE group (P < .05). The prevalence of PE was 64.1% and 36.9% in the prostatitis-like symptom and chronic prostatitis group, respectively, of the 7372 eligible men. CONCLUSIONS: The results of our study showed a high prevalence of PE in patients with chronic prostatitis. An examination of the prostate, physically and microbiologically, should be considered during the assessment of patients with PE.
35Premature ejaculation in patients with lower urinary tract symptoms: a systematic review.PubMed
Retta Catherina Sihotang, Timotius Alvonico, Akmal Taher, et al.
Int J Impot Res. 2021 Jul;33(5):516-524. doi: 10.1038/s41443-020-0298-5. Epub 2020 May 11.
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.
36Lower urinary tract symptoms and depressive symptoms among patients presenting for distressing early ejaculation.PubMed
Francesco Chierigo, Paolo Capogrosso, Luca Boeri, et al.
Int J Impot Res. 2020 Mar;32(2):207-212. doi: 10.1038/s41443-019-0147-6. Epub 2019 Apr 25.
We aimed to assess the correlation between premature ejaculation (PE), lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and depression in the cohort of the last 329 patients seeking medical help for distressing early ejaculation at a single tertiary-referral center. All patients completed the premature ejaculation diagnostic tool (PEDT), the International Index of Erectile Function (IIEF), the Beck's Inventory for Depression (BDI), and the International Prostate Symptom Score (IPSS) at their first assessment. Overall, 133 (0.4) patients had PEDT ≥ 11, suggestive for PE. The characteristics of patients with and without PE according to PEDT findings were compared with the Mann-Whitney and Fisher's exact tests. Linear regression analysis tested the association between LUTS and PEDT score. Patients with PE depicted lower median scores for IIEF-overall satisfaction, intercourse satisfaction and erectile function than non-PE individuals (all p < 0.004). Similarly, patients with PE showed higher median BDI scores (7 versus 4; p < 0.0002), median IPSS total score (7 versus 5), storage (4 versus 2), and voiding (3 versus 2) subscores (all p < 0.01) compared to those without PE. At linear regression analysis, IPSS storage subscore (Coeff: 0.28; 95%CI: 0.05-0.51, p = 0.01) and BDI score (Coeff: 0.10; 95%CI: 0.01-0.19, p = 0.02) were associated with higher PEDT values, after accounting for IIEF-EF score, patients' age, body mass index and Charlson Comorbidity Index. Our findings suggest that storage symptoms and depression should be carefully investigated when assessing patients complaining of PE in the real-life setting.
37Lower Urinary Tract Symptoms Correlate with Erectile Dysfunction and Premature Ejaculation but Not with Men's Sexual Activity: Results from a Large Population-Representative Study.PubMed
Mikolaj Przydacz, Pawel Rajwa, Sabrina De Cillis, et al.
Healthcare (Basel). 2024 Jul 15;12(14):1408. doi: 10.3390/healthcare12141408.
BACKGROUND: Lower urinary tract symptoms (LUTS) contribute to erectile dysfunction (ED) and premature ejaculation (PE). However, only a few studies have been conducted with representative groups of men that had well-balanced demographic characteristics. Thus, we aimed to confirm the effect of LUTS on ED and PE and to analyze the association between LUTS and men's sexual activity in a large representative cohort. In addition, we evaluated the sex-specific and overall quality of life of men who had LUTS with either ED or PE. METHODS: We used the latest census and estimated the sample size to build a group of men representative of the population. LUTS, ED, and PE were evaluated with reliable instruments. Regression models were used to analyze the data. RESULTS: All included men were representative in relation to their age and residential location ( = 3001). ED and PE were more common in men who reported LUTS compared with men who did not have LUTS ( < 0.001). Age, comorbidity, and lifestyle did not affect the negative effect of LUTS on ED or PE (regression coefficients of 0.159 and 0.528 for ED and PE, respectively, < 0.001). However, regression models did not validate the impact of LUTS on sexual activity, defined by intercourse frequency and number of sexual partners (odds ratio of 0.981, CI 0.961-1.001, = 0.061). Nevertheless, men with LUTS and either ED or PE had worse quality of sexual life and general quality of life compared with the remaining respondents. CONCLUSION: LUTS worsened ED and PE but had no impact on men's sexual activity. Our findings confirm the recommendations to assess for LUTS in men reporting ED or PE. CLINICAL TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (NCT05462171).
38The influence of prostatic calculi on lower urinary tract symptoms and sexual dysfunction: a narrative review.PubMed
Hao Wang, Ming Ma, Feng Qin, et al.
Transl Androl Urol. 2021 Feb;10(2):929-938. doi: 10.21037/tau-20-1046.
Prostatic calculi (PC) are commonly found in patients who present for urologic consultation. However, the effect of PC on urinary symptoms remains controversial. In this study, we searched the Embase and PubMed databases for literature related to the following keywords: "prostatic calculi", "prostatic stone", "prostatic lithiasis" and "prostatic calcification", along with the limits, "lower urinary tract symptoms", "sexual dysfunction", "erectile dysfunction", "erectile function", and "premature ejaculation". According to the literature, there are various subtypes of PC based on X-ray or ultrasound findings, including type I/II, type A/B, and endogenous PC/extrinsic PC. Furthermore, the formation of PC remains unclear, and more importantly, the ability of PC to cause lower urinary tract symptoms (LUTS) and sexual dysfunction (SD) is worth exploring. We retrospectively reviewed all available literature and found that most studies agreed that PC are associated with LUTS. The factors which may play an important role in the pathogenesis of LUTS include the size and location of PC, induced inflammation, and the blood flow of the prostate. Similarly, SD was also examined in the patients with PC, and psychological factors cannot be ignored in this regard. However, more in-depth study of the molecular mechanisms, including prospective, controlled, longitudinal, and large- sample studies, are needed in the future.
39Premature ejaculation associated with lumbosacral lesions.PubMed
F Courtois, K Charvier
Spinal Cord. 2014 Dec;52(12):905-10. doi: 10.1038/sc.2014.175. Epub 2014 Nov 4.
STUDY DESIGN: Retrospective study. OBJECTIVES: Spinal cord injuries are usually associated with anejaculation, but few premature ejaculations (PE) are described in lumbosacral lesions. The objective of the study is to analyze the retrospective files of patients with lumbosacral lesions to explore whether PE is systematic, and which type of lesions (conus teminalis, epiconal, cauda equina) is associated with these PE. METHODS: Standard sexological consultations from 34 men with L5-S4 lesions were analyzed including questions on psychogenic and reflexogenic erection, and ejaculation. Medical assessment included bulbocavernosus, anal, and cremasteric reflexes and urodynamics. RESULTS: Thirty one (31/33) patients maintained natural ejaculations, but 18 complained of PE and five of spontaneous ejaculations. Fourteen patients complained of dribbling ejaculation, and 27 of non-climactic ejaculation (13 no sensation, 10 some sensation, 4 painful sensation). Medical assessments showed absent or diminished anal sensation in 28 patients, absent or diminished anal reflexes in 21, absent or diminished bulbocavernosus reflexes in 20, but 12/13 positive cremasteric reflex. Urodynamics showed 12/20 areflex and 2/20 hyperactive bladders. CONCLUSIONS: Most men with lower lumbosacral lesions maintain natural ejaculation, but often complain of PE following injury. The PE is such that a mere sexual thought can trigger the response, or appear spontaneously as daytime ('sticky paints') or nighttime ('sticky sheets') emissions. PE appears to be a direct consequence of the lesion as it is reported from the very first ejaculation post injury, in men who otherwise controlled their ejaculation prior to injury. Underlying mechanisms may involve sacral inhibition on ejaculation, or simultaneous activation of psychogenic erection and emission. Clinical implications are discussed.
40Premature emission after spinal cord injury.PubMed
C S Kuhr, J Heiman, D Cardenas, et al.
J Urol. 1995 Feb;153(2):429-31. doi: 10.1097/00005392-199502000-00045.
Physicians and psychologists almost always treat premature emission or ejaculation as a psychological problem. We report on 6 men who had sudden onset of severe premature emission after spinal cord injury. All men suffered spinal cord injury related to trauma at the T12-L1 level, and had areflexic bladders after the injury. Two men had normal penile sensation. None of the men had premature ejaculation before injury with average time of intercourse of 10 to 20 minutes before organsm. After the injury they noticed emission before or at vaginal entry. Two patients reported emission with any sexual thoughts and 1 had emission when started in a nonsexual manner. Sexual therapy using squeeze and stop/start techniques was unsuccessful in all cases. Patients were started on phenoxybenzamine, terazosin or prazosin and reported slight improvement. We believe that injury in the conus area of the spinal cord may disinhibit the ejaculatory mechanism and allow for premature emission.
41Sexual dysfunction in men with spinal cord injury: a case-control study.PubMed
M Virseda-Chamorro, J Salinas-Casado, A M Lopez-Garcia-Moreno, et al.
Int J Impot Res. 2013 Jul-Aug;25(4):133-7. doi: 10.1038/ijir.2013.1. Epub 2013 Feb 21.
The objective of this study is to confirm that spinal cord injury (SCI) alters the neurological pathways of sexual function (SF) and to ascertain whether other differences exist among men with SCI compared with men without SCI (WSCI) and sexual dysfunction (SD). The method comprise a case study of 98 men with SCI and SD, and 89 men with WSCI and SD as controls. A questionnaire was administered to these men regarding their SF, anxiety, depression, self-esteem and quality of life. Additionally, a penile eco-Doppler study was performed after a prostaglandin E1 (PGE1) injection, in addition to neurophysiological tests of the innervation pathways of SF. The mean age of cases (39.35 years) was significantly lower than the control group (48.5 years). The SCI group had a higher frequency of ejaculatory disorders, and the WSCI group had a higher frequency of decreased sexual desire, erectile dysfunction (ED) and premature ejaculation. The WSCI group had greater anxiety and depression than the SCI group. The systolic velocities of both cavernous arteries were higher in the SCI group. Significant differences were observed in electromyography of the bulbocavernosus muscle, pudendal sensory thresholds, somatosensory potentials, genital sympathetic potentials and electromyography of the cavernous bodies after PGE1 injection. SCI causes significant alterations in the innervation pathways of SF.
42Sacrolumbar intersegmental reflex circuit in men and its relation to the ejaculatory process.PubMed
Cumhur Ertekin, Hilmi Uysal, Fikret Bademkiran, et al.
Clin Neurophysiol. 2007 Nov;118(11):2368-74. doi: 10.1016/j.clinph.2007.07.020. Epub 2007 Sep 20.
OBJECTIVE: We aimed to investigate electrophysiologically the intersegmental reflex circuit from sacral to lumbar cord segments in normopotent adult men, in patients with spinal cord injury and in patients with premature ejaculation. METHODS: Reflex EMG activity of the cremasteric (CM) and bulbocavernosus (BC) muscles was recorded simultaneously by needle electrodes during electrical stimulation of the upper lumbar and sacral dermatomes, respectively. Thirty-three healthy male volunteers, 16 patients with spinal cord injury (SCI) at the thoracic or cervical levels, and 26 men with premature ejaculation (PME) were included in the study. RESULTS: In controls, upper lumbar dermatomal stimulation (ULS) at the inner side of thigh only elicited a reflex response from the CM muscle and did not produce a regular response from the lower sacral myotomes such as in the BC muscle. However lower sacral dermatomal stimulation (LSS) at the dorsal nerve of penis consistently evoked reflex responses from both CM and BC muscles. These basic electrophysiological features were not different in patients with SCI. LSS did not elicit a reflex response from the CM muscle in about 39% of patients with PME, while the BC reflex was obtained from all patients with PME. CONCLUSIONS: The neurophysiological pattern in BC and CM muscles during sacral or lumbar dermatomal stimulation reflects the sacrolumbar intersegmental reflex linkage that may be related to the ejaculatory process in men. The intersegmental sacrolumbar reflex circuit may be functionally disturbed in some patients with PME. SIGNIFICANCE: Interaction between the reflex activity of sacral to lumbar dermatomes could prove useful in defining electrophysiological mechanisms related to ejaculation in men.
43Effect and prognosis of thoracolumbar fracture combined with incomplete spinal cord injury on male sexual function.PubMed
Si Gao, Wang Yuexin, Hu Daole, et al.
J Orthop Surg Res. 2025 Feb 19;20(1):176. doi: 10.1186/s13018-025-05587-5.
BACKGROUND AND PURPOSE: Severe thoracolumbar fractures are associated with spinal cord injury that potentially leads to sexual dysfunction. Our purpose is to study the factors that influence sexual dysfunction and its prognosis. METHODS: This study included 117 male patients with thoracolumbar fractures and incomplete spinal cord injury. Data reflecting spinal cord functions and male sexual functions, including American Spinal Injury Association (ASIA) grade, Premature Ejaculation Diagnostic Tool (PEDT) score, International Index of Erectile Function-5(IIEF-5) score and The International Spinal Cord Injury Male Sexual Function Basic Data Set was obtained prior to injury, 3 months post-injury, at 2-year follow-up, and at final follow-up. Wilcoxon signed ranks test is used to verify whether there are differences in IIEF-5 and PEDT scores over time. Kendall's Tau-b correlation analysis is used to investigate factors affecting sexual function impairment and recovery. RESULTS: The IIEF-5 score is 19.5 ± 6.4 before injury and 8.7 ± 8.0 after injury, representing a significant difference. The PEDT score is 5.3 ± 3.1 before injury and 6.9 ± 5.2 after injury, representing a significant difference. The IIEF-5 score at 2-year follow-up was 17.5 ± 7.1, markedly improved relative to post-injury; the average PEDT at 2-year follow-up is 6.4 ± 5.1, showing no considerable difference from post-injury. CONCLUSIONS: Thoracolumbar fractures combined with incomplete spinal cord injury may lead to decreased erectile function and premature ejaculation. The degree of spinal cord injury and the injured segment exhibit a strong correlation with the extent of reduced sexual function post-injury. Approximately 70% of patients have sexual function recover to pre-injury levels at the 2-year postoperative follow-up.
