The application of intraoperative neurophysiological monitoring in selective dorsal neurotomy for primary premature ejaculation: a prospective single-center study / 亚洲男科学杂志(英文版)

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 / 亚洲男科学杂志(英文版)

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.

Considerações sobre a ejaculação precoce / Premature ejaculation considerations

Este artigo versa sobre ejaculação precoce. De forma breve, aborda situações que podem ser vivenciadas pelos homens, entre elas: a presença de sintomas de ansiedade e de depressão, a dificuldade com a parceira geradora de estresse no relacionamento amoroso. As opções de tratamento dos modelos multimodal e tridimensional são apresentadas como forma de tratamento para ajudar o homem a recuperar a condição que tinha antes da disfunção sexual. Em geral, há relatos de vergonha e de dificuldade em satisfazer a parceira sexualmente. Recomenda-se avaliar o grau de sintomas de depressão e de ansiedade nos homens em decorrência do impacto na função sexual e na resposta sexual. A depressão é um fator de risco às disfunções sexuais masculinas, evidenciando desde a baixa do desejo sexual à perda de satisfação que pode, nesses casos, estar associada às alterações cognitivas e comportamentais. A ansiedade está presente em diferentes graus nos pacientes com ejaculação precoce em relação ao padrão de evitação do intercurso sexual com penetração vaginal. Interfere na capacidade do homem de manter a excitação física e/ou psíquica presente na sensação premonitória do orgasmo durante o coito. A psicoterapia enfoca o pensamento desadaptativo cujo temor da atividade sexual com penetração vaginal está presente, diminuindo a capacidade de enfrentar a situação e aprender novas maneiras de lidar com a sexualidade e o intercurso sexual com penetração vaginal. PALAVRAS-CHAVE: Ejaculação precoce, sexualidade, ansiedade, depressão, psicoterapia

Safety and efficacy of "on-demand" tramadol in patients with premature ejaculation: an updated meta-analysis

ABSTRACT Introduction: Tramadol has been used for the treatment of premature ejaculation, however, the studies published for the same are not well designed. The primary objective of this study was to explore the literature pertaining to the use of tramadol in patients with PE to determine its safety and efficacy in this population. Materials ande methods: Systematic literature search of various electronic databases was conducted to include all the randomized studies and quasi-randomized studies. Standard PRISMA (Preferred reporting Items for Systematic reviews and Meta-analysis) guidelines were pursued for this review and study protocol was registered with PROSPERO (CRD42019123381). Results: Out of 9 studies included in this review, 5 were randomized controlled trials, and rests of the 4 studies were quasi-randomized studies. Tramadol resulted in significantly higher improvement of IELT with the mean difference (MD) of 139.6 seconds and confidence interval (CI) 106.5-172.6 seconds with a p-value of p <0.00001. All dosages except 25mg fared well as compared to placebo. Tramadol fared better than placebo at 1 month, 2 months, and 3 months after initiation of therapy as compared to the placebo. Tramadol group had reported a significantly higher number of adverse events with treatment as compared to placebo but none of them were serious. Conclusion: Tramadol appears to be an effective drug for the management of PE with a low propensity for serious adverse events. However, evidence obtained from this study is of low to moderate quality. Furthermore, effective dose and duration of therapy remain elusive.

Spontaneous Ejaculation Due to Duloxetine: A Case Report

ABSTRACT Ejaculation is controlled by both the sympathetic and parasympathetic system and consists of an emission and expulsion phase. Ejaculation latency time is regulated by the sympathetic system. Hypothetically, by reducing ejaculatory latency time, spontaneous ejaculation can occur. Extending the duration of ejaculation is a well-known side effect of antidepressants, especially selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors and noradrenergic reuptake inhibitors. Adrenergic drugs are sometimes used as treatment for delayed ejaculation. A spontaneous ejaculation due to the use of these drugs has rarely been reported. Although most reports of spontaneous ejaculations are related to the use of venlafaxine and reboxetine, this study is based on a case of the side effect of duloxetine.

