Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes: results from the Turkish Society of Andrology Sexual Health Survey

IntroductionIn addition to the previously known lifelong and acquired premature ejaculation (PE) syndromes, the existence of two more PE syndromes has been suggested: natural variable PE and premature‐like ejaculatory dysfunction. However, epidemiological studies investigating the prevalence of these four PE syndromes have yet to be conducted.AimTo determine the prevalence of the complaint of ejaculating prematurely across the four PE syndromes.MethodsThis study, conducted between June 2009 and December 2009, was designed as a non‐interventional, observational cross‐sectional field survey. Participating couples were randomly selected from 17 provinces of Turkey. All participants were asked to complete a questionnaire including data regarding demographics, socioeconomic status, social and cultural factors, medical and sexual history, current medications, and ejaculation time. Subjects with a complaint of ejaculating prematurely were classified as lifelong, acquired, and natural variable PE, or premature‐like ejaculatory dysfunction.Main Outcome MeasuresThe main outcome measures were prevalence of complaint of ejaculating prematurely in the general population and across the four PE syndromes.ResultsA total of 2,593 couples (mean age, 41.9 ± 12.7 years for males and 38.2 ± 12.1 years for females) were enrolled. Five‐hundred twelve subjects (20.0%) complained of ejaculating prematurely. Fifty‐eight (2.3%), 100 (3.9%), 215 (8.5%), and 131 (5.1%) subjects were classified as lifelong, acquired, and natural variable PE, and premature‐like ejaculatory dysfunction, respectively.ConclusionsThe prevalence of the complaint of ejaculating prematurely among Turkish men was 20.0%, with the highest PE syndrome being natural variable PE (8.5%) and premature‐like ejaculatory dysfunction (5.1%). Serefoglu EC, Yaman O, Cayan S, Asci R, Orhan I, Usta MF, Ekmekcioglu O, Kendirci M, Semerci B, and Kadioglu A. Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes: Results from the Turkish Society of Andrology Sexual Health Survey.     

Premature ejaculation and erectile dysfunction prevalence and attitudes in the Asia-Pacific region

IntroductionPremature ejaculation (PE) is a common male sexual dysfunction. The prevalence of PE in the Asia‐Pacific region has not been comprehensively studied.AimThe aim of this study is to evaluate PE prevalence in nine Asia‐Pacific countries and the impact of PE on sufferers.MethodsA random sample of heterosexual males aged 18–65 years in a stable sexual relationship currently or in the past 2 years completed a 48‐question survey by computer‐assisted interviewing, online, or in‐person; the survey and recruitment methodologies varied by location. The survey included demographic questions, the five‐question Premature Ejaculation Diagnostic Tool (PEDT), the five‐question Sexual Health Inventory for Men (SHIM), and the 10‐question Index of Premature Ejaculation (IPE). Separately, men self‐reported having PE (lifelong or acquired) or erectile dysfunction (ED).Main Outcome MeasuresThe PEDT was used to diagnose PE or probable PE; the SHIM was used to diagnose ED; and the IPE was used to assess respondent's attitudes toward PE.ResultsOf the 4,997 men who completed the survey, the prevalences of PEDT‐diagnosed PE, PEDT‐diagnosed probable PE, and self‐reported PE were 16%, 15%, and 13%, respectively. Less than half of men with PEDT‐diagnosed PE (N = 816) or probable PE (N = 738) self‐reported the condition (40% and 19%, respectively), and 6% of men with a PEDT diagnosis of no PE self‐reported PE. In contrast, more respondents self‐reported ED (8%) than had SHIM‐diagnosed moderate or severe ED (5%). IPE responses indicated that 45%, 46%, and 23% of men with PEDT‐diagnosed PE were somewhat or very dissatisfied with the length of intercourse before ejaculation, their control over ejaculation, and with sexual intercourse, respectively.Conclusions.In this study, PE was more prevalent than ED in the Asia‐Pacific countries surveyed, but only 40% of men with PEDT‐diagnosed PE self‐reported PE. McMahon CG, Lee G, Park JK, and Adaikan PG. Premature ejaculation and erectile dysfunction prevalence and attitudes in the Asia‐Pacific region. J Sex Med 2012;9:454–465.     

