射精潜伏期的研究进展

早泄虽然是男性人群中常见的性功能障碍类型,但迄今为止,尚没有被广泛接受的统一的早泄定义。越来越多的医生接受了多维早泄的定义,射精潜伏期(IELT)是早泄定义的3个重要维度(射精时间、不能控制或不能延迟射精、消极后果)之一。射精过快是早泄的核心症状之一。IELT是衡量射精快慢的较好客观指标,也是评价早泄的重要工具。本文对一般男性人群、早泄患者或自诉有早泄人群的IELT、估计的IELT与测量的IELT关系以及IELT的影响因素等研究进展进行了综述。     

帕罗西汀与氯丙咪嗪治疗早泄的临床对照研究

目的：研究氯丙咪嗪与帕罗西汀治疗早泄的疗效和副作用。方法：选择先例DSM-Ⅳ上泄诊断标准的病人80名，随机分为帕罗西汀和氯丙咪嗪两个治疗组，病人每天服用帕罗西汀20mg或氯丙咪嗪30mg，4周后用自行编制的问卷评价治疗结果。结果：帕罗西汀组有5个病人脱落，氯丙咪嗪组脱落7个，两组之间在疗效和起效时间方面没有明显差异，氯丙咪嗪组副作用略多于帕罗西汀组。结论：两种药都可以用于治疗早泄，鉴于大剂量服用氯丙咪嗪有一定危险性，建议由有经验的医生使用。     

性功能正常男性的射精潜伏期与阴茎敏感度的关系

为了客观测量性功能正常男性的射精潜伏期和阴茎敏感度，作者分别检测正常男性在检查室、家中手淫及性交时射精潜伏期的正常范围，用2个振动计测量阴茎表面6个不同区域阴茎敏感度的范围、评价阴茎敏感度与射精潜伏期是否相关。58名年龄20～40岁的健康志愿者参与研究，提供了3次射精潜伏期并分别在阴茎表面6个区域接受生物震感域测量器和SMV-5振动计检查。     

中国早泄患者性功能评价表对早泄患者的多维评估

目的 评估中国早泄患者性功能评价表(CIPE)对早泄诊断的临床意义。方法 以早泄为主诉患者和性功能正常的健康人,分别填写CIPE,进行统计学分析。结果 早泄患者167例,射精潜伏期平均(1.6±1.2)min,正常对照组114例,射精潜伏期平均(10.2±9.5)min,两组,CIPE 10项目平均积分分别为(26.7±4.6)分和(41.9±4.0)分,两组比较差异有显著意义(P<0.001)。回归相关分析结果,CIPE 10项问题中筛选出CIPE-5 5项问题包括射精潜伏期、患者性生活满意度、配偶性生活满意度、射精控制困难程度及焦虑紧张程度等与早泄显著相关(P<0.001)。同时早泄患者可分类轻度20.4％(>13分),中度53.4％(10～13分),重度26.2％(5～9分)。结论 CIPE有利于临床上评估早泄患者性功能,并提供较客观的量化指标。     

包皮成形术对早泄治疗的探讨

早泄是一种最常见的男性性功能障碍 ,有资料表明发病率最高达 75 %。但大多数的研究表明早泄的发病率是 14%～ 4 1% [1] 。我们根据阴茎包皮的解剖结构特点以及性反射机理 ,自 1996年开始采用包皮成形术 ,使射精潜伏期延长 ,取得了较好的疗效。现报告如下。1　资料与方法1.1　一般资料　入选标准 :①符合美国泌尿外科学会 (AUA) [2 ] 早泄的诊断标准 ;②已婚或同居、有稳定和规律性生活的男性 ;③无勃起功能障碍和严重的肝肾疾病 ;④自愿进行包皮及系带成型手术治疗观察。自 1996年 7月～ 2 0 0 2年 7月 ,我科共收治门诊治疗的早泄病人 11…     

