Application of micronised acellular dermal matrix for primary premature ejaculation: A preliminary study

This study aimed to explore the efficacy of injection of micronised acellular dermal matrix (MADM) particles for treating primary premature ejaculation. This study was a prospective single-arm clinical trial. Thirty patients who met the surgical indications were enrolled. MADM particles, mixed in platelet-rich plasma, were injected into Buck's fascia to spread over the dorsal penile nerve, suppress the influx of nerve impulses and, thus, reduce penis sensitivity. We evaluated the changes according to intravaginal ejaculation latency time using a stopwatch and a premature ejaculation diagnostic tool. Meanwhile, we also recorded sexual partner satisfaction and adverse events. All patients recovered well after surgery with no complications such as infections or allergies. The mean intravaginal ejaculation latency time before surgery was 0.72 ± 0.28 min, compared with 2.41 ± 0.54 min, 2.64 ± 0.41 min, 2.79 ± 0.25 min and 2.89 ± 0.35 min at, respectively, 4, 8, 16 and 20 weeks after surgery. The premature ejaculation diagnostic values and sexual partner satisfaction had significantly improved after treatment. Injection of MADM particles is an effective, safe and simple method for treating premature ejaculation.     

Psychosocial stress,somatoform dissociative symptoms and free testosterone in premature ejaculation

One of the most common sexual dysfunctional diseases in adult males is premature ejaculation. So far, there is no evidence of how premature ejaculation is associated with psychosocial stress. We tested the relationship between neuroendocrine changes in patients with premature ejaculation and indicators of stress experience as a new psychosomatic hypothesis where psychosocial stress may significantly contribute to the aetiology of premature ejaculation. A total of 55 patients with premature ejaculation were included in the study. The control group consisted of 55 healthy men. The diagnosis of premature ejaculation was confirmed by a sexology examination, a history of patients and the values of the premature ejaculation diagnostic tool questionnaire. Comprehensive biochemical serum analysis was focused on the values of total testosterone, free testosterone, luteinising hormone, thyroid-stimulating hormone, dehydroepiandrosterone sulphate, sex hormone-binding globulin and a premature ejaculation diagnostic tool score with trauma symptom checklist and somatoform dissociation questionnaire. The results show significant Spearman correlations of trauma symptom checklist with the premature ejaculation diagnostic tool score (R = 0.84) and free testosterone (R = 0.62) and somatoform dissociation questionnaire with the premature ejaculation diagnostic tool score (R = 0.53) and free testosterone (R = 0.57). Spearman correlations of trauma symptom checklist with somatoform dissociation questionnaire show significant correlation (R = 0.54).     

Does anogenital distance change with age?

It was known that in animals, anogenital distance (AGD), an indicator of prenatal androgen environment, was a stabile phenotype that persists throughout life. However, it is not known whether this applies to humans. In this study, we aimed to investigate whether anogenital distance is stable or not in males. We evaluated a total of 130 men targeted for group 1 (fathers) and group 2 (sons) in each 65 participants. AGD, the distance from anus to the posterior base of the scrotum, was measured with digital calipers. Anthropometric characteristics and testosterone levels of groups were recorded. We studied anogenital index (AGI), by dividing AGD by BMI to control bias of the weight and height, which could influence the measurement of AGD. The mean age of fathers was 61.5 ± 10.2 and that of children was 32.1 ± 5.48 (p = .00). The mean AGD scores were 55.46 ± 10.36 vs. 60.21 ± 10.04 (p = .09) and the mean total testosterone levels were 3.6 ± 1.47 vs. 5.45 ± 2.3 (p = .00) in group 1 and 2 respectively. There was no significant difference in height and weight between the two groups. AGD decreases with age, but further longitudinal studies are needed.     