The Global Online Sexuality Survey (GOSS): The United States of America in 2011 Chapter III—Premature Ejaculation Among English‐Speaking Male Internet Users

IntroductionThe Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders. In 2010, the first report of GOSS came from the Middle East.AimThis report studies the prevalence rate of premature ejaculation (PE) in the U.S. as of 2011–2012 and evaluates risk factors for PE.MethodsGOSS was randomly deployed to English‐speaking male web surfers in the USA via paid advertising on Facebook®, comprising 146 questions.Main Outcome MeasuresPrevalence of PE as per the International Society of Sexual Medicine's (ISSM) definition.ResultsWith a mean age of 52.38 years ± 14.5, 1,133 participants reported on sexual function. As per the ISSM definition of PE, the prevalence rate of PE in the USA as of 2011 was 6.3%. This is in contrast to 49.6% as per the Premature Ejaculation Diagnostic Tool (PEDT), 77.6% as per unfiltered subjective reports, and 14.4% as per subjective reporting on more consistent basis. 56.3% of the latter reported lifelong PE. 63.2% could be classified as having natural variable PE. Erectile dysfunction is a possible predisposing factor for acquired PE, while genital size concerns may predispose to lifelong PE. Age, irregular coitus, circumcision, and the practice of masturbation did not pose a risk for PE, among other risk factors. Oral treatment for PE was more frequently used and reported to be more effective than local anesthetics, particularly in those with lifelong PE.ConclusionApplying the ISSM definition, prevalence of PE is far less than diagnosed by other methods, 6.3% among Internet users in USA as of the year 2011. PEDT measures both lifelong and acquired PE, in addition to 35% men with premature‐like ejaculatory dysfunction, making it inaccurate for isolating lifelong and acquired PE cases. Shaeer O. The Global Online Sexuality Survey (GOSS): The United States of America in 2011 chapter III—Premature ejaculation among English‐speaking male Internet users. J Sex Med **;**:**–**.     

The diagnostic value of the premature ejaculation diagnostic tool and its association with intravaginal ejaculatory latency time

IntroductionPremature ejaculation (PE) is the most prevalent male ejaculation disorder. The premature ejaculation diagnostic tool (PEDT) was developed to systematically apply the DSM‐IV‐TR criteria in diagnostic PE.AimsTo evaluate the diagnostic value of the PEDT and its association with intravaginal ejaculatory latency time (IELT).Methods(i) Korean validation of PEDT: data was collected from men interviewed by one of the two clinical experts, who made a diagnostic of present or absence of PE, using DSM‐IV‐TR criteria. A total of 103 patients with PE and 100 men without PE were enrolled into the study and requested to complete the PEDT; and (ii) The correlation between IELT and PEDT: 200 participants were enrolled and each participant was asked to make out PEDT. All participants were requested to measure IELT.Main Outcome MeasuresValidity and reliability of the PEDT and its association with IELT.ResultsThe geometric mean IELT of the PE group was 115.37 ± 78.14 seconds. The number of men reporting IELTs of <1, 1 to ≤2, and >2 minutes were 28 (28.6%), 29 (29.6%), and 41 (41.8%), respectively. The Cronbach's alpha score was calculated as 0.93, showing adequate internal consistency. The test–retest correlation coefficients of each item were higher than 0.72 and the correlation coefficients of the total score was 0.88. (P < 0.001) Sensitivity and specificity analyses suggested a score of ≤8 indicated no PE, 9 and 10 probable PE, and ≥11 PE. The PEDT total score and IELT showed an adequate negative correlation. (ρ = ?0.77, P < 0.0001) also, the PEDT total score of the PE subgroup (IELT ≤ 2 minutes) and IELT showed a negative correlation. (ρ = ?0.6, P < 0.0001)ConclusionsThe PEDT was highly effective in detecting the presence of PE. The result of our study supports its validity as a diagnostic tool in the clinical setting. Kam SC, Han DH, and Lee SW. The diagnostic value of the premature ejaculation diagnostic tool and its association with intravaginal ejaculatory latency time. J Sex Med 2011;8:865–871.     