精索静脉结扎术对阴道内射精潜伏期的影响

目的:调查精索静脉曲张患者的阴道内射精潜伏期(IELT),并研究精索静脉结扎术对IELT的影响及疼痛视觉模拟评分(VAS)与IELT的关系。方法:选择接受精索静脉结扎术的有规律性生活的112例患者,术后6个月进行随访,根据术前IELT分为IELT≤2 min组及IELT2 min组,调查入选患者手术前后IELT、VAS评分及中国早泄患者性功能评价(CIPE-5)评分。结果:81例患者获得有效随访。①81例精索静脉曲张患者中IELT≤2 min组18例,IELT2 min组63例。IELT≤2 min组及IELT2 min组患者术后均较术前出现IELT显著延长[(1.26±0.37)min vs(4.53±1.69)min,P0.01;(5.14±2.03)min vs(7.69±4.51)min,P0.05]。②IELT≤2 min组患者CIPE-5手术后较手术前有显著升高[(15.64±2.37)分vs(11.27±3.52)分,P0.05],IELT2 min组患者手术前后CIPE-5未见显著差异[(21.83±5.49)分vs(20.42±4.65)分,P0.05]。两组患者CIPE-5评分分级术后分别较本组术前有显著性差异(χ2=6.353,P=0.042;χ2=3.910,P=0.048)。③两组患者VAS评分手术后较手术前有显著下降[(1.56±0.83)分vs(3.18±0.92)分和(1.74±0.79)分vs(3.24±0.95)分,P均0.05]。两组患者治疗后VAS评分分级较同组术前均有显著改善(χ2=4.433,P=0.035;χ2=10.088,P=0.001)。④两组患者VAS评分变化与IELT变化呈显著负相关(r=-0.572,P0.01;r=-0.465,P0.05)。结论:精索静脉曲张可能是早泄的原因之一,精索静脉结扎术可使部分精索静脉曲张并IELT≤2 min的患者受益,且疼痛的VAS评分改善情况与IELT延长时间呈显著负相关,精索静脉曲张与早泄的关系值得进一步研究。     

曲唑酮治疗继发性早泄疗效相关文献的系统评价

目的参照Cochrane体系,系统评价曲唑酮治疗继发性早泄患者的相关文献,探讨曲唑酮治疗继发性早泄的临床疗效。方法通过检索1995年1月至2015年1月期间中国学术期刊数据库等8个数据库内相关的随机对照试验(RCT),严格评价纳入文献质量和资料提取,使用Stata/SE version 12.0软件进行系统评价。结果最终纳入7篇RCT,共542例患者,其中实验组203例(予以曲唑酮)、对照组194例(予以安慰剂)。系统评价结果显示:相比使用安慰剂的对照组,经曲唑酮治疗后第2周的阴道内射精潜伏期显著延长[SMD 1.28,95%CI(0.98,1.57)],第4周的阴道内射精潜伏期显著延长[SMD 4.09,95%CI(2.56,5.62)],并且患者对性生活的满意度显著提升[RR1.39,95%CI(1.07,1.79)];经偏倚性验证,上述结论稳健,具有推广性。结论经曲唑酮治疗继发性早泄,能显著延长患者的阴道内射精潜伏期、提升患者性生活满意度,其疗效确切,值得临床推广。     

阴茎背神经选择性切断术提高阴茎感觉阈值的临床分析

目的 观察阴茎背神经选择性分支切断术治疗原发性早泄(PPE)的临床疗效,及在勃起状态下手术前后的阴茎震动感觉阈值变化.方法 对116例PPE实施阴茎背神经选择性切断术,观察手术治疗前后的的平均阴道内射精潜伏期、患者及配偶性交满意度评分.使用生物振动测试仪测定阴茎勃起状态下的振动感觉阈,测定部位为示指、阴茎头、阴茎干的皮肤.结果 116例PPE术后射精潜伏期延长显效为78例,好转27例,总有效率为90.51%,无效1 1例.患者及其配偶的性交满意度评分在术后较术前均显著提高(P<0.01).阴茎勃状态下,PPE手术治疗后的阴茎头、阴茎干振动感觉阈值显著高于术前(P<0.01).结论 阴茎背神经选择性分支切断术治疗PPE的疗效确切.     

