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Premature ejaculation
Abstract
Premature ejaculation (PE) is the most common masculine sexual disorder with a potentially deleterious effect on the patient's morale and the relationship with the partner. It is underdiagnosed, or self-diagnosed, and as patients hesitate to confide in their doctor, and doctors do not enquire about it, it is rarely treated. Effective medication does exist, in particular serotonin reuptake inhibitors.
Medical literature was reviewed and combined with expert opinion of the authors.
The distinction is rarely made between lifelong, primary and acquired PE but this distinction determines the choice and efficacy of the therapeutic strategy. Originally seen from a psychoanalytical viewpoint, it was later seen from a behavioral angle. For primary PE, according to Kaplan and contemporary sexology, a psycho-sexological concept has been evoked: sinful stain and symbolic frustration of the woman following an unresolved conflict, revived by a conflict with the partner. For primary PE, a pathophysiological origin with the notion of genetic susceptibility with possible variation of the central serotoninergic neurotransmission has been suggested. We give here the different etiological hypotheses, the clinical types and the different therapeutic strategies for management of PE (a more precise etio-pathological diagnosis). Some key points are highlighted: factors related to the partner are underestimated, her 'use' as therapy is underexploited, an integrated or combined approach which is potentially more efficacious can go beyond the prolongation of the ejaculation time lapse to optimize the patient's relationship and equilibrium. Maintaining the results over time is however problematic.
When rapid ejaculation causes a distress, it is a sexual dysfunction deserving medical and/or psycho-sexological management currently evidence-based.
... Premature ejaculation (PE) is the most widespread [1] sexual disorder among men. It affects 5 to 40% of sexually active men, with age-based variations [2]. Its diagnosis involves several parameters such as intravaginal ejaculatory latency time, personal satisfaction and the impact on the couple [3]. ...
Objectives: Premature ejaculation is the most common sexual disorder whose definition is still very controversial. The purpose of this study is to assess its incidence, social impact and support in our population. Methodology: It was a descriptive and cross-cutting study which took place in CNHU HKM and Ménontin district hospital over a period of one month from 15th May to 15th June 2016. Outcomes: 42.2% of the study population are faced with premature ejaculation. The average age of premature ejaculators was 39.0 years ± 13.5. The average intravaginal ejaculation latency time (IELT) among premature ejaculators was 7.8 min ± 8.4 against 11.95 min ± 8.9 for non-premature ejaculators. 74.9% of respondents’ partners were satisfied with the intravaginal ejaculation latency time of their spouse. Only 28.1% of premature ejaculators resorted to treatment at least once to improve their intravaginal ejaculation latency time. Conclusion: Premature ejaculation is a cross-cutting issue in the population but the absence of consensus on its parameters prevents a satisfactory research.
... Cela rappelle les anciennes classifications cliniques d'EP primaire (vie durant), secondaires (après un évènement déclenchant) ou intermittentes. Certains auteurs classent l'EP « vie durant » comme « une EP maladie », en la départageant des EP acquises des anciennes classifications du DSMIII (Porto et Giuliano, 2013). ...
The difficulties inherent in identifying a simple definition of premature ejaculation (PE) (premature for some, too quickly for others) should be seen in the light of the fact that although many genetic, neurobiological, pharmacological, psychological, urological and endocrinological factors have been proposed, and may coexist, its aetiology is unknown. Evidence-based aetiologies have found contradictory results and orient clinicians towards a more multifactorial evaluation. In addition, the role of the partner may trigger awareness of this problem among young men, or their frustration may accentuate the problem, and shows that from a clinical perspective the couple's interaction, and the consequences of PE for them must be a strong focus. Nevertheless, a more precise differentiation between the psychological and physiological covariate implicated in ejaculation syndromes can ameliorate the application of integrated treatment approaches, which take account of relational and psychological problems that are involved in the dyadic and/or attenuate the psychological response of men affected by premature ejaculation. It is the understanding of the factors that are implicated in concepts of premature ejaculation that enable a clinical reflection of its evaluation and management.
This chapter will focus on the diagnostic work around sexual dysfunction in Parkinson's disease, especially laboratory tests and biomarkers. A number of methods to analyze if sexual dysfunction is caused by neural pathology, vascular dysfunction or other mechanisms are now available. Other methods can be used to differentiate between psychogenic/functional reasons behind sexual dysfunction and organic ones. The role of biomarkers for diagnosis, but also for understanding the reason behind and for counteracting sexual dysfunction is becoming more evident. There is also a rich and increasing number of scales and other instruments available for detecting and quantifying sexual hypo- and hyperactivity. When investigating the reason behind sexual dysfunction in patients with Parkinson's disease comorbidities should also be considered. Finally, early and pronounced sexual dysfunction might in some cases be an indication that differential diagnosis, like Multisystem Atrophy, should be thought about. All these aspects of the diagnostic procedures around sexual dysfunction in Parkinson's disease will be covered in this chapter.
Résumé
La sexualité humaine suscite beaucoup de curiosité, d’intérêt, d’étonnements et de questionnements. La sexologie a pour vocation de répondre à cette volonté de comprendre les différentes composantes qui la façonnent. Le Sexocorporel est une approche sexologique intégrative, construite à partir de connaissances et d’observations de la réalité. La formation de MK propose également un modèle bio-psycho-social pour traiter les douleurs. De la nociception à la proprioception et au plaisir, il y a quelques pas que chacun de nous peut suggérer aux personnes souffrant de dysfonctions sexuelles. La connaissance du rôle et des limites de chacun peut nous amener à définir une complémentarité susceptible de proposer un accompagnement sur mesure dans le champ de la santé sexuelle.