Premature ejaculation and stress

Recent findings indicate that men with premature ejaculation report more frequent sexual problems associated with increased anxiety and interpersonal difficulties. Bearing this in mind, the neuroendocrine changes were examined in men with premature ejaculation and compared to other indicators of stressful experiences to see whether there can be any correlation which could indicate how these factors may contribute to the aetiology of premature ejaculation. Our study comprised 60 male outpatients diagnosed as having secondary premature ejaculation. Clinical examinations were focused on biochemical analysis of cortisol and psychometric scoring using a diagnostic tool for premature ejaculation, traumatic stress and somatoform dissociation. The control group consisted of a 60 healthy men. The results showed significant Spearman correlations of the Premature Ejaculation Diagnostic Tool score with Trauma Symptom Checklist score (R = .86), cortisol level (R = .47) and Somatoform Dissociation Questionnaire score (R = .61). In the control group, the results did not reach statistical significance. Spearman correlations of the Premature Ejaculation Diagnostic Tool score with Trauma symptoms checklist score was (R = .21), cortisol (R = .27) and with Somatoform dissociation questionnaire score (R = .25). These results represent the first reported findings documenting the relationship of traumatic stress indicators with the experience of secondary premature ejaculation and cortisol levels.     

Safety and efficacy of traditional Chinese medicine,Qiaoshao formula,combined with dapoxetine in the treatment of premature ejaculation: An open-label,real-life,retrospective multicentre study in Chinese men

To evaluate the safety and efficacy of Chinese medicine, Qiaoshao formula combined with dapoxetine was used for the treatment of premature ejaculation in a real-life setting. Nine hundred and five males diagnosed with premature ejaculation were reviewed in this retrospective cohort study. We divided the patients into two groups: dapoxetine alone and Qiaoshao formula combined with dapoxetine according to actual interventions provided to patients in clinics. The perceived intravaginal ejaculation latency time and the premature ejaculation profile measures markedly improved in both groups. However, in men with severe premature ejaculation (baseline perceived intravaginal ejaculation latency time <1 min) and those with baseline age ≤30 years, the perceived intravaginal ejaculation latency time was slightly but significantly longer with combined therapy than with dapoxetine alone (p < .05). Therefore, combined therapy involving the Qiaoshao formula and dapoxetine proved to safe as well as effective for treating premature ejaculation while prolonging the perceived intravaginal ejaculation latency time, which significantly improved the overall satisfaction of the patient and likely that of the couple.     

Impact of varicocelectomy on urine dopamine value in patients with premature ejaculation and varicocele

Dopamine is an important regulator of male sexual function and behaviour. Decreased levels of this substance have been observed in blood and seminal plasma of infertile men. Hence, this study was carried out to determine the impact of varicocelectomy on 24‐hr urine dopamine values in patients with both premature ejaculation (PE) and varicocele. In this prospective study, 55 consecutive patients with premature ejaculation and grade 2 or 3 varicocele were enrolled. The urine dopamine level was measured in a 24‐hr sample by HPLC method in a single laboratory centre. Two samples were gathered from each patient, one before and the other 1 month after varicocelectomy. The mean initial and final 24‐hr urine dopamine levels were 259.6 ± 86.3 and 602.9 ± 88.4 micrograms, respectively, showing statistically significant increase (p = .0001), while there was no statistically significant difference between urine volume and creatinine. However, the change in intravaginal ejaculation latency time value was not statistically significant at this short time visit. According to our findings, varicocelectomy results in a significant increase in 24‐hr urine dopamine levels in patients with premature ejaculation and varicocele. However, the effect of this change on premature ejaculation in the long term has yet to be determined.     