Profile of sexuality and symptoms of lower urinary tract in non-institutionalized elderly

ABSTRACT Introduction: Urinary or sexual dysfunction in the elderly are underreported. However, they are highly prevalent. This study aims to identify the prevalence of these conditions. Objective: The aim is to carry out an investigation in non-institutionalized individuals over 60 years of age, to obtain data on its sexual and urinary health in São Paulo, Campinas, Santo André and Londrina. Results: 6.000 questionnaires were distributed, and 3425 were included in the study, for the analysis of the questionnaires separately. In relation to ADAM, 92% of the 1385 evaluated were suspicious of androgen deficiency (ADAM). As for the male sexual function, it was observed 37% of premature ejaculation. As for the female sexual function, 1300 (74%) did not practice sexual intercourse and the main reasons were: lack of partner and lack of sexual desire. In addition, 988 (78%) of women who had no sexual intercourse responded that they didn't want sex and, more importantly, about 22% of them would like to have sexual intercourse. International prostate symptom score (IPSS) showed gradual worsening of urinary symptoms with increasing age, being the most prevalent: nocturia and urinary urgency. As for the female IPSS, we noted that even after 80 years, the majority have mild symptoms related to voiding dysfunction; with increasing age there is a gradual increase in the result of the IPSS. Conclusion: Due to the large number of sexual and urinary disorders found, we recommend the improvement in health conditions, promoting a better quality of life in the elderly.

Considerações sobre a ejaculação precoce: o modelo multimodal e o modelo tridimensional de compreensão da disfunção sexual / Considerations on the premature ejaculation: the model multimodal and the model three-dimensional understanding of sexual dysfunction Abrir no Google Tradutor •

A ejaculação precoce é uma disfunção sexual sem etiologia descrita na literatura, apesar de os primeiros relatos clínicos serem de 1890. Ao longo dos anos, foi utilizada a definição da Internacional Society for Medicine Sexual para compreensão da ejaculação precoce e dos seus critérios diagnósticos. Muitos homens acreditam que a resposta sexual é automática e nata, no entanto, o medo de falhar e a perda do mundo erótico associados à angústia, frustração e evitação da intimidade sexual são aspectos subjetivos relacionados à dificuldade de controle ejaculatório. O homem cuja parceira apresenta postura ativa e envolvimento no intercurso sexual tem o seu processo de aprendizagem facilitado, controlando, assim, a excitação e mantendo a ereção. Essa parceira, em geral, tem maior qualidade de comunicação sexual, construto associado de forma positiva à função sexual masculina (por exemplo, ao aumento da excitação e ao controle ejaculatório); diminuindo a vulnerabilidade e a predisposição ao desenvolvimento de disfunção sexual. O presente artigo versa, também, sobre a proposta de tratamento do modelo multimodal e tridimensional para a ejaculação precoce. O primeiro modelo apresenta a resposta excitatória na ejaculação por meio de um sistema de software, sistema psicológico (variável conforme o contexto e com base na experiência sexual); e um hardware, sistema biológico (com pouca variação intrínseca e determinante genética), combina farmacoterapia e psicoterapia; o segundo, tridimensional, apresenta coordenadas cartesianas para corroborar aspectos subjetivos e relacionais da ejaculação precoce, apresentando uma baixa de serotonina na fenda sináptica, impactando a sensação de controle e reflexo ejaculatório.

Prevalencia y caracterización de disfunciones sexuales masculinas en el personal de la Unidad Académica de Salud y Bienestar de la Universidad Católica de Cuenca, año 2019 / Prevalence and characterization of male sexual dysfunctions in the staff of the Academic Unit of Health and Welfare of the Catholic University of Cuenca, 2019

Objetivo: determinar la prevalencia y caracterizar la disfunción sexual masculina en el personal docente y administrativo de la Unidad Académica de Salud y Bienestar de la Universidad Católica de Cuenca en el 2019. Metodología: estudio cuantitativo, observacional y transversal. Se encuestaron a 114 varones que cumplieron los criterios de inclusión. El análisis se realizó mediante estadística descriptiva, para variables cuantitativas se empleó media y desviación estándar y para las cualitativas frecuencias y porcentajes. Resultados: la prevalencia de disfunciones sexuales masculinas fue de 75.4%. Un 60.5% tuvieron edades entre 20 a 39 años, 60.5% estaban casados, 87.2% religión católica, 67.4% eran docentes. Según trastornos del deseo, el 27.9% presentó hiperactividad masculina, el 18.6% fobia y un 9.3% hipoactividad; según los trastornos de excitación, el 53.5% presentó disfunción eréctil, siendo un 93.5% leve. El trastorno orgásmico y la dispareunia masculina se presentó en el 30.2% y el 29.1% respectivamente. Conclusiones: la prevalencia de disfunciones sexuales fue elevada en comparación con la bibliografía consultada