44Current and emerging treatment options for premature ejaculation.PubMed
Murat Gul, Kadir Bocu, Ege Can Serefoglu
Nat Rev Urol. 2022 Nov;19(11):659-680. doi: 10.1038/s41585-022-00639-5. Epub 2022 Aug 25.
Premature ejaculation (PE) is a prevalent male sexual dysfunction. Current standard treatment regimens include behavioural therapies, topical anaesthetics, dapoxetine and other selective serotonin reuptake inhibitors (SSRIs). Most of the pharmacotherapeutic options target neurotransmitters (such as serotonin and oxytocin) that have a role in the ejaculation mechanism. However, these treatments are mildly effective and only provide a temporary delay in the ejaculation latency time, and PE recurs when the treatment is stopped. Thus, a treatment for PE is urgently needed and research is ongoing to find the ideal PE therapy. The efficacy and safety of topical anaesthetics and SSRIs in delaying ejaculation have been confirmed in many well-designed controlled trials. Both preclinical and clinical studies on new-generation SSRIs are ongoing. Moreover, promising results came from clinical trials in which the efficacy of on-demand PE therapies targeting neurotransmitters other than serotonin, such as α1-adrenoceptor antagonists and oxytocin antagonists, was assessed. Surgical intervention and neuromodulation have been proposed as potential treatment options for PE; however, current PE guidelines do not recommend these treatments owing to safety concerns.
45Evaluation and treatment of premature ejaculation: a critical review.PubMed
J S St Lawrence, S Madakasira
Int J Psychiatry Med. 1992;22(1):77-97. doi: 10.2190/UWP1-CNHH-L0NK-YQY9.
OBJECTIVE: Premature ejaculation is the most prevalent male sexual dysfunction. The present article is a comprehensive review of the literature on premature ejaculation. METHOD: This critical discussion of the literature evaluates the definitional issues, theoretical conceptualizations, assessment strategies, and treatment alternatives for premature ejaculation. RESULTS: The review integrates the most recent findings on the diagnosis and treatment of premature ejaculation updating an earlier review with the addition of more than fifty recent articles and adding sections on treatment generalization and maintenance, medical evaluation, pharmacological intervention, and a discussion of methodological issues in the literature. CONCLUSIONS: The pause-squeeze technique remains the current treatment of choice for the disorder. However, this unitary treatment recommendation disguises a multidimensional disorder which has yet to evolve an operational definition, psychometrically sound assessment procedures, or clearly articulated etiology.
46Comparison of the results of stop-start technique with stop-start technique and sphincter control training applied in premature ejaculation treatment.PubMed
Kazım Doğan, Cem Keçe
PLoS One. 2023 Aug 10;18(8):e0283091. doi: 10.1371/journal.pone.0283091. eCollection 2023.
BACKGROUND: The aim of this study is to compare the results of stop-start technique with stop-start technique together with sphincter control training applied in the treatment of premature ejaculation. METHODS: This research was conducted as a pre-test post-test quasi-experimental study. The sample of the study consisted of 80 men. The study was conducted on men who applied to the urology outpatient clinic of LIV Hospital, a prıvate hospital, in Gaziantep, Turkey, between 01 October 2021 and 01 March 2022. "Personal Information Form", "Intravaginal Ejaculation Latency Time (IELT)", "Fold Increase Intravaginal Ejaculation Latency Time (F-IELT)" "Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire" and "Arabic Index Premature Ejaculation (AIPE)" were used as the data collection tools. Behavioral therapy, consisting of a total of 6 sessions, was applied once every two weeks, with each session lasting for 45 minutes. After 3rd and 6th months from the beginning of the application, the data collection tools were applied again. "Stop-Start Technique (Group A)" and "Stop-Start Technique and Sphincter Control Training (Group B)" were used in the treatment. RESULTS: In both groups, the IELT and AIPE values after 3rd and 6th months from the beginning of the application were statistically higher than those obtained before (p<0.05). IELT and AIPE values increased more in Group B than Group A (p<0.05). F-IELT values after 6th months from the beginning of the application were found to be statistically significant with a low level of effect size than those obtained before (p<0.05, Cohen's d = 0.027). In both groups, the PEDT values in the 3rd and 6th months after the application were statistically lower than those seen before (p<0.05). PEDT value decreased more in Group B than Group A (p<0.05). The differences between the two groups' IELT (Cohen's d = 0.011), AIPE (Cohen's d = 0.044), and PEDT (Cohen's d = 0.066) values in the 3rd month after the application and IELT (Cohen's d = 0.025), AIPE (Cohen's d = 0.048), and PEDT (Cohen's d = 0.024) values in the 6th month after the application were found to be clinically weak. CONCLUSIONS: It was determined that the stop-start technique given to men with premature ejaculation increased the time spent in the vagina and eliminated the problem of premature ejaculation. It was determined that the stop-start technique in combination with sphincter control training were more effective than the stop-start technique alone.
48Effects of a new functional-sexological treatment for premature ejaculation.PubMed
François de Carufel, Gilles Trudel
J Sex Marital Ther. 2006 Mar-Apr;32(2):97-114. doi: 10.1080/00926230500442292.
Premature ejaculation is the most-prevalent sexual problem in men. Various treatments have been developed to increase control over the moment of ejaculation, with two of the most frequent techniques used in behavior therapy being the squeeze method developed by Masters and Johnson (1970) and the "stop-and-start" technique described by Semans (1956). These treatments are effective and improve matters in most cases. However, couples can be averse to using them, with some women reluctant to squeeze their partner's penis and some couples unwilling to interrupt sexual interaction once initiated. Under a new functional-sexological treatment intended to improve control over the moment of ejaculation, men learn how to control their arousal without having to interrupt sexual activity. In this study, we compared three groups of couples in which the man suffered from premature ejaculation. One followed the new functional-sexological treatment, another followed a behavioral treatment--including the squeeze and stop-and-start techniques--and a control group was placed on a waiting list. We used several questionnaires to assess the effects of the various treatments. Moreover, subjects provided an objective measure of duration of intercourse from penetration to ejaculation. These measures were taken pre- and posttreatment and at three-month follow-up. We ran analyses of variance to assess the effects of the treatments. Results indicate that the new treatment is very effective. We observed significant improvements in duration of intercourse, sexual satisfaction, and sexual functioning. The subjects in the behavioral treatment group obtained similar results. Furthermore, subjects from both groups were satisfied with their respective treatment.
49Psychosocial interventions for premature ejaculation.PubMed
Tamara Melnik, Stanley Althof, Alvaro N Atallah, et al.
Cochrane Database Syst Rev. 2011 Aug 10(8):CD008195. doi: 10.1002/14651858.CD008195.pub2.
BACKGROUND: Premature ejaculation (PE) is a very common sexual dysfunction among patients, and with varying prevalence estimates ranging from 3% to 20%. Although psychological issues are present in most patients with premature PE, as a cause or as a consequence, research on the effects of psychological approaches for PE has in general not been controlled or randomised and is lacking in long-term follow up. OBJECTIVES: To assess the efficacy of psychosocial interventions for PE.To investigate any differences in efficacy between different types of psychosocial treatments for PE.To compare psychosocial interventions with pharmacological treatment and pharmacological treatment in association with psychosocial treatment for PE. SEARCH STRATEGY: Trials were searched in computerized general and specialized databases, such as: MEDLINE by PubMed (1966 to 2010); PsycINFO (1974 to 2010); EMBASE (1980 to 2010); LILACS (1982 to 2010); the Cochrane Central Register of Controlled Trials (Cochrane Library, 2010); and by checking bibliographies, and contacting manufacturers and researchers. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials evaluating psychosocial interventions compared with different psychosocial interventions, pharmacological interventions, waiting list, or no treatment for PE. DATA COLLECTION AND ANALYSIS: Information on patients, interventions, and outcomes was extracted by at least two independent reviewers using a standard form. The primary outcome measure for comparing the effects of psychosocial interventions to waiting list and standard medications was improvement in IELT (i.e., time from vaginal penetration to ejaculation). The secondary outcome was change in validated PE questionnaires. MAIN RESULTS: In one study (De Carufel 2006) behavioral therapy (BT) was significantly better than waiting list for duration of intercourse (MD (mean difference) 407.90 seconds, 95% CI 302.42 to 513.38), and couples' sexual satisfaction (MD -26.10, CI -50.48 to -1.72). BT was also significantly better for a new functional-sexological treatment (FS) (MD 412.00 seconds, 95% CI 305.88 to 518.12), change over time in subjective perception of duration of intercourse (Women: MD 2.88, 95% CI 2.06 to 3.70; Men: MD 2.52, CI 1.65 to 3.39) and couples' sexual satisfaction (MD -25.10, 95% CI -47.95 to -2.25), versus waiting list.One study (Li 2006) showed that the combination of chlorpromazine and BT was superior than chlorpromazine alone for IELT (MD 1.11, 95% CI 0.82 to 1.40), SAS (Self-rating Anxiety Scale) (MD -8.72, 95% CI -11.09 to -6.35) and for some CIPE (Chinese Index Premature Ejaculation) questions ('anxiety in sexual activity', 'partner sexual satisfaction', 'patient sexual satisfaction', 'control ejaculatory reflex' and 'ejaculatory latency') ('Analysis 1.2').One study (Yuan 2008) showed that citalopram significantly improved IELT (RR (risk ratio) 0.52, 95% CI 0.34 to 0.78) and the number of couples satisfied with their sex life after treatment (RR 0.60, 95% CI 0.39 to 0.93), versus BT.In the last study (Abdel-Hamid 2001), 31 patients received 1 of 4 drugs administered on an as-needed basis 35 hours before anticipated coitus (clomipramine, sertraline, paroxetine, sildenafil), or were instructed to use the pause-squeeze technique. The study consisted of five four-week periods of treatment, separated by two-week washout periods. Anxiety score and ejaculation latency time were measured before treatment, after each treatment and during washout periods. Sexual satisfaction scores were measured after each treatment. However the available data from the article were not sufficient to be included, and the related database was not available anymore, according to the main author. AUTHORS' CONCLUSIONS: Overall, there is weak and inconsistent evidence regarding the effectiveness of psychological interventions for the treatment of premature ejaculation. Three of the four included randomised controlled studies of psychotherapy for PE reported our primary outcome (Improvement in IELT), and the majority have a small sample size. The early success reports (97.8%) of Masters and Johnson could not be replicated. One study found a significant improvement from baseline in the duration of intercourse, sexual satisfaction and sexual function with a new functional-sexological treatment and behavior therapy compared to waiting list. One study showed that the combination of chlorpromazine and BT was superior to chlorpromazine alone. Randomised trials with larger group samples are still needed to further confirm or deny the current available evidence for psychological interventions for treating PE.
50Psychosocial interventions for premature ejaculation.PubMed
Oscar Eduardo Hidetoshi Fugita
Sao Paulo Med J. 2012;130(2):132. doi: 10.1590/s1516-31802012000200013.
BACKGROUND:: Premature ejaculation (PE) is a very common sexual dysfunction among patients, and with varying prevalence estimates ranging from 3% to 20%. Although psychological issues are present in most patients with premature PE, as a cause or as a consequence, research on the effects of psychological approaches for PE has in general not been controlled or randomised and is lacking in long-term follow up. OBJECTIVE:: To assess the efficacy of psychosocial interventions for PE. CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW:: Trials were searched in computerized general and specialized databases, such as: MEDLINE by PubMed (1966 to 2010); PsycINFO (1974 to 2010); EMBASE (1980 to 2010); LILACS (1982 to 2010); the Cochrane Central Register of Controlled Trials (Cochrane Library, 2010); and by checking bibliographies, and contacting manufacturers and researchers. SELECTION CRITERIA:: Randomised or quasi-randomised controlled trials evaluating psychosocial interventions compared with different psychosocial interventions, pharmacological interventions, waiting list, or no treatment for PE. DATA COLLECTION AND ANALYSIS:: Information on patients, interventions, and outcomes was extracted by at least two independent reviewers using a standard form. The primary outcome measure for comparing the effects of psychosocial interventions to waiting list and standard medications was improvement in IELT (i.e., time from vaginal penetration to ejaculation). The secondary outcome was change in validated PE questionnaires. MAIN RESULTS:: In one study behavioral therapy (BT) was significantly better than waiting list for duration of intercourse (MD (mean difference) 407.90 seconds, 95% CI 302.42 to 513.38), and couples’ sexual satisfaction (MD -26.10, CI -50.48 to -1.72). BT was also significantly better for a new functional-sexological treatment (FS) (MD 412.00 seconds, 95% CI 305.88 to 518.12), change over time in subjective perception of duration of intercourse (Women: MD 2.88, 95% CI 2.06 to 3.70; Men: MD 2.52, CI 1.65 to 3.39) and couples’ sexual satisfaction (MD -25.10, 95% CI -47.95 to -2.25), versus waiting list. AUTHORS’ CONCLUSIONS:: Overall, there is weak and inconsistent evidence regarding the effectiveness of psychological interventions for the treatment of premature ejaculation. Three of the four included randomised controlled studies of psychotherapy for PE reported our primary outcome (Improvement in IELT), and the majority have a small sample size. The early success reports (97.8%) of Masters and Johnson could not be replicated. One study found a significant improvement from baseline in the duration of intercourse, sexual satisfaction and sexual function with a new functional-sexological treatment and behavior therapy compared to waiting list. One study showed that the combination of chlorpromazine and BT was superior to chlorpromazine alone. Randomised trials with larger group samples are still needed to further confirm or deny the current available evidence for psychological interventions for treating PE.