An Evidence‐Based Unified Definition of Lifelong and Acquired Premature Ejaculation: Report of the Second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation

IntroductionThe International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence‐based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE.AimThe aim of this article is to review and critique the current literature and develop a contemporary, evidence‐based definition for acquired PE and/or a unified definition for both lifelong and acquired PE.MethodsIn April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence‐based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted.ResultsThe committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time (IELT) as compared with men with lifelong PE. A self‐estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut‐off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE); (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.ConclusionThe ISSM unified definition of lifelong and acquired PE represents the first evidence‐based definition for these conditions. This definition will enable researchers to design methodologically rigorous studies to improve our understanding of acquired PE. Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, Becher EF, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An evidence‐based unified definition of lifelong and acquired premature ejaculation: Report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. J Sex Med 2014;11:1423–1441.     

Prevalence and correlates of premature ejaculation in a primary care setting: a preliminary cross-sectional study

IntroductionPremature ejaculation (PE) is common. However, it has been underreported and undertreated.AimsTo determine the prevalence of PE and to investigate possible associated factors of PE.MethodsThis cross‐sectional study was conducted at a primary care clinic over a 3‐month period in 2008. Men aged 18–70 years attending the clinic were recruited, and they completed self‐administered questionnaires that included the Premature Ejaculation Diagnostic Tool (PEDT), International Index of Erectile Function, sociodemography, lifestyle, and medical illness. The operational definition of PE included PE and probable PE based on the PEDT.Main Outcome MeasurePrevalence of PE.ResultsA total of 207 men were recruited with a response rate of 93.2%. There were 97 (46.9%) Malay, 57 (27.5%) Chinese, and 53 (25.6%) Indian, and their mean age was 46.0 ± 12.7 years. The prevalence of PE was 40.6% (N = 82) (PE: 20.3%, probable PE: 20.3% using PEDT). A significant association was found between ethnicity and PE (Indian 49.1%, Malay 45.4%, and Chinese 24.6%; χ² = 8.564, d.f. = 2, P = 0.014). No significant association was found between age and PE. Multivariate analysis showed that erectile dysfunction (adjusted odds ratio [OR] 4.907, 95% confidence interval [CI] 2.271, 10.604), circumcision (adjusted OR 4.881, 95% CI 2.346, 10.153), sexual intercourse ≤5 times in 4 weeks (adjusted OR 3.733, 95% CI 1.847, 7.544), and Indian ethnicity (adjusted OR 3.323, 95% CI 1.489, 7.417) were predictors of PE.ConclusionPE might be frequent in men attending primary care clinics. We found that erectile dysfunction, circumcision, Indian ethnicity, and frequency of sexual intercourse of ≤5 times per month were associated with PE. These associations need further confirmation. Tang WS and Khoo EM. Prevalence and correlates of premature ejaculation in a primary care setting: A preliminary cross‐sectional study. J Sex Med 2011;8:2071–2078.     

Erectile dysfunction and premature ejaculation in men who have sex with men

IntroductionQuantitative research into sexual function and dysfunction in men who have sex with men (MSM) has been sparse due in large part to a lack of validated, quantitative instruments for the assessment of sexuality in this population.AimTo assess prevalence and associations of erectile problems and premature ejaculation in MSM.MethodsMSM were invited to complete an online survey of sexual function. Ethnodemographic, sexuality, and health‐related factors were assessed.Main Outcome MeasureParticipants completed a version of the International Index of Erectile Function modified for use in MSM (IIEF‐MSM) and the Premature Ejaculation Diagnostic Tool (PEDT). Total score on the erectile function (EF) domain of the IIEF‐EF (IIEF‐MSM‐EF) was used to stratify erectile dysfunction (ED) severity (25–30 = no ED, 16–24 mild or mild moderate ED, 11–15 moderate ED, and ≤10 severe ED). PEDT scores were used to stratify risk of premature ejaculation (PE, diagnosed as PEDT score ≥9).ResultsNearly 80% of the study cohort of 2,640 men resided in North America. The prevalence of ED was higher in older men whereas the prevalence of PE was relatively constant across age groups. Multivariate logistic regression revealed that increasing age, HIV seropositivity, prior use of erectogenic therapy, lower urinary tract symptoms (LUTS), and lack of a stable sexual partner were associated with greater odds of ED. A separate multivariate analysis revealed that younger age, LUTS, and lower number of lifetime sexual partners were associated with greater odds of PE.Conclusions.Risk factors for sexual problems in MSM are similar to what has been observed in quantitative studies of non‐MSM males. Urinary symptoms are associated with poorer sexual function in MSM. Shindel AW, Vittinghoff E, and Breyer BN. Erectile dysfunction and premature ejaculation in men who have sex with men. J Sex Med 2012;9:576–584.     