Objective: to determine the prevalence and characterize male sexual dysfunction in the teaching and administrative staff of the Academic Unit of Health and Welfare of the Catholic University of Cuenca in 2019. Methodology: It is a quantitative, observational and cross-sectional study. A total of 114 men who met the inclusion criteria were surveyed. The analysis was performed using descriptive statistics; mean and standard deviation were used for quantitative variables, and frequencies and percentages for the qualitative variables. Results: the prevalence of male sexual dysfunctions was 75.4%. The 60.5% were between 20 and 39 years old, 60.5% were married, 87.2% were Catholic, and 67.4% were teachers. According to desire disorders, 27.9% presented male hyperactivity, 18.6% phobia and 9.3% hypoactivity; according to arousal disorders, 53.5% presented erectile dysfunction, 93.5% being mild. Orgasmic disorder and male dyspareunia occurred in 30.2% and 29.1% respectively. Conclusions: the prevalence of sexual dysfunctions was high compared to the literature consulted

Which of available selective serotonin reuptake inhibitors (SSRIs) is more effective in treatment of premature ejaculation? A randomized clinical trial

ABSTRACT Purpose: To compare the efficacy and safety of available selective serotonin reuptake inhibitors (SSRIs) in order to find the most effective drug with the least number of side effects in treatment of premature ejaculation (PE). Materials and Methods: This study was a randomized clinical trial. Four hundred and eighty patients with PE in the 4 groups referred to Imam Reza hospital Tehran, Iran from July 2018 to February 2019 were enrolled in the study. The patients received sertraline 50mg, fluoxetine 20mg, paroxetine 20mg and citalopram 20mg, every 12 hours daily. The intravaginal ejaculatory latency time (IELT) before treatment, fourth and eighth weeks after treatment was recorded by the patient's wife with a stopwatch. Results: Mean IELT before, 4 and 8 weeks after treatment in four groups were: sertraline 69.4±54.3, 353.5±190.4, 376.3±143.5; fluoxetine 75.5±64.3, 255.4±168.2, 314.8±190.4; paroxetine 71.5±69.1, 320.7±198.3, 379.9±154.3; citalopram 90.39±79.3, 279.9±192.1, 282.5±171.1 seconds, respectively. The ejaculation time significantly increased in all groups (p <0.05), but there was no significant difference between the groups (P=0.75). Also, there was no significant difference in drugs side effects between groups (p >0.05). The most common side effects were drowsiness and dyspepsia, which were not severe enough to cause discontinuation of the drug. Conclusions: All available SSRIs were effective and usually had no serious complications. In patients who did not respond to any of these drugs, other SSRI drugs could be used as a salvage therapy.

Low serum vitamin D is associated with an increased likelihood of acquired premature ejaculation

Abstract Purpose: To investigate the relationship between 25-hydroxyvitamin D (25 (OH) D) levels and acquired premature ejaculation (PE). Materials and Methods: A total of 97 patients with acquired PE and 64 healthy men as a control group selected from volunteers without PE attending our Andrology Outpatient Clinic between November 2016 and April 2017 were included the study. All patients were considered to have acquired PE if they fulfilled the criteria of the second Ad Hoc International Society for Sexual Medicine Committee. Premature ejaculation diagnostic tool questionnaires were used to assessment of PE and all participants were instructed to record intravaginal ejaculatory latency time. Vitamin D levels were evaluated in all participants using high performance liquid chromatography method included in the study. Results: Compared to men without PE, the patients with acquired PE had significantly lower 25 (OH) D levels (12.0 ± 4.5 ng/mL vs. 18.2 ± 7.4 ng/mL, p < 0.001). In the logistic regression analysis, 25 (OH) D was found to be an independent risk factor for acquired PE, with estimated odds ratios (95% CI) of 0.639 (0.460-0.887, p = 0.007) and the area under curve of the ROC curve of 25 (OH) D diagnosing acquired PE was 0.770 (95% CI: 0.695 to 0.844, p < 0.001). The best cut-off value was 16 ng/mL with a sensitivity of 60.9%, specificity of 83.5%, PPV of 70.9%, and NPV of 76.4% to indicate acquired PE. Conclusions: This study demonstrates that lower vitamin D levels are associated with the acquired PE. The result of our study showed that the role of serum vitamin D levels should be investigate in the etiology of acquired PE. Perhaps supplementation of vitamin D in men with acquired PE will ameliorate the sexual health of these patients.

