Current therapeutic strategies for premature ejaculation and future perspectives

Premature ejaculation （PE） is a common sexual disorder in men that is mediated by disturbances in the peripheral and central nervous systems. Although all pharmaceutical treatments for PE are currently used ＇off-label＇, some novel oral agents and some newer methods of drug administration now provide important relief to PE patients. However, the aetiology of this condition has still not been unified, primarily because of the lack of a standard animal model for basic research and the absence of a widely accepted definition and assessment tool for evidence-based clinical studies in patients with PE. In this review, we focus on the current therapeutic strategies and future treatment perspectives for PE.

Prevalence of Premature Ejaculation among Patients with Type 2 Diabetes in a Tertiary Health Institution: A Cross-Sectional Study

Background: Premature ejaculation (PE) is one of the sexual dysfunctions commonly present among patients with diabetes mellitus (DM), but rarely reported and not commonly investigated compared to erectile dysfunction. In this study, we aimed to investigate the prevalence of PE in a group of patients with type 2 DM and explore possible determinants of its occurrence and its association with erectile dysfunction. Methods: This was a cross-sectional study of subjects recruited from the Diabetes clinic and whose sexual function was assessed using the premature ejaculation diagnostic tool (PEDT) and erection hardness score (EHS), who were in heterosexuals relationship and resides together with their wives and had no major organ failure or acute infection within the last 1 month. Other socio-demographic history and diabetes-related questions were assessed. Results: A total of 69 subjects were recruited. The prevalence of PE was 27.5% in the study. There was a significant inverse relationship between the prevalence of premature ejaculation and frequency of sexual intercourse. Almost half 14/30 (46.7%) of those with erectile dysfunction had premature ejaculation. Diabetic patients with erectile dysfunction (ED) showed a significantly higher incidence of PE with significantly lower values of EHS. Higher level of fasting blood glucose was associated with higher prevalence of erectile dysfunction. Conclusions: The prevalence of PE was relatively high at 19/69 (27.5%) among our type 2 diabetic patients. Hence, health care giver should always endeavour to ask about it even when patients do not volunteer the information.

Sexual function of premature ejaculation patients assayed with Chinese Index of Premature Ejaculation

Aim: To assess the psychometric properties of the Chinese Index of Premature Ejaculation (CIPE). Methods: The sexual function of 167 patients with and 114 normai controls without premature ejaculation (PE) were evaluated with CIPE. All subjects were married and had regular sexual activity. The CIPE has 10 questions, focusing on libido, erectile function, ejaculatory latency, sexual satisfaction and difficulty in delaying ejaculation, self-confi dence and depression. Each question was responded to on a 5 point Likert-type scale. The individual question score and the total scale score were analyzed between the two groups. Results: There were no significant differences between the age, duration of marriage and educational level (P > 0.05) of patients with and vvithout PE and normai controls. The mean latency of patients with PE and normai controls were 1.6±1.2 and 10.2±9.5 minutes, respectively. Significant differences between patients with (26.7±4.6) PE and normai controls (41.9±4.0) were observed on the total score of CIPE (P < 0.01). Using binary logistic regression analysis, PE was significantly related to five questions of the original measure. They are the so-called the CIPE-5 and include: ejaculatory latency, sexual satisfaction of patients and sexual partner, difficulty in delaying ejaculation, anxiety and depression. Receiver Operat ing Characteristic (ROC) curve analysis of CIPE-5 questionnaire indicated that the sensitivity and specificity of CIPE were 97.60 % and 94.74 %, respectively. Employing the total score of CIPE-5, patients with PE could be divided into three groups: mild (>15 point) 19.8 %, moderate (10-14 point) 62.8 % and severe (< 9 point) 16.7 %. Conclusion: The CIPE-5 is a useful method for the evaluation of sexual function of patients with PE and can be used as a clinical endpoint for clinical trials studying the efficacy of pharmacologica] intervention.

