The pathophysiology of acquired premature ejaculation

SUMMARYOBJECTIVE:The aim of this study was to evaluate the quality of life of patients with lifelong and acquired premature ejaculation and to examine its relationship with depression and anxiety.METHODS:Between February 2017 and January 2018, a total of 175 patients with premature ejaculation and 132 control men who applied to the urology department of the training and research hospital with the complaint of Premature Ejaculation were included. Patients were divided into three groups according to International Society for Sexual Medicine (ISSM) criteria as follows: Group 1, lifelong premature ejaculation; Group 2, acquired premature ejaculation, and Group 3, control group without premature ejaculation. A detailed medical history of patients was obtained and physical examinations were performed. Intravaginal ejaculation latency time (IELT) was recorded and patients were administered International Erectile Function Index-5 (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT), Sexual Health Inventory for Men (SHIM), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI)-1 and STAI-2, and Short Form-36 (SF-36).RESULTS:The mean mental component score (MCS) of the SF-36 was 51.65±6.57 in the lifelong premature ejaculation group, 49.33±8.65 in the acquired premature ejaculation group, and 61.12±11.09 in the control group (p<0.0001). The mean physical component score (PCS) was 50.99±7.43 in the lifelong premature ejaculation group, 48.32±11.58 in the acquired premature ejaculation group, and 55.17±8.10 in the control group (p<0.0001). Quality of life of premature ejaculation patients as assessed by SF-36 was lower in the subscales of physical functioning, general health perception, vitality, and role limitations due to emotional functioning, compared to the control group.CONCLUSIONS:Lifelong and acquired premature ejaculation patients deteriorate their quality of life: the deterioration in these patients’ quality of life also negatively affects their depression and anxiety states.

Premature ejaculation (PE) is a very common male sexual dysfunction. Recently (February 2014), an update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of PE became available on the International Society of Sexual Medicine website.1 One of the most promising treatments for PE is selective serotonin reuptake inhibitors (SSRI). The present study reported a relationship between plasma melatonin levels and the efficacy of SSRI in PE patients.2 It is very interesting, and the findings that the mean plasma melatonin levels in men with PE were significantly lower than that in healthy controls are important. Although the reasons for low plasma melatonin levels in men with PE are not clear, to elevate serum melatonin levels seems to be one of the effective methods for PE treatment. I would like to know more about the following two issues that affect serum melatonin levels. (1) In the present study, PE patients were treated with three SSRI (paroxetine, fluoxetine and sertraline). There is another short-acting SSRI especially for PE, dapoxetine. Do serum melatonin levels elevate with dapoxetine administration? (2) How about administration of a melatonin supplement, and/or melatonin MT1 and MT2 receptor agonist (ramelteon) for PE treatment? Intravaginal ejaculation latency times measured by stopwatch are a useful and objective parameter to evaluate PE. However, stopwatch measurements of intravaginal ejaculation latency times are bothersome and disruptive to sexual pleasure. Recent reports showed that self-estimation by the patient and their partner of ejaculatory latency should be used to determine intravaginal ejaculation latency times in clinical practice.3 It is much easier to evaluate PE by self-estimation, and we can investigate clinical PE conditions and efficacy of treatments for PE more smooth and widely. Therefore, further investigations of PE, including the two aforementioned issues, are expected in the near future. It is significant that this paper suggested serum melatonin levels as an alternative PE treatment strategy. None declared.

Premature ejaculation (PE) has been reported in 40.6-51.5% of men affected by Parkinson's disease (PD), however, this non-motor sexual complaint has not been studied in detail. We describe eight PD patients who asked for a sexological consultation between 2008 and 2014 because of a new-onset of PE. They were diagnosed with acquired PE (APE) according to the DSM-V criteria and the International Society for Sexual Medicine (ISSM) committee. Patients' demographic, medical and sexual related data were retrieved and studied. The average age of onset of PD was 53.3 ± 12.7 years (range 38-77 years) and the sexual problem appeared 4.0 ± 3.1 years later. The mean intravaginal ejaculation latency (IELT) before APE onset was 7.3 (range 2-20) min. Interestingly, the ejaculatory disorder appeared abruptly, characterized by a dramatically shortened IELT in all patients, while in three of the cases ejaculation occurred before vaginal penetration, hampering sexual intercourse. Some patients had 2 additional sexual problems, (four with erectile dysfunctions, five with libido changes: increased desire in four and reduced in one). In this case series of PD patients with APE, the ejaculatory dysfunction developed when patients were on antiparkinsonian medications, suggesting a possible medication effect.