Changes in the Prevalence and Risk Factors of Erectile Dysfunction during a Decade: The Korean Internet Sexuality Survey (KISS), a 10-Year-Interval Web-Based Survey

PURPOSE: Although the prevalence of erectile dysfunction (ED) can be affected by social changes, this association has not been well evaluated. We aimed to evaluate the prevalence and risk factors of ED through a 10-year-interval web-based survey using the previous database of same group of panels, with same methodology. MATERIALS AND METHODS: We sent e-mails and surveyed the panels registered in the Internet survey agency. RESULTS: In total, 900 participants were recruited in 2016. The age-adjusted overall prevalences of self-reported ED (self-ED) and International Index of Erectile Function-5-assessed ED (IIEF-5-ED; score ≤21) in the 2016 study were 3.2% and 44.8%, respectively, which were lower than the prevalences of 8.1% (p=0.036) and 51.4% (p=0.323), respectively, in the 2006 study. The risk factors of IIEF-5-ED in their 20s and 30s in 2016 were psycho-social factors such as depression, low frequency of conversation about sex with sexual partner. The risk factors of IIEF-5-ED in their 40s to 60s in 2016 were organic factors, such as hypertension, diabetes mellitus, smoking, alcohol use, and self-reported premature ejaculation. CONCLUSIONS: Although the age-adjusted overall prevalence of self-ED has decreased during a decade, there was no difference in the age-adjusted overall prevalence of IIEF-5-ED. Psycho-social support may be important for young men with ED and overall healthcare can be helpful for elderly men with ED.

Metabolic Syndrome Is an Independent Risk Factor for Acquired Premature Ejaculation

PURPOSE: To determine the role of metabolic syndrome (MetS) as a risk factor for acquired premature ejaculation (PE) after considering the various risk factors, such as lower urinary tract symptoms, erectile dysfunction, hypogonadism, and prostatitis. MATERIALS AND METHODS: From January 2012 to January 2017, records of 1,029 men were analyzed. We performed multivariate analysis to identify risk factors for PE, including the covariate of age, marital status, International Prostate Symptom Score, International Index of Erectile Function (IIEF) score, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score, serum testosterone levels, and all components of MetS. Acquired PE was defined as self-reported intravaginal ejaculation latency time ≤3 minutes, and MetS was diagnosed using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: Of 1,029 men, 74 subjects (7.2%) had acquired PE and 111 (10.8%) had MetS. Multivariate analysis showed that the IIEF overall satisfaction score (odds ratio [OR]=0.67, p<0.001), NIH-CPSI pain score (OR=1.07, p=0.035), NIH-CPSI voiding score (OR=1.17, p=0.032), and presence of MetS (OR=2.20, p=0.022) were significantly correlated with the prevalence of acquired PE. In addition, the Male Sexual Health Questionnaire for Ejaculatory Dysfunction scores and ejaculation anxiety scores progressively decreased as the number of components of MetS increased. CONCLUSIONS: MetS may be an independent predisposing factor for the development of acquired PE. Effective prevention and treatment of MetS could also be important for the prevention and treatment of acquired PE.

Regular penis-root masturbation, a novel behavioral therapy in the treatment of primary premature ejaculation / 亚洲男科学杂志(英文版)

The primary premature ejaculation (PPE) is a common male sexual disorder. We proposed a novel behavioral therapy for PPE through regular penis-root masturbation (PRM). Nine heterosexual men with PPE completed the self-controlled study. After a 3-month PRM training, the median intravaginal ejaculatory latency time (IELT) increased from 60 s to 180 s (P = 0.018), and the mean Premature Ejaculation Diagnostic Tool (PEDT) score decreased from 14.8 ± 3.7 to 12.8 ± 4.1 (P = 0.074). Five out of eight patients had the prolonged dorsal nerve somatosensory evoked potential (DNSEP). The results suggest that PRM has a short-term therapeutic effect. Randomized controlled trials are needed to validate the efficacy.

Premature ejaculation: an update on definition and pathophysiology / 亚洲男科学杂志(英文版)

Premature ejaculation (PE) is the most common male sexual dysfunction, which represents a diagnostic as well as a therapeutic challenge for physicians. However, no universally accepted definition is currently available for PE. As a result, physicians continue to diagnose patients with PE according to major guidelines set by the professional societies. These guidelines either recommend the use of validated questionnaires or patient-reported outcomes. Recent efforts directed toward classifying PE may help provide a better understanding of the prevalence and risk factors of this disorder. While the exact etiology of PE has not been clearly elucidated, several risk factors have been strongly reported in the literature. Clearly, to understand the revised definition of PE, its etiology and pathophysiology is necessary to improve the clinical management of this medical condition and form the basis of future research in this regard. In this review, we highlight the past and current definitions of PE and present an appraisal on the classifications and theories suggested for the etiopathogenesis of PE.

Lifestyle Modification Strategy for Patients with Premature Ejaculation as Metabolic Syndrome

No abstract available.