New insights on premature ejaculation： a review of ：lefinition, classification, prevalence and treatmeni

There are ongoing debates about the definition, classification and prevalence of premature ejaculation （PE）. The first evidence-based definition of PE was limited to heterosexual men with lifelong PE who engage in vaginal intercourse. Unfortunately, many patients with the complaint of PE do not meet these criteria. However, these men can be diagnosed as one of the PE subtypes, namely acquired PE, natural variable PE or premature-like ejaculatory dysfunction. Nevertheless, the validity of these subtypes has not yet been supported by evidence. The absence of a universally accepted PE definition and lack of standards for data acquisition have resulted in prevalence studies that have reported conflicting rates. The very high prevalence of 20%-30% is probably due to the vague terminology used in the definitions at the time when such surveys were conducted. Although many men may complain of PE when questioned for a population-based prevalence study, only a few of them will actively seek treatment for their complaint, even though most of these patients would define symptoms congruent with PE. The complaints of acquired PE patients may be more severe, whereas complaints of patients experiencing premature-like ejaculatory dysfunction seem to be least severe among men with various forms of PE. Although numerous treatment modalities have been proposed for management of PE, only antidepressants and topical anaesthetic creams have currently been proven to be effective. However, as none of the treatment modalities have been approved by the regulatory agencies, further studies must be carried to develop a beneficial treatment strategy for PE.

Possible association of the 5-HTTLPR serotonin transporter promoter gene polymorphism with premature ejaculation in a Turkish population

We evaluated the genotypes of the serotonin transporter gene （5-HTT） in patients with premature ejaculation （PE） to determine the role of genetic factors in the etiopathogenesis of PE and possibly to identify the patient subgroups. A total of 70 PE patients and 70 controls were included in this study. All men were heterosexual, had no other disorders and were either married or in a stable relationship. PE was defined as ejaculation that occurred within 1 min of vaginal intromission. Genomic DNA from patients and controls was analyzed using polymerase chain reaction, and allelic variations of the promoter region of the serotonin transporter gene （5-HTTLPR） were determined. The 5-HTTLPR （serotonin transporter promoter gene） genotypes in PE patients vs. controls were distributed as follows： L/L 16% vs. 17%, L/S 30% vs. 53% and S/S 54% vs. 28%. We examined the haplotype analysis for three polymorphisms of the 5-HTTLPR gene： LL, LS and SS. The appropriateness of the allele frequencies in the 5-HTTLPR gene was analyzed by the Hardy-Weinberg equilibrium using the Z-test. The short （S） allele of the 5-HTTLPR gene was significantly more frequent in PE patients than in controls （P 〈 0.05）. We suggest that the 5-HTTLPR gene plays a role in the pathophysiology of all primary PE cases. Further studies are needed to evaluate the relationship between 5-HTTLPR gene polymorphism and patient subgroup （such as primary and secondary PE） responses to selective serotonin reuptake inhibitors as well as ethnic differences.

Premature ejaculation： current and future treatments

Premature ejaculation （PE） is recognized to be the most common male sexual disorder. PE provides difficulties for professionals who treat this condition because there is neither a universally accepted definition nor a medication approved by the Food and Drug Administration （FDA）. Despite these shortcomings, physicians continue to diagnose their patients with PE according to major guidelines and treat them with either behavioral therapies or off-label medications. This review focuses on current and emerging treatment options and medications for PE. Advantages and limitations of each treatment option are discussed in the light of current published peer-reviewed literature.

A new potential risk factor in patients with erectile dysfunction and premature ejaculation： folate deficiency

We investigated serum folic acid （FA） levels in patients with erectile dysfunction （ED） and/or premature ejaculation （PE）. Fasting serum samples were obtained from 42 patients with ED, 36 with PE, 25 ED patients with PE, and 30 healthy men; the mean intravaginal ejaculation latency time （IELT） was measured during a 4 weeks baseline period. Levels of sex hormones （follicle-stimulating hormone, luteinizing hormone, total testosterone）, homocysteine （Hcys）, and FA were measured using chemiluminescent immunoassays. The sexual functions of PE patients and normal control men were evaluated using the Chinese Index of Premature Ejaculation （CIPE）. The abridged Intemational Index of Erectile Function-5 （IIEF-5） questionnaire was used to gauge erectile quality for ED patients and for normal controls. Serum FA concentrations were lower in ED （7.61 ~ 3.97 ng ml-1）, PE （9.37 ＋ 3.40 ng ml-1）, and ED/PE （8.84 ＋ 4.28 ng m1-1） patients than in healthy men （12.23 ~ 5.76 ng ml-z, P〈 0.05）. No significant differences in sex hormone levels were found between patients with sexual dysfunction and healthy controls （P 〉 0.05）. There were positive correlations between serum FA concentrations and ClPE scores （r= 0.530, P〈 0.01）, IIEF-5 scores （r= 0.589, P〈 0.01）, and IELT （r= 0.445, P〈 0.01）; negative correlations with Hcys concentrations （r= -0.487, P〈 0.01） were found in all participants. These findings showed a strong relationship between serum FA levels and sexual dysfunction, possibly due to an effect of FA on the metabolism of nitric oxide, Hcys, and 5-hydroxytryptamine.