Development and evaluation of the Arabic Index of Premature Ejaculation (AIPE)

ObjectivesOur report describes the construction and evaluation of the Arabic Index Premature Ejaculation (AIPE) as a diagnostic tool for premature ejaculation (PE) and presents data supporting its validity.Methods and Main Outcome MeasuresSeventy-one men complaining of PE and 73 healthy subjects were asked to complete the seven-question AIPE. Diagnosis of PE was based on the criteria set by the second consultation on sexual dysfunctions. The seven items selected were based on assessment of erectile function, sexual desire, ejaculation latency, ejaculation control, patient satisfaction, partner satisfaction, and psychological distress. The AIPE was examined for sensitivity, specificity, and construct validity.ResultsA receiver operating characteristic curve indicated that the AIPE is an excellent diagnostic test. A cutoff score of 30 (range of scores 7–35) discriminated best (sensitivity = 0.98, specificity = 0.88). Severity of PE ranged from none (31–35) to severe (7–13). A high kappa value (0.85) indicated existence of significant agreement existed between the predicted and “true” PE classes.ConclusionsAIPE shows a potential to be a reliable aid to decrease the number of misdiagnosed cases of PE.Arafa M, and Shamloul R. Development and evaluation of the Arabic Index of Premature Ejaculation (AIPE).     

Brain Functional Biomarkers Distinguishing Premature Ejaculation From Anejaculation by ALFF: A Resting-State fMRI Study

IntroductionPremature ejaculation (PE) and anejaculation (AJ) are 2 opposite disorders of male ejaculatory dysfunction. Recent studies have demonstrated that the process of ejaculation is mediated by certain neural circuits in the brain. However, different mechanisms between PE and AJ are still unclear.AimTherefore, we used resting-state functional magnetic resonance imaging (fMRI) to explore the underlying neural mechanisms in patients with PE and AJ by measuring the amplitude of low-frequency fluctuations (ALFF).MethodsResting-state fMRI data were acquired in 17 PE, 20 AJ patients and 23 matched healthy controls (HC).Main Outcome MeasureDifferences of ALFF values among the 3 groups were compared. We also explored the correlations between brain regions showing altered ALFF values and scores of Premature Ejaculation Diagnostic Tool (PEDT) in the PE group.ResultsThere were widespread differences of ALFF values among the 3 groups, which included left anterior cingulate gyrus, precentral and postcentral gyrus, paracentral lobule, superior temporal gyrus, calcarine fissure, putamen; right postcentral gyrus, paracentral lobule, middle temporal gyrus, putamen. Compared with HC, PE patients had greater ALFF in the right inferior frontal gyrus (opercular part), AJ patients had greater ALFF in the left postcentral gyrus. In addition, PE patients exhibited greater ALFF in the left Rolandic operculum, anterior cingulate gyrus, inferior frontal gyrus (orbital part), putamen, and right putamen when compared with AJ patients, as well as decreased ALFF in the right postcentral gyrus. Moreover, positive correlations were found between ALFF of left postcentral gyrus, inferior frontal gyrus (orbital part), right inferior frontal gyrus (opercular part), and PEDT scores.Clinical ImplicationsThe differences in central pathophysiological mechanisms between PE and AJ might be useful for improving the clinical diagnosis of ejaculation dysfunction.Strength & LimitationsOur results showed that the method of fMRI could identify the differences of ALFF between PE and AJ and that these alterations in ALFF were related to clinical function. However, this was a relatively small sample study, and further multimodal neuroimaging studies with large samples were needed.ConclusionThe findings demonstrated that altered ALFF of frontal, parietal cortex, and putamen might help distinguish premature ejaculation from anejaculation. Abnormal function of these brain regions might play a critical role in the physiopathology of ejaculatory dysfunction of patients.Chen J, Yang J, Huang X, et al. Brain Functional Biomarkers Distinguishing Premature Ejaculation From Anejaculation by ALFF: A Resting-State fMRI Study. J Sex Med 2020;17:2331–2340.     

Are There Differences in Brain Morphology in Patients with Lifelong Premature Ejaculation?