Comparison of the safety and efficacy of the on-demand use of sertraline,dapoxetine, and daily use of sertraline in the treatment of patients with lifelong premature ejaculation: A prospective randomised study

This study compared the safety and efficacy of the on-demand (OD) use of sertraline (50 mg), sertraline (100 mg) and dapoxetine (30 mg), and the daily use of sertraline (50 mg) in the treatment of patients with premature ejaculation (PE). This prospective randomised study involved 120 lifelong PE patients (intravaginal ejaculatory latency time [IELT]: <1 min; Arabic Index of Premature Ejaculation [AIPE] score: < 30) without secondary causes of PE, identified between March 2018 and May 2020. Patients were divided into 4 groups (30 patients per group) and treated for 8 weeks. Assessments were conducted using the AIPE form as a diagnostic tool. Sertraline (50 mg, daily; 196.7 ± 115.5 s) and sertraline (100 mg, OD; 173.3 ± 97.0 s) had similar IELT and AIPE scores. The latter groups had better results in comparison with sertraline (50 mg, OD; 100.5 ± 54.4 s) and dapoxetine (93.7 ± 53.5 s; p < 0.01). Sertraline (100 mg, OD) had a similar efficacy to that of sertraline (50 mg, daily) and was more effective than sertraline (50 mg, OD) and dapoxetine (30 mg, OD). Sertraline (100 mg, OD) can be considered in the treatment of lifelong PE treatment, having tolerable side effects.     

The efficacy of regular penis-root masturbation,versus Kegel exercise in the treatment of primary premature ejaculation: A quasi-randomised controlled trial

To explore the efficacy of regular penis-root masturbation (PRM) versus Kegel exercise (KE) in the treatment of primary premature ejaculation (PPE). This study was a prospective quasi-randomised controlled trial. Thirty-seven heterosexual males with PPE were selected according to the time sequence of outpatient consultations and the preliminary results of a pre-experiment and were assigned to an PRM group and a KE group. Differences in intravaginal ejaculatory latency times (IELTs) and premature ejaculation diagnostic tool (PEDT) scores were compared between the two groups. The study was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University. Among the 37 PPE patients, 18 performed PRM and 19 patients performed KE. The IELTs of patients who performed PRM and KE were significantly prolonged before treatment, and the difference after treatment was statistically significant (p < .05). Compared with the KE group, the IELT prolongation effect in the PRM group was more significant PRM (p < .05). The PEDT scores of patients after performing PRM and KE were significantly lower than those before performing these exercises (p < .05). Compared with the KE group, the PEDT scores of the PRM group exhibited a greater decrease (p < .05). Thus, both PRM and KE have therapeutic effects on PPE. Compared with KE, PRM is more effective in the treatment of PPE.     

脱细胞异体真皮在阴茎增粗效果下对原发性早泄的影响

目的探讨应用人脱细胞异体真皮(human acellular dermal mantrix,HADM)在阴茎增粗方案中治疗男性原发性早泄的疗效及安全性。方法采用回顾性分析我院2017年3月~2019年8月收治的94例原发性早泄患者,通过阴茎神经电生理结果划分阴茎皮肤高敏感型及混合型早泄患者作为本次课题研究对象,评估内容包括手术前后阴茎体感诱发电位(DNSEP/GPSEP)潜伏期、阴茎交感皮肤反应(PSSR)潜伏期、阴茎中段周径(疲软)、中国早泄指数-5评分(CIPE-5)、阴道内射精潜伏期(IELT)、国际勃起功能评分问卷-5(IIEF-5)以及患者与性伴侣的满意度。结果对比患者术前及术后3月各项指标,除IIEF-5外,术后患者阴茎中段周径(疲软)明显增粗、阴茎体感诱发电位(DNSEP/GPSEP)潜伏期、阴茎交感皮肤反应(PSSR)潜伏期、IELT明显延长、CIPE-5及性伴侣的满意度明显改善,有统计学意义(P<0.05)。结论在应用脱细胞异体真皮阴茎增粗方案中,治疗男性原发性阴茎皮肤高敏感型及混合型早泄效果显著,患者阴道内射精潜伏期时间明显增长,同时,性生活质量显著提升,并发症极少,安全有效。因此,值得在当今临床中应用和推广。     