Prevalence of premature ejaculation in young and middle-aged men in Korea： a multicenter intemet-based survey from the Korean Andrological Society

In this study, we aimed to investigate the prevalence and perception of premature ejaculation （PE） in young and middle-aged Korean men. The study was conducted using an Internet-assisted questionnaire. A total of 2 037 Korean male adults, aged 20 years or older, were randomly sampled based on age and residency. The questionnaire developed by the PE Study Group of the Korean Andrological Society includes four categories （overall sexual function, symptoms, distress and treatment） with a total of 16 questions. For each question, symptoms were evaluated by a scale ranging from 0 to 10. Intravaginal ejaculation latency time was ‘5-10 min＇ in 38.6%, followed by ‘longer than 10 min＇ in 2919%, ‘2-5 min＇ in 23.6%, ‘1-2 min＇ in 5.4% and ‘shorter than 1 min＇ in 2.5%. In our series, 27.5% of respondents reported having PE. Control over ejaculation within a recent 3-month period was 6.2 points on average. Respondent complaints of PE-related stress averaged 7.1 points and stress-related complaints from sexual partners averaged 7.1 points. The effect of PE on sexual life was 6.8 points. Of the respondents determined as having PE, 42.6% responded that they were inclined to receive treatment. Results from this study suggest that the prevalence of PE diagnosed by the respondent on his own was approximately 27.5% in young and middle-aged men in Korea. PE-related stress had a significant effect on the stress, sexual activity and quality of life of the respondent and his sexual partner.

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 souRht.

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.

Comparative study of on-demand and daily use of sertraline in treatment of premature ejaculation:A randomized clinical trial

Objective:The intravaginal ejaculatory latency time(IELT)may increase less in on-demand compared to daily intake,but may fulfill a suitable treatment for specific patients.We decided to compare the efficacy and safety of on-demand and daily use of sertraline in order to find the most effective and least complicated method in treatment of premature ejaculation(PE).Methods:This study was parallel or concurrent control randomized clinical trial.Two hundred and forty patients with PE diagnosed by urologist in the two groups of 120 from July 2017 to February 2019 enrolled in the study.In the first group,it is prescribed 50 mg sertraline each 12 h daily and the second group received 50 mg 4 h before coitus for 4 and 8 weeks.The IELT before treatment and during all coitus after treatment were recorded by the patient’s wife with a stopwatch.Results:Mean IELT before,4 and 8 weeks after treatment in two groups were:On-demand group 101.62±65.44 s,208.75±128.02 s and 265.87±145.70 s;daily use group 102.50-81.22 s,276.87±181.08 s and 353.75±176.45 s,respectively.The ejaculation time increased significantly in both groups(p<0.05).However,increase in ejaculation time in daily use group was significantly higher than the on-demand group in 4 weeks(p=0.036),especially in 8 weeks(p=0.009).The percent of side effects in daily use group(26.7%)was higher than on-demand group(20%)(p<0.05).Drowsiness,diarrhea and vertigo were significantly higher in the daily use than on-demand(p<0.05).Conclusions:On-demand and daily use of sertraline are effective and usually have no serious complications,but the on-demand method is considerably more tolerable.In patients who did not tolerate to daily use of this drug,on-demand could be used as a salvage therapy.