51The role of local anaesthetics in premature ejaculation.PubMed
Michael G Wyllie, Julia A Powell
BJU Int. 2012 Dec;110(11 Pt C):E943-8. doi: 10.1111/j.1464-410X.2012.11323.x. Epub 2012 Jul 3.
UNLABELLED: What's known on the subject? and What does the study add? It is now accepted that both biological and psychological factors are important in the aetiology of premature ejaculation (PE). Of particular interest is the correlation between ejaculatory latency and penile sensory thresholds. Men with PE appear to have a heightened sensory response to penile stimulation and also generally exhibit other abnormal reflex pathways within the ejaculatory process, suggesting a link between penile hypersensitivity and PE. Considering these sensory differences, drugs that selectively produce some degree of penile desensitization or act within the afferent-efferent reflex could delay ejaculatory latency without adversely affecting the sensation of ejaculation. This review evaluates published clinical trial data for local anaesthetics used off-label in PE as well as novel topical agents in development. New analyses of the phase III data are presented for topical eutectic mixture for PE (TEMPE, also known as PSD502, Plethora Solutions Plc., London), a proprietary formulation of lidocaine and prilocaine in a metered-dose aerosol delivery system. OBJECTIVES: • To review the published clinical trial data for local anaesthetics used off-label in premature ejaculation (PE), as well as novel topical agents in development. • To evaluate the safety and efficacy of topical eutectic mixture for PE (TEMPE) in subjects with PE and their sexual partners using all available phase III data. RESULTS: • Topical treatments can be applied as needed and systemic side-effects are unlikely. However, existing off-label topical treatments for PE have several disadvantages: they can be messy, interfere with spontaneity, and could cause numbness in the man or his partner. • Several novel topical agents are in development for the treatment of PE. TEMPE appears to be closest to approval. • TEMPE, applied 5 min before sexual intercourse (539 subjects) resulted in an increase in the geometric mean intra-vaginal ejaculatory time (IELT) from a baseline of 0.58 min to 3.17 min during 3 months of double-blind treatment; a 3.3-fold delay in ejaculation compared with placebo (P < 0.001). • IELT continued to increase further with continued use of TEMPE throughout the double-blind and open-label phases. • Treatment with TEMPE also resulted in marked improvements in subjective measures, e.g. ejaculatory control, sexual satisfaction and distress, with little or no evidence of systemic side-effects and minimal desensitization of the genitalia in subjects or their sexual partners. CONCLUSIONS: • The use of a topical agent could be an acceptable first-line option for PE, given the favourable risk/benefit ratio of these products. • Topical aerosol application of TEMPE may provide safe, effective, on-demand treatment for PE.
52PSD502 improves ejaculatory latency, control and sexual satisfaction when applied topically 5 min before intercourse in men with premature ejaculation: results of a phase III, multicentre, double-blind, placebo-controlled study.PubMed
W Wallace Dinsmore, Michael G Wyllie
BJU Int. 2009 Apr;103(7):940-9. doi: 10.1111/j.1464-410X.2009.08456.x. Epub 2009 Feb 23.
OBJECTIVES: To determine the effect of PSD502 applied topically 5 min before intercourse on the Index of Premature Ejaculation (IPE) and intravaginal ejaculatory latency time (IELT) of men with lifelong premature ejaculation (PE) defined according to the International Society of Sexual Medicine (ISSM) definition; secondary objectives were to evaluate the safety and tolerability of PSD502 in patients with PE, and their sexual partners. PATIENTS AND METHODS: Men aged >18 years, in stable heterosexual, monogamous relationships, and with lifelong PE diagnosed according to both the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (text revision) criteria and the ISSM definition, consented (together with their partners) to enter the baseline period of the study. Patients who documented an IELT of <or=1 min with two or more of the first three sexual encounters during the 4-week baseline period were randomized, in a 2:1 ratio, to receive double-blind treatment with PSD502 (three actuations of spray each containing 7.5 mg lidocaine and 2.5 mg prilocaine applied 5 min before intercourse) or placebo for 3 months. Patients completed IPE and Premature Ejaculation Profile (PEP) questionnaires at entry and at monthly clinic visits, and recorded stopwatch-timed IELT during each sexual encounter. Patients rated the quality of their orgasms on a 5-point scale at baseline and at the end of the treatment period, and rated the study medication on a 4-point scale. Safety was assessed by collecting adverse event data. RESULTS: In all, 300 men with PE were randomized from 31 centres in Europe. The geometric mean (range) IELT over the 3-month treatment period increased from a baseline of 0.6 min in both groups to 3.8 (0.3-57.8) and 1.1 (0-15.0) min in the PSD502 and placebo groups, respectively. Adjusting for treatment-group imbalances, this represents a 6.3-fold and 1.7-fold increase in adjusted geometric means. There were significantly greater increases in the scores for the IPE domains of ejaculatory control and sexual satisfaction in the PSD502 group than in the placebo group, with a mean (sem) 7.0 (0.59)-point difference between treatments in change from baseline in the IPE domain for ejaculatory control and a 5.9 (0.57)- point difference in change from baseline in the IPE domain for sexual satisfaction (both P < 0.001). This was supported by improvements in all secondary endpoints. At the end of the treatment period 66% of patients rated PSD502 as 'good' or 'excellent'. PSD502 was well tolerated and no systemic adverse events were reported. Localized treatment-related adverse events were reported by 2.6% and 3.1% of patients and partners, respectively. CONCLUSION: PSD502 applied topically 5 min before intercourse improved ejaculatory latency and significantly improved ejaculatory control and sexual satisfaction, factors relevant for acceptance of a PE treatment by both patient/physician and regulatory authorities. PSD502 was well tolerated by both patients and partners, with no systemic side-effects and a low incidence of localized effects, and was rated favourably by most users. PSD502 therefore appears to offer significant advantages over other therapies in development for the treatment of PE.
53Premature ejaculation: treatment update.PubMed
E J McCarty, W W Dinsmore
Int J STD AIDS. 2010 Feb;21(2):77-81. doi: 10.1258/ijsa.2009.009434.
Premature ejaculation (PE) is the most common male sexual problem worldwide affecting 22-38% of men. It has a significant morbidity both on patients and their partners, causing distress, anxiety and relationship difficulties. The mainstay of treatment is a combined approach using behavioural therapies and non-licensed medication such as topical anaesthetic preparations, selective serotonin re-uptake inhibitors and phosphodiesterase-5 inhibitors. In recent years, there has been a greater emphasis placed on researching novel treatments and exploring the on-demand use of current preparations. This review provides an overview of current accepted treatments and emerging agents for the use in PE.
54Improved ejaculatory latency, control and sexual satisfaction when PSD502 is applied topically in men with premature ejaculation: results of a phase III, double-blind, placebo-controlled study.PubMed
Culley Carson, Michael Wyllie
J Sex Med. 2010 Sep;7(9):3179-89. doi: 10.1111/j.1743-6109.2010.01913.x.
INTRODUCTION: PSD502 is a novel aerosolized, lidocaine-prilocaine, spray being developed for the treatment of lifelong premature ejaculation. The clinical profile of PSD502 is described in one of two double-blind, placebo-controlled, phase III studies. AIM: To determine the effect of PSD502 on the Index of Premature Ejaculation (IPE) and intravaginal ejaculatory latency (IELT) of men with lifelong PE. METHODS: Men with lifelong PE who documented an IELT ≤ 1 minute with two or more of the first three sexual encounters during a 4-week baseline period were randomized to receive double-blind treatment with PSD502 or placebo for 3 months. Patients completed IPE and Premature Ejaculation Profile questionnaires at entry and monthly visits, and recorded stop-watch timed IELT during each encounter. Safety was assessed by collecting adverse event data and standard safety measures. MAIN OUTCOME MEASURES: Stopwatch timed IELT recordings and a patient-reported outcome questionnaire the IPE were used in this study to determine the effect of PSD502 applied topically 5 minutes before intercourse. RESULTS: Two hundred fifty-six men with PE were randomized from 38 centers in the U.S., Canada, and Poland. The geometric mean IELT over the 3-month treatment period increased from a baseline of 0.56 minute and 0.53 minute in the PSD502 and placebo group respectively to 2.60 and 0.80 minute. There were significantly greater increases in the scores for the IPE domains of ejaculatory control, sexual satisfaction and distress in the PSD502 group than in the placebo group, with a mean 5.0 point difference between treatments in change from baseline in the IPE domain for ejaculatory control, 4.6 point difference in change from baseline in the IPE domain for sexual satisfaction, and a 2.5 point difference in change from baseline in the IPE domain for distress. This was supported by improvements in all secondary endpoints. CONCLUSION: In this study, PSD502 applied topically to the glans penis 5 minutes before intercourse showed significantly improved ejaculatory latency, ejaculatory control, sexual satisfaction and distress and was shown to be well tolerated by patients and partners.
55A benefit-risk assessment of dapoxetine in the treatment of premature ejaculation.PubMed
Kate Hutchinson, Kelly Cruickshank, Kevan Wylie
Drug Saf. 2012 May 1;35(5):359-72. doi: 10.2165/11598150-000000000-00000.
Premature ejaculation (PE) is considered to be the most common sexual problem affecting men, despite the likelihood that it is under-diagnosed. It is a complex condition with many physical and psychological components, making management complicated. It is important to develop treatments for PE as it adversely affects quality of life for individuals and partners. Dapoxetine is a short-acting selective serotonin reuptake inhibitor (SSRI) that has been developed principally for the treatment of PE. It is considered more suitable for the treatment of PE than other SSRIs as it can be used as an 'on demand' treatment to be taken a few hours before an expected sexual encounter, reducing the possibility of adverse effects. Dapoxetine may represent a breakthrough in the treatment of PE as it is the first drug to be licensed for this indication. This review attempts to present a balanced benefit-risk assessment of dapoxetine by examining the evidence from phase III clinical trials, focusing on its efficacy in prolonging intravaginal ejaculatory latency time (IELT), patient sexual satisfaction and safety in patients with PE. The benefits and risks of other therapies that are used to treat PE off-licence are also reviewed. There has only been one study to date that directly compares dapoxetine to another therapy, paroxetine, for this indication. It was found that dapoxetine is most effective at a dose of 60 mg in increasing IELT compared with placebo. All studies have also found that dapoxetine is well tolerated as an 'on-demand' therapy and with continual dosing; however, there are little data regarding possible long-term adverse effects. Findings of the dapoxetine development programme demonstrated that dapoxetine is associated with vasovagal-mediated (neurocardiogenic) syncope. No other associated significant cardiovascular adverse events were identified. Further research is needed to directly compare dapoxetine with other therapies and to investigate the outcomes of dapoxetine used in conjunction with behavioural therapies, and other non-pharmaceutical therapies.
56Pharmacotherapy for premature ejaculation.PubMed
Marcel D Waldinger
Expert Opin Pharmacother. 2015;16(17):2615-24. doi: 10.1517/14656566.2015.1096928. Epub 2015 Nov 18.
INTRODUCTION: Four premature ejaculation (PE) subtypes are distinguished on the basis of the duration of the intravaginal ejaculation latency time (IELT), its course in life, and frequency of complaints. Since the 1930s oral drug treatment and local anesthetics have been used to treat PE. Apart from dapoxetine, all currently available drugs to treat PE (SSRIs, clomipramine, and local anesthetics) are off-label. Not only men with lifelong and acquired PE, but also men with normal IELT values may want to postpone their ejaculation time. AREAS COVERED: The guideline of the International Society for Sexual Medicine for the treatment of PE has provided evidence-based recommendations for the pharmacotherapy of lifelong and acquired PE. Selective serotonin reuptake inhibitors (SSRIs) delay ejaculation by interfering with the serotonin (5-HT) neurotransmission system in the central nervous system. Attention is given not only to the well-known but also to the recently published, very rare side effects of SSRIs. EXPERT OPINION: Men with normal IELT values who want to postpone ejaculation do not need "drugs for the treatment of PE" but "ejaculation delaying drugs." Pharmacological research of these ejaculation-delaying drugs ought to be investigated in men with normal IELT values, such as in men with subjective PE, variable PE, and in male volunteers.
57[Dapoxetine in treatment of premature ejaculation: a systematic review].PubMed
Ya-bo Wang, Yu Mao, Qiang Wei, et al.
Beijing Da Xue Xue Bao Yi Xue Ban. 2010 Aug 18;42(4):425-32.