Relationship between atherogenic indices and acquired premature ejaculation

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

Correlations and stratification analysis between premature ejaculation and psychological disorders

We studied the associations and correlations between premature ejaculation (PE) and psychological disorders, such as anxiety and depression, in new perspectives with an aim of improving PE patients' treatment outcomes. Between December 2017 and December 2018, we selected 1,010 men aged over 18 years old. Self‐estimated IELT, the premature ejaculation diagnostic tool, the International Index of Erectile Function‐5, the General Anxiety Disorder‐7 and the Patients Health Questionnaire‐9 were used to measure latency time, premature ejaculation, erectile dysfunction, anxiety and depression respectively. Premature ejaculation patients were categorised into two types: lifelong PE (LPE) and acquired PE (APE). Among the 958 men evaluated, the prevalence of anxiety and depression in PE group was 82.07% (444/541) and 74.68% (404/541) respectively. Premature ejaculation patients after adjustment for age, negative association of IIEF‐5 and positive relation of PEDT score with GAD‐7/PHQ‐9 were observed (p < 0.01 for all). These associations in men with LPE were stronger than APE. Stratification of the duration of PE showed that the longer the duration is, the more the prevalence of anxiety and depression will be. Age stratification showed that under the impact of PE, young men tend to have severe psychological problems.     

Relevance of seminal plasma nitric oxide levels and the efficacy of SSRI treatment on lifelong premature ejaculation

The aim of this study was to determine the relevance of seminal plasma nitric oxide (NO) levels and the efficacy of selective serotonin reuptake inhibitor (SSRI) treatment on premature ejaculation. A total of 16 men (aged 32.18 ± 3.32) with lifelong premature ejaculation [intravaginal ejaculation latency time (IELT) <1 min] and 11 healthy men (control group) were included in this study. The healthy men formed Group 1, and the patients were randomly categorised into two groups. Group 2 patients received 20 mg day^?1 of paroxetine, and Group 3 patients received 50 mg day^?1 of sertraline for 4 weeks. Baseline and post‐treatment findings were compared among the three groups. Mean baseline seminal NO levels in men with premature ejaculation were significantly higher than in the healthy control group (32.24 ± 5.61 μm  l^?1 versus 19.71 ± 3.50 μm  l^?1, respectively) (P < 0.001). There was no significant difference between the sertraline and paroxetine groups in terms of IIEF scores, IELT scores and NO levels. At the end of the first month, the mean IELT scores of the paroxetine and sertraline groups showed a significant improvement compared with the baseline values (P < 0.001). After treatment with paroxetine and sertraline, NO levels dec‐reased from baseline. Our study indicates that premature ejaculation is significantly related with a higher level of seminal NO. Baseline seminal plasma NO values obtained in patients with premature ejaculation were significantly higher than in the healthy control group. After treatment with SSRIs, decreased seminal NO may retard ejaculation. Further studies are needed to confirm this suggestion and the role of NO in the pathophysiology and treatment of premature ejaculation.     

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

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

The decline in sexual function,psychological disorders (anxiety and depression) and life satisfaction in older men: A cross-sectional study in a hospital-based population

