Zhonghua Yi Xue Za Zhi. 2009 Dec 15; 89(46): 3249-52
Jiang XZ, Zhou CK, Guo LH, Chen J, Wang HQ, Zhang DQ, Shi BK, Xu ZS

OBJECTIVE: Primary premature ejaculation (PPE) is a prevalent sexual dysfunction among men while its precise pathologic mechanism has remained poorly understood. In current study the correlation between excitability of bulbocavernosus reflex (BCR) to stimulation of prostatic urethra and primary premature ejaculation was studied. METHODS: Forty-two patients with PPE and 20 normal potent male volunteers were studied by inserting a specially designed Foley catheter with two electrodes mounted on its distal surface (intraurethral catheter electrode) into bladder to evoke the BCR to stimulation of prostatic urethra to record the sensory thresholds of BCR to stimulation of prostatic urethra, thresholds to evoke stable BCR and latencies of BCR. Also the sensitivity of glans penis to electrical stimulation was detected by two surface electrodes. RESULTS: The mean sensory thresholds of BCR to stimulation of prostatic urethra, thresholds to evoke stable BCR, latencies of BCR and sensory thresholds of glans penis were (18.2 +/- 2.7) mA (0.2 ms in duration, 1 Hz), (34.8 +/- 4.2) mA (0.2 ms, 1 Hz), (71.2 +/- 5.8) ms and (14.2 +/- 1.9) mA (0.04 ms in duration, 3 Hz) in normal potent men respectively and were (12.4 +/- 3.7) mA (0.2 ms, 1 Hz), (23.8 +/- 5.6) mA (0.2 ms, 1 Hz), (70.5 +/- 6.3) ms and (11.9 +/- 2.3) mA (0.04 ms, 3 Hz) in patients with PPE respectively. Statistically significant differences were seen regarding the sensory thresholds of BCR to stimulation of prostatic urethra, the thresholds to evoke stable BCR and the sensory thresholds of glans penis between two groups (all P 0.05). CONCLUSION: Patients with PPE have hyperexcitable BCR to stimulation of prostatic urethra. It is probably one of the important etiological factors. Moreover the findings may provide new therapeutic modalities of PPE.

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Eur Urol. 2010 Feb 20;
Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, Vardi Y, Wespes E

CONTEXT: Erectile dysfunction (ED) and premature ejaculation (PE) are the two most prevalent male sexual dysfunctions. OBJECTIVE: To present the updated version of 2009 European Association of Urology (EAU) guidelines on ED and PE. EVIDENCE ACQUISITION: A systematic review of the recent literature on the epidemiology, diagnosis, and treatment of ED and PE was performed. Levels of evidence and grades of recommendation were assigned. EVIDENCE SYNTHESIS: ED is highly prevalent, and 5-20% of men have moderate to severe ED. ED shares common risk factors with cardiovascular disease. Diagnosis is based on medical and sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to the patient’s complaints and risk factors. Treatment is based on phosphodiesterase type 5 inhibitors (PDE5-Is), including sildenafil, tadalafil, and vardenafil. PDE5-Is have high efficacy and safety rates, even in difficult-to-treat populations such as patients with diabetes mellitus. Treatment options for patients who do not respond to PDE5-Is or for whom PDE5-Is are contraindicated include intracavernous injections, intraurethral alprostadil, vacuum constriction devices, or implantation of a penile prosthesis. PE has prevalence rates of 20-30%. PE may be classified as lifelong (primary) or acquired (secondary). Diagnosis is based on medical and sexual history assessing intravaginal ejaculatory latency time, perceived control, distress, and interpersonal difficulty related to the ejaculatory dysfunction. Physical examination and laboratory testing may be needed in selected patients only. Pharmacotherapy is the basis of treatment in lifelong PE, including daily dosing of selective serotonin reuptake inhibitors and topical anaesthetics. Dapoxetine is the only drug approved for the on-demand treatment of PE in Europe. Behavioural techniques may be efficacious as a monotherapy or in combination with pharmacotherapy. Recurrence is likely to occur after treatment withdrawal. CONCLUSIONS: These EAU guidelines summarise the present information on ED and PE. The extended version of the guidelines is available at the EAU Web site (http://www.uroweb.org/nc/professional-resources/guidelines/online/).

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Int Urol Nephrol. 2010 Feb 20;
Gökçe A, Demirtas A, Halis F, Ekmekcioglu O

