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.

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.

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.

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.

射精功能障碍

在射精功能障碍(ejaculatory dysfunction)中,早泄(premature ejaculation,PE),射精延迟(delayed ejaculation,DE),不射精(anejaculation,AE)和逆行射精(retrograde ejaculation,RE)是最为常见的射精功能障碍类型,其他还包括高潮障碍(orgasmic disorder)、射精疼痛(painful ejaculation)、射精后综合征(postorgasmic illness syndrome)等少见情况[1],根据临床的常见情况,本文重点介绍PE和DE。

Effect of Selective Dorsal Neurectomy on Erectile Function in Rats

Objective This study aimed to investigate the effect of penile selective dorsal neurectomy(SDN)on erectile function in rats.Methods Twelve adult male Sprague-Dawley rats(15 weeks old)were divided into three groups(n=4 per group):in control group,rats received no treatment;in sham group,rats underwent a sham operation;in SDN group,rats underwent SDN with half of the dorsal penile nerve severed.The mating test was performed,and the intracavernous pressure(ICP)assessed six weeks after the surgical treatment.Results At postoperative six weeks,the mating test revealed no significant difference in mounting latency and mounting frequency among the three groups(P>0.05),while the ejaculation latency(EL)was significantly longer and ejaculation frequency(EF)lower in the SDN group than in the control and sham groups(P<0.05).There were no significant differences in preoperative and postoperative ICP and ICP/mean arterial blood pressure(MAP)among the three groups(P>0.05).Conclusion SDN does not adversely affect the erectile function and sexual desire of rats,and at the same time it can reduce EL and EF,providing an application basis for SDN in the clinical treatment of premature ejaculation.

Prostate-derived IL-1βupregulates expression of NMDA receptor in the paraventricular nucleus and shortens ejaculation latency in rats with experimental autoimmune prostatitis

Experimental autoimmune prostatitis(EAP)-induced persistent inflammatory immune response can significantly upregulate the expression of N-methyl-D-aspartic acid(NMDA)receptors in the paraventricular nucleus(PVN).However,the mechanism has not yet been elucidated.Herein,we screened out the target prostate-derived inflammation cytokines(PDICs)by comparing the inflammatory cytokine levels in peripheral blood and cerebrospinal fluid(CSF)between EAP rats and their controls.After identifying the target PDIC,qualified males in initial copulatory behavior testing(CBT)were subjected to implanting tubes onto bilateral PVN.Next,they were randomly divided into four subgroups(EAP-1,EAP-2,Control-1,and Control-2).After 1-week recovery,EAP-1 rats were microinjected with the target PDIC inhibitor,Control-1 rats were microinjected with the target PDIC,while the EAP-2 and Control-2 subgroups were only treated with the same amount of artificial CSF(aCSF).Results showed that only interleukin-1β(IL-1β)had significantly increased mRNA-expression in the prostate of EAP rats compared to the controls(P<0.001)and significantly higher protein concentrations in both the serum(P=0.001)and CSF(P<0.001)of the EAP groups compared to the Control groups.Therefore,IL-1βwas identified as the target PDIC which crosses the blood-brain barrier,thereby influencing the central nervous system.Moreover,the EAP-1 subgroup displayed a gradually prolonged ejaculation latency(EL)in the last three CBTs(all P<0.01)and a significantly lower expression of NMDA NR1 subunit in the PVN(P=0.043)compared to the respective control groups after a 10-day central administration of IL-1βinhibitors.However,the Control-1 subgroup showed a gradually shortened EL(P<0.01)and a significantly higher NR1 expression(P=0.004)after homochronous IL-1βadministration.Therefore,we identified IL-1βas the primary PDIC which shortens EL in EAP rats.However,further studies should be conducted to elucidate the specific molecular mechanisms through which IL-1βupregulates NMDA expression.

Aerobic exercise improves ejaculatory behaviors and complements dapoxetine treatment by upregulating the BDNF-5-HT duo:a pilot study in rats

Accumulating evidence has revealed many clues that regular aerobic exercise benefits brain health and behaviors.The aims of this study were to explore the effect of aerobic exercise on ejaculatory behaviors,as well as to make a preliminary assessment of aerobic exercise as a complementary strategy to dapoxetine treatment in rapid ejaculators.Copulatory tests of rats and a treadmill training protocol were performed in this study.In total,12 rapid ejaculators were selected on the basis of ejaculation distribution theory and randomly assigned to 4 groups:control(Ctrol)group,aerobic exercise(Ex)group,dapoxetine(Dapo)group,and Ex+Dapo group.We evaluated the changes in ejaculatory parameters in the 4 groups.Variations in biological markers,including serum corticosterone,serotonin(5-HT),and brain-derived neurotrophic factor(BDNF)of the raphe nucleus,were determined by enzyme-linked immunosorbent assay(ELISA).The primary finding of our study was that both aerobic exercise and acute dapoxetine could enhance ejaculation control and prolong ejaculation latency in rapid ejaculator rats.The ejaculation delay effect of aerobic exercise was nearly equivalent to that of acute dapoxetine.In addition,both aerobic exercise and dapoxetine treatment could lead to increased expression of BDNF and 5-HT in the raphe nucleus of rapid ejaculators.Moreover,the two interventions,when applied together,may further upregulate the expression of BDNF-5-HT duo in a complementary manner.This study highlights the positive effects of aerobic exercise on ejaculation control.Regular aerobic exercise might be a promising complementary treatment to dapoxetine in rats.