Résumé
L’éjaculation prématurée (EP) est le trouble sexuel le plus fréquent affectant 20 à 24 % des hommes. La dapoxetine est le premier médicament ayant obtenu l’AMM en France. Son intérêt dans la prise en charge de l’éjaculation prématurée est prouvé et semble être amélioré lorsqu’il est associé à une autre thérapie de type cognitivo-comportementale avec une amélioration de la durée du rapport sexuel et une diminution progressive du nombre de comprimés nécessaires.
To describe drugs used in sexual medicine.
Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies web sites (HAS and ANSM).
5PDIs and intracavernous injection of alprostadil are first- and second-line therapies of erectile dysfunction. Dapoxetine is the first specific and approved treatment of premature ejaculation. Androgene supplementation improves sexual desire among patient with hypogonadism as much as initial serum testosterone levels are low. Female sexual dysfunctions pharmacology is to date less developed, although candidate drugs reach phase III clinical studies.
Pharmacology is one but not the only therapeutic avenue in sexual medicine. Despite real breakthrough such as 5PDIs for erectile dysfunction, incomplete knowledge and understanding of physiology, pathophysiology and pharmacology of human sexual function reduces its development particularly for women.
Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Introduction:
Yoga is a popular form of complementary and alternative treatment. It is practiced both in developing and developed countries. Use of yoga for various bodily ailments is recommended in ancient ayvurvedic (ayus = life, veda = knowledge) texts and is being increasingly investigated scientifically. Many patients and yoga protagonists claim that it is useful in sexual disorders. We are interested in knowing if it works for patients with premature ejaculation (PE) and in comparing its efficacy with fluoxetine, a known treatment option for PE.
Aim:
To know if yoga could be tried as a treatment option in PE and to compare it with fluoxetine.
Methods:
A total of 68 patients (38 yoga group; 30 fluoxetine group) attending the outpatient department of psychiatry of a tertiary care hospital were enrolled in the present study. Both subjective and objective assessment tools were administered to evaluate the efficacy of the yoga and fluoxetine in PE. Three patients dropped out of the study citing their inability to cope up with the yoga schedule as the reason.
Main outcome measure:
Intravaginal ejaculatory latencies in yoga group and fluoxetine control groups.
Results:
We found that all 38 patients (25-65.7% = good, 13-34.2% = fair) belonging to yoga and 25 out of 30 of the fluoxetine group (82.3%) had statistically significant improvement in PE.
Conclusions:
Yoga appears to be a feasible, safe, effective and acceptable nonpharmacological option for PE. More studies involving larger patients could be carried out to establish its utility in this condition.
Sexual health is an integral part of overall health. Sexual dysfunction can have a major impact on quality of life and psychosocial and emotional well-being.
To provide evidence-based, expert-opinion consensus guidelines for clinical management of sexual dysfunction in men.
An international consultation collaborating with major urologic and sexual medicine societies convened in Paris, July 2009. More than 190 multidisciplinary experts from 33 countries were assembled into 25 consultation committees. Committee members established scope and objectives for each chapter. Following an exhaustive review of available data and publications, committees developed evidence-based guidelines in each area. Main Outcome Measures. New algorithms and guidelines for assessment and treatment of sexual dysfunctions were developed based on work of previous consultations and evidence from scientific literature published from 2003 to 2009. The Oxford system of evidence-based review was systematically applied. Expert opinion was based on systematic grading of medical literature, and cultural and ethical considerations.
Algorithms, recommendations, and guidelines for sexual dysfunction in men are presented. These guidelines were developed in an evidence-based, patient-centered, multidisciplinary manner. It was felt that all sexual dysfunctions should be evaluated and managed following a uniform strategy, thus the International Consultation of Sexual Medicine (ICSM-5) developed a stepwise diagnostic and treatment algorithm for sexual dysfunction. The main goal of ICSM-5 is to unmask the underlying etiology and/or indicate appropriate treatment options according to men's and women's individual needs (patient-centered medicine) using the best available data from population-based research (evidence-based medicine). Specific evaluation, treatment guidelines, and algorithms were developed for every sexual dysfunction in men, including erectile dysfunction; disorders of libido, orgasm, and ejaculation; Peyronie's disease; and priapism.
Sexual dysfunction in men represents a group of common medical conditions that need to be managed from a multidisciplinary perspective.
Erectile dysfunction (ED) and premature ejaculation (PE) are the two most prevalent male sexual dysfunctions.
To present the updated version of 2009 European Association of Urology (EAU) guidelines on ED and PE.
A systematic review of the recent literature on the epidemiology, diagnosis, and treatment of ED and PE was performed. Levels of evidence and grades of recommendation were assigned.
ED is highly prevalent, and 5-20% of men have moderate to severe ED. ED shares common risk factors with cardiovascular disease. Diagnosis is based on medical and sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to the patient's complaints and risk factors. Treatment is based on phosphodiesterase type 5 inhibitors (PDE5-Is), including sildenafil, tadalafil, and vardenafil. PDE5-Is have high efficacy and safety rates, even in difficult-to-treat populations such as patients with diabetes mellitus. Treatment options for patients who do not respond to PDE5-Is or for whom PDE5-Is are contraindicated include intracavernous injections, intraurethral alprostadil, vacuum constriction devices, or implantation of a penile prosthesis. PE has prevalence rates of 20-30%. PE may be classified as lifelong (primary) or acquired (secondary). Diagnosis is based on medical and sexual history assessing intravaginal ejaculatory latency time, perceived control, distress, and interpersonal difficulty related to the ejaculatory dysfunction. Physical examination and laboratory testing may be needed in selected patients only. Pharmacotherapy is the basis of treatment in lifelong PE, including daily dosing of selective serotonin reuptake inhibitors and topical anaesthetics. Dapoxetine is the only drug approved for the on-demand treatment of PE in Europe. Behavioural techniques may be efficacious as a monotherapy or in combination with pharmacotherapy. Recurrence is likely to occur after treatment withdrawal.