OBJECTIVE: The aim of this study is to measure the ejaculation latency time (ELT) and to evaluate the effects of vardenafil on ELT and rigidity parameters of patients with lifelong premature ejaculation (PE) in a laboratory setting. MATERIALS AND METHODS: Double-blind, placebo-controlled, cross-over laboratory study was performed with 40 males with lifelong PE. As the subject ingested the placebo or vardenafil, real-time penile tumescence and rigidity monitoring began. Audiovisual sexual stimulation (AVSS) was performed 45 min later. The patient began vibratory stimulation to the frenular area at 8th minute of AVSS till ejaculation. A button has been placed under the cover where the patient presses to operate the vibrator. ELT was calculated in seconds with a chronometer. Following ejaculation, AVSS was stopped. The test was repeated with second medication in 7-15 days. RESULTS: Among 40 patients, the results of 17 could be evaluated. When the patient took placebo and vardenafil, mean ELTs were 62.7 and 189.5 s, respectively. When compared with placebo, vardenafil improved ELT significantly (P = 0.04). After the beginning of AVSS, time to first recorded base or tip rigidities was shorter and time to last recorded tip or base rigidities following ejaculation was longer than placebo; however, these differences were not significant (P > 0.05 for each). CONCLUSIONS: This laboratory design might be used to evaluate the effects of drugs on patients with ejaculation disorders. In this laboratory setting study, vardenafil exerted a threefold increase in ejaculation delay outside the vagina in patients with lifelong PE.

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Arch Sex Behav. 2010 Feb 19;
Christensen BS, Grønbæk M, Osler M, Pedersen BV, Graugaard C, Frisch M

Sexual dysfunctions and difficulties are common experiences that may impact importantly on the perceived quality of life, but prevalence estimates are highly sensitive to the definitions used. We used questionnaire data for 4415 sexually active Danes aged 16-95 years who participated in a national health and morbidity survey in 2005 to estimate the prevalence of sexual dysfunctions and difficulties and to identify associated sociodemographic factors. Overall, 11% (95% CI, 10-13%) of men and 11% (10-13%) of women reported at least one sexual dysfunction (i.e., a frequent sexual difficulty that was perceived as a problem) in the last year, while another 68% (66-70%) of men and 69% (67-71%) of women reported infrequent or less severe sexual difficulties. Estimated overall frequencies of sexual dysfunctions among men were: premature ejaculation (7%), erectile dysfunction (5%), anorgasmia (2%), and dyspareunia (0.1%); among women: lubrication insufficiency (7%), anorgasmia (6%), dyspareunia (3%), and vaginismus (0.4%). Highest frequencies of sexual dysfunction were seen in men above age 60 years and women below age 30 years or above age 50 years. In logistic regression analysis, indicators of economic hardship in the family were positively associated with sexual dysfunctions, notably among women. In conclusion, while a majority of sexually active adults in Denmark experience sexual difficulties with their partner once in a while, approximately one in nine suffer from frequent sexual difficulties that constitute a threat to their well-being. Sexual dysfunctions seem to be more common among persons who experience economic hardship in the family.

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Arch Sex Behav. 2010 Feb 19;
Christensen BS, Grønbæk M, Osler M, Pedersen BV, Graugaard C, Frisch M

Sexual dysfunctions and difficulties are common experiences that may impact importantly on the perceived quality of life, but prevalence estimates are highly sensitive to the definitions used. We used questionnaire data for 4415 sexually active Danes aged 16-95 years who participated in a national health and morbidity survey in 2005 to estimate the prevalence of sexual dysfunctions and difficulties and to identify associated sociodemographic factors. Overall, 11% (95% CI, 10-13%) of men and 11% (10-13%) of women reported at least one sexual dysfunction (i.e., a frequent sexual difficulty that was perceived as a problem) in the last year, while another 68% (66-70%) of men and 69% (67-71%) of women reported infrequent or less severe sexual difficulties. Estimated overall frequencies of sexual dysfunctions among men were: premature ejaculation (7%), erectile dysfunction (5%), anorgasmia (2%), and dyspareunia (0.1%); among women: lubrication insufficiency (7%), anorgasmia (6%), dyspareunia (3%), and vaginismus (0.4%). Highest frequencies of sexual dysfunction were seen in men above age 60 years and women below age 30 years or above age 50 years. In logistic regression analysis, indicators of economic hardship in the family were positively associated with sexual dysfunctions, notably among women. In conclusion, while a majority of sexually active adults in Denmark experience sexual difficulties with their partner once in a while, approximately one in nine suffer from frequent sexual difficulties that constitute a threat to their well-being. Sexual dysfunctions seem to be more common among persons who experience economic hardship in the family.

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Arch Esp Urol. 2010 Enero-Febrero; 63(1): 53-55
Cardona Maya W

OBJECTIVES: To discuss a concept about the current definition and treatment of premature ejaculation. METHODS: A detailed review was performed on the current definition and treatment of premature ejaculation. RESULTS: Several definitions were found, however a consensus on how to define premature ejaculation is lacking. In addition, there are several treatments: daily, on demand and topical agents. CONCLUSIONS: Premature ejaculation implicated three specific characteristics: short intravaginal ejaculatory latency time, lack of control, and sexual dissatisfaction.