OBJECTIVE: To assess the effectiveness of dapoxetine in the treatment of premature ejaculation. METHODS: Both English and Chinese studies involving men with prematrue ejaculation who were treated with dapoxetine from the Cochrane Library, MEDLINE, EMBASE and CNKI, CBM, VIP between 1979 and 2009.were included in the randomized controlled trials (RCTs) and the data processed by RevMan. RESULTS: Five RCTs involving 4433 patients were included in the Meta analysis, of which 3 were of grade A and 2 were of grade B according to the quality evaluation of methodology. Intravaginal ejaculatory latency time (IELT), patient-reported global impression of change (PGI), satisfaction with sexual intercourse (SWSI), perceived control over ejaculation (PCOE), personal distress related to ejaculation (PDRE) were used for assessment. Meta analysis based on included studies of patients having been treated with dapoxetine for 9-24 weeks showed that: (1) the difference of the patients' IELT between treatment group and control group was statistically significant [P<0.001, WMD (95%CI) was 1.38 (1.21,1.55)]; (2) the difference of the PGI of development in premature ejaculation between treatment group and control group was statistically significant [P<0.001, OR (95%CI) was 3.56 (2.60,4.88)]; (3) the difference of the patients' SWSI between treatment group and control group was statistically significant [P<0.001, OR (95%CI) was 3.85 (2.08,7.10)]; the difference of the patients' score of SWSI between treatment group and control group was statistically significant [P<0.001, WMD (95%CI) was 0.55 (0.48,0.62)]; (4) the difference of the patients' change of PCOE between treatment group and control group was statistically significant [P<0.001, OR (95%CI) was 2.87(2.30,3.58)]; the difference of the patients' score of PCOE between treatment group and control group was statistically significant [P<0.001, WMD (95%CI) was 0.63(0.49,0.78)]; (5) after being treated with dapoxetine for 9-24 weeks, the difference of the patients' change of PDRE between treatment group and control group was statistically significant [P<0.001, OR (95%CI) was 2.02 (1.69,2.42)]. All the RCTs reported the side effects of dapoxetine, but the results showed that there were no serious side effects of dapoxetine during the treatment period. CONCLUSION: The available evidence indicates that dapoxetine would improve the symptoms of premature ejaculation, prolong IELT over 9-24 weeks in men from a wide range of cultural backgrounds, and significantly improve all patients' reported outcomes and the patients' clinical global impressions of premature ejaculation, including more control, greater satisfaction, and less distress.
58[Efficacy and tolerability of dapoxetine in the treatment of premature ejaculation].PubMed
Lin Yang, Lei Luo, Xing-fa Chen, et al.
Zhonghua Nan Ke Xue. 2015 Oct;21(10):892-5.
OBJECTIVE: To investigate the efficacy and adverse effects of dapoxetine in the treatment of premature ejaculation. METHODS: We randomly assigned outpatients with premature ejaculation in the proportion of 2:1 to receive 30 mg dapoxetine on demand (n =78) or 50 mg sertraline qd for one month (n = 39). Follow-up was accomplished in 95 cases, 63 in the dapoxetine group and 32 in the sertraline group. We recorded the intravaginal ejaculatory latency time (IELT), clinical global impression of change (CGIC) score, and adverse reactions of the patients and compared them between the two groups. RESULTS: IELT was significantly increased in both the dapoxetine (from [0.87 ± 0.31] to [2.84 ± 0.68] min, P < 0.05) and the sertraline group (from [0.84 ± 0.28] to [2.71 ± 0.92] min, P < 0.05) after medication. Based on the CGIC scores in premature ejaculation, the rate of excellence or effectiveness was 36.5% in the dapoxetine and 37. 5% in the sertraline group, and the rate of improvement was 63.5% in the former and 71.9% in the latter. The incidence rates of dizziness, nausea, headache, and diarrhea were slightly higher (P > 0.05) while those of fatigue, somnolence, and dry mouth significantly higher (P < 0.05) in the sertraline than in the dapoxetine group. CONCLUSION: On-demand oral medication of dapoxetine is effective and well-tolerated for the treatment of premature ejaculation.
59Selective serotonin re-uptake inhibitors for premature ejaculation in adult men.PubMed
Niranjan J Sathianathen, Eu Chang Hwang, Ruma Mian, et al.
Cochrane Database Syst Rev. 2021 Mar 21;3(3):CD012799. doi: 10.1002/14651858.CD012799.pub2.
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.
60Premature ejaculation: do we have effective therapy?PubMed
Ege Can Serefoglu, Theodore R Saitz, Landon Trost, et al.
Transl Androl Urol. 2013 Mar;2(1):45-53. doi: 10.3978/j.issn.2223-4683.2013.01.02.
INTRODUCTION: Premature ejaculation (PE) is the most common sexual dysfunction, with the majority of PE patients remaining undiagnosed and undertreated. Despite its prevalence, there is a current paucity of data regarding available treatment options and mechanisms. The objective of the current investigation is to review and summarize pertinent literature on therapeutic options for the treatment of PE, including behavioral/psychologic, oral pharmacotherapy, and surgery. METHODS: A pubmed search was conducted on articles reporting data on available treatment options for PE. Articles describing potential mechanisms of action were additionally included for review. Preference was given towards randomized, controlled trials, when available. RESULTS: PE remains an underdiagnosed and undertreated disease process, with limited data available regarding potential underlying mechanisms and long-term outcomes of treatment options. Psychological/behavioral therapies, including the stop-start, squeeze, and pelvic floor rehabilitation techniques have demonstrated improvements in short-term series, with decreased efficacy with additional follow-up. Topical therapies, which are commonly utilized result in prolonged intravaginal ejaculatory latency time (IELT) at the expense of potential penile/vaginal Hypothesia. Oral therapies similarly demonstrate improved IELTs with variable side effect profiles and include selective serotonin reuptake inhibitors (daily or on demand), phosphodiesterase-5 inhibitors, alpha-1 adrenergic antagonists, and tramadol. Alternative therapies such as acupuncture have shown benefits in limited studies. Surgery is not commonly performed and is not recommended by available guidelines. CONCLUSIONS: PE is a common condition, with limited data available regarding its underlying pathophysiology and treatment. Available therapies include topical, oral, behavioral/psychologic modification, or a combination thereof. Additional research is required to assess the optimal treatment strategies and algorithms as well as to better define the mechanisms for PE and its management.
61Disorders of orgasm and ejaculation in men.PubMed
David Rowland, Chris G McMahon, Carmita Abdo, et al.
J Sex Med. 2010 Apr;7(4 Pt 2):1668-86. doi: 10.1111/j.1743-6109.2010.01782.x.
INTRODUCTION: Ejaculatory/orgasmic disorders are common male sexual dysfunctions, and include premature ejaculation (PE), inhibited ejaculation, anejaculation, retrograde ejaculation, and anorgasmia. AIM: To provide recommendations and guidelines concerning current state-of-the-art knowledge for management of ejaculation/orgasmic disorders in men. METHODS: An international consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 25 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge of disorders of orgasm and ejaculation represent the opinion of seven experts from seven countries developed in a process over a 2-year period. MAIN OUTCOME MEASURE: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. RESULTS: Premature ejaculation management is largely dependent upon etiology. Lifelong PE is best managed with PE pharmacotherapy (selective serotonin re-uptake inhibitor [SSRI] and/or topical anesthetics). The management of acquired PE is etiology specific and may include erectile dysfunction (ED) pharmacotherapy in men with comorbid ED. Behavioral therapy is indicated when psychogenic or relationship factors are present and is often best combined with PE pharmacotherapy in an integrated treatment program. Retrograde ejaculation is managed by education, patient reassurance, pharmacotherapy, or bladder neck reconstruction. Delayed ejaculation, anejaculation, and/or anorgasmia may have a biogenic and/or psychogenic atiology. Men with age-related penile hypoanesthesia should be educated, reassured, and instructed in revised sexual techniques which maximize arousal. CONCLUSIONS: Additional research is required to further the understanding of the disorders of ejaculation and orgasm.
62Pharmacologic treatment of rapid ejaculation: levels of evidence-based review.PubMed
Ibrahim A Abdel-Hamid
Curr Clin Pharmacol. 2006 Sep;1(3):243-54. doi: 10.2174/157488406778249352.
Rapid (premature) ejaculation (RE) is defined as persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before it is wished by the man or his partner. RE is the most frequently encountered sexual complaint of men and couples. Estimates suggest that as many as one third of all sexually active men suffer from RE. RE has been treated with various modalities. These include behavioral therapy, topical applications, oral pharmacotherapy and intracavernosal vasoactive drug injection. The success rates of these modalities are variable, however, to date an approved treatment does not exist. In this article, we review the evidence surrounding the pharmacological management of RE. The search included (i) a MEDLINE search from 1980 through August 2005 limited to English-language medical literature; (ii) relevant abstracts from 2003, 2004, and 2005; and (iii) a pipeline search for therapeutics in development. The review does not include behavioral therapy. The distinct feature of this review is that the level of evidence supporting each treatment will be discussed in details. Results showed that there is consistent evidence which supports the daily use of paroxetine, clomipramine, sertraline and fluoxetine for the treatment of RE. There is no strong evidence suggesting the use of these previous drugs on an as-needed basis. There is strong evidence to suggest the use of dapoxetine on an as-needed in RE. Available evidence indicates that topical anesthetic agents such as prilocaine-lidocaine and SS-cream appears to be effective in treatment of RE. There is no strong evidence to suggest that PDEI5 could prolong IELT in RE when used on-demand. In conclusion, based on literature data, although some drugs may be effective in treatment of RE, more extended multi-center prospective double-blind, placebo-controlled stopwatch studies on the benefits of SSRIs, SNRIs and PDEI5 in RE are required.
63Paroxetine in the treatment of premature ejaculation: a systematic review and meta-analysis.PubMed
Dong Zhang, Yue Cheng, Kerong Wu, et al.
BMC Urol. 2019 Jan 3;19(1):2. doi: 10.1186/s12894-018-0431-7.
BACKGROUND: Paroxetine is one of the selective serotonin reuptake inhibitors (SSRIs) used in the treatment of premature ejaculation (PE). However, this use is not approved in many countries. The purpose of this systematic review and meta-analysis is to review the efficacy and safety of paroxetine for PE patients. METHODS: We searched relevant randomized, controlled trials through May 2018, using PubMed, Embase and Cochrane Central Register. The main endpoint included intra-vaginal ejaculatory latency time (IELT) and side effects in the treatment of PE. Cochrane Collaboration's Revman software, version 5.3, was used for statistical analysis. RESULTS: Out of 493 unique articles, a total of 19 randomized, controlled trials (RCTs) were reviewed. Quite a few RCTs were considered to have unclear risk of bias because of limited information. Pooled outcomes suggested that paroxetine was more effective than placebo, fluoxetine and escitalopram at increasing IELT (all p < 0.05). However, there existed a high level of heterogeneity in the paroxetine vs. fluoxetine groups and the paroxetine vs. placebo groups. Comparing paroxetine with tramadol, sertraline, phosphodiesterase 5 inhibitors (PDE5Is), local lidocaine gel, behaviour therapy or dapoxetine, we found that the increase in IELT was not statistically significant between groups. Paroxetine combined with tadalafil or behaviour therapy was more efficacious than paroxetine alone (all p < 0.05). Although the side effects in the combination group were more common than in the paroxetine alone group, the most common adverse events, such as nausea, muscle soreness, palpitation and flushing, were mild and tolerable. The main limitations of this systematic review and meta-analysis were the different definitions of PE and short follow-up times. CONCLUSIONS: According to this systematic review and meta-analysis, paroxetine provided better efficacy than placebo, fluoxetine and escitalopram in the treatment of PE, with well-tolerated side effects. The combination group had better efficacy than the paroxetine alone group. TRIAL REGISTRATION: This review was reported in agreement with the PRISMA statement and was registered on PROSPERO 2018CRD42018097014 .
64Premature ejaculation: state of the art.PubMed
Marcel D Waldinger
Urol Clin North Am. 2007 Nov;34(4):591-9, vii-viii. doi: 10.1016/j.ucl.2007.08.011.
Premature ejaculation (PE) is a frequent male sexual complaint.This occurrence does not automatically imply the existence of a male sexual disorder. The current DSM definition of PE has a low positive predictive value with a high associated risk for false-positive diagnoses of PE. A new classification in four well-defined PE syndromes has recently been proposed for the pending DSM-V. According to this new classification there are different pathophysiologies and treatments of PE, dependent on the underlying PE syndrome. Some types are particularly neurobiologically or medically determined and need drug treatment; other types, which are mainly psychologically determined, need psychotherapy or both drug treatment and psychotherapy. A meta-analysis of all selective serotonin reuptake inhibitors (SSRIs) and clomipramine studies, which were performed according to current standards of evidence-based medicine, demonstrated a similar efficacy for the daily treatment with the serotonergic antidepressants paroxetine hemihydrate, clomipramine, sertraline, and fluoxetine, with paroxetine hemihydrate exerting the strongest effect on ejaculation. On-demand treatment with SSRIs generally exerts much less ejaculation delay than daily SSRI treatment. Other on-demand treatment options are the topical use of anesthetics, tramadol, and phosphodiesterase type 5 inhibitors. Caution is needed with tramadol with regard to its potential addictive properties. There is insufficient evidence for the ejaculation delaying effects of phosphodiesterase type 5 inhibitors and intracavernous injection of vasoactive drugs.
65Off-label Uses of Selective Serotonin Reuptake Inhibitors (SSRIs).PubMed
Tommaso B Jannini, Giorgio D Lorenzo, Emanuela Bianciardi, et al.
Curr Neuropharmacol. 2022;20(4):693-712. doi: 10.2174/1570159X19666210517150418.
Psychiatric drugs have primacy for off-label prescribing. Among those, selective serotonin reuptake inhibitors (SSRIs) are highly versatile and, therefore, widely prescribed. Moreover, they are commonly considered as having a better safety profile compared to other antidepressants. Thus, when it comes to off-label prescribing, SSRIs rank among the top positions. In this review, we present the state of the art of off-label applications of selective serotonin reuptake inhibitors, ranging from migraine prophylaxis to SARS-CoV-2 antiviral properties. Research on SSRIs provided significant evidence in the treatment of premature ejaculation, both with the on-label dapoxetine 30 mg and the off-label paroxetine 20 mg. However, other than a serotoninergic syndrome, serious conditions like increased bleeding rates, hyponatremia, hepatoxicity, and post-SSRIs sexual dysfunctions, are consistently more prominent when using such compounds. These insidious side effects might be frequently underestimated during common clinical practice, especially by nonpsychiatrists. Thus, some points must be addressed when using SSRIs. Among these, a psychiatric evaluation before every administration that falls outside the regulatory agencies-approved guidelines has to be considered mandatory. For these reasons, we aim with the present article to identify the risks of inappropriate uses and to advocate the need to actively boost research encouraging future clinical trials on this topic.