These EAU guidelines summarise the present information on ED and PE. The extended version of the guidelines is available at the EAU Web site (http://www.uroweb.org/nc/professional-resources/guidelines/online/).
To study sexual activity, the prevalence of sexual dysfunction and related help-seeking behaviors among mature adults in the United States of America, a telephone survey was conducted in 2001-2002. A total of 1491 individuals (742 men/749 women) aged 40-80 years completed the survey. Overall, 79.4% of men and 69.3% of women had engaged in sexual intercourse during the 12 months preceding the interview. Early ejaculation (26.2%) and erectile difficulties (22.5%) were the most common male sexual problems. A lack of sexual interest (33.2%) and lubrication difficulties (21.5%) were the most common female sexual problems. Less than 25% of men and women with a sexual problem had sought help for their sexual problem(s) from a health professional. Many men and women in the United States report continued sexual interest and activity into middle age and beyond. Although a number of sexual problems are highly prevalent, few people seek medical help.
While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men.
To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders.
Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults.
A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey.
Risk of experiencing sexual dysfunction as well as negative concomitant outcomes.
Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being.
The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
No systematic study has examined the psychological impact of premature ejaculation (PE) on the man and his partner. This study explores this vital issue by reporting on interviews of 28 men with self-diagnosed PE. From a qualitative perspective, these interviews assess whether these men had concerns about their PE and, if so, what they were. These men focused on two major themes: impact on self-confidence and future/current relationships. This suggests that PE has a similar qualitative impact on the individual as erectile dysfunction. Further investigation will need to determine how prevalent these concerns are in the PE population and also to delineate the impact on the men s partners.
The Global Study of Sexual Attitudes and Behaviors (GSSAB) is an international survey of various aspects of sex and relationships among adults aged 40-80 y. An analysis of GSSAB data was performed to estimate the prevalence and correlates of sexual problems in 13,882 women and 13,618 men from 29 countries. The overall response rate was modest; however, the estimates of prevalence of sexual problems are comparable with published values. Several factors consistently elevated the likelihood of sexual problems. Age was an important correlate of lubrication difficulties among women and of several sexual problems, including a lack of interest in sex, the inability to reach orgasm, and erectile difficulties among men. We conclude that sexual difficulties are relatively common among mature adults throughout the world. Sexual problems tend to be more associated with physical health and aging among men than women.
Premature ejaculation (PE) has an estimated prevalence of 22% of sexually active men. Treatment options are being drawn towards poles of clinical management, i.e. sole use of an anti-depressant or behavioural therapy. We speculated that a combination approach may offer both an improvement in ejaculatory delay, but also facilitate engagement with behavioural therapies. Our aims were to to compare ejaculatory delay between paroxetine 20mg daily or Premjact Spray™, followed by a behavioural therapy that did not include solitary or mutual masturbation. A randomised trial of pharmacological intervention for two months was followed immediately by a standardised behavioural therapy programme for a further two months. It was found that both paroxetine 20mg and Premjact Spray™ provided a statistically significant delay in ejaculation (measured by stopwatch); combination therapy indicated that ejaculatory delay had been maintained. Self-reported improvement to relationships was established, but did not correlate to the timed ejaculatory delay, i.e. successful treatment did not depend on a time delay, but on a reintroduction of intimacy. We conclude that combination therapy may provide a viable option for clinical management in men with psychogenic PE. Using medication, an initial stabilising effect to a relationship can be established, thus improving the uptake of behavioural therapy resulting in an improvement from baseline ejaculatory latency.
La alexitimia comprende un grupo de características cognitivas y afectivas inicialmente observadas en los pacientes que presentan enfermedades psicosomáticas clásicas y posteriormente en pacientes con diversas alteraciones médicas y psiquiátricas. Los rasgos más sobresalientes son: dificultades para identificar y describir las emociones, dificultades para distinguir las sensaciones corporales correlativas al estado emocional del sentimiento psicológico, pobre imaginario y mecanismos cognitivos orientados hacia la realidad exterior. Este estudio muestra niveles sensiblemente más elevados de alexitimia en los pacientes que padecen de eyaculación prematura (EP) primaria que los de un grupo control (p < 0,001). Además los niveles de alexitimia se corresponden positivamente con la intensidad de la EP (p < 0,001). La evaluación de la alexitimia basal, podría ser un predíctor útil de los resultados de tratamiento y podría contribuir a la orientación terapéutica. Podría acordarse una atención particular a las dificultades alexitímicas de los pacientes durante la relación clínica. Las técnicas corporales, de relajación, de percepción corporal, de hipnosis, métodos imaginativos y tratamientos farmacológicos y psicológicos combinados, podrían estar particularmente indicados en el tratamiento de los pacientes alexitímicos que padecen de EP. La participación de la pareja es generalmente importante, tanto para el proceso diagnóstico como para el tratamiento de la EP, pero su implicación está particularmente indicada si el paciente además presenta características alexitmicas.
Historically, in order to explain and treat premature ejaculation (PE), a wholly psychoanalytical approach was used. Next, a wholly behavioural approach emerged. Then Helen Kaplan summarised the combined following concept: according to her sperm carries sadistic symbolism in PE; it sullies the woman and leaves her frustrated, due to an unresolved oedipal complex which is “awoken by” a conflict with the partner. The current consensus is that a psycho-physiological approach is appropriate (considering both the psychological state and history of the subject, as well as his neuro-biological condition). However, recent publications concerning the effectiveness of some anti-depressants and possible genetic differences in the period of time taken to ejaculate have caused many professionals to interpret PE as a primarily biological phenomenon. This is evidence of the absurd propensity that science has to separate psychological aetiologies from biological ones, although these causes are interlinked. In reality, demonstrating that there is a physiological vulnerability in PE patients does not mean that there is no central involvement. The current therapeutic approach, which is based on the idea that PE is a psycho-physiological phenomenon, should address, directly or indirectly, all levels of the ejaculatory process. Apart from the particular case of secondary PE, which responds to an individual psychodynamic approach and couple therapy before treatment with possible combined sex therapy, strategies in permanent primary PE involve an integrated cognitive-behavioural approach as well as physical techniques and pharmacological treatments that are appropriate to each case. The integrated nature of this approach seems to improve therapeutic effectiveness, not only in terms of time taken to ejaculate, but also on the subject’s relationships in general. An appropriate treatment for PE must go beyond simply extending the time it takes for a man to ejaculate, which is a very limited solution to a more complex problem. The question as to how permanent these results are remains unanswered.