IntroductionEven though lifelong premature ejaculation (PE) is highly prevalent, few studies have investigated the neural mechanisms underlying PE.AimThis study aimed to investigate whether patients with lifelong PE exhibit macrostructural or microstructural alterations of the parts of the brain involved in the male sexual response.Materials and MethodsWe enrolled 42 healthy participants and 54 lifelong PE patients. Lifelong PE was diagnosed according to the Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculation latency time (IELT). We compared measures of cortical morphology, such as volumes of gray matter, white matter, cerebellum volumes, and subcortical structures (ie, amygdala, caudate, hippocampus, globus pallidus, putamen, and thalamus) between the groups using a voxel-based morphometry method from whole-brain T1-weighted magnetic resonance imaging. Moreover, we evaluated the relationships between the relevant cerebral alterations and the severity of symptoms obtained from participants via self-reported questionnaires.Main Outcome MeasuresCerebral macrostructural and microstructural alterations were assessed in PE patients and controls, along with the correlation of caudate nucleus changes in PE patients with clinical data (including the PEDT and the IELT).ResultsThe mean volume of the caudate nucleus was significantly larger in the lifelong PE patients compared with healthy controls (P = .048). Moreover, caudate nucleus volume was positively correlated with PEDT score (r = 0.621; P = .0179) and negatively correlated with the IELT (r = ?0.592; P = .0101). However, cortex morphology and the other subcortical volumes were not significantly different between the 2 groups (P > .05).Clinical ImplicationsMicrostructural alterations in deep gray matter nuclei might be a useful parameter for studying the mechanism of the neurobiology underlying PE.Strengths and LimitationsThere are few studies examining microstructural changes in PE patients. This study furthers our understanding of the etiology of PE. Limitations include the small sample, which limits our ability to make an absolute determination as to whether such subcortical changes are the cause or the consequence of lifelong PE.ConclusionsWe found a significant difference in caudate nucleus volume between patients with PE and healthy controls. In addition, the caudate nucleus volume was positively associated with the severity of PE symptoms. More extensive and possibly longitudinal studies are needed to improve our understanding of the mechanism of the neurobiology underlying PE.Atalay HA, Sonkaya AR, Ozbir S, et al. Are There Differences in Brain Morphology in Patients with Lifelong Premature Ejaculation? J Sex Med 2019;16:992–998.     

Relationship between Premature Ejaculation and Chronic Prostatitis/Chronic Pelvic Pain Syndrome

IntroductionChronic 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.AimsThis study aims to evaluate the relationship between PE and CP/CPPS.MethodsA 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 MeasuresAssociations of PEDT with NIH‐CPSI.ResultsThe 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).ConclusionsOur 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. Lee JH and Lee SW. Relationship between premature ejaculation and chronic prostatitis/chronic pelvic pain syndrome. J Sex Med 2015;12:697–704.     

Evaluation of Tramadol on Demand Vs. Daily Paroxetine as a Long-Term Treatment of Lifelong Premature Ejaculation

IntroductionPremature ejaculation (PE) is the most common male sexual dysfunction with many lines of treatment that show conflicting results. Paroxetine and tramadol were both reported to be effective in treatment of PE.AimTo investigate the effectiveness of long-term daily paroxetine vs. on-demand tramadol HCl in treatment of PE.Main Outcome MeasuresIntravaginal ejaculatory latency time (IELT) and Arabic Index of PE (AIPE) were used to assess the efficacy of investigated drugs.MethodsThirty-five cases with lifelong PE were enrolled in this study. Baseline recording of IELT using a stop watch and AIPE was done. Patients were randomized to take tramadol HCl on-demand or daily paroxetine. Reassessment was done after 6 and 12 weeks. A wash-out period for 2 weeks was given before cross-over to the other medication. Assessment of the effect of the second medication after 6 and 12 weeks was done.ResultsTramadol and paroxetine increased IELT significantly after 6 weeks by seven- and 11-folds, respectively, compared with baseline. After 12 weeks, a decline of IELT to fivefolds was recorded with tramadol whereas further increase of IELT to 22-folds was recorded with paroxetine compared with baseline (P < 0.05). Tramadol improved AIPE score significantly after 6 weeks but not after 12 weeks vs. baseline, whereas paroxetine increased the AIPE score after 6 and 12 weeks vs. baseline (P < 0.05).ConclusionsDaily paroxetine is more effective than on-demand tramadol for treatment of lifelong PE. Tramadol is not recommended as a long-term treatment of lifelong PE. Alghobary M, El-Bayoumy Y, Mostafa Y, E-HM Mahmoud, and Amr M. Evaluation of tramadol on demand vs. daily paroxetine as a long-term treatment of lifelong premature ejaculation.     