66Comparison of Dapoxetine /Tadalafil and Paroxetine/Tadalafil Combination Therapies for the Treatment of the Premature Ejaculation: A Randomized Clinical Trial.PubMed
Hamed Mohseni Rad, Telma Zahirian Moghadam, Ali Hosseinkhani, et al.
Urol J. 2021 Nov 13;19(2):138-143. doi: 10.22037/uj.v18i.6644.
PURPOSE: The purpose of this study was to compare the effectiveness of Dapoxetine, and Paroxetine as well as Dapoxetine/Tadalafil and Paroxetine/Tadalafil combinational therapies, for the treatment of patients with premature ejaculation. MATERIALS AND METHODS: In this clinical trial study, 120 patients with premature ejaculation were randomly divided into 4 groups: The first group was treated with Paroxetine (Pa), while the second group received Dapoxetine(Da). The third group received Paroxetine combined with Tadalafil(PT) whereas the fourth group's treatment involved the use of Dapoxetine and Tadalafil(DT) for one month. In the next 2 and 4 weeks, the cases were evaluated in terms of ejaculation duration, frequency of intercourse per week, and drug side effects. RESULTS: The mean age of the Da, Pa, PT, DT groups was 32 ± 6.9, 32.4 ± 7.2, 31.6 ± 1.9, and 32.9 ± 7.7 years, respectively. There was a significant difference between the Da and DT groups (p = .029) in the ejaculation latency in the 4-week follow-up. In the two weeks follow-up, a significant difference was observed between DA and DT (p = 0.043), Pa and PT (p = 0.006), and Pa and DT groups (p = 0.004) in terms of ejaculation latency. Four weeks after the intervention, a significant difference was detected in the intercourse frequency of Da and PT groups (p =0.033), Pa and PT groups (p = 0.043), Pa and DT groups (p = 0.02), and Da and DT groups (p = 0.016). CONCLUSION: Combination therapy (Tadalafil plus Paroxetine or Dapoxetine) was more effective in IELT (Intra ejaculation latency time) than mono-therapy especially in younger patients despite its slightly more side effects.
67Phosphodiesterase Type 5 Inhibitors for Premature Ejaculation: A Systematic Review and Meta-analysis.PubMed
Marrissa Martyn-St James, Katy Cooper, Shijie Ren, et al.
Eur Urol Focus. 2017 Feb;3(1):119-129. doi: 10.1016/j.euf.2016.02.001. Epub 2016 Feb 19.
CONTEXT: Phosphodiesterase type 5 inhibitors (PDE5-Is) are prescribed off-label for the treatment of premature ejaculation (PE). OBJECTIVE: To systematically review the evidence from randomised controlled trials (RCTs) for PDE5-Is in the management of PE. EVIDENCE ACQUISITION: Medline and other databases were searched through September 2015. Quality of RCTs was assessed. Intravaginal ejaculatory latency time (IELT) data were pooled in a meta-analysis. Heterogeneity was assessed. EVIDENCE SYNTHESIS: Fifteen RCTs were included. The majority were of unclear methodological quality. Pooled IELT evidence suggests that PDE5-Is are significantly more effective than placebo (231 participants, p<0.00001), that there is no difference between PDE5-Is and selective serotonin reuptake inhibitors (SSRIs; 405 participants, p=0.50), and that PDE5-Is combined with an SSRI are significantly more effective than SSRIs alone (521 participants, p=0.001); however, high levels of statistical heterogeneity are evident (I ≥ 40%). Single-RCT evidence suggests that sildenafil is significantly more effective than the squeeze technique, but both lidocaine gel and tramadol are significantly more effective than sildenafil. Sildenafil combined with behavioural therapy is significantly more effective than behavioural therapy alone. Sexual satisfaction and ejaculatory control appear to be better with PDE5-Is compared with placebo and with PDE5-Is combined with an SSRI compared with an SSRI alone. Adverse events are reported with both PDE5-Is and other agents. CONCLUSIONS: PDE5-Is are significantly more effective than placebo and PDE5-Is combined with an SSRI are significantly more effective than SSRIs alone at increasing IELT and improving other effectiveness outcomes; however, heterogeneity is evident across RCTs. The methodological quality of the majority of RCTs is unclear. PATIENT SUMMARY: We reviewed phosphodiesterase type 5 inhibitors (PDE5-Is) for treating premature ejaculation. We found evidence to suggest that PDE5-Is are effective compared with placebo and that PDE5-Is combined with an SSRI are more effective than an SSRI alone. Adverse events are reported with PDE5-Is and other agents; however, the quality of the evidence is uncertain. TRIAL REGISTRATION: PROSPERO registration number CRD42013005289.
68Selective serotonin reuptake inhibitors combined with traditional Chinese medicine for premature ejaculation: A systematic review and meta-analysis.PubMed
Xuefeng Chang, Mingwei Xu, Yuanzhe Chen, et al.
Andrology. 2023 Jan;11(1):112-124. doi: 10.1111/andr.13307. Epub 2022 Oct 13.
BACKGROUND: Premature ejaculation (PE) is still a tough problem in drug treatment. Many clinical trials have proven that traditional Chinese medicine (TCM) has a significant effect in the treatment of PE. This article aims to provide the latest evidence for the efficacy and safety of TCM combined with selective serotonin reuptake inhibitors (SSRIs) in the treatment of PE. METHODS: We looked for randomized controlled trials (RCTs) from China National Knowledge Infrastructure, Wanfang, VIP Database, MEDLINE, PubMed, Web of Science, EMBASE, and Cochrane Library until June 30, 2022. STATA 15.1 software was used to analyze all data for this article. The quality of the included articles was evaluated using the Cochrane Reviewer's Handbook 5.3. RESULTS: Finally, we selected 16 high-quality RCTs in our meta-analysis, which containing 889 patients. Meta-analysis suggested that, compared with SSRIs alone, combination of TCM with SSRIs increased significantly intravaginal ejaculation latencv time and the scores of ejaculation control ability, sexual life satisfaction, PE-related distress, and communication difficulties between partners related to PE. Also, there was no significant difference in adverse effects between the two groups. In addition, the results of publication bias test showed that no significant bias occurred. CONCLUSION: The combined use of TCM and SSRIs has significant effect in the treatment of PE compared with SSRIs monotherapy and was generally well tolerated. Due to the small sample size, multicenter and large sample RCT is still needed in the future to further confirm the effectiveness and safety of TCM combined with SSRIs in the treatment of PE.
69Safety and efficacy of traditional Chinese medicine, Qiaoshao formula, combined with dapoxetine in the treatment of premature ejaculation: An open-label, real-life, retrospective multicentre study in Chinese men.PubMed
Jun Guo, Fu Wang, Qing Zhou, et al.
Andrologia. 2021 Feb;53(1):e13915. doi: 10.1111/and.13915. Epub 2020 Nov 24.
To evaluate the safety and efficacy of Chinese medicine, Qiaoshao formula combined with dapoxetine was used for the treatment of premature ejaculation in a real-life setting. Nine hundred and five males diagnosed with premature ejaculation were reviewed in this retrospective cohort study. We divided the patients into two groups: dapoxetine alone and Qiaoshao formula combined with dapoxetine according to actual interventions provided to patients in clinics. The perceived intravaginal ejaculation latency time and the premature ejaculation profile measures markedly improved in both groups. However, in men with severe premature ejaculation (baseline perceived intravaginal ejaculation latency time <1 min) and those with baseline age ≤30 years, the perceived intravaginal ejaculation latency time was slightly but significantly longer with combined therapy than with dapoxetine alone (p < .05). Therefore, combined therapy involving the Qiaoshao formula and dapoxetine proved to safe as well as effective for treating premature ejaculation while prolonging the perceived intravaginal ejaculation latency time, which significantly improved the overall satisfaction of the patient and likely that of the couple.
70Synergistic effect of Chaihu-Shugan-San combined with paroxetine tablets in the treatment of acquired premature ejaculation: study protocol for a randomized controlled proof-of-concept trial.PubMed
Shengqiang Qian, Jintao Wei, Peihai Zhang, et al.
Front Pharmacol. 2025 Oct 7;16:1651654. doi: 10.3389/fphar.2025.1651654. eCollection 2025.
INTRODUCTION: Acquired premature ejaculation (APE) is a common male sexual dysfunction characterized by a clinically significant reduction in intravaginal ejaculatory latency time. In China, its prevalence ranges from 4% to 39%, while globally, approximately 26% of men report premature ejaculation (PE), with APE accounting for 18.8% of cases. The mechanisms of APE remain unclear, with psychological factors (e.g., anxiety, depression) and neurological factors identified as key influences. Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, delay ejaculation by elevating synaptic 5-HT levels, but they are associated with side effects and poor compliance. Chaihu-Shugan-San (CHSGS), a classical Traditional Chinese Medicine (TCM) formula for depression and anxiety, is commonly used in TCM andrology for APE. It is hypothesized that CHSGS alleviates APE symptoms by improving emotional states through central nervous system modulation. METHODS AND ANALYSIS: This is a randomized, blinded interventional trial with four parallel groups. A total of 84 eligible participants will be randomly assigned to one of four groups: the paroxetine group, CHSGS group, CHSGS + paroxetine group, or placebo group. The primary outcomes are Intravaginal ejaculatory latency time (IELT) and Pre- and post-treatment brain fMRI scans. The Secondary Outcomes include Premature ejaculation profile (PEP), Chinese Index of Premature Ejaculation (CIPE) and TCM syndrome score. ETHICS AND DISSEMINATION: The trial has been registered with the International Traditional Medicine Clinical Trial Registry (Registration No. ITMCTR2025000309) and Ethics Committee of Chongqing Hospital of Traditional Chinese Medicine (Registration No. 2023-ky-87). It will be proceeded in the Departments of Urology and Radiology at Chongqing Traditional Chinese Medicine Hospital in Chongqing, China. TRIAL REGISTRATION NUMBER: ITMCTR2025000309.
71Efficacy of combination therapy with biofeedback and dapoxetine in lifelong premature ejaculation treatment: a prospective randomized study.PubMed
Ali Haydar Yılmaz, Ahmet Emre Cinislioglu, Saban Oğuz Demirdöğen, et al.
Int Urol Nephrol. 2022 Nov;54(11):2813-2818. doi: 10.1007/s11255-022-03338-7. Epub 2022 Aug 10.
PURPOSE: Premature ejaculation (PE) is a common sexual dysfunction that significantly affects the quality of life of the patient and their partner. We aimed to compare the efficacy and safety of the combination therapy with biofeedback-guided pelvic floor exercise therapy (BFT) and dapoxetine 30 mg. METHODS: Sixty-five patients diagnosed with lifelong PE were included in the study. Patients were divided into three groups as BFT, dapoxetine 30 mg and a combination of BFT and dapoxetine 30 mg. The patients were compared with the intravaginal ejaculatory latency time (IELT) pre-treatment and post-treatment 1st and 3rd months. RESULTS: The mean IELTs of the patients in Group 1 were 40 s in pre-treatment, 115 s at the end of the 4th week and 140 s at the end of the 12th week. The IELT values of the patients in Group 2 were 40 s in pre-treatment, 145 s in the 4th week and 170 s in the 12th week. The IELT values were calculated in Group 3 as 42.5 s in pre-treatment, 185 s in the 4th week and 205 s in the 12th week When the IELT was statistically compared between the groups at 1st and 3rd months, the duration in the combination group was found to increase significantly (p < 0.001). CONCLUSION: Combination therapy with BFT and dapoxetine 30 mg in lifelong PE treatment is a good alternative with a low side effect profile and acceptable continuous efficiency.
72[Premature ejaculation: the main physiological mechanisms and new approaches to the treatment].PubMed
A A Kamalov, D A Ohobotov, M V Frolova, et al.
Urologiia. 2020 Mar(1):95-102.
Premature ejaculation (PE) is characterized by an early ejaculation, which occurs within 1 minute after or before vaginal penetration. PE is the most common sexual problem and leads to a number of negative psychological consequences. To understand the etiopathogenesis of PE, it is necessary to understand the physiological mechanisms of the ejaculatory reflex. A group of galanine-ergic lumbar spinothalamic cells (LSt cells) with their numerous projections to various structures of the central nervous system plays a crucial role. The main approaches to the treatment of PE are based on the inhibition of glans sensitivity. In recent years, most of the studies on PE are dedicated to various technologies of reflexotherapy and a possibility of biofeedback. We have analyzed the available literature data and explained the main links of ejaculatory reflex, as well as possible approaches to treatment.
73[Clinical efficacy of Manlyman Spray combined with biofeedback therapy on premature ejaculation].PubMed
Gao-Yue Zhang, Shan-Wen Chen, Guang-Hong Fang, et al.
Zhonghua Nan Ke Xue. 2023 Jul;29(7):630-633.