早泄诊断和治疗

早泄(premature ejaculation,PE)是临床上最常见的主诉之一,其共同特征为:射精潜伏期缩短、延迟或控制射精的能力下降、并引起患者痛苦/烦恼。目前尚无一致公认的PE定义。不同定义之间争论的焦点是如何设定射精潜伏期(intravaginal ejaculatory latency time,IELT)。新的分类方法将PE分为:原发性、继发性、自然变异性和早泄样射精障碍。不同类型PE发生的病理生理和病因学不同,决定了治疗方案的差异。     

射精潜伏期与人格因素的相关研究

目的 探讨射精潜伏期与人格特质的关系.方法 采用自制射精功能调查简表和华东师范大学心理系修订的卡特尔16种个性因素量表(16PF),对22例原发性早泄患者和41例性功能正常的志愿者进行调查检测分析.结果 ①原发性早泄组的自律性、幻想性的低分异常率明显高于正常对照组(X2=8.940;p<0.01,X2=7.960;p<0.05).②原发性早泄组的自律性、心理健康因素的均数分别为4.250±1.426、19.547±4.487,均明显低于健康对照组(5.273±1.331、23.343±5.498)(p<0.01).忧虑性均数为6.335±1.739,明显高于健康对照组(5.032±1.563)(P<0.01).③射精潜伏期与忧虑性呈高度显著负相关(r=-0.353;p<0.01),与自律性(r=0.314)、心理健康因素(r=0.276)呈显著正相关(p<0.05).结论 某些人格特质对原发性早泄患者的射精潜伏期有显著的影响,尤其是高忧虑性和低自律性.     

The effects of three phosphodiesterase type 5 inhibitors on ejaculation latency time in lifelong premature ejaculators: a double-blind laboratory setting study

Study Type – Therapy (RCT)
Level of Evidence 1b What’s known on the subject? and What does the study add? Several authors have reported their experience with PDE5 inhibitors alone or in combination with selective serotonin re‐uptake inhibitors for treating premature ejaculation. However, to our knowledge, this is the first laboratory design study to evaluate the effects of three PDE5 inhibitors throughout the ejaculation process in men with lifelong premature ejaculation. In this laboratory setting study PDE5 inhibitors seem to prolong ELT but the difference from placebo is significant only in vardenafil. The quality of penile rigidity is better with PDE5 inhibitors in the post‐ejaculatory period but the difference is significant only in sildenafil and vardenafil.

OBJECTIVE

? To evaluate the effects of three phosphodiesterase type 5 (PDE5) inhibitors on the ejaculation process in men with lifelong premature ejaculation using a double‐blind laboratory setting.

PATIENTS AND METHODS

? Eighty men with lifelong premature ejaculation, 20 in each group, received placebo, vardenafil (10 mg), sildenafil (50 mg) or tadalafil (20 mg) in a double‐blind study design. Placebo or PDE5 inhibitor was ingested after at least 2 h fasting and non‐smoking. The subjects were placed in a silent room immediately and real‐time penile rigidity and tumescence was monitored. ? Subjects read some magazines or newspapers without any sexually stimulating material for 1.5 h. At the end of this period audiovisual sexual stimulation began with a video film and after the 8th minute the subject began vibratory stimulation to the frenular area. ? At the beginning of ejaculation the patient stopped stimulation. When the patient began and stopped stimulation, the light near the observer turned on and off and the observer calculated the ejaculation period with a chronometer. The elapsed time was the ejaculation latency time (ELT) in seconds. ? There was no interaction between subjects and observer during the test. The ELT, and the qualities of base and tip rigidities during ELT and after ejaculation were calculated.