A Double-Blind, Placebo-Controlled Study of the Effectiveness of Mate Endurance TM Dietary Supplement on Sexual Satisfaction, Ejaculatory Control, and Distress in Men with Premature Ejaculation

Background: To assess the efficacy of the dietary supplement Mate Endurance on sexual satisfaction, ejaculatory control, and sexually related personal distress in patients with premature ejaculation. Methods: In a double-blind, randomized, placebo-controlled study, 68 patients between 21 and 60 years old with premature ejaculation were randomized to receive either Mate Endurance or placebo treatment for three months. The patients were provided a questionnaire at the start of the study and again three months post commencement of the study. The questionnaires were comprised of the Index of Premature Ejaculation (IPE) and the PE Diagnostic Tool (PEDT). Results: Participants in the treatment group experienced a significant improvement in symptoms often associated with premature ejaculation versus those in the placebo group. The treatment was widely used with limited adverse effects. Conclusions: The results of the study demonstrate the effectiveness of the dietary supplement Mate Endurance in improving symptoms associated with premature ejaculation, including general sexual satisfaction and distress associated with sexual encounters.

The sensitivity difference between the glans penis and penile shaft in primary premature ejaculation

The penis is a vital organ of perception that transmits perceived signals to ejaculation-related centers.The penis consists of the glans penis and penile shaft,which differ considerably in both histology and innervation.This paper aims to investigate whether the glans penis or the penile shaft is the main source of sensory signals from the penis and whether penile hypersensitivity affects the whole organ or only part of it.The thresholds,latencies,and amplitudes of somatosensory evoked potentials(SSEPs)were recorded in 290 individuals with primary premature ejaculation using the glans penis and penile shaft as the sensory areas.The thresholds,latencies,and amplitudes of SSEPs from the glans penis and penile shaft in patients were significantly different(all P<0.0001).The latency of the glans penis or penile shaft was shorter than average(indicating hypersensitivity)in 141(48.6%)cases,of which 50(35.5%)cases were sensitive in both the glans penis and penile shaft,14(9.9%)cases were sensitive in the glans penis only,and 77(54.6%)cases were sensitive in the penile shaft only(P<0.0001).There are statistical differences in the signals perceived through the glans penis and the penile shaft.Penile hypersensitivity does not necessarily mean that the whole penis is hypersensitive.We classify penile hypersensitivity into three categories,namely,glans penis,penile shaft,and whole-penis hypersensitivity,and we propose the new concept of penile hypersensitive zone.

The application of intraoperative neurophysiological monitoring in selective dorsal neurotomy for primary premature ejaculation:a prospective single-center study

Selective dorsal neurotomy(SDN)is a surgical treatment for primary premature ejaculation(PE),but there is still no standard surgical procedure for selecting the branches of the dorsal penile nerves to be removed.We performed this study to explore the value of intraoperative neurophysiological monitoring(IONM)of the penile sensory-evoked potential(PSEP)for standard surgical procedures in SDN.One hundred and twenty primary PE patients undergoing SDN were selected as the PE group and 120 non-PE patients were selected as the normal group.The PSEP was monitored and compared between the two groups under both natural and general anesthesia(GA)states.In addition,patients in the PE group were randomly divided into the IONM group and the non-IONM group.During SDN surgery,PSEP parameters of the IONM group were recorded and analyzed.The differences in PE-related outcome measurements between the perioperative period and 3 months'postoperation were compared for the PE patients,and the differences in effectiveness and complications between the IONM group and the non-IONM group were compared.The results showed that the average latency of the PSEP in the PE group was shorter than that in the normal group under both natural and GA states(P<0.001).Three months after surgery,the significant effective rates in the IONM and non-IONM groups were 63.6%and 34.0%,respectively(P<0.01),and the difference in complications between the two groups was significant(P<0.05).IONM might be useful in improving the short-term therapeutic effectiveness and reducing the complications of SDN.