Four Measures of Investigating Ejaculatory Performance

Premature Ejaculation (PE) is a common male sex problem and incidence wise it is much commoner than erectile dysfunction with incidence in some studies being greater than 30% [1, 2]. In spite of this it does not attain enough attention of research workers. Ejaculation time (ET) may vary, but patient usually seeks medical help when it consistently becomes short at every coitus and causes distress to the couple. American Urological Association (AUA) defines PE when it “occurs sooner than desire” and causes “distress to one or both partners” [3]. For clinical assessment quantification is essential and in this case is possible by measuring Intravaginal Ejaculation Latency Time (IELT).this calculated by time period between vaginal penetration of phallus and intravaginal ejaculation. A more categorical and working definition comes from the International Society for Sexual Medicine (ISSM) which states that PE is “ejaculation that occurs prior to or within 1 minute of vaginal penetration” [4]. In our study we have taken IELT of less than 1 minute as PE. Serotonin has been found to have an inhibitory action on seminal emission/ejaculation via action on brain, brainstem, raphe nuclei and reticular formation. These observation leads to several studies which show that selective serotonin reuptake inhibitor (SSRI) achieve significant increase in IELT [5].

Objective Different mechanisms such as psychological, neurobiological, autonomic, and genetic factors might be involved in the etiology of lifelong Premature Ejaculation (PE). Albeit cortical activity changes have been reported, the relationship between PE and impulsivity/decision-making is minimally studied to date. The present study aimed to assess impulsivity and risky decision-making in individuals with lifelong PE for the first time. Method 26 lifelong PE patients were diagnosed by the International Society for Sexual Medicine (ISSM-2014) criteria and 26 healthy volunteers were recruited. The Premature Ejaculation Diagnostic Tool (PEDT), International Erectile Function Index (IIEF), Barratt Impulsiveness Scale-11 (BIS-11), Patient Health Questionnaire-9 (PHQ-9), Balloon Analogue Risk Task (BART), and Monetary Choice Questionnaire-27 (MCQ-27) were administered. Results The mean age was 37.28 (18-55). No differences were found between groups in risky decision-making and impulsivity. Conclusion No alterations of impulsivity and risky decision-making were found in lifelong PE patients. Impulsivity may only exist in a subset of individuals with lifelong PE or may only be evident in neural levels or specific subtypes of impulsivity.

We read with great interest the recently published manuscript on premature ejaculation (PE), based on the global online sexual survey (GOSS) [ 1 Shaeer O. The global online sexuality survey (GOSS): The United States of America in 2011 Chapter III—Premature ejaculation among English‐speaking male Internet users. J Sex Med. 2013; 10: 1882-1888 Crossref PubMed Scopus (31) Google Scholar ]. Similar in scope to other papers published from the observational Internet‐based, cross‐sectional GOSS data [ 2 Shaeer O. Shaeer K. Shaeer E. The global online sexuality survey (GOSS): Female sexual dysfunction among Internet users in the reproductive age group in the Middle East. J Sex Med. 2012; 9: 411-424 Crossref PubMed Scopus (51) Google Scholar , 3 Shaeer O. Shaeer K. The global online sexuality survey (GOSS): Ejaculatory function, penile anatomy, and contraceptive usage among Arabic‐speaking Internet users in the Middle East. J Sex Med. 2012; 9: 425-433 Crossref PubMed Scopus (31) Google Scholar , 4 Shaeer O. Shaeer K. The global online sexuality survey (GOSS): Erectile dysfunction among Arabic‐speaking Internet users in the Middle East. J Sex Med. 2011; 8: 2152-2160 Crossref PubMed Scopus (47) Google Scholar ], this study focuses on determining the prevalence of erectile dysfunction and PE among English‐speaking “Internet users.” Through application of The Premature Ejaculation Diagnostic Tool (PEDT), the author reported that 49.6% of the subjects were diagnosed as having PE, while through application of the International Society for Sexual Medicine (ISSM) definition of lifelong PE, a prevalence of 6.3% was reported.