RESULTS

? Median age of patients was 29 (range 22–39) years and median duration of premature ejaculation was 60 (range 7–180) months and there was no significant difference between groups. Median duration of vibratory stimulation (ELT) of subjects who received placebo was 48.5 s: 53.5 s for sildenafil, 70.0 s for tadalafil and 82.5 s for vardenafil. Compared with the placebo group, ELT was significantly longer only in subjects receiving vardenafil (P = 0.019). ? In the post‐ejaculatory refractory period, times to last recorded base rigidities were significantly longer than placebo in vardenafil and sildenafil groups with better erection quality (P < 0.01 for each).

CONCLUSIONS

? The PDE5 inhibitors seem to prolong ELT and the quality of penile rigidity is better with PDE5 inhibitors in post‐ejaculatory period. ? These findings suggest that PDE5 inhibitors might have some beneficial effects in men with lifelong premature ejaculation.     

Effect of premature ejaculation desensitisation therapy combined with dapoxetine hydrochloride on the treatment of primary premature ejaculation

To evaluate the overall treatment benefits of premature ejaculation desensitisation therapy combined with 30 mg dapoxetine hydrochloride treatment on patients with primary premature ejaculation (PPE). Ninety‐nine PPE patients were randomly divided into two groups at the ratio of 2:1. Sixty‐six PPE patients received premature ejaculation desensitisation therapy accomplished by Weili Automatic Semen Collection—Penis Erection Detection and Analysis workstation (WLJY‐2008) combined with 30 mg dapoxetine hydrochloride treatment (DTCD group), and another 33 patients received 30 mg dapoxetine hydrochloride‐only treatment (DO group). Intravaginal ejaculation latency time (IELT) and premature ejaculation profile (PEP) were recorded before and during the treatment, and clinical global impression of change (CGIC) in PPE was recorded at the fourth week and the end of the treatment and the items. In both groups were significantly improved (p < 0.0001) in IELT, PEP and CGIC for premature ejaculation compared with baseline, and DTCD treatment showed a more significant improvement on PPE patients in the items compared with DO treatment (p < 0.05). Thus, premature ejaculation desensitisation combined with dapoxetine therapy may be a better choice for improving premature ejaculation with PPE.     

Safety and efficacy of tramadol hydrochloride on treatment of premature ejaculation

Premature ejaculation (PE) is the most common sexual disorder. It affects 20%–30% of adult men; the aetiology of this condition has not yet been elucidated. The aim of this study is to evaluate the efficacy, safety, tolerability, undesirable effects and improved satisfaction with sexual intercourse with tramadol hydrochloride at different dosages for the treatment of PE. A total of 300 patients who presented with lifelong (primary) PE were included in this study. The study was performed for 28 weeks, in which placebo (starch tablet) was given for 4 weeks, and active ingredient (tramadol hydrochloride) was administered at different therapeutic dosages for 24 weeks. Patients were divided into three equal groups, each consisting of 100 patients. The first group (A) was given tramadol hydrochloride capsule 25 mg. The second group (B) was given tramadol hydrochloride capsule 50 mg. The third group (C) was given tramadol hydrochloride capsule 100 mg. All of the 300 participants included completed the study voluntarily. The age of the patients varied from 25 to 50 years. After the treatment period, the recorded data were collected for each group and analysed. The results showed a highly significant increase in the mean intravaginal ejaculatory latency time (IELT) in all groups compared to baseline data (P<0.0001). We concluded that using tramadol hydrochloride at different doses on demand for the treatment of PE is effective, safe and tolerable, with minimal undesirable effects, and approval for this indication should be sought.     