The Combination of Dapoxetine and Behavioral Treatment Provides Better Results than Dapoxetine Alone in the Management of Patients with Lifelong Premature Ejaculation

IntroductionIt is not known whether the efficacy of dapoxetine, the only drug approved for the on‐demand treatment of premature ejaculation (PE), can be increased by the addition of sexual behavioral treatment (SBTx).AimTo test the hypothesis that combined dapoxetine and SBTx provide better result than dapoxetine alone in the management of patient with lifelong PE.MethodsAfter a 4‐week run‐in period, 50 patients with lifelong PE entered a 24‐week, open‐label, prospective study with a 1:1 assignment. Twenty‐five patients (group A) received on‐demand dapoxetine 30 mg alone, and the remaining 25 patients (group B) combined on‐demand dapoxetine 30 mg and SBTx. The CONSORT 2010 statement was adhered to where possible.Main Outcome MeasuresThe intravaginal ejaculatory latency time (IELT), the premature ejaculation diagnostic tool (PEDT) score, and the treatment‐emergent adverse events (TEAEs) were analyzed.ResultsMean age was 34.16 years in group A and 34.44y in group B. From baseline to 4‐, 12‐ and 24‐week evaluation, both groups experienced a significant (P < 0.0001) increase in mean IELT and decrease in mean PEDT score, but patients in group A showed a significantly lower increase in mean IELT (85.0; 84.8; 130.7; 160.0 vs. 92.0; 137.9; 232.7; 370.7 seconds, respectively; P < 0.0001) and a significantly lower decrease in mean PEDT score (20.4; 18.16; 15.88; 14.68 vs. 19.56; 16.0; 11.96; 7.92, respectively; P < 0.0001) than those in group B. At 24‐week evaluation, no patient in group A reached a PEDT score ≤8 (absence of PE) as opposed to 80% of patients in group B. There was no difference between groups in TEAEs rate (16% vs. 16%; P = 1.00). Limitations included the absence of a group receiving SBTx alone or group crossover.ConclusionsCombined dapoxetine and SBTx proved to be more effective than dapoxetine alone in treating patients with lifelong PE, up to restoring a normal ejaculatory function in most of them. Cormio L, Massenio P, La Rocca R, Verze P, Mirone V, and Carrieri G. The combination of dapoxetine and behavioral treatment provides better results than dapoxetine alone in the management of patients with lifelong premature ejaculation. J Sex Med 2015;12:1608–1614.     

Efficacy and safety of dapoxetine for the treatment of premature ejaculation: integrated analysis of results from five phase 3 trials

IntroductionDapoxetine 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.AimTo present integrated efficacy and safety data from phase 3 trials of dapoxetine.MethodsData 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.Main Outcome MeasuresEnd points included stopwatch‐measured IELT, Premature Ejaculation Profile (PEP) items, clinical global impression of change (CGIC) in PE, and adverse events (AEs).ResultsAverage 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.ConclusionsIn this diverse population, dapoxetine significantly improved all aspects of PE and was generally well tolerated. McMahon CG, Althof SE, Kaufman JM, Buvat J, Levine SB, Aquilina JW, Tesfaye F, Rothman M, Rivas DA, Porst H. Efficacy and safety of dapoxetine for the treatment of premature ejaculation: Integrated analysis of results from five phase 3 trials. J Sex Med 2011;8:524–539.     

Comparison Between On‐Demand Dosing of Dapoxetine Alone and Dapoxetine Plus Mirodenafil in Patients with Lifelong Premature Ejaculation: Prospective,Randomized, Double‐Blind,Placebo‐Controlled,Multicenter Study