Conflict of Interest. Dr. Rowland is a part-time consultant for ALZA Corporation. Drs. Bull, Jamieson and Ho are employees of the ALZA Corporation.
Background. Although premature ejaculation (PE) is a common male sexual dysfunction, its relevant parameters have not been adequately studied in large community-based samples.
Objective. To examine the diagnostic utility of two self-report questions based on the DSM-IV-TR definition of PE and to investigate the relationship between self-identified PE, sexual functioning, and sexual satisfaction in men.
Methods. An Internet survey of general health and aspects of sexual functioning and satisfaction was conducted in 2056 males. Subjects were classified as having “probable” or “possible” PE, or as “non-PE” by survey responses.
Results. A total of 1158 men met the selection criteria (sexually active in a stable heterosexual relationship), and 189 (16.3%) were classified as having probable PE by reporting they ejaculated before they wished and indicating it was “very much” or “somewhat” a problem. Another 188 (16.2%) men reported ejaculating before they wished but rated their distress lower and were classified as having possible PE. Compared to non-PE men, those with probable and possible PE reported significantly worse sexual functioning in 6 of 8 study measures. Concern about partner satisfaction was high in all groups. The importance of ejaculatory control and the ability to have intercourse for the desired time was significantly higher in men with PE as compared to non-PE men (P < 0.01).
Conclusions. PE was a common problem, was characterized by a lack of ejaculatory control, and was associated with significant effects on sexual functioning and satisfaction. Additional research on the sensitivity and specificity of these self-report questions should be pursued.
Introduction:
Apart from the involvement of central serotonergic neurotransmission on lifelong premature ejaculation, interference of thyroid function has been speculated.
Aim:
To study thyroid function in a large group of men with lifelong premature ejaculation (LPE).
Methods:
Lifelong premature ejaculation was defined as an intravaginal ejaculation latency time (IELT) of less than 1 minute. Any consecutive man with LPE and no erectile dysfunction assessed by medical history and the International Index of Erectile Function (IIEF-5) was eligible for the study. Apart from the assessment of thyroid-stimulating hormone (TSH) also free thyroxin (f T4) was determined in case of a TSH of <0.3 mU/L or TSH of >4.0 mU/L (being the lower and upper limits of normal values, respectively). Blood samples were drawn throughout the day within office hours.
Main outcome measures:
Thyroid-stimulating hormone and f T4.
Results:
Included were 620 men; age (mean+/-SD) was 39.9+/-9.4 years (range 19-65). TSH concentrations from morning, early and late afternoon samples did not differ. The geometrical mean TSH concentration was 0.85 mU/L (95% confidence intervals: 0.82-0.90) with a coefficient of variation of 57.9%. Fourteen men had a TSH of <0.3 mU/L (2.2%), while five men (0.8%) of >4.0 mU/L. All men with an abnormal TSH had a normal f T4 (between 10 and 20 pmol/L). No relationship was found between age and TSH concentrations.
Conclusion:
Thyroid-stimulating hormone distribution was analyzed in a cohort of Dutch men with lifelong premature ejaculation and no erectile dysfunction. According to statistical analysis, there appeared to be no interaction between this ejaculatory complaint and the prevalence of thyroidal dysfunction. However, further studies are needed to gain more insight into the role of thyroid dysfunction and regulation of ejaculation time.
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.
Introduction
Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Specifically, we have witnessed substantial progress in understanding the physiology of ejaculation, clarifying the real prevalence of PE in population-based studies, reconceptualizing the definition and diagnostic criterion of the disorder, assessing the psychosocial impact on patients and partners, designing validated diagnostic and outcome measures, proposing new pharmacologic strategies and examining the efficacy, safety and satisfaction of these new and established therapies. Given the abundance of high level research it seemed like an opportune time for the International Society for Sexual Medicine (ISSM) to promulgate an evidenced-based, comprehensive and practical set of clinical guidelines for the diagnosis and treatment of PE.
Aim
Develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts.
Method
Review of the literature.
Results
This article contains the report of the ISSM PE Guidelines Committee. It affirms the ISSM definition of PE and suggests that the prevalence is considerably lower than previously thought. Evidence-based data regarding biological and psychological etiology of PE are presented, as is population-based statistics on normal ejaculatory latency. Brief assessment procedures are delineated and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients.
Conclusion
Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. Therefore, it is strongly recommended that these guidelines be re-evaluated and updated by the ISSM every 4 years. Althof SE, Abdo CHN, Dean J, Hackett G, McCabe M, McMahon CG, Rosen RC, Sadovsky R, Waldinger M, Becher E, Broderick GA, Buvat J, Goldstein I, El-Meliegy AI, Giuliano F, Hellstrom WJG, Incrocci L, Jannini EA, Park K, Parish S, Porst H, Rowland D, Segraves R, Sharlip I, Simonelli C, and Tan HM. International Society for Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation.
Introduction. Premature ejaculation (PE) is the most common male sexual dysfunction affecting men and their partners. Lack of community-based data describing this condition limits understanding of PE and its outcomes.
Aim. To characterize PE in a large population of men with and without PE using patient-reported outcome (PRO) measures elicited from men and their partners.