The 5-HT2c receptor gene Cys23Ser polymorphism influences the intravaginal ejaculation latency time in Dutch Caucasian men with lifelong premature ejaculation

It has been postulated that the persistent short intravaginal ejaculation latency time （IELT） of men with lifelong premature ejaculation （LPE） is related to 5-hydroxytryptamine （HT）2c receptor functioning. The aim of this study was to investigate the relationship of Cys23Ser 5-HT2c receptor gene polymorphism and the duration of IELT in men with LPE. Therefore, a prospective study was conducted in 64 Dutch Caucasian men with LPE. Baseline IELT during coitus was assessed by stopwatch over a 1-month period. All men were genotyped for Cys23Ser 5-HT2c receptor gene polymorphism. Allele frequencies and genotypes of Cys and Ser variants of 5-HT2c receptor gene polymorphism were determined. Association between Cys/Cys and Ser/Ser genotypes and the natural logarithm of the IELT in men with LPE were.investigated. As a result, the geometric mean, median and natural mean IELT were 25.2, 27.0, 33.9s, respectively. Of all men, 20.0%, 10.8%, 23.1% and 41.5% ejaculated within 10, 10-20, 20-30 and 30-60s after vaginal penetration. Of the 64 men, the Cys/Cys and Ser/Ser genotype frequency for the Cys23Ser polymorphism of the 5-HT2c receptor gene was 81% and 19%, respectively. The geometric mean IELT of the wildtypes （Cys/Cys） is significantly lower （22.6s; 95% CI 18.3-27.8s） than in male homozygous mutants （Ser/Ser） （40.4s; 95% CI 20.3-80.4s） （P = 0.03）. It is concluded that Cys23Ser 5-HT2c receptor gene polymorphism is associated with the IELT in men with LPE. Men with Cys/Cys genotype have shorter IELTs than men with Ser/Ser genotypes.     

Venlafaxine extended release for the treatment of patients with premature ejaculation: a pilot, single-blind, placebo-controlled, fixed-dose crossover study on short-term administration of an antidepressant drug

In this study, we aimed at evaluating the efficacy and safety of venlafaxine extended release 75 mg, a serotonin and noradrenaline reuptake inhibitor, in the treatment of patients with premature ejaculation. Thirty-one patients with intravaginal ejaculation latency of less than 2 min received venlafaxine XR (75 mg/day) or placebo during a 2-week period for each agent with a washout period of 1 week between agents. Efficacy was assessed for each agent with changes in ejaculation latency measured with a stopwatch and sexual satisfaction scores of patients and partners. Side-effects, pre- and post-treatment levels of biochemical and spermiogram parameters, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin and total testosterone were recorded for each agent. Statistical analysis was performed on 21 patients. After 2 weeks of treatment with placebo and venlafaxine, ejaculation latency time was significantly increased from 60.1 +/- 39.1 to 126.9 +/- 98.3 sec and to 178.1 +/- 122.8 sec, respectively (p < 0.0001 for each one). However, the difference between the two agents was insignificant (p = 0.144). Venlafaxine and placebo increased sexual satisfaction scores of both patients and partners similarly, no statistically significant difference was found between them in this respect. The incidence of side-effects with venlafaxine was indifferent than that of placebo (p > 0.1) except nausea (p = 0.035). Both agents did not change the blood and spermiogram parameters significantly, except FSH increases. Short-term use of venlafaxine XR 75 mg has only a placebo effect on ejaculation latency and sexual satisfaction scores, therefore, is not appropriate for the patients with premature ejaculation. Further dose-time studies are required to draw final conclusions on the inefficacy of this drug in premature ejaculation.     

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。     

女性心理因素与早泄

早泄(PE)是男性最常见的性功能障碍之一,其不同程度地影响着男性的生殖及身心健康。目前相关研究发现PE所影响的不仅仅是患者本身,其在一定程度上还影响着患者配偶的心理状态。女性的心理状态在受到男性PE发病影响的同时,也在一定程度上通过干扰男性在面对PE问题时采取的态度和措施,间接地减轻或加重PE的症状。然而,在现阶段PE的研究及临床诊治中,女性心理因素与PE发病间的联系多被患者甚至临床医生所忽略。