ORIGINAL RESEARCH—EJACULATORY DISORDERS: Antibiotic Treatment Can Delay Ejaculation in Patients with Premature Ejaculation and Chronic Bacterial Prostatitis

Some factors associated with the four premature ejaculation (PE) syndromes have been studied, but the association between International Prostate Symptom Score (IPSS) and the four PE syndromes has not been investigated. We performed this study to evaluate the association between IPSS and intravaginal ejaculatory latency time (IELT) in men with the four PE syndromes. From June 2012 to January 2014, a total of 690 men aged 40-59 years complaining of ejaculating prematurely and another 452 male healthy subjects of the same age without these complaints were included in this study. Men with the complaints of ejaculating prematurely were classified as one of the four PE syndromes: lifelong PE, acquired PE (APE), variable PE, and subjective PE. Each of them completed a detailed questionnaire including information on demographics, medical and sexual history (e.g., self-estimated IELT), IPSS, and International Index of Erectile Function-5. Associations between IPSS and self-estimated IELT in middle-aged men with the four PE syndromes. Men complaining of ejaculating prematurely reported higher IPSS (11.2 ± 6.0 vs. 5.5 ± 3.3 ) and shorter self-estimated IELT (2.1 ± 1.6 minutes vs. 4.8 ± 3.3) than men without complaints (P < 0.001 for each). By unilabiate analysis, self-estimated IELT in men with the four PE syndromes showed significant correlations with IPSS (P < 0.001 for all). After adjusting for age, self-estimated IELT was negatively associated with IPSS in men with PE complaints (adjusted r = -0.378, P < 0.001). Also, the association was stronger in men with APE (adjusted r = -0.502, P < 0.001). Men complaining of ejaculating prematurely reported worse IPSS than men without these complaints. Self-estimated IELT was negatively associated with IPSS in men complaining of ejaculating prematurely, and the correlation was the strongest in men with APE.

Surʻat-e-Inzāl (Premature Ejaculation) is the most prevalent male sexual dysfunction affecting 25 - 40% global population of men. It is a universal disorder and is independent of age, social or marital status. It has a significant impact on both- patients and their partners, causing distress, anxiety and relationship difficulties affecting the quality of life. Several aetiologies have been proposed by various researchers which are not evidence-based but speculative. Accordingly the International Society for Sexual Medicine (ISSM) issued treatment guidelines for Premature Ejaculation (PE) recommending Serotonergic Antidepressants (SSRIs) and Local Anaesthetics (LA) for its management in modern medicine. However, these treatments were not actually developed for PE, and have limitations associated with their off-label use. Furthermore, nearly all the recommended drugs have a wider spectrum of adverse effects and serious drug interactions which sometimes could be fatal. On the other hand, centuries old Unani medicine offers a complete line of treatment for Surʻat-e-Inzāl based on traditional knowledge and experience. Unani physicians devised a large number of poly-herbal recipes which are still in vogue. Majoon-e-Piyaz (MP) is one of the compound Unani formulations which are in use for the treatment of premature ejaculation since centuries. This article is an attempt to summarize scientific investigations in support of the claim made by Unani physicians regarding Majoon-e-Piyaz (MP). &#x0D; Keywords: Surʻat-e-Inzāl, Premature Ejaculation, Majoon-e-Piyaz, Unani Medicine

Eyaculación prematura

Background and objective Although several studies have reported that sexual dysfunction is associated with chronic prostatitis (CP), specific differences in self-reported questionnaires and correlation with CP are not well-known. This study aimed to evaluate the prevalence and correlation of sexual dysfunction in men with CP. Material and methodsThis cross-sectional study included 892 men who visited our health care center, who were then divided into two groups. In Group 1, subjects are characterized with National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) pain score ≥4, and Group 2 subjects are characterized with NIH-CPSI<4. Intravaginal Ejaculation Latency Time, Premature Ejaculatory Diagnostic Tool (PEDT), Male Sexual Health Questionnaire-ejaculation, International Index of Erectile Function (IIEF), and IIEF-5 were self-reported by participants. Total testosterone (TT) level was also checked. Data obtained were compared between the groups and the relationships identified. ResultsThe mean age was 52.8±7.3 years, and CP was prevalent in 136 (15.2%) of the 892 participants. All questionnaire scores showed worse results in Group 1 compared to those in Group 2 (p<0.05). In total, the prevalence of erectile dysfunction (IIEF-5≤21) and premature ejaculation (PEDT≥9) were 508 (56.3%) and 290 (32.5%), respectively. A higher prevalence of erectile dysfunction (71.3% vs. 53.6%, p<0.001) and premature ejaculation (44.8% vs. 30.3%, p=0.001) was identified in Group 1 than in Group 2. By correlation analysis, IIEF-5 (r=−0.208, p=0.015) and TT (r=−0.331, p=0.011) showed correlation with NIH-CPSI pain score in Group 1. ConclusionThe prevalence and severity of erectile dysfunction and premature ejaculation were higher in Group 1. Moreover, the IIEF-5 showed correlation with NIH-CPSI pain score. These results indicate that screening for erectile dysfunction and premature ejaculation in men with CP is useful for early detection of comorbidities.