This study explored the relationships between the decline in sexual function and psychological burdens and life satisfaction in older men with the aim of providing prospective targets for interventions. From January 2016 to January 2019, we selected 1,326 men aged over 50 years old. We adopted the International Index of Erectile Function-5 (IIEF-5), self-estimated intravaginal ejaculatory latency time (IELT), the premature ejaculation diagnostic tool (PEDT), the General Anxiety Disorder-7 (GAD-7), the Patients Health Questionnaire-9 (PHQ-9), the satisfaction with life scale and the control, autonomy, self-realisation and pleasure scale (CASP-19) to measure premature ejaculation, erectile dysfunction and well-being (including, depression, anxiety, and life quality and satisfaction) respectively. The individuals were divided into two main groups: the decline group and the no-decline group. The incidences of erectile dysfunction (ED), premature ejaculation (PE), anxiety and depression in men who reported a decline in sexuality were 73.83% (330/447), 63.98% (286/447), 75.84% (339/447) and 68.46% (306/447) respectively. Men who showed a decline in sexuality had significantly worse psychological and life satisfaction/quality scores than those in the no-decline group (p < .001 for all). When they had PE or ED simultaneously, these differences widened. Significantly worsened psychological status and life quality/satisfaction scores could be observed in patients who had declined sexual desire and declined frequency of sex (p < .001 for both). Under the impact of the decline in sexual function, the younger participants (age < 60) had significantly worsened negative emotions and life quality and satisfaction. Based on the results of the study, we found that the decline in sexuality was associated with depression and anxiety and worse life satisfaction and quality. Clinicians need to pay more attention to psychological status and life satisfaction and quality for those patients affected by a decline in sexuality.     

西酞普兰治疗早泄的临床观察

目的:探讨西酞普兰治疗早泄的临床疗效和安全性。方法:将2011年5月至2012年5月男科门诊就诊的80例早泄患者随机分为治疗组和对照组,每组40例。治疗组每天口服西酞普兰20 mg,对照组口服安慰剂,记录治疗前、治疗2周和4周后患者阴道内射精潜伏时间(IELT)和性交满意度分值。结果:治疗组治疗2、4周后IELT分别为(5.64±1.31)min和(7.12±1.56)min,均比治疗前[(0.91±0.18)min]明显延长(P均<0.01),且西酞普兰治疗4周后的IELT明显高于2周后(P<0.01);治疗组治疗2、4周后性交满意度分别为(6.1±1.3)分和(6.3±1.1)分,与治疗前[(2.5±0.8)分]相比有明显提高(P<0.01),而治疗2周和4周后性交满意度无显著性差异(P>0.05)。对照组治疗2、4周后IELT和性交满意度分别为(1.02±0.24)min、1.01±0.21 min和(3.0±1.1)分、(3.1±1.3)分,与治疗前[(0.95±0.17)min和(3.2±1.2)分]比较,均无显著性差异(P均>0.05)。结论:每天口服西酞普兰20 mg,对早泄患者IELT和性交满意度均有明显改善,西酞普兰治疗早泄具有较好的临床疗效和安全性。     

Impact of physical activity on patient self‐reported outcomes of lifelong premature ejaculation patients: Results of a prospective,randomised, sham‐controlled trial

Previous studies have investigated whether physical activity increases serotonin hormone levels. Serotonin receptor dysfunction is one of the frequently accused factors of premature ejaculation (PE). Nevertheless, no studies up to date have demonstrated that the association between physical activity and premature ejaculation. We aimed to investigate the relationship between physical activity and PE and determine whether moderate physical activity might delay ejaculation time or be an alternative treatment for PE. A total of 105 patients diagnosed with PE were enrolled in this study. Of the patients, 35 were treated with dapoxetine, (30 mg) on demand (Group 1), 35 performed moderate physical activities (Group 2), and 35 performed minimal physical activity (Group 3‐sham). Demographic characteristics, metabolic equivalents (MET), premature ejaculation diagnostic tool (PEDT) and intravaginal ejaculatory latency time (IELT) were recorded. There were no significant differences among three groups in terms of age, BMI, MET, PEDT or IELT before treatment. At the end of the study, there was significant decrease in PEDT scores, and increase in IELT in groups 1 and 2 as compared to Group 3. In conclusion, a moderate physical activity longer than 30 min at least 5 times a week leads to ejaculation delay, and appears as an alternative to dapoxetine on demand for the treatment of PE.     

Penile Sensitivity in Patients with Primary Premature Ejaculation

Purpose

We investigated penile sensory levels in patients with primary premature ejaculation to determine whether there is an etiological basis for this condition.