Methods. 4-week, multicenter, observational study of males (≥18 years) and their female partners in monogamous relationships (≥6 months). Screening, baseline, and follow-up visits scheduled at 2-week intervals. Clinicians diagnosed PE utilizing DSM-IV-TR criteria. Intravaginal ejaculatory latency time (IELT), measured by a stopwatch held by the partner, was recorded for each sexual intercourse experience. Subject and partner independently assessed PROs: control over ejaculation and satisfaction with sexual intercourse (0 = very poor to 4 = very good), personal distress and interpersonal difficulty (0 = not at all to 4 = extremely), and severity of PE (0 = none to 3 = severe).
Results. Of the total study population (N = 1,587), 207 subjects were diagnosed with PE and 1,380 were assigned to the non-PE group. Median IELT (min) was 1.8 (range, 0–41) for PE and 7.3 (range, 0–53) for non-PE subjects (P < 0.0001). More PE vs. non-PE subjects gave ratings of “very poor” or “poor” for control over ejaculation (72% vs. 5%; P < 0.0001) and satisfaction with sexual intercourse (31% vs. 1%; P < 0.0001). More subjects in the PE vs. non-PE group gave ratings of “quite a bit” or “extremely” for personal distress (64% vs. 4%; P < 0.0001) and interpersonal difficulty (31% vs. 1%; P < 0.0001). Subject and partner assessments showed similar patterns and correlated moderately (0.36–0.57).
Conclusions. PE subjects reported significantly shorter IELT. Overlap in IELT distributions was observed between the PE and non-PE groups, indicating the need for additional PRO measures to characterize PE. Shorter IELT was significantly associated with reduced ejaculatory control and sexual satisfaction and increased distress and interpersonal difficulty.
A massive survey of sexual lifestyles has been conducted in France (Nature 1992, 360, 407–409) in response to the spread of the AIDS epidemic. This survey was applied to 20 055 people aged 18–69 years and was focused on a detailed description of sexual practices and means of protection against AIDS contamination. Questions concerning sexual dysfunctions were included in an additional questionnaire. This article examines the most common male sexual dysfunction, premature ejaculation (PE) and its association with erectile dysfunction (ED). The prevalence rate of PE reported “often” was 11% (ED reported “often”: 7%). The prevalence rate of PE reported “often” or “sometimes” or “quite seldom” was 65% (ED: 47%). With regard to the association of PE with ED, 26% of men aged 18–24 reported neither PE, nor ED, 11% reported only ED, 41% only PE, and 22% both PE and ED; 4% of men aged 60–69 reported neither PE nor ED, 27% reported only ED, 28% only PE, and 41% both PE and ED. I discuss these prevalence rates and I propose a typology of PE.
Considérée comme le plus commun des troubles sexuels masculins, l’éjaculation prématurée se caractérise par l’absence de maîtrise
du réflexe éjaculatoire, que l’on s’accorde à rattacher à une mauvaise gestion de l’excitation et du plaisir. Après avoir
commenté le problème de fond que soulève l’EP, et insisté sur la nécessité de relativiser le problème, l’auteur expose les
principales thérapies utiles dans cette dysfonction, et en précise les indications en fonction des différents facteurs favorisants
détectés par l’évaluation, et suivant que l’on a affaire à une forme d’EP structurelle ou conjoncturelle
Considered as the most common male sexual problem, premature ejaculation is characterized by the absence of control over the
ejaculatory reflex with a correspondingly poor perception of sexual arousal and pleasure. After first considering the nature
of the problems underlying premature ejaculation, this article emphasizes the relevance of pathophysiological aspects and
considers the main treatments available according to the various contributory factors identifiable during investigation in
relation to whether the problem is structural or psychological. Successful treatments is dependent upon modifying and correcting
the mental and sensory processes of the premature ejaculator during his sexual activity. When premature ejaculation is an
isolated symptom without a concomitant psychological problem, it may be considered a sexual learning disability and has excellent
prognosis with sex therapy using behavioural methods (“squeeze technique”, “start-stop technique”). In other cases, the symptom
of premature ejaculation is associated with deeper psychological problems and treatment requires a more complex psychodynamic
approach, but one which does not exclude behavioural measures when appropriate.
Premature ejaculation (PE) is a widely observed male sexual dysfunction with a major impact on quality of life for many men and their sexual partners.
To assess the safety of tramadol orally disintegrating tablet (ODT) (Zertane) and its efficacy in prolonging intravaginal ejaculation latency time (IELT) and improving Premature Ejaculation Profile (PEP) scores.
We conducted an integrated analysis of two identical 12-wk randomized double-blind, placebo-controlled phase 3 trials across 62 sites in Europe. Healthy men 18-65 yr of age with a history of lifelong PE according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, and an IELT ≤ 120 s were included. There were 604 intent-to-treat subjects included in the analysis.
Subjects were randomized to receive 1:1:1 placebo (n=200), 62 mg tramadol ODT (n=206), or 89 mg tramadol ODT (n=198).
We measured overall change and fold increase in median IELT and the mean change in all four measures of the PEP. Differences across treatment groups were analyzed using Wilcoxon rank-sum tests, analysis of variance, and chi-square analyses.
Tramadol ODT resulted in significant increases in median IELT compared with placebo; increases were 0.6 min (1.6 fold), 1.2 min (2.4 fold), and 1.5 min (2.5 fold) for placebo, 62 mg tramadol ODT, and 89 mg tramadol ODT, respectively (p<0.001 for all comparisons). Men saw significantly greater improvement in all four measures of the PEP in both doses compared with placebo (p<0.05 for all comparisons). Tramadol ODT was well tolerated; study discontinuation occurred in 0%, 1.0%, and 1.6% of subjects in placebo, 62 mg, and 89 mg tramadol ODT groups, respectively. Limitations include study inclusion for men with IELT up to 120 s.