Objective: To examine retrospectively sexual dysfunction in the male spouses of 425 female patients who had presented to our clinic and were diagnosed with primary vaginismus. Materials and methods: Seven questions related to age, profession, educational status, number of marriages, personality structure, sexual experience, and sexual dysfunction history were directed to the spouses of the 425 female patients presenting to our clinic for vaginismus treatment between 2015 and 2018. Men reporting sexual dysfunction were evaluated by a urologist, and the necessary treatment was initiated. Cognitive-behavioral couple therapy was started for all patients. Results: Of the 425 men, 73.9% stated that they did not have any sexual problems. Of the 111 men (26.1%) stated that they had one or more sexual problems, 77 (18.1%) were diagnosed with premature ejaculation, 25 (5.8%) erectile dysfunction, 36 (8.4%) hypoactive sexual desire, and one (0.2%) had delayed ejaculation. Premature ejaculation and erectile dysfunction were identified in nine patients, premature ejaculation and hypoactive sexual desire in seven, and erectile dysfunction and hypoactive sexual desire in four patients. There was an increased rate of sexual dysfunction in men in cases where the duration of marriage without coitus was longer than three years. Conclusion: In the treatment of vaginismus, male sexual dysfunction should not be ignored. Spouses should be questioned for sexual dysfunction and included in the treatment process.

Lifelong premature ejaculation (PE) is a frequent male sexual dysfunction and is thought to be mediated in part by disturbances of serotonergic (5-hydroxytryptamine; 5-HT) neurotransmission and ejaculation-mediating 5-HT receptors in the CNS. The aetiology of the dysfunction is unclear, but probably includes neurobiological and environmental factors. Lifelong PE is a syndrome characterised by a cluster of symptoms. Rapid ejaculations become manifest around the first sexual encounters in puberty or adolescence. Intravaginal ejaculation latency time usually occurs within 30 – 60 s, or maximally within 2 min after vaginal penetration, is present with nearly every sexual partner, and remains similar throughout life or may aggravate during ageing. The syndrome may lead to secondary psychological, sexual and relationship problems. Daily treatment with some selective serotonin re-uptake inhibitors (SSRIs) leads to strong ejaculation delay, but may be accompanied by side effects. New treatment with SSRIs with a short half-life (if approved) for on-demand use 1 – 2 h prior to coitus exerts less ejaculation-delaying effects than daily SSRI strategies. Animal studies have shown that strong, immediate ejaculation delay may be induced by the combination of an SSRI with a 5-HT1A receptor antagonist. The combination of an SSRI and any other compound that immediately strongly raises 5-HT neurotransmission may form the basis for the development of new on-demand drugs to treat PE.

Chronic prostatitis (CP) is a frequent prostate-related complaint, impacts negatively on quality of life and is mostly of unclear etiology. Increasing attention has been paid to the prevalence of sexual dysfunctions in CP patients; however, the impact of specific types of CP and the correlation of sexual dysfunctions with psychological disorders associated with CP are not well understood. Type IIIa CP is characterized by chronic pelvic pain, urination symptoms and white blood cells in expressed prostatic secretion, but free of bacterial infection. A population of 600 type IIIa CP patients were randomly selected and 40 normal man were included as the control group. Queries were conducted by urologists. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Index of Erectile Function (IIEF-5) and the Symptom Checklist 90-R were used to evaluate the symptoms and severity of prostatitis, erectile dysfunctions and psychological problems, respectively. Scores of ejaculatory pain and premature ejaculation were also collected. Our study revealed that sexual dysfunctions are frequently associated with this specific type of CP. The prevalence of erectile dysfunction, premature ejaculation and ejaculatory pain was 19, 30 and 30 %, respectively. A variety of psychological problems exist among type IIIa CP patients, including depression, anxiety, somatization, obsessive-compulsive and interpersonal sensitivity. In particular, the severity of erectile dysfunctions, but not premature ejaculation and ejaculatory pain, correlated significantly with depression and anxiety. Our data indicate that a moderate level of sexual dysfunctions exists among the type IIIa CP patients, and highlight the association of depression and anxiety with erectile dysfunction in CP patients, suggestting that special attention should be paid to these psychological issues in clinical treatments of the prostatitis symptoms and the associated erectile dysfunctions.