Objective： To observe the clinical effect of Manlyman Spray combined with biofeedback therapy in the treatment of premature ejaculation (PE)．Methods： A total of 60 primary premature ejaculation patients with stable sexual partners and regular sexual activity (≥１ times per week) from April 2021 to October 2022 were involved in the clinical observation, The patients' age is (34.3 ± 4.9) years old, and the course of the disease is (112.5 ± 65.5) months, and Manlyman Spray combined with biofeedback therapy was used to treat patients for 8 weeks. Manlyman Spray was sprayed 3 times on the surface of the penisqd for 4 weeks, and Biofeedback therapy is treated twice a week according to the AI setting module, for a total of 8 weeks. Before and 8 weeks after medication and at 4 weeks after drug withdrawal, the Intravaginal Ejaculation Latency Time (IELT), Premature Ejaculation Diagnostic Tool (PEDT) scores and Clinical Global Impression of Change (CGIC) scores were Obtained and compared. Results： After 8 weeks of treatment, the IELT of the patients was significantly prolonged (［351.4 ± 76.7］ vs ［87 ± 16.8］,P<0.05) and at 4 weeks after drug withdrawal, the therapeutic effect still existed (［345.9 ± 80.3］ vs ［87 ± 16.8］,P<0.05), the PEDT scores were significantly improved after treatment (［18.2 ± 1.1］ vs ［9.0 ± 1.4］,P<0.05)and at 4 weeks after drug withdrawal(［18.0 ± 1.2］ vs ［9.0 ± 1.4］,P<0.05), and so were the CGIC scores (［13.4 ± 1.3］ vs ［3.3 ± 1.4］,P<0.05, and ［12.6 ± 1.6］ vs ［3.3 ± 1.4］,P<0.05). Conclusion： The combination of Manlyman Spray and biofeedback therapy can effectively treat primary premature ejaculation, with a long duration of treatment and good safety, and the specific mechanism needs further study.
74Differential efficacy of pelvic floor muscle training in primary versus acquired premature ejaculation: an 8-week comparative study using non-invasive biomechanical assessment.PubMed
Yinan Lyu, Jiawei Gong, Houdong He, et al.
Sex Med. 2025 Oct 13;13(5):qfaf081. doi: 10.1093/sexmed/qfaf081. eCollection 2025 Oct.
BACKGROUND: Premature ejaculation (PE), including lifelong (LPE) and acquired (APE) subtypes, negatively affects men's sexual, psychological, and relational well-being. AIM: This study aimed to investigate pelvic floor muscle function differences between healthy individuals and premature ejaculation patients and evaluate the efficacy of pelvic floor muscle training in improving premature ejaculation subtype symptoms using an innovative assessment approach. METHODS: In this 8-week prospective study, 199 men were enrolled (LPE, n = 66; APE, n = 83; healthy controls [HC], n = 50). PE participants received PFMT comprising PFM awareness, biofeedback-based strengthening, and integration into sexual activity. PFM function was measured with a perineometry/biofeedback device; anxiety and depression with 7-item Generalized Anxiety Disorder scale (GAD-7) and 9-item Patient Health Questionnaire (PHQ-9); and intravaginal ejaculatory latency time (IELT) by stopwatch. OUTCOME: The primary outcomes were improvements in pelvic floor muscle function, ejaculatory latency time, and premature ejaculation symptom severity. RESULTS: After 8 weeks of PFMT, significant improvements were observed in both groups. In the APE group, IELT increased from a median of 120 s to 180 s, and premature ejaculation diagnostic tool (PEDT) scores decreased by 2 points ( < 0.001). In the LPE group, IELT increased from 30 s to 60 s, and PEDT scores decreased by 1.5 points ( < 0.001). Reductions in PHQ-9 (APE: -3.0; LPE: -2.0) and GAD-7 (APE: -3.0; LPE: -1.0) scores were also observed, with APE showing greater overall benefits. No significant baseline differences were found in PFM strength; however, both groups showed post-training increases in maximum contraction pressure and sustained contraction average pressure (all < 0.001). CLINICAL IMPLICATIONS: Pelvic floor muscle training appears effective in addressing psychological and physical symptoms of premature ejaculation, particularly for acquired premature ejaculation. STRENGTHS AND LIMITATIONS: This study is the first to use a non-invasive biomechanical approach to compare pelvic floor muscle function between healthy individuals and PE patients. It also uniquely examines how PFM training affects different PE subtypes, offering insights for more targeted treatment strategies. However, the research is limited by the absence of sham controls, which are necessary to distinguish placebo effects, and it also lacks long-term follow-up to assess enduring outcomes. CONCLUSION: Pelvic floor muscle training improves ejaculatory control and psychological outcomes in premature ejaculation patients, with greater efficacy observed in acquired premature ejaculation; further research is needed to explore long-term effects and underlying mechanisms.
75Awareness and timing of pelvic floor muscle contraction, pelvic exercises and rehabilitation of pelvic floor in lifelong premature ejaculation: 5 years experience.PubMed
Giuseppe La Pera
Arch Ital Urol Androl. 2014 Jun 30;86(2):123-5. doi: 10.4081/aiua.2014.2.123.
OBJECTIVES: To assess the cure rate of patients with premature ejaculation who underwent a treatment involving: 1) awareness of the pelvic floor muscles 2) learning the timing of execution and maintenance of contraction of the pelvic floor muscles during the sensation of the pre-orgasmic phase 3) pelvic floor rehabilitation (bio feed back, pelvic exercises and electrostimulation). MATERIALS AND METHODS: We recruited 78 patients with lifelong premature ejaculation who completed the training. The patients were informed of the role of the pelvic floor. They were taught to carry out the execution and maintenance of contraction of the pelvic floor muscles during the sensation of the pre-orgasmic phase to control the ejaculatory reflex. In order to improve the awareness, the tone and the endurance of the pelvic floor muscles, patients were treated with the rehabilitation of pelvic floor (RPF) consisting mainly in biofeedback, pelvic exercises and in some cases also in electro-stimulation (ES). The training was carried out for a period of about 2-6 months with an average of 2-5 visits per cycle. RESULTS: 54% of patients who completed the training were cured of premature ejaculation and learned over time to be able to postpone the ejaculation reflex. In a subgroup of 26 patients was also measured the IELT which on the average increased from < 2 minutes to >10 minutes. The best results occurred mainly in patients aged less than 35 where the cure rate was 65%. There were no side effects. CONCLUSIONS: In this study, approximately half of patients with premature ejaculation were cured after applying the above treatment.This therapy, necessitates a fairly long period of time (2-6 months) and a great commitment on the part of the patient, nevertheless it can be a valid and effective treatment for patients with premature ejaculation. This treatment makes the patient independent in that he is not bound to specific times for taking medication. Furthermore there are no side effects and this therapy is particularly effective in young males.
76Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation: a novel therapeutic approach.PubMed
Antonio L Pastore, Giovanni Palleschi, Andrea Fuschi, et al.
Ther Adv Urol. 2014 Jun;6(3):83-8. doi: 10.1177/1756287214523329.
OBJECTIVES: Premature ejaculation is the most common male sexual disorder. The aim of the study was to evaluate the possible therapeutic role of pelvic floor muscle rehabilitation in patients affected by lifelong premature ejaculation. METHODS: We treated 40 men with lifelong premature ejaculation, reporting, a baseline intravaginal ejaculatory latency time (IELT) ≤ 1 min, with 12-week pelvic floor muscle rehabilitation. RESULTS: At the end of the rehabilitation, mean IELTs were calculated to evaluate the effectiveness of the therapy. At the end of the treatment, 33 (82.5%) of the 40 patients gained control of their ejaculatory reflex, with a mean IELT of 146.2 s (range: 123.6-152.4 s). A total of 13 out of 33 (39%) patients were evaluated at 6 months follow up, and they maintained a significant IELT (112.6 s) compared with their initial IELT (mean 39.8 s). CONCLUSIONS: The results obtained in our subjects treated with pelvic floor rehabilitation are promising. This therapy represents an important cost reduction compared with the standard treatment (selective serotonin reuptake inhibitors). Based on the present data, we propose pelvic floor muscle rehabilitation as a new, viable therapeutic option for the treatment of premature ejaculation.
77Clinical efficacy and safety of selective dorsal neurectomy/cryoablation for treatment of premature ejaculation: systematic review and meta-analysis.PubMed
Mehmet Gokhan Culha, Mustafa Erkoc, Caner Baran, et al.
J Sex Med. 2025 Aug 4;22(8):1383-1389. doi: 10.1093/jsxmed/qdaf140.
INTRODUCTION: Premature ejaculation (PE) is a prevalent sexual dysfunction with limited treatment options for some patients. Selective dorsal neurectomy/cryoablation (SDN/CA) has emerged as a potential treatment, aiming to desensitize the penis. OBJECTIVES: To assess the efficacy of SDN/CA on intravaginal ejaculation latency time (IELT), PE-related questionnaires, treatment satisfaction, erectile function, and adverse events in the treatment of PE. METHOD: A systematic review and meta-analysis were conducted, including randomized controlled trials, clinical trials, and prospective/retrospective studies. Databases such as Embase, PubMed, Cochrane, and Web of Science were searched. The Cochrane risk-of-bias tool and Risk of Bias in Non-randomized Studies of Interventions-I tool were used for quality assessment. IELT (sec), questionnaires (Premature Ejaculation Diagnostic Tool, Premature Ejaculation Profile, Sexual Satisfaction Score), erectile status (IIEF [International Index of Erectile Function]-5), and adverse events were evaluated. Comprehensive meta-analysis and R software were used for statistical analyses. RESULTS: Seven studies (235 patients) were included. SDN/CA significantly improved IELT (mean difference: 147.47 sec, P < .05). Questionnaires showed improvements in sexual satisfaction and ejaculation control. No meaningful change was observed in the erectile function. The adverse event rate was 11.17%, with no significant difference between groups. CONCLUSION: SDN/CA is controversial as a treatment option for PE, affecting IELT and patient satisfaction. The heterogeneity of the included studies and short-term follow-up periods shed light on further research. However, further research into standard protocols and longer follow-ups is needed.
78Transcutaneous functional electrical stimulation-a novel therapy for premature ejaculation: results of a proof of concept study.PubMed
Arik Shechter, E C Serefoglu, Tal Gollan, et al.
Int J Impot Res. 2020 Jul;32(4):440-445. doi: 10.1038/s41443-019-0207-y. Epub 2019 Sep 30.
Premature Ejaculation (PE) is a very common and disturbing sexual dysfunction in men. Currently available treatment modalities are associated with limited efficacy and low treatment adherence. In this prospective, single-blinded, self-controlled study, we evaluated the efficacy and safety of transcutaneous electrical stimulation (TES) for the treatment of (PE). We included 23 patients aged 20-60 (mean: 38.7) with lifelong PE. On the first visit, we delivered either TES or sham treatment to the perineum, based on the enrollment order. For stimulation, we used a commercial neuromuscular electrical stimulation device. The patients were invited for the second visit after at least 7 days for receiving the alternating treatment. During the treatment sessions, the patients were left alone in a privet silent room to masturbate and a stopwatch was used to measure their masturbation ejaculatory latency time (MELT). The patients also filled-out safety questionnaires after each visit and on each of the 3 following days. Of the 20 patients who completed the study, 17 (85%) experienced prolonged MELT under TES compared with the sham treatment. Mean MELT values increased 3.5-folds under TES (p = 0.0009). We demonstrated a significant increase in MELT in lifelong PE patients using TES. This therapeutic option may have the potential to become an on-demand treatment option for PE. Future studies with wireless devices are needed to confirm the efficacy and safety of this treatment concept during intercourse.
79A novel on-demand therapy for lifelong premature ejaculation using a miniature transperineal electrical stimulator-the vPatch: an as-treated analysis.PubMed
Arik Shechter, Nicola Mondaini, Ege Can Serefoglu, et al.
J Sex Med. 2023 Jan 14;20(1):22-29. doi: 10.1093/jsxmed/qdac012.
BACKGROUND: While premature ejaculation (PE) is a common and disturbing sexual dysfunction in men, current available treatment modalities have limited efficacy and low treatment adherence. AIM: To assess the feasibility, safety, and efficacy of the vPatch, a miniaturized on-demand perineal transcutaneous electrical stimulation device for treating PE. METHODS: This prospective bicenter international first-in-human clinical study consisted of 2 arms, was sham controlled, and had a randomized double-blind design. In terms of statistical power calculation, 59 patients aged 21 to 56 years (mean ± SD, 39.8 ± 9.28) with lifelong PE were included. During the initial visit, intravaginal ejaculatory latency time (IELT) was measured over a 2-week run-in period. Eligibility was confirmed in visit 2, based on IELT values, medical and sexual history, and patients' individualized sensory and motor activation thresholds during perineal stimulation with the vPatch. Patients were randomized to the active (vPatch) and sham device groups in a 2:1 ratio, respectively. The vPatch device's safety profile was determined by comparing the incidence of treatment-emergent adverse events. During visit 3, IELTs, Clinical Global Impression of Change scores, and Premature Ejaculation Profile questionnaire outcomes were recorded. Primary end points assessed vPatch device efficacy as mean change in geometric mean IELT; each person was compared with himself, with and without the device, and the sham group was compared with the active group. OUTCOMES: Outcomes included changes in IELT and Premature Ejaculation Profile before and after treatment, last visit Clinical Global Impression of Change scores, and vPatch safety profile. RESULTS: Of 59 patients, 51 completed the study: 34 in the active group and 17 in the sham group. The baseline geometric mean IELT significantly increased from 67 to 123 seconds (P < .01) in the active group, as compared with an insignificant increase from 63 to 81 seconds (P = .17) in the sham group. The increase in mean IELT in the active group was significantly higher than in the sham group (56 vs 18 seconds, P = .01). IELT significantly increased by 3.1 times in the active vs sham group. The mean ratio of fold change (active:sham) was 1.4, significantly different from 1.0 (P = .02). No serious adverse events were reported. CLINICAL IMPLICATIONS: Therapeutic use of the vPatch during coitus may become an on-demand, noninvasive, and drug-free treatment for PE. STRENGTHS AND LIMITATIONS: To our knowledge, this is the first rigorous study investigating whether transcutaneous electrical stimulation during coitus could improve the symptoms of men with lifelong PE. The study is limited by the small number of patients, the exclusion of patients with acquired PE, the short-term follow up, and the use of a device based on a theoretic mechanism of action. CONCLUSION: We demonstrated the possibility to treat lifelong PE by prolonging coitus on demand, using electric stimulation of ejaculation muscles with the vPatch.Clinical trial registration: NCT03942367 (ClinicalTrials.gov).