On-demand 62mg tramadol ODT is an effective treatment for PE in a low and safe therapeutic dose and provides a new option for managing mild to severe PE.
The psychological impacts of premature ejaculation (PE), which include guilt, anxiety, and distress, have been well established in Western countries. However, in Asia, although a substantial number of epidemiological studies have surveyed the prevalence of PE, researchers have not thoroughly investigated the relationship between PE and depression, or have defined PE properly.
We studied the association between PE and depression and other psychological disturbances, in a Korean cohort by applying an appropriate definition for PE and validated outcome measures of depression. METHODS. A total of 956 males (≥20 years) were initially approached via an Internet survey company. Participants were asked to complete a questionnaire requesting detailed medical and sexual histories, which included questions from the Erectile Function Domain score in the International Index of Erectile Function (IIEF-EF) and the Beck Depression Inventory (BDI). The prevalence of PE was evaluated using two different definitions-self-assessed PE and presumed PE. Presumed PE was defined as a short ejaculation time (an estimated intravaginal ejaculatory latency time ≤5 minutes), an inability to control ejaculation, and the presence of distress resulting from PE.
Ejaculation-related questionnaire, the IIEF-EF, and BDI.
A total of 334 men were evaluated. The prevalence of PE was 10.5% according to the Presumed PE definition, whereas by self-assessment, it was 25.4%. Self-assessed PE patients suffered from various psychological problems, such as depression, low self-esteem, bother, and low sexual satisfaction. Even after excluding erectile dysfunction (ED) subjects, a significant relationship was found between self-assessed PE and depression. Moreover, after further classification of the Self-assessed PE group, we found that subjects included in this group, but not in the Presumed PE group, suffered more from psychological burden than any other members of the cohort.
Korean men with subjective perceptions of PE are prone to various psychological problems, which include depression.
Dapoxetine has been evaluated for the on-demand treatment of premature ejaculation (PE) in five phase 3 studies in various populations worldwide and has recently been approved in several countries.
To present integrated efficacy and safety data from phase 3 trials of dapoxetine.
Data were from five randomized, multicenter, double-blind, placebo-controlled studies conducted in over 25 countries. Men (N=6,081)≥18 years who met the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision criteria for PE; four studies required a baseline intravaginal ejaculatory latency time (IELT) of ≤2 minutes. Dapoxetine 30 and 60 mg on demand (prn; 1-3 hours before intercourse) were evaluated for either 12 or 24 weeks in four studies; one study evaluated dapoxetine 60 mg daily (qd; included in safety assessments only) or prn for 9 weeks.
End points included stopwatch-measured IELT, Premature Ejaculation Profile (PEP) items, clinical global impression of change (CGIC) in PE, and adverse events (AEs).
Average IELT (mean [standard deviation], geometric mean [standard error]) increased from baseline (across groups, 0.9 [0.49] minutes, 0.8 [1.01] minutes) to a significantly greater extent with dapoxetine 30 (3.1 [3.91] minutes, 2.0 [1.03] minutes) and 60 mg (3.6 [3.85] minutes, 2.3 [1.03] minutes) vs. placebo (1.9 [2.43] minutes, 1.3 [1.02] minutes; P<0.001 for all) at week 12 (geometric mean fold increase, 2.5, 3.0, and 1.6, respectively). All PEP items and CGIC improved significantly with both doses of dapoxetine vs. placebo (P<0.001 for all). The most common AEs included nausea, dizziness, and headache, and evaluation of validated instruments demonstrated no anxiety, akathisia, suicidality, or changes in mood with dapoxetine use and no discontinuation syndrome following abrupt withdrawal.
In this diverse population, dapoxetine significantly improved all aspects of PE and was generally well tolerated.
Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Specifically, we have witnessed substantial progress in understanding the physiology of ejaculation, clarifying the real prevalence of PE in population-based studies, reconceptualizing the definition and diagnostic criterion of the disorder, assessing the psychosocial impact on patients and partners, designing validated diagnostic and outcome measures, proposing new pharmacologic strategies and examining the efficacy, safety and satisfaction of these new and established therapies. Given the abundance of high level research it seemed like an opportune time for the International Society for Sexual Medicine (ISSM) to promulgate an evidenced-based, comprehensive and practical set of clinical guidelines for the diagnosis and treatment of PE.
Develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method. Review of the literature.
This article contains the report of the ISSM PE Guidelines Committee. It affirms the ISSM definition of PE and suggests that the prevalence is considerably lower than previously thought. Evidence-based data regarding biological and psychological etiology of PE are presented, as is population-based statistics on normal ejaculatory latency. Brief assessment procedures are delineated and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients.
Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. Therefore, it is strongly recommended that these guidelines be re-evaluated and updated by the ISSM every 4 years.
Objective:
To develop a contemporary, evidence-based definition of premature ejaculation (PE).
Methods:
There are several definitions of PE; the most commonly quoted, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders - 4th Edition - Text Revision, and other definitions of PE, are all authority-based rather than evidence-based, and have no support from controlled clinical and/or epidemiological studies. Thus in August 2007, the International Society for Sexual Medicine (ISSM) appointed several international experts in PE to an Ad Hoc Committee for the Definition of PE. The committee met in Amsterdam in October 2007 to evaluate the strengths and weaknesses of current definitions of PE, to critically assess the evidence in support of the constructs of ejaculatory latency, ejaculatory control, sexual satisfaction and personal/interpersonal distress, and to propose a new evidence-based definition of PE.
Results:
The Committee unanimously agreed that the constructs which are necessary to define PE are rapidity of ejaculation, perceived self-efficacy, and control and negative personal consequences from PE. The Committee proposed that lifelong PE be defined as a male sexual dysfunction characterized by ejaculation which always or nearly always occurs before or within about one minute of vaginal penetration, and 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. This definition is limited to men with lifelong PE who engage in vaginal intercourse. The panel concluded that there are insufficient published objective data to propose an evidence-based definition of acquired PE.