Materials and Methods

Penile biothesiometry was performed in 120 patients with primary premature ejaculation without erectile dysfunction and neurological deficit, and in 66 normal potent male volunteers. Vibratory thresholds were recorded at the glans penis, penile shaft, scrotum and index finger using a biothesiometer.

Results

On the glans penis and penile shaft the values in patients with premature ejaculation were significantly less than those in normal potent men (p less than 0.001). In normal potent men an age dependency of biothesiometric parameters was noted, with a significant increase in vibratory threshold at the glans penis and penile shaft in older patients. However, in patients with premature ejaculation there were consistently decreased values without age dependency at the glans penis and penile shaft (p greater than 0.05).

Conclusions

Patients with primary premature ejaculation have penile hypersensitivity, which provides further implications for an organic basis of premature ejaculation.     

Long-term effects of glans penis augmentation using injectable hyaluronic acid gel for premature ejaculation

The authors created the glans penis augmentation by injectable hyaluronic acid gel and reported the 6-month result for premature ejaculation. In a total of 38 patients, long-term effects of 5 years were compared to those of 6 months in terms of residual volume of implants and efficacy on premature ejaculation. Maximal glandular circumference measured by tapeline significantly decreased by 15% (P<0.05) but mean patient's visual estimation (Gr 0-Gr 4) did not decrease (3.60 vs 3.56, P>0.05). Compared to 6-month follow-up, intravaginal ejaculatory latency time and vibratory threshold decreased at 5 years (P<0.05), but still well increased considering those of preaugmentation. Hence, 76% of patients and 63% of partners were still satisfied. There was no serious adverse reaction. In the 5-year long-term follow-up of glans penis augmentation by filler, the implants were well maintained and effective for glans penis hypersensitivity in premature ejaculation patients.     

The prevalence of premature ejaculation in young Turkish men

This study was conducted to investigate the prevalence of premature ejaculation (PE) in young Turkish men and to evaluate PE in a population having good physical and mental health. A total of 1230 healthy university graduates aged between 24 and 30 attending the police academy having no physical or mental problems were included in the study. To identify the presence of PE, the participants were asked to complete the premature ejaculation diagnostic tool (PEDT). The mean ages in the PE and non‐PE group were 27.3 and 26.7 respectively. There was no statistically significant difference between the two groups concerning age, body mass index (BMI), smoking status and alcohol consumption (P > 0.05). The PE prevalence was found to be 9.2%. The mean PEDT score was calculated as 6.3. Of the participants, 92 scored 11 and higher (9.2%), 66 scored 9 and 10 (6.6%), and the remaining 842 obtained a score equal to or lower than 8 (84.2%). The lower prevalence of PE in young Turkish men compared to the results of studies in the literature can be attributed to the physical and mental well‐being of the participants. This study showed that the prevalence of PE in young men with good physical and mental health is lower than that found in the literature.     

A new perspective on penis length measurement in children: How healthy are the results obtained with the current techniques?

In order to detect abnormalities in the size of the penis, firstly, the penis length must be measured correctly. Controversies about the best technique on to be used to measure the length of the penis still persist. The hypothesis of this study is to show that penile length in children is longer than measured under normal examination conditions. A total of 155 children who applied to our institution for circumcision whose stretched penis length (SPL) measurements were performed were included in the study. The distance from the pubic bone to the tip of the glans penis, which was maximally stretched, was measured. Under normal examination conditions (SPL 1), under general anaesthesia (SPL 2) and after skin/ subcutaneous tissues were released during circumcision (SPL 3). The mean age of the patients was 4.20 ± 2.66 years. Mean SPLs were measured as 5.48 ± 1.03 and 5.96 ± 1.01 and 6.54 ± 1.01 cm in SPL 1, SPL 2 and SPL 3 respectively. The amount of increase between penis length measurements was statistically significant (p = .001). In all cases (100%), penis length measurements in SPL 3 were longer relative to SPL 1 and SPL 2.