Abnormal cortical surface-based spontaneous and functional connectivity in the whole brain in lifelong premature ejaculation patients

Recent research has highlighted structural and functional abnormalities in the cerebral cortex of patients with premature ejaculation(PE).These anomalies could play a pivotal role in the physiological mechanisms underlying PE.This study leveraged functional magnetic resonance imaging(fMRI),a noninvasive technique,to explore these neural mechanisms.We conducted resting-state fMRI scans on 36 PE patients and 22 healthy controls(HC),and collected data on Premature Ejaculation Diagnostic Tool(PEDT)scores and intravaginal ejaculation latency time(IELT).Employing a surface-based regional homogeneity(ReHo)approach,we analyzed local neural synchronous spontaneous activity,diverging from previous studies that utilized a volume-based ReHo method.Areas with significant ReHo differences between PE and HC groups underwent surface-based functional connectivity(FC)analysis.Significant discrepancies in ReHo and FC across the cortical surface were observed in the PE cohort.Notably,PE patients exhibited decreased ReHo in the left triangular inferior frontal gyrus and enhanced ReHo in the right middle frontal gyrus.The latter showed heightened connectivity with the left lingual gyrus and the right orbital superior frontal gyrus.Furthermore,a correlation between ReHo and FC values with PEDT scores and IELT was found in the PE group.Our findings,derived from surface-based fMRI data,underscore specific brain regions linked to the neurobiological underpinnings of PE.

Short‐term effect of the prone masturbation training on premature ejaculation

Background:Whether conventional behavioral therapies for premature ejaculation can significantly improve the intravaginal ejaculatory latency time is still controversial.Prone masturbation is rare and observed in some patients with delayed ejaculation.Therefore,we tried to verify whether the regular prone masturbation training method had a therapeutic effect on premature ejaculation.Methods:From July to December 2018,a total of 21 patients met the enrollment criteria and volunteered to participate.Participants were diagnosed with premature ejaculation with an intravaginal ejaculatory latency time of less than 3min and a Premature Ejaculation Diagnostic Tool score greater than 9.Participants performed 12‐week prone masturbation training.Results:Ten patients completed the entire treatment regimen.The mean age of the 10 participants was 30.4±6.1 years,the mean frequency of sexual intercourse was 1.9±0.83 times a week,and the median duration of premature ejaculation was 1.5 years.After 3 months of prone masturbation training,the median self‐reported intravaginal ejaculatory latency time significantly increased from 60 to 105 s(p=0.011),and the mean Premature Ejaculation Diagnostic Tool scores decreased from15.0±3.7 to 12.7±3.7 points(p=0.119).Conclusions:The regular prone masturbation training method,as a novel behavioral therapy,probably has a therapeutic effect on premature ejaculation.

血清5-HT、NGF水平与原发性早泄患者阴茎背神经选择性切除术后复发的关系

目的探究血清5-羟色胺(5-HT)、神经生长因子(NGF)水平变化与原发性早泄患者阴茎背神经选择性切除术后复发的关系。方法选择原发性早泄患者200例,均行阴茎背神经选择性切除术治疗,术后6个月根据患者是否复发分为复发组(n=23)与未复发组(n=177),比较两组患者的临床资料、血清5-HT、NGF水平,分析5-HT、NGF与中国早泄问卷调查表(CIPE-5)、国际勃起功能(IIEF-5)评分、射精潜伏期(IELT)的相关性及术后复发影响因素,并构建列线图模型评价含血清指标模型预测术后复发与实际观察的一致性,用决策曲线评价该模型的临床获益。结果复发组术后3个月血清5-HT水平、IELT、CIPE-5评分均低于未复发组,NGF水平高于未复发组(P均<0.05);原发性早泄患者术前、术后1个月、术后3个月,血清5-HT水平与CIPE-5评分、IELT呈正相关(P均<0.05),与IIEF-5评分无相关性(P均>0.05);血清NGF水平与CIPE-5评分、IELT呈负相关(P均<0.05),与IIEF-5评分无相关性(P均>0.05);术后3个月IELT、CIPE-5评分及血清5-HT、NGF水平均为原发性早泄患者术后复发的独立影响因素(P均<0.05);列线图模型预测原发性早泄患者术后复发相关因素的一致性指数为0.775(95%CI=0.674~0.802);决策曲线显示,当含血清指标的模型预测原发性早泄患者术后复发的值为0.20~0.85时,可提供附加临床获益。结论原发性早泄患者阴茎背神经选择性切除术后3个月血清5-HT水平下降、NGF水平升高,二者水平变化对预测患者术后复发有一定参考价值。

Penile sensory thresholds in subtypes of premature ejaculation： implications of comorbid erectile dysfunction