Conclusion:
The ISSM definition of lifelong PE represents the first evidence-based definition of PE. This definition will hopefully lead to the development of new tools and patient-reported outcome measures for diagnosing and assessing the efficacy of treatment interventions, and encourage ongoing research into the true prevalence of this disorder, and the efficacy of new pharmacological and psychological treatments.
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.
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.
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.
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.
In a study of 28 attenders of a sexual and marital clinic, the relationship between marital distress and both general and specific sexual dysfunctions was investigated. It was found that for men there was a much closer relationship between sexual and marital problems than for women. In particular, it was noted that the specific male sexual dysfunctions of impotence and premature ejaculation played a much larger part in marital discord than did the female dysfunctions of anorgasmia and vaginismus.
In a prospective investigation of the long-term outcome of 140 couples who had entered sex therapy 1–6 yrs earlier for a variety of sexual dysfunctions, successful follow-up, mostly by interview, was possible with at least one partner in 75% of cases. While recurrence of sexual difficulties was common, coping strategies were identified which often helped overcome relapses. Improvements in couples' general relationships resulting from treatment were usually sustained. Long-term outcome was excellent for vaginismus, good for erectile dysfunction, but often poor for premature ejaculation, and especially, for female impaired sexual interest. While the results of this study support the continued use of sex therapy for sexual dysfunction, they also emphasize the need for new therapeutic approaches for problems with poor outcome, especially female loss of sexual interest.
We evaluated the efficacy of a new lidocaine-prilocaine cream in preventing premature ejaculation.
An open pilot, unblinded study was done using lidocaine-prilocaine cream in 11 healthy, married men with premature ejaculation without organic or erectile problems. The patients were instructed to apply 2.5 gm. of the cream 30 minutes before sexual contact and to cover the penis with a condom. Patients were asked to grade the effect of the cream on ejaculation after each application.
There was a significant improvement in premature ejaculation statistically and clinically. Five patients graded the result as excellent compared to baseline, 4 graded it as better and 2 claimed to have no change compared to ejaculation before use of the cream. No adverse effects were noted.
These promising results should prompt a large double-blind placebo-controlled trial. If confirmed, this therapy may be a breakthrough in the treatment of the most common form of male sexual dysfunction.
This study evaluated the associations between intimacy, quality of life, and sexual dysfunction in men and women. Participants were 145 sexually functional (43 men, 102 women) adults drawn from the general population and 198 sexually dysfunctional (114 men, 84 women) adults who came to a university sexual behavior clinic. All respondents were currently involved in a heterosexual relationship. Respondents completed a series of questionnaires to evaluate the level of intimacy in their relationships, their quality of life, and their level of sexual dysfunction. All aspects of intimacy were lower among sexually dysfunctional men than among sexually functional men for all subgroups of dysfunctionality (premature ejaculation, erectile failure, and lack of sexual desire). Levels of intimacy were less likely to discriminate between functional and dysfunctional women, with functional women only obtaining higher intimacy scores than each of the dysfunctional groups of women (inorgasmia, lack of arousal, lack of sexual desire) for social intimacy and recreational intimacy and, to a lesser extent, for sexual intimacy. Objective levels of quality of life as well as the satisfaction and importance of the quality of life domains were more likely to be lower when sexually dysfunctional women were compared with their functional counterparts than when sexually dysfunctional men were compared with their functional counterparts. The implications of these findings for an understanding of factors that contribute to sexual dysfunction, and the treatment of these disorders, is discussed.
Premature ejaculation has generally been considered a psychosexual disorder with psychogenic aetiology. Although still mainly treated by behavioural therapy, in recent years double-blind studies have indicated the beneficial effects of some of the serotonergic antidepressants (SSRIs) in delaying ejaculation. We describe here the neurophysiology and the peripheral neuroanatomy of ejaculation and provide a review of the involvement of serotonin in the central nervous system in relation to serotonergic nuclei and their projections. A hypothesis of the role of 5-HT1A and 5-HT2C receptors in premature ejaculation is postulated.
To evaluate the efficacy of sertraline hydrochloride in the drug treatment of premature ejaculation (P.E.).
Forty-six normally potent men, aged 22 to 63 years (mean 42 years) with premature ejaculation were treated with oral sertraline in a dose ranging study. All men were either married or in a stable relationship. The mean ejaculatory interval was 1 minute (range 0-5 min). All men were started on Sertraline 25 mg daily and were increased to 50 mg after 3 weeks and 100 mg after a further 3 weeks. None of the men received any formal psychosexual therapy.
With a dose of 25 mg, the mean ejaculatory interval increased to 7.6 min (range 0-20 min). With a dose of 50 mg, the mean ejaculatory interval increased to 13.1 min (range 7 min-anejaculation) with 4 men experiencing anejaculation. With a dose of 100 mg, the mean ejaculatory interval increased to 16.4 min (range 7 min-anejaculation), 10 men experiencing anejaculation. With a dose of 25 mg, 1 man described transient dizziness. With a dose of 50 mg, 1 man described some drowsiness and anorexia and 1 man experienced minor dyspepsia. With a dose of 100 mg, 2 men described erectile dysfunction and reduced libido, 2 men described transient drowsiness and anorexia, 2 men experienced minor dyspepsia and 2 men described feelings of anxiety.
Sertraline appears to be a useful agent in the pharmacological treatment of premature ejaculation.
There has been little research carried out on the prevalence and types of sexual dysfunction in the general population, although the indications are that such problems are relatively common. Most common sexual problems are potentially treatable. However GPs have estimated the prevalence of sexual problems to be far lower than survey estimates.
To provide an estimate of the prevalence of sexual problems in the general population, and assess the use of and need for professional help for such problems.