IntroductionThere is partial evidence to support the use of phophodiesterase‐5 inhibitor (PDE5‐I) for the treatment of premature ejaculation (PE).AimWe compared on‐demand dosing of dapoxetine alone and combined with mirodenafil in subjects with lifelong PE and without erectile dysfunction (ED).MethodsOur prospective, randomized, double‐blind, placebo‐controlled, multicenter trial enrolled 118 subjects with lifelong PE without ED. PE was diagnosed using Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. Patients were divided into two groups: dapoxetine 30 mg plus placebo (group A, n = 56) and dapoxetine 30 mg plus mirodenafil 50 mg (group B, n = 62).Main Outcome MeasuresDuring 12 weeks, intravaginal ejaculatory latency time (IELT) and the time from foreplay to beginning intercourse (FTIT) with a stopwatch, and Premature Ejaculation Profile (PEP) were measured. Overall sexual act time (OSAT; sum of FTIT and IELT) was calculated. Any treatment‐emergent adverse events (TEAEs) were also recorded.ResultsOver 12 weeks, IELT, OSAT, and PEP index score significantly improved in group B compared with group A (increased geometric mean IELT in group A and B = 3.6 and 6.1 minutes, P = 0.026; increased geometric mean OSAT in group A and B = 5.5 and 9.9 minutes, P = 0.012; increased median PEP index score in group A and B = 1.0 and 1.3, P = 0.046). However, there was no significant difference between two groups with respect to improvement of FTIT (P = 0.147). TEAEs did not differ between groups (all P > 0.05), and there was no serious adverse event in any subjects.ConclusionsLow dose of dapoxetine combined with mirodenafil showed better results in terms of IELT, OSAT, and PEP index score, and similar TEAEs, compared with that of dapoxetine only. Our results support the suggestion that the PDE5‐Is have a potential role in the treatment of PE without ED. Lee WK, Lee SH, Cho ST, Lee YS, Oh CY, Yoo C, Cho JS, Lee SK, and Yang DY. Comparison between on‐demand dosing of dapoxetine alone and dapoxetine plus mirodenafil in patients with lifelong premature ejaculation: Prospective, randomized, double‐blind, placebo‐controlled, multicenter study. J Sex Med 2013;10:2832–2841.     

Relationship between premature ejaculation and depression in Korean males

IntroductionThe 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.AimWe 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.MethodsA 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.Main Outcome MeasuresEjaculation‐related questionnaire, the IIEF‐EF, and BDI.ResultsA 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.ConclusionKorean men with subjective perceptions of PE are prone to various psychological problems, which include depression. Son H, Song SH, Lee J‐Y, and Paick J‐S. Relationship between premature ejaculation and depression in Korean males. J Sex Med 2011;8:2062–2070.     

Prevalence and Factors Associated with the Complaint of Premature Ejaculation and the Four Premature Ejaculation Syndromes: A Large Observational Study in China

IntroductionAlthough the new classification of premature ejaculation (PE) has been proposed by Waldinger et al., there have been few studies investigating the four PE syndromes in China.AimsWe investigated the prevalence and factors associated with the complaint of PE and the four PE syndromes in Anhui province, China.MethodsBetween September 2011 and September 2012, subjects were selected from five cities in Anhui province, China. They participated in this survey by completing a detailed verbal questionnaire regarding their demographic data and medical and sexual history. Men with PE complaint were diagnosed as lifelong PE (LPE), acquired PE (APE), natural variable PE (NVPE), or premature‐like ejaculatory dysfunction (PLED).Main Outcome MeasuresPE complaint was divided into four PE syndromes. Anxiety, depression, and erectile dysfunction were independently assessed by the self‐rating anxiety/depression scale and the international index of erectile function‐5, respectively.ResultsOf the 3,016 men evaluated, 25.80% complained of PE. The distribution of the four PE syndromes in men with PE complaint was in the order of NVPE (44.09%), PLPE (24.81%), APE (18.77%), and LPE (12.34%). Patients with PE complaint were older and more likely to smoke, had more comorbidities, and a higher body mass index (BMI) than patients without the complaint (P < 0.001 for all). Similar findings were also observed in patients with APE compared with other PE patients (depression P = 0.012, cardiovascular P = 0.003, others P < 0.001). In addition, the rates of counseling by a doctor in men with LPE and APE were higher than those in men with NVPE and PLED (P < 0.001).ConclusionThe prevalence of PE complaint in male population of Anhui province, China, was 25.80%, with the highest PE syndromes being NVPE and PLPE. Patients with PE complaint or APE were older and more likely to smoke, had more comorbidities, and a higher BMI. Gao J, Zhang X, Su P, Liu J, Xia L, Yang J, Shi K, Tang D, Hao Z, Zhou J, and Liang C. Prevalence and factors associated with the complaint of premature ejaculation and the four premature ejaculation syndromes: a large observational study in China. J Sex Med 2013;10:1874–1881.     

