Prevalence of premature ejaculation: a global and regional perspective

The effort to determine the global burden of premature ejaculation (PE) has been impeded by the lack of a clear and universally accepted definition of the condition. Current diagnostic criteria are variable and rely, to a large degree, on subjective measurements. Moreover, the absence of a clear consensus on what constitutes a normal ejaculatory latency has impeded research into the prevalence of PE, although evidence is gradually accruing that may make this definition easier. Perception of "normal" ejaculatory latency varies by country and can differ when assessed either by the patient or their partner. Despite these limitations, information from the Global Study of Sexual Attitudes and Behaviors and other sources suggests a global prevalence of PE of approximately 30% across all age groups. The etiology underpinning this prevalence remains to be clarified, but current evidence reflects a shift from psychogenic theories to more neurobiological bases. While elucidation of the etiology of PE will undoubtedly aid the development of more effective therapies, it is clear that, whatever the cause of the condition, it is associated with a significant burden on psychological and overall health.     

Endometriosis in a rural remote setting: a cross-sectional study

Women in Western nations are exposed to an “unnatural” high number of menstrual cycles and this has been claimed to favour the development of endometriosis. If so, the prevalence of the disease should be low in remote rural settings characterized by high fertility rate, frequent teen-age pregnancy and protracted breast-feeding. To verify this hypothesis, we investigated the prevalence of endometriosis among women referring to the District Hospital of Aber, Northern Uganda for gynecological complaints. Subjects were considered affected if they had a history of surgery for endometriosis or if they had a positive clinical or ultrasound examination. Overall, a total of 528 gynecological consultancies were performed during the one year study period. Endometriosis was recorded in only one case. The frequency of the disease in the whole cohort of referred cases was thus 0.2% (95% confidence intervals (CI): 0.01–0.9%). When focusing on non-pregnant women in their reproductive age, it was 0.3% (95% CI: 0.01–1.3%). When considering women complaining symptoms suggestive for endometriosis, it was 0.4% (95% CI: 0.02–1.9%). In conclusion, endometriosis is rare in a community characterized by high fertility rate, frequent teen-age pregnancy and protracted breast-feeding, supporting the idea that the reproductive pattern plays a crucial role in the pathogenesis of the disease.     

Yoga in premature ejaculation: a comparative trial with fluoxetine

IntroductionYoga 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.AimTo know if yoga could be tried as a treatment option in PE and to compare it with fluoxetine.MethodsA 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 MeasureIntravaginal ejaculatory latencies in yoga group and fluoxetine control groups.ResultsWe 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.ConclusionsYoga 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. Dhikav V, Karmarkar G, Gupta M, and Anand KS. Yoga in premature ejaculation: A comparative trial with fluoxetine.     

Diagnosis and treatment of premature ejaculation: the physician's perspective

Premature ejaculation (PE) is a common condition associated with significant adverse effects on the sexual and overall quality of life of men with this condition. Behavioral therapies, such as the "squeeze" and "stop-start" techniques, and psychotherapy, have been the mainstay of PE management for many years. However, evidence of their short-term efficacy is limited while support for their long-term benefit is lacking. There are currently no medications licensed specifically for the treatment of PE. This paucity of pharmacological treatment may, in turn, contribute to the absence of systematic procedures for the identification, evaluation, and treatment of PE patients. Current "off-label" pharmacotherapeutic approaches include topical anesthetics, phosphodiesterase-5 inhibitors, and serotonin reuptake inhibitors. Of these, the serotonin reuptake inhibitors show the greatest efficacy and an increasing body of evidence is illuminating their mode of action. Nevertheless, all current "off-label" pharmacotherapeutic approaches fall short of the ideal therapy for PE. In the absence of a cure, such a treatment should be tolerable, inconspicuously used, effective from first dose, rapid in onset of action, and available as a prn-dosing regimen. It is anticipated that agents in development for the specific indication of PE will come closer to this ideal than existing pharmacotherapeutic approaches.     

The burden of premature ejaculation: the patient's perspective

Premature ejaculation (PE) remains an underdetected and under-treated condition, despite the advances in available treatment options. Men with PE often feel stigmatized by the condition and embarrassment is a key barrier to discussing the problem with healthcare professionals. Men with PE perceive themselves as having little control over ejaculation and this lack of control is mirrored in diminished satisfaction with sexual intercourse. The burden of PE is both emotional and physical. Premature ejaculation is associated with low self-esteem, anxiety, and feelings of shame and inferiority. In some studies there is an association with depression. Premature ejaculation places a significant burden on the patient-partner relationship and there is evidence to suggest that there is a higher prevalence of female sexual dysfunction associated with PE. Patients with PE often view the condition as purely psychological or as a problem that will resolve with time and many are unaware that medical treatment could be of benefit. This endorses the particularly important role of healthcare professionals in recognizing the barriers to patient diagnosis and promoting the view that PE is not only a common but also a treatable medical condition.     

Thermal ablation performed in a primary care setting: the South Warwickshire Experience

OBJECTIVE: To assess the feasibility of performing outpatient thermal ablation in a primary care setting. DESIGN: Prospective study. SETTING: A small peripheral hospital in the UK used by local general practitioners and visiting hospital practitioners for its outpatient facilities. POPULATION: The area of South Warwickshire serves a population of 270,000. METHODS: Two general practitioners were trained to perform outpatient thermal ablation using the Thermachoice thermal ablation system (Thermachoice II). The unit functioned autonomously with support from a local gynaecologist and radiologist, accepting referrals from hospital consultants and general practitioners. MAIN OUTCOME MEASURES: Severity of menstrual loss, premenstrual symptoms, dysmenorrhoea and quality of life assessed by visual analogue scales before treatment and at one month, two months, one year and two years. RESULTS: Eighty-seven women were treated. No major complications were encountered from the procedure. Reduction of menstrual loss or cure was reported by over 94% of women. Premenstrual syndrome (PMS) and symptoms of dysmenorrhoea were also improved by treatment. The majority of women were satisfied with the operation at one month (96%), two months (93%), one year (92%) and two years (94%). CONCLUSIONS: Thermal ablation is a simple procedure well suited to an outpatient setting. There are few complications as a result of the use of the thermal ablation catheters, and this study has shown that the procedure can be undertaken in a primary care setting with excellent results.     

Female sexuality and common sexual dysfunctions: evaluation and management in a primary care setting

Sexual dysfunctions are highly prevalent in today’s society. Male sexual disorders have received considerable attention, leading to a multitude of treatment options. Female sexual dysfunctions, on the other hand, have gone vastly underreported and untreated. A large part of this could be attributed to social mores, resulting in an overall lack of communication. The complex interplay between psychological and physiological factors involved in sexual response requires a comprehensive understanding of the norm and deviations from it. This review of the literature attempts to bring this topic into focus by concentrating on normal female sexual response, the many levels at which these dysfunctions may occur, identification in a clinical setting, and current therapeutic modalities.     

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.