We used an anonymous postal questionnaire survey. The study was set in four general practices in England*, and the study population was a stratified random sample of the adult general population (n = 4000). The subjects were 789 men and 979 women who responded to the questionnaire. The main outcome measures were the presence and type of current sexual problems in men and women, and the provision and use of treatments for sexual problems.
A response rate of 44% was obtained. The median age of the responders was 50 years. A third of men (34%) and two-fifths of women (41 %) reported having a current sexual problem. The most common problems were erectile dysfunction (n = 170) and premature ejaculation (n = 88) in men; in women the most widely reported problems were vaginal dryness (n = 186) and infrequent orgasm (n = 166). In men, the proportion of responders reporting sexual problems increased with age, but there was no similar trend in women. Of those responders who reported a sexual problem, 52% said that they would like to receive professional help for this problem, but only one in ten of these people (n = 50) had received such help.
Among responders there was a high level of reported sexual problems. The most frequently reported problems (vaginal dryness, erectile problems) may be amenable to physical treatment in practice, and yet few had sought or received help. However, many said that they would like to receive help. These figures suggest that there may be an important burden of potentially reversible sexual problems in the general population.
To investigate the prevalence of chronic prostatitis in men with premature ejaculation. The etiology of premature ejaculation is currently considered psychological in nature. However, the possibility that urologic, hormonal, or neurologic factors may contribute to this condition should be considered in its management.
We evaluated segmented urine specimens before and after prostatic massage and expressed prostatic secretion specimens from 46 patients with premature ejaculation and 30 controls by bacteriologic localization studies. The incidence of premature ejaculation in the subjects with chronic prostatitis was also evaluated.
Prostatic inflammation was found in 56.5% and chronic bacterial prostatitis in 47.8% of the subjects with premature ejaculation, respectively. When compared with the controls, these novel findings were statistically significant (P <0.05).
Considering the role of the prostate gland in the mechanism of ejaculation, we suggest a role for chronic prostate inflammation in the pathogenesis of some cases of premature ejaculation. Since chronic prostatitis has been found with a high frequency in men with premature ejaculation, we stress the importance of a careful examination of the prostate before any pharmacologic or psychosexual therapy for premature ejaculation.
Premature ejaculation is a common male sexual disorder in which orgasm and ejaculation occur before the desired moment. The primary therapeutic approach to premature ejaculation has been behavioural and pharmacotherapy. In this study, we evaluated the efficacy and optimum usage of lidocaine-prilocaine cream 5% in preventing premature ejaculation. Forty patients were examined in the study group and randomized into four groups, each comprising 10 patients. Patients in group 1 applied lidocaine-prilocaine cream 5% for 20 min, the patients in group 2 applied it for 30 min, and the patients in group 3 applied the cream for 45 min before sexual contact, with all patients covering the penis with a condom. Patients in the fourth group applied a base cream as placebo. In group 1, the pre-ejaculation period increased to 6.71 +/- 2.54 min without any adverse effects. In group 2, although the pre-ejaculation period increased in four patients up to 8.70 +/- 1.70 min, six patients in this group and all patients in group 3 had erection loss because of numbness. In the placebo group, there was no change in their pre-ejaculation period. Therefore, lidocaine-prilocaine cream 5% is effective in premature ejaculation and 20 min of application time before sexual contact is the optimum period.
To assess the use of a topical anaesthetic mixture to improve premature ejaculation (PE), for which penile hypersensitivity might be a cause.
The study included 42 men divided in two groups; group A used a lidocaine-prilocaine solution and group B used an inert cream. The tubes of cream were distributed randomly and participants asked to note any unpleasant symptoms, difficulties and the results of each attempt at intercourse, assessed by the intravaginal ejaculatory latency time (IELT).
There was a significant increase in the mean (sd) IELT, from 1.49 (0.9) to 8.45 (0.9) min (P < 0.001) in group A but not in group B, at 1.67 (0.7) to 1.95 (0.12) min (P > 0.05).
We suggest that anaesthetic cream might be effective for treating PE.
Introduction and objectives:
Rapid ejaculation (RE) is the most common sexual dysfunction in males. The aim of the present study is to determine the contribution of intrapsychic, organic and relational factors to the pathogenesis of RE and the relationship between RE and erectile dysfunction (ED) in a sample of patients attending for the first time to an Outpatient Clinic for sexual dysfunction.
Methods:
We studied a consecutive series of 755 patients using Structured Interview on Erectile Dysfunction (SIEDY), a brief, recently validated, multidimensional instrument specifically designed by our group for the study of pathogenetic factors of ED. RE was defined as ejaculation within 1 minute of vaginal intromission and its severity was categorized on a 4-point scale using a standard question. A complete physical examination and a series of biochemical, hormonal, psychometric, penile vascular and rigidometric evaluations were performed.
Results:
Twenty-eight percent (n = 214) of patients attending to our sexology clinic reported RE of any degree. Patients reporting RE were younger (48.5 +/- 12.6 vs. 52.9 +/- 12.9 years old for RE and not RE respectively; p < 0.0001) and showed a higher prevalence of anxiety symptoms when compared to the rest of the sample. Among organic factors subjects with RE showed a higher prevalence of hyperthyroidism and significantly lower fasting plasma glucose (94 [87-110] and 98 [89-113] mg/dl for RE and non-RE respectively; p < 0.01). No difference among groups was observed for other hormones or clinical, biochemical and instrumental parameters. Finally RE patients showed a higher prevalence of partial erection sufficient for penetration when compared to the rest of the sample. Similar differences were observed between patients with and without RE when those without ED were excluded from the analysis.
Conclusion:
Our data suggest a minor involvement of organic factors to the pathogenesis of ED in patients with concomitant RE. On the other hand, in our sample, patients complaining about RE are younger, healthier than the rest of the sample and are characterized by high degree of anxiety symptoms and hyperthyroidism.
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.