80A prospective and comparative evaluation of a male masturbation device for premature ejaculation-functional outcomes, safety, and satisfaction assessment: a pilot study.PubMed
Manuel Alonso-Isa, Borja García-Gómez, Esther García-Rojo, et al.
J Sex Med. 2025 Jun 29;22(7):1115-1121. doi: 10.1093/jsxmed/qdaf090.
BACKGROUND: Premature ejaculation (PE) is a common sexual dysfunction that negatively impacts the quality of life and relationships for men. AIM: To compare the effectiveness, side effects, and satisfaction between a novel cognitive-behavioral therapy based on sphincter control training (SCT) supported by a mechanical masturbation device and dapoxetine, a pharmacological treatment for PE. METHODS: A crossover study with 20 male patients diagnosed with PE was designed. Participants were randomly assigned to start with an 8-week cognitive-behavioral therapy program supported by a masturbation device or an 8-week treatment with dapoxetine (60 mg). After a 2-week washout time, treatments were crossed. Effectiveness was measured through intravaginal ejaculation latency time (IELT), Premature Ejaculation Diagnostic Tool (PEDT) scores, and the International Index of Erectile Function. Satisfaction rates were measured using the Erectile Dysfunction Inventory of Treatment Satisfaction scale and Likert scale. Adverse effects were recorded for both treatments. OUTCOMES: Changes in IELT, PEDT scores, satisfaction rates, and side effects. RESULTS: In the randomized phase, SCT + device demonstrated superior outcomes compared to dapoxetine for PEDT scores: 15.2 (SD = 1.7) vs 18.4 (SD = 2.6), P = .01; though IELT improvements were comparable: 111.7 (SD = 56.7) seconds vs 91.8 (SD = 77.8) seconds, P = .20. After crossover, patients switching from dapoxetine to SCT + device achieved significantly greater IELT 171.8 (SD = 148.8) seconds vs 76.7 (SD = 37.1) seconds, P = .02; and better PEDT scores: 14.6 (SD = 2.7) vs 17.7 (SD = 2.7), P = .04. Notably, dapoxetine underperformed relative to historical data. Treatment satisfaction was markedly higher with SCT + device: 64.9% (SD = 9.3) vs 33.3% (SD = 20.7), P = .003; with fewer adverse effects (25% vs 60%). CLINICAL IMPLICATIONS: This pilot study suggests a potential role for cognitive-behavioral therapy supported by a mechanical masturbation device in managing PE, but further research is needed to confirm its effectiveness and comparative advantages. STRENGTHS AND LIMITATIONS: The main strengths of the study is its crossover design, which minimizes the influence of individual patient variability. Limitations include the small sample size, the lack of long-term follow-up to assess the durability of treatment effects, and the absence of a sham arm using masturbation alone, which makes it unclear whether the observed improvements are due to the device itself or the act of masturbating. CONCLUSION: This pilot study suggests that the cognitive-behavioral therapy program supported by the male masturbation device may offer potential benefits for managing PE, but further research with larger samples is needed to confirm these preliminary findings.
81Poor Sleep Quality is an Independent Risk Factor for Acquired Premature Ejaculation.PubMed
Wei Zhang, Yuyang Zhang, Jingjing Gao, et al.
Nat Sci Sleep. 2022 Feb 22;14:255-263. doi: 10.2147/NSS.S349511. eCollection 2022.
PURPOSE: To determine the role of poor sleep quality as a risk factor for acquired premature ejaculation (APE) after considering the various risk factors, such as ages, lower urinary tract symptoms (LUTS), anxiety, depression, and erectile dysfunction. METHODS: This study presents a multivariate analysis to identify risk factors for PE, including the covariate of age, International Prostate Symptom Score (IPSS), General Anxiety Disorder-7 (GAD-7) score, Patient Health Questionnaire-9 (PHQ-9) score, International Index of Erectile Function (IIEF) score, and Pittsburgh Sleep Quality Index (PSQI). Acquired PE was defined as self-reported intravaginal ejaculation latency time ≤3 minutes, and poor sleep quality was diagnosed using the Pittsburgh Sleep Quality Index tool. RESULTS: A total of 349 men were enrolled in the study after completing the questionnaires and the medical history survey. Among 349 men, 203 individuals (58.17%) suffered from acquired PE. The IIEF-5 score, IPSS, GAD-7 score, PHQ-9 score, and PSQI score of the population with PE were significantly different from the non-PE group. Further multivariate analysis showed that erectile dysfunction, depression, severe prostatitis-like symptoms, and poor sleep quality were high-risk factors of APE. Additionally, our study showed that premature ejaculation diagnostic tool (PEDT) score was associated with IPSS/GAD-7/PHQ-9/PSQI scores positively and associated with IIEF-5 scores negatively. The stratified analysis of sleep quality showed that APE patients with different sleep qualities have different prevalence rates of anxiety, depression, prostatitis-like symptoms, and erectile function. CONCLUSION: In general, sleep quality may be a potential risk factor for patients with acquired premature ejaculation. Our research revealed the impact of sleep quality on premature ejaculation and provided new viewpoints for further understanding and perfecting the pathogenesis of premature ejaculation.
82Variations in objectively measured sleep parameters in patients with different premature ejaculation syndromes.PubMed
Xu Wu, Yuyang Zhang, Hui Jiang, et al.
J Sex Med. 2024 Sep 28;21(10):889-896. doi: 10.1093/jsxmed/qdae106.
BACKGROUND: Poor sleep quality is now a cause of sexual dysfunction. AIM: To investigate variations in sleep quality among patients with different types of premature ejaculation (PE) and a control group. METHODS: Patients with PE were categorized into groups according to 4 types: lifelong (LPE), acquired (APE), variable (VPE), and subjective (SPE). Basic demographic information about the participants was first collected, and then clinical data were obtained. OUTCOMES: Outcomes included the 5-item International Index of Erectile Function, Premature Ejaculation Diagnostic Tool, 7-item Generalized Anxiety Disorder, 9-item Patient Health Questionnaire, Pittsburgh Sleep Quality Index, self-estimated intravaginal ejaculation latency time (minutes), and sleep monitoring parameters obtained from a wearable device (Fitbit Charge 2). RESULTS: A total of 215 participants were enrolled in the study, of which 136 patients with PE were distributed as follows: LPE (31.62%), APE (42.65%), VPE (10.29%), and SPE (15.44%). Subjective scales showed that patients with APE were accompanied by a higher prevalence of erectile dysfunction, anxiety, and depression, as well as poorer sleep quality (assessed by the Pittsburgh Sleep Quality Index). The results of objective sleep parameters revealed that average durations of sleep onset latency (minutes) and wake after sleep onset (minutes) in patients with APE (mean ± SD; 20.03 ± 9.14, 55 ± 23.15) were significantly higher than those with LPE (15.07 ± 5.19, 45.09 ± 20.14), VPE (13.64 ± 3.73, 38.14 ± 11.53), and SPE (14.81 ± 4.33, 42.86 ± 13.14) and the control group (12.48 ± 3.45, 37.14 ± 15.01; P < .05). The average duration of rapid eye movement (REM; minutes) in patients with APE (71.34 ± 23.18) was significantly lower than that in patients with LPE (79.67 ± 21.53), VPE (85.93 ± 6.93), and SPE (80.86 ± 13.04) and the control group (86.56 ± 11.93; P < .05). Similarly, when compared with the control group, patients with LPE had significantly longer durations of sleep onset latency and wake after sleep onset and a significantly shorter duration of REM sleep. CLINICAL IMPLICATIONS: Our study suggests that clinicians should pay attention not only to male physical assessment but also to mental health and sleep quality. STRENGTHS AND LIMITATIONS: This study suggests that changes in sleep structure occur in patients with PE, which may provide some direction for future research. However, the cross-sectional study design does not allow us to conclude that sleep is a risk factor for PE. CONCLUSION: After controlling for traditional parameters such as age, erectile dysfunction, anxiety, and depression, sleep parameters are independently associated with PE. Patients with APE and LPE show significant alterations in sleep parameters, with patients with APE having notably poorer sleep quality, whereas patients with VPE and SPE have sleep parameters similar to controls.
83Pelvic floor muscle training improves erectile dysfunction and premature ejaculation: a systematic review.PubMed
Christopher Myers, Moira Smith
Physiotherapy. 2019 Jun;105(2):235-243. doi: 10.1016/j.physio.2019.01.002. Epub 2019 Jan 14.
BACKGROUND: Erectile dysfunction (ED) and premature ejaculation (PE) often have underlying musculoskeletal abnormalities. Despite this, traditional management has focused on pharmaceutical prescription. OBJECTIVE: To investigate the efficacy of pelvic floor muscle training in treating ED and PE. DATA SOURCES: A computerized literature search of CINAHL, Cochrane, InFormit, Ovid Medline, Pedro, and Scopus (from inception until January 2018) was conducted of type of dysfunction and intervention. Secondary search strategies included Medical Subject Headings expansion, hand searching of conference abstracts, key authors, reference lists and forward citation searching via Web of Science. STUDY SELECTION: All studies where participants were males greater than 18years with ED or PE, with no history of neurological injury or previous major urological surgery were included. STUDY APPRAISAL: Two independent reviewers assessed methodological quality using the Crowe Critical Appraisal Tool. Disagreements between reviewers were resolved by consensus. RESULTS: Ten trials were included for review. Among the measures of ED, all trials showed comparative improvement and cure rates in response to treatment. Within PE outcomes, the majority of trials showed comparative improvement rates, with a greater range in overall cure rates in response to treatment. Training protocols varied significantly in overall therapist contact, concurrent interventions, intervention length, training frequency and intensity. LIMITATIONS: The included studies were of low to moderate methodological quality with discrepancies in reporting. Study heterogeneity was not conducive to data pooling. CONCLUSION: Pelvic floor muscle training appears effective in treating ED and PE; however, no optimal training protocol has been identified. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42016047261.
84The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction: A Narrative Review.PubMed
David Yaacov, Gadi Nelinger, Leonid Kalichman
Sex Med Rev. 2022 Jan;10(1):162-167. doi: 10.1016/j.sxmr.2021.02.001. Epub 2021 Apr 27.
INTRODUCTION: Increasing evidence has suggested that pelvic floor exercises and manual physical therapy may improve premature ejaculation (PE) and erectile dysfunction (ED) in males. OBJECTIVES: To examine the effects of pelvic floor physical therapy treatment in men suffering from PE and ED. METHODS: We searched Google Scholar, PubMed, Medline, PEDro databases from inception till January 2020 applying the following keywords: pelvic floor, erectile dysfunction, impotence, physiotherapy, exercises, rehabilitation, and pelvic floor muscle exercises. RESULTS: The review included 37 papers reporting on PE and ED, of which 5 were randomized controlled trials, 2 meta-analyses, and 4 observational studies. Pelvic floor physical therapy treatment included education and rehabilitation. The rehabilitation part encompassed manual therapy techniques that contribute to the normalization of muscle tone and improvement of muscle relaxation. Moreover, exercises, according to the patients' clinical assessment were presented. Most of the studies reported that by strengthening the pelvic floor muscles (PFMs), ED and PE can be improved if manual physical therapy treatments are combined with PFM training. CONCLUSIONS: A multifaceted approach should be chosen by physical therapists when evaluating and treating ED and PE and contending with both musculoskeletal dysfunction and behavioral contributions. It is recommended that exercises be monitored and situations involving, that is, hyperactivity/increased tone of the PFMs should be avoided. PFM training is simple, safe, and noninvasive; therefore, it should be a preferred approach in the management of ED and PE. This paper presents narrative reviews with a potential bias that systematic reviews or meta-analyses do not have, however, we strove to be all-encompassing and unbiased. There is a demand for high-quality scientific reviews examining the effectiveness of PFM training, manual therapy, and the rationale of pelvic floor physical therapy, in general, in treating individuals with PE and ED. Yaacov D, Nelinger G, Kalichman L. The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction: A Narrative Review. Sex Med Rev 2022;10:162-167.
85Pelvic physical therapy for male sexual disorders: a narrative review.PubMed
Emel Sahin, Alma Brand, Elif Nazli Cetindag, et al.
Int J Impot Res. 2025 Dec;37(12):941-949. doi: 10.1038/s41443-025-01034-5. Epub 2025 Feb 27.
Pelvic physical therapy is an evidence-based, first-line treatment for many pelvic floor disorders and sexual dysfunction. Studies have shown that pelvic physical therapy programs can both improve pelvic floor dysfunctions and sexual function. This article aims to provide an overview of the current state of the art regarding pelvic physical therapy for male sexual dysfunction to inform healthcare providers who treat men with sexual dysfunction better. A literature review was performed in Google Scholar, PubMed, and Science Direct to find review articles, research articles, and case studies about the effect of pelvic physical therapy treatments for male sexual dysfunction. Twenty-six articles were found about various pelvic physical therapy interventions. Besides this overview of the literature, an overview of interventions used in clinical practice is also provided. This narrative review supports the potential efficacy of pelvic physical therapy in addressing male sexual dysfunction. Pelvic physical therapy approaches that comprise exercise modalities, electrotherapy approaches, manipulative techniques, lifestyle changes, behavioral suggestions, and pain management strategies, should be suggested for potential benefits in improving erectile function, premature ejaculation, and sexual dysfunction-associated chronic pelvic pain. More research is needed to examine the effect of pelvic physical therapy on hypoactive sexual desire and delayed ejaculation.