Antibiotic treatment can delay ejaculation in patients with premature ejaculation and chronic bacterial prostatitis

IntroductionPremature ejaculation (PE) is regarded as the most common male sexual disorder. Previous studies reported that prostatic inflammation was highly prevalent in PE. However, the effect of antibiotic treatment of cases with PE and chronic prostatitis has not been extensively investigated.AimTo examine the effect of antibiotic treatment in delaying ejaculation in patients with PE and chronic prostatitis.MethodsA total of 145 consecutive men attending of secondary premature ejaculation (SPE) were included in this study. Sequential microbiologic specimens were obtained from urine and prostatic fluid. Antibiotics were given for 1 month according to the results of their culture and sensitivity test. All patients were instructed to follow up with our clinic monthly for at least 4 months. At the end of the 4-month follow-up, another prostatic secretion analysis was performed.ResultsBased on expressed prostatic secretion culture and white blood cell (WBC) count, 94 (64.8%) were having chronic bacterial prostatitis. The remaining 51 (35.2%) patients had negative WBC count. Of the 94 patients with SPE and chronic bacterial prostatitis, 20 patients were left untreated and considered as a control group. All 74 patients with PE and chronic prostatitis continued the 1-month treatment duration. Following 1-month antibiotic treatment, all 74 patients with initially positive cultures had sterile final cultures (P < 0.05). Sixty-two (83.9%) patients showed increases in their ejaculatory latency time and reported good control of their ejaculation and were considered treatment responsive. None of the control group patients experienced any improvement either in their prostatic infection condition or in their ejaculation time. The follow-up of treatment-responsive patients (N = 62) revealed no recurrence of PE with negative prostatic culture.ConclusionsSuccessful eradication of causative organisms in patients with PE and chronic prostatitis may lead to marked improvement in intravaginal ejaculatory latency time and ejaculatory control. El-Nashaar A, and Shamloul R. Antibiotic treatment can delay ejaculation in patients with premature ejaculation and chronic bacterial prostatitis.     

Premature Ejaculation Is Associated with Glycemic Control in Type 1 Diabetes

IntroductionPremature ejaculation (PE) is the most common male sexual dysfunction. Its prevalence in Type 1 diabetes is unknown.AimThe aim of this study was to assess the prevalence of PE in Type 1 diabetes and the influence of glycemic control on ejaculatory function.MethodsOne hundred Type 1 diabetic male patients (age < 40 years) and 51 age-matched nondiabetic control subjects were evaluated for PE. A subgroup of 30 diabetic patients (20 with PE and 10 without) were also evaluated for blood glucose variability.Main Outcome MeasuresThe presence of PE was assessed with the premature ejaculation diagnostic tool (PEDT) and the self-estimated intravaginal ejaculatory latency time (IELT). Glucose variability was evaluated by continuous glucose monitoring for a 7-day period with a DexCom G4 CGM system: the mean amplitude of glycemic excursions (MAGEs), low (LBGI) and high (HBGI) blood glucose indices, and the standard deviation of blood glucose (BGSD) were calculated.ResultsPE prevalence did not differ significantly between the two groups: pathological values of the PEDT score (>8) and IELT score (<1 minute) were recorded in 24 out of 100 diabetic patients (24%) and in 12 out of 51 controls (23.5%). There were significant associations between hemoglobin A1c and the PEDT score (r = 0.27; P = 0.006) and IELT (r = −0.3; P = 0.01). In the subgroup assessed for glucose variability, the PEDT score was associated with LBGI (r = 0.43; P = 0.01), but not with BGSD (r = 0.1, P = 0.6), MAGE (r = −0.1; P = 0.4), or HBGI (r = 0.1; P = 0.6).ConclusionsOur results show a similar prevalence of PE in young male patients with Type 1 diabetes and in the age-matched control population; in diabetic patients with PE, a higher glycemic variability in the hypoglycemic domain is significantly associated with the PEDT score. Bellastella G, Maiorino MI, Olita L, Della Volpe E, Giugliano D, and Esposito K. Premature ejaculation is associated with glycemic control in Type 1 diabetes. J Sex Med 2015;12:93–99.