Penile hypersensitivity plays an important role in premature ejaculation （PE）, but differences in penile sensitivity among subtypes of PE are unknown. Therefore, we compared penile sensory thresholds in PE subtypes of lifelong and acquired PE, PE with and without erectile dysfunction （ED）, PE with an intravaginal ejaculation latency time 〈1 min and 〉1 min, and PE with and without orgasmic pleasure perceptual dysfunction. During August 2014 to January 2016, 136 patients with PE were included. Penile warm, cold, and vibratory thresholds were measured. Data of clinical characteristics, sexual life, Premature Ejaculation Diagnostic Tool （PEDT） score, and the 5-item version of the International Index of Erectile Function （IIEF-5） score were collected. Vibratory thresholds of the PE with ED group were higher in the right coronal sulcus （median amplitude： 4.92 vs 3.65 μm, P= 0.02） and the right penile shaft （median amplitude： 3.87 vs 3.30 μm, P = 0.03）, while differences in penile sensory thresholds between other subtypes were not significant. The median PEDT score was lower in the PE without ED group （12 vs 14, P 〈 0.001）. The IIEF-5 and PEDT scores were negatively correlated （r = -0.29, P 〈 0.001）. Patients with orgasmic pleasure perceptual dysfunction had a lower median IIEF-5 score （20 vs 21, P = 0.02）. Patients with PE and ED had lower penile sensitivity, and ED was associated with more severe symptoms and weaker orgasmic pleasure perception. In men with PE, management of comorbid ED is necessary. In case of side effects in erectile function, topical anesthetics should be cautiously used in men with PE and ED.

Pelvic muscle floor rehabilitation as a therapeutic option in lifelong premature ejaculation： long-term outcomes

The aim of the study was to evaluate the long-term outcomes of pelvic floor muscle （PFM） rehabilitation in males with lifelong premature ejaculation （PE）, using intravaginal ejaculatory latency time （IELT） and the self-report Premature Ejaculation Diagnostic Tool （PEDT） as primary outcomes. A total of 154 participants were retrospectively reviewed in this study, with 122 completing the training protocol. At baseline, all participants had an IELT 〈60 s and PEDT score 〉11. Participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. The effectiveness of intervention was evaluated by comparing the change in the geometric mean of IELT and PEDT values, from baseline, at 3, 6, and 12 months during the intervention, and at 24 and 36 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex, with a mean IELT of 161.6 s and PEDT score of 2.3 at the 12-week endpoint of the intervention, representing an increase from baseline of 40.4 s and 17.0 scores, respectively, for IELT and PEDT （P 〈 0.0001）. Of the 95 participants who completed the 36-month follow-up, 64% and 56% maintained satisfactory eiaculation control at 24 and 36 months oostintervention, respectively.

Dorsal penile nerves and primary premature ejaculation

Background Based on our clinical experience, the number of dorsal penile nerves in patients with primary premature ejaculation （PPE） is not consistent with the average number （2 branches）. In this study, we evaluated the number and distribution of dorsal penile nerves among healthy Chinese adults and patients with PPE. Methods The dorsal nerve of the penis, the deep dorsal vein of the penis, and the dorsal artery of the penis between the deep fascia of the penis and the albuginea penis were carefully educed, observed, and counted in 38 adult autopsy specimens. The number and distribution of the dorsal penile nerve in 128 surgical patients with PPE were determined. Results The numbers of dorsal penile nerves of the 38 cases were as follows： 7 branches in 1 case; 6 branches in 1 case; 5 branches in 6 cases; 4 branches in 9 cases; 3 branches in 14 cases; and 2 branches in 7 cases. Most of the dorsal nerves were parallel to each other and in the dorsum of the penis. In only 8 cases, the branches were connected by some communicating branches. In 4 cases, 1 or 2 thin dorsal nerves continued their pathway over the ventral aspect of the penis. The average number of branches of the dorsal penile nerve in patients with PPE was 7.16. Conclusions Based on the study of 38 cases, the average number of dorsal penile nerves was 3.55 branches and that of patients with PPE was greater. These preliminary results suggest that the excessive dorsal penile nerves may have an impact on PPE via increased sensitivity and provide topographic data for the possible treatment of PPE.