86Pelvic floor muscle training in males: practical applications.PubMed
Andrew L Siegel
Urology. 2014 Jul;84(1):1-7. doi: 10.1016/j.urology.2014.03.016. Epub 2014 May 10.
The pelvic floor muscles are vital to male genitourinary health. Pelvic floor muscle training may prove helpful in a variety of clinical circumstances: stress urinary incontinence that follows prostate surgery, overactive bladder, postvoid dribbling, erectile dysfunction, ejaculation issues including premature ejaculation, and pelvic pain due to levator muscle spasm.
87Interventions for sexual dysfunction following stroke.PubMed
Hezekiah Stratton, Joshua Sansom, Anita Brown-Major, et al.
Cochrane Database Syst Rev. 2020 May 1;5(5):CD011189. doi: 10.1002/14651858.CD011189.pub2.
BACKGROUND: Sexual dysfunction following stroke is common but often is poorly managed. As awareness of sexual dysfunction following stroke increases as an important issue, a clearer evidence base for interventions for sexual dysfunction is needed to optimise management. OBJECTIVES: To evaluate the effectiveness of interventions to reduce sexual dysfunction following stroke, and to assess adverse events associated with interventions for sexual dysfunction following stroke. SEARCH METHODS: We conducted the search on 27 November 2019. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; from June 2014), in the Cochrane Library; MEDLINE (from 1950); Embase (from 1980); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1982); the Allied and Complementary Medicine Database (AMED; from 1985); PsycINFO (from 1806); the Physiotherapy Evidence Database (PEDro; from 1999); and 10 additional bibliographic databases and ongoing trial registers. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared pharmacological treatments, mechanical devices, or complementary medicine interventions versus placebo. We also included other non-pharmacological interventions (such as education or therapy), which were compared against usual care or different forms of intervention (such as different intensities) for treating sexual dysfunction in stroke survivors. DATA COLLECTION AND ANALYSIS: Two review authors independently selected eligible studies, extracted data, and assessed study quality. We determined the risk of bias for each study and performed a 'best evidence' synthesis using the GRADE approach. MAIN RESULTS: We identified three RCTs with a total of 212 participants. We noted significant heterogeneity in interventions (one pharmacological, one physiotherapy-based, and one psycho-educational), and all RCTs were small and of 'low' or 'very low' quality. Based on these RCTs, data are insufficient to provide any reliable indication of benefit or risk to guide clinical practice in terms of the use of sertraline, specific pelvic floor muscle training, or individualised sexual rehabilitation. AUTHORS' CONCLUSIONS: Use of sertraline to treat premature ejaculation needs to be tested in further RCTs. The lack of benefit with structured sexual rehabilitation and pelvic floor physiotherapy should not be interpreted as proof of ineffectiveness. Well-designed, randomised, double-blinded, placebo-controlled trials of long-term duration are needed to determine the effectiveness of various types of interventions for sexual dysfunction. It should be noted, however, that it may not be possible to double-blind trials of complex interventions.
88Effects of physical exercise interventions on ejaculation control.PubMed
Caoyuan Niu, Pekka Santtila
Sex Med Rev. 2023 Dec 23;12(1):106-113. doi: 10.1093/sxmrev/qead042.
INTRODUCTION: Premature ejaculation is a prevalent male sexual dysfunction that causes significant distress for men and their partners on a global scale. Despite its widespread impact, effective treatment options without undesirable side effects remain limited. OBJECTIVES: The present review aimed to provide an overview of experimental studies that analyzed the effects of physical exercise interventions on premature ejaculation. METHODS: The inclusion criteria for the review included: Population: Adult men. Intervention: An intervention designed to increase physical exercise was delivered in the study. Comparison: Before versus after intervention with or without a comparison group receiving a drug treatment or an active or no control intervention. Outcomes: Self-reported or clinician-rated premature ejaculation or its symptoms. Study type: Experimental designs. We conducted the search process in 9 databases: APA PsycNET, PubMed, Scopus, SPORTDiscus, JSTOR, ScienceDirect, Web of Science, Embase, and CAB Direct. This review included six intervention studies that included 433 participants (307 men with premature ejaculation) ranging from 18 to 50 years of age. All participants had a stable female sexual partner and had not any other physical or mental problems. RESULTS: The synthesized results indicated that yoga, running, and high-intensity interval training alleviate premature ejaculation symptoms in men with premature ejaculation after varying intervention duration times. The effectiveness of physical exercise for premature ejaculation symptoms was similar to that of drug treatments. CONCLUSION: Physical exercise can be one of the potential treatment modalities for premature ejaculation. The intensity of physical exercise and the effort of participants during exercise are key factors affecting improvements in ejaculation control. A potential limitation was that the review did not include any literature written in non-English languages.
89Health-Related Lifestyle Factors and Sexual Dysfunction: A Meta-Analysis of Population-Based Research.PubMed
Mark S Allen, Emma E Walter
J Sex Med. 2018 Apr;15(4):458-475. doi: 10.1016/j.jsxm.2018.02.008. Epub 2018 Mar 6.
BACKGROUND: Sexual dysfunction is a common problem among men and women and is associated with negative individual functioning, relationship difficulties, and lower quality of life. AIM: To determine the magnitude of associations between 6 health-related lifestyle factors (cigarette smoking, alcohol intake, physical activity, diet, caffeine, and cannabis use) and 3 common sexual dysfunctions (erectile dysfunction, premature ejaculation, and female sexual dysfunction). METHODS: A comprehensive literature search of 10 electronic databases identified 89 studies that met the inclusion criteria (452 effect sizes; N = 348,865). Pooled mean effects (for univariate, age-adjusted, and multivariable-adjusted estimates) were computed using inverse-variance weighted random-effects meta-analysis and moderation by study and population characteristics were tested using random-effects meta-regression. RESULTS: Mean effect sizes from 92 separate meta-analyses provided evidence that health-related lifestyle factors are important for sexual dysfunction. Cigarette smoking (past and current), alcohol intake, and physical activity had dose-dependent associations with erectile dysfunction. Risk of erectile dysfunction increased with greater cigarette smoking and decreased with greater physical activity. Alcohol had a curvilinear association such that moderate intake was associated with a lower risk of erectile dysfunction. Participation in physical activity was associated with a lower risk of female sexual dysfunction. There was some evidence that a healthy diet was related to a lower risk of erectile dysfunction and female sexual dysfunction, and caffeine intake was unrelated to erectile dysfunction. Publication bias appeared minimal and findings were similar for clinical and non-clinical samples. CLINICAL TRANSLATION: Modification of lifestyle factors would appear to be a useful low-risk approach to decreasing the risk of erectile dysfunction and female sexual dysfunction. STRENGTHS AND LIMITATIONS: Strengths include the testing of age-adjusted and multivariable-adjusted models and tests of potential moderators using meta-regression. Limitations include low statistical power in models testing diet, caffeine, and cannabis use as risk factors. CONCLUSION: Results provide compelling evidence that cigarette smoking, alcohol, and physical activity are important for sexual dysfunction. Insufficient research was available to draw conclusions regarding risk factors for premature ejaculation or for cannabis use as a risk factor. These findings should be of interest to clinicians treating men and women with complaints relating to symptoms of sexual dysfunction. Allen MS, Walter EE. Health-Related Lifestyle Factors and Sexual Dysfunction: A Meta-Analysis of Population-Based Research. J Sex Med 2018;15:458-475.
90Alcohol and sex.PubMed
M E Vijayasenan
N Z Med J. 1981 Jan 14;93(675):18-20.
Diminished sexual functioning among individuals dependent upon alcohol has been assessed. Ninety-seven male patients entered the study, all inpatients as the unit for treatment of alcoholism and drug addiction (Villa 6) in Porirua Hospital, Porirua. The sexual ability of these patients before the development of alcoholism was also rated for the same items and this rating was used as a control. Of the 97 patients, 69 (71 percent) suffered from sexual dysfunction for a period more than 12 months prior to admission to hospital. The disturbances noted were diminished sexual desire (58 percent of patients), erectile impotence (16 percent), premature ejaculation (4 percent), ejaculatory in competence (22 percent). A high proportion of the alcoholics showed signs of sexual deviation-19 percent having performed sexual crimes and a further 28 percent having repeated thought of sexual crimes. The possible causes of alcohol induced sexual dysfunction are discussed.
91Alcohol-associated sexual dysfunction: How much is the damage?PubMed
Bhupendra Yadav, Harpreet Singh Dhillon, Shibu Sasidharan, et al.
Med J Armed Forces India. 2024 Mar-Apr;80(2):166-171. doi: 10.1016/j.mjafi.2022.05.002. Epub 2023 Oct 10.
BACKGROUND: The existing literature on alcohol-induced sexual dysfunction has mainly deliberated on erectile dysfunction and premature ejaculation, ignoring other important domains of sexual dysfunctions (viz sexual pleasure, sexual desire, arousal, orgasmic function). This study was undertaken to assess the extent of alcohol-associated sexual dysfunction and to compare their severity with the severity of alcohol dependence in males. METHODS: A cross-sectional descriptive study design recruited 78 male patients and an assessment was conducted using the male clinical version, , , Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) and International Classification of Diseases-10 (ICD-10). A correlation between years of alcohol consumed and its effect on various domains of sexual dysfunction was also carried out using Pearson's correlation coefficient. RESULTS: Seventy-seven percent of the study population had complaints of sexual dysfunction in one or more domains, with reduced sexual pleasure (71.8%) as the most common followed by low sexual desire (in terms of frequency) in 61.5% and erectile dysfunction in 43.6%. The severity of the sexual dysfunction was found to be directly proportional to the severity of alcohol dependence with almost 100 percent of the patients with severe alcohol dependence having sexual dysfunction in all the domains. CONCLUSION: The most common sexual dysfunction reported in the current study was decreased sexual pleasure (71.8%) followed by low sexual desire 61.5% (in terms of frequency). These findings emphasize the fact, that alcohol significantly compromises almost all domains of sexual functioning in addition to erectile dysfunction.
92Effect of psychiatric symptoms and male sexual function of couples on the success of treatment for vaginismus.PubMed
Emre Baser, Demet Aydogan Kirmizi, Eylem Unlubilgin, et al.
Sex Health. 2020 Nov;17(5):453-461. doi: 10.1071/SH20116.
UNLABELLED: Background This study evaluated psychiatric factors and sexual functions of women with vaginismus and their partners during the treatment process. METHODS: The study was performed on 110 women diagnosed with vaginismus and their partners. The women underwent cognitive behavioural therapy (CBT), and couples were divided into two groups: successful and unsuccessful therapy. Sexual function in couples was evaluated using the Golombok Rust Index of Sexual Satisfaction (GRISS) in men and the Female Sexual Function Index in women. The psychopathological symptoms of participants were evaluated using the Symptom Check List-90-Revised (SCL-90-R). RESULTS: Of the 110 women in this study, 98 completed CBT and treatment was successful for 59 (60.2%). GRISS scores pertaining to the subscales of infrequency (66.7% and 39.0%), non-communication (56.4% and 22.0%), avoidance (76.9% and 52.5%), impotence (56.4% and 33.9%) and premature ejaculation (64.1% and 32.2%) before treatment were significantly lower in the successful than unsuccessful treatment group (P < 0.05). Furthermore, there was a positive correlation between complaints of impotence and premature ejaculation in men and symptoms of depression and anxiety in men. In the successful treatment group, pretreatment values were lower for the SCL-90-R subscales of anxiety and depression in men and anxiety, depression, phobic anxiety and obsessive compulsiveness in women than in the unsuccessful treatment group. CONCLUSIONS: The psychiatric symptoms and sexual functions of couples were found to affect the success of treatment for vaginismus. As such, treatments should be administered in accordance with other symptoms present in couples.
93Rare, fatal pulmonary fat embolism after acupuncture therapy: A case report and literature review.PubMed
Luyao Xu, Xiaohui Tan, Xuebing Chen, et al.
Forensic Sci Int. 2023 Apr;345:111619. doi: 10.1016/j.forsciint.2023.111619. Epub 2023 Feb 27.
BACKGROUND: Death from nontraumatic pulmonary fat embolism associated with minor soft tissue contusion, surgery, cancer chemotherapy, hematologic disorders and so on has been reported. Patients often present with atypical manifestations and rapid deterioration, making diagnosis and treatment difficult. However, there are no reported cases of death from pulmonary fat embolism after acupuncture therapy. This case emphasizes that the stress induced by acupuncture therapy, a mild soft tissue injury, plays an important role in pulmonary fat embolism. In addition, it suggests that in such cases, pulmonary fat embolism as a complication of acupuncture therapy needs to be taken seriously, and autopsy should be used to identify the source of fat emboli. CASE PRESENTATION: The patient was 72 years old female and experienced dizziness and fatigue after silver-needle acupuncture therapy. She experienced a significant drop in blood pressure and died 2 h later despite treatment and resuscitation. A systemic autopsy and histopathology examination (H&E and Sudan Ⅲ staining) were performed. More than 30 pinholes were observed in the lower back skin. Focal hemorrhages were seen surrounding the pinholes in the subcutaneous fatty tissue. Microscopically, numerous fat emboli were observed in the interstitial pulmonary arteries and alveolar wall capillaries, in addition to the vessels of the heart, liver, spleen and thyroid gland. The lungs showed congestion and edema. The cause of death was identified as pulmonary fat embolism. CONCLUSION: This article suggests that high vigilance for risk factors and the complication of pulmonary fat embolism following silver-needle acupuncture therapy should be exercised. In postmortem examinations, it should be pay attention that the peripheral arterial system and the venous system draining from non-injured sites should be examined for the formation of fat emboli, which can help distinguish posttraumatic and nontraumatic pulmonary fat embolism.