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J Sex Med. 2010 Jan 14;
Gallo L, Perdonà S, Gallo A

ABSTRACT Introduction. The role of short frenulum and the effects of frenulectomy on premature ejaculation (PE) were never investigated. Aims. The aims of this study were to evaluate the prevalence of short frenulum in a population of patients affected by lifelong PE and to investigate the role of frenulectomy as first-line treatment for this condition. Methods. We performed frenulectomy to patients complaining of lifelong PE in which we found the presence of a short frenulum at physical examination. We evaluated intravaginal ejaculatory latency time (IELT) and the score of a validated PE questionnaire at baseline and after frenulectomy. Main Outcome Measures. We evaluated the change in mean IELT and in mean PE questionnaire score. Results. We found the presence of a short frenulum in 59 out of 137 (43%) subjects who came to our center complaining of lifelong PE. Mean age of study population was 38.2 years (+/-5.3 standard deviation). At baseline period, mean IELT was 1.65 minutes (+/-1.15), and mean PE questionnaire score was 15.8 (+/-2.85). No complications related to surgery occurred. Mean follow-up time was 7.3 months (+/-3.18). After frenulectomy, mean IELT was 4.11 minutes (+/-1.77), and mean PE questionnaire score was 9.85 (+/-3.2). An increase in mean IELT of 2.46 minutes (P < 0.0001) and a reduction in mean PE questionnaire symptoms score of 5.95 (P < 0.0001) were noted. Conclusion. Short frenulum is a genital anomaly found in 43% of individuals affected by lifelong PE in our data set. We suggest always ruling out at physical examination the presence of a short frenulum in all patients complaining of PE and to propose frenulectomy as first-line treatment in these cases. Gallo L, Perdonà S, and Gallo A. The role of short frenulum and the effects of frenulectomy on premature ejaculation. J Sex Med **;**:**-**.

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Int J STD AIDS. 2010 Feb; 21(2): 77-81
McCarty EJ, Dinsmore WW

Premature ejaculation (PE) is the most common male sexual problem worldwide affecting 22-38% of men. It has a significant morbidity both on patients and their partners, causing distress, anxiety and relationship difficulties. The mainstay of treatment is a combined approach using behavioural therapies and non-licensed medication such as topical anaesthetic preparations, selective serotonin re-uptake inhibitors and phosphodiesterase-5 inhibitors. In recent years, there has been a greater emphasis placed on researching novel treatments and exploring the on-demand use of current preparations. This review provides an overview of current accepted treatments and emerging agents for the use in PE.

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Harefuah. 2009 Sep; 148(9): 620-4, 656
Galin A, Bronner G, Raviv G

INTRODUCTION: Premature ejaculation (PE) is one of the most common sexual dysfunctions among men. PE is poorly defined and inadequately characterized, therefore, professionals find it difficult to cope with the diagnosis, treatment and research. Men who complain about their PE also describe their problem in different ways. PURPOSE: This article describes the prevalence of PE, presents the different definitions of the problem and provides a model for evaluation and treatment combining medical and psychosexual techniques. METHODS: The proposed model for the diagnosis and treatment of PE was composed by combining information from relevant literature with the multi-professional staff experience in our Sexual Medicine Center. OUTCOMES: Selective serotonin release inhibitors (SSRIs) have been the most promising medication for treatment of PE. Psychosexual therapy, offering cognitive-behavioral techniques contribute to the man’s ability to improve his sexual and couple relationships. CONCLUSIONS: Diagnosis of PE is mainly based on sexual history as described by the male patient. Therefore, it is essential to have a comprehensive medical and sexual history, description of the effect of PE on sexual activity, and the degree of personal and couple distress. It is important to clarify the onset of the problem, as PE may be the result of another sexual dysfunction of the man or his sexual partner.

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J Sex Med. 2010 Feb 5;
Santtila P, Jern P, Westberg L, Walum H, Pedersen CT, Eriksson E, Kenneth Sandnabba N

ABSTRACT Introduction. Previous research has suggested brain dopamine (DA) neurotransmission to be involved in the control of ejaculation. Furthermore, previous studies indicate a partly hereditary background to premature ejaculation. Aim. To investigate whether the dopamine transporter gene (DAT1) polymorphism is associated with premature ejaculation. Methods. Retrospective self-reports of four indicators reflecting ejaculatory function-anteportal ejaculation, number of penile thrusts, ejaculation latency time, and feeling of control over ejaculation-and saliva samples for DNA analysis were obtained from 1,290 men (M = 26.9, standard deviation = 4.7 years; range 18-45) with sexual experience. Main Outcome Measures. Calculations of allelic effects were computed using the Generalized Estimating Equations module of SPSS 17. Results. Carriers of the 10R10R genotype had scores indicating a lower threshold to ejaculate on each of the indicators compared to the combined 9R9R/9R10R carrier group. The differences were significant both for the composite score and for anteportal ejaculation, number of thrusts, and feeling of control over ejaculation, but not for ejaculation latency time. The effect of the polymorphism remained significant after controlling for age, homosexual experience, having a regular sexual partner, level of sexual desire, and frequency of sexual activity, hence suggesting that it is not secondary to an association between the studied polymorphism and some other aspect of sexual behavior, but due to a specific influence of DA on ejaculation. Conclusions. The findings of the present study support results of previous studies indicating involvement of dopaminergic neurotransmission in ejaculation. Santtila P, Jern P, Westberg L, Walum H, Pedersen CT, Eriksson E, and Sandnabba NK. The dopamine transporter gene (DAT1) polymorphism is associated with premature ejaculation. J Sex Med **;**:**-**.

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