PURPOSE: To determine whether biothesiometry, bulbocavernous reflex latency(BCRL), and dorsal nerve somatosensory evoked potential(DNSEP) test could predict efficacy of tricyclic antidepressant(TCA) or selective serotonin reuptake inhibitor(SSRI) to prolong the ejaculatory latency in premature ejaculation. MATERIALS AND METHODS: A total of 33 patients with pramature ejaculation(mean age: 44 years) completed the entire study, Patients took each of clomipramine(50mg), sertraline(1 00mg), and fluoxetine(40mg) consecutively during a 4-week period per each agent. We obtained increased intravaginal ejaculatory latency by the most effective drug among 3 drugs. We analyzed correlations of the increased intravaginal ejaculatory latency with vibration threshold of penile shaft and glans, BCRL, and latency and amplitude of DNSEP. RESULTS: According to Pearson's correlation analysis, there was no correlation of intravaginal ejaculatory latency with vibration threshold of penile shaft and glans, BCRL, and latency and amplitude of DNSEP(all p> 0.05). There was no difference in intravaginal ejaculatory latency between the groups of high and low vibration threshold, long and short BCRL, long and short latency of DNSEP, and large and small amplitude at cerebral cortex on DNSEP test(all p> 0.05). CONCLUSIONS: It seems that biothesiometry, BCRL, and DNSEP test can not predict the efficacy of tricyclic antidepressant or selective serotonin reuptake inhibitor to prolong the ejaculatory latency in premature ejaculation.
Cerebral Cortex ; Drug Therapy* ; Humans ; Premature Ejaculation* ; Reflex ; Serotonin ; Vibration

OBJECTIVETo assess the efficacy of dapoxetine on demand for premature ejaculation and provide evidence for clinical decision-making.

METHODSWe searched PubMed, Embase, BIOSIS Previews, Cochrane Library, CNKI Database and Wanfang Database for literature on dapoxetine on demand for premature ejaculation. We performed meta-analysis on the identified publications and evaluated its therapeutic efficacy based on the intravaginal ejaculatory latency time (IELT), patient-reported global impression of change (PGI), and composite PRO criteria for clinical benefit (CCCB).

RESULTSFour relevant studies were included involving 6 081 cases of premature ejaculation. Compared with the placebo controls, the patients treated with dapoxetine on demand showed significant improvement in IELT (WMD = 1.39, 95% CI [1.23, 1.55], P < 0.000 01), PGI (OR = 2.59, 95% CI [2.21, 3.04], P < 0. 000 01), and CCCB (OR = 2.59, 95% CI [1.98, 3.39], P < 0.000 01). There were significant differences between the 60 mg and 30 mg dapoxetine groups in IELT (WMD = 0.46, 95% CI [0.19, 0.74], P = 0.001 0) and PGI (OR = 1.32, 95% CI [1.06, 1.64], P = 0.01), but not in CCCB (OR = 1.39, 95% CI [0.90, 2.15], P = 0.13).

CONCLUSIONDapoxetine on demand can prolong IELT and improve PGI and CCCB, either at the dose of 60 mg or 30 mg, and has an even better efficacy in prolonging IELT and improving PGI at 60 mg.

Benzylamines ; therapeutic use ; Ejaculation ; Humans ; Male ; Naphthalenes ; therapeutic use ; Premature Ejaculation ; drug therapy ; Treatment Outcome

OBJECTIVETo investigate the clinical effectiveness of sertraline hydrochloride combined with four-spot caress in the treatment of primary premature ejaculation (PE).

METHODSWe randomly assigned 90 primary PE patients to three groups of equal number. The patients in group A (aged [28.1 ± 5.2] yr and with a disease course of [3.1 ± 1.9] yr) were treated with oral sertraline hydrochloride at 50 mg qd, those in B (aged [27.8 ± 4.1] yr and with a disease course of [3.2 ± 2.0] yr) by four-spot caressing (caressing the tongue, breasts, and vulva prior to intercourse), and those in C (aged [27.1 ± 4.7] yr and with a disease course of [3.1 ± 2.0] yr) by the combination of oral sertraline hydrochloride and four-spot caressing, all for 12 weeks. Before and after 4, 8, and 12 weeks of treatment, we obtained the intravaginal ejaculatory latency time (IELT) and Chinese Index of Sexual Function for Premature Ejaculation-5 (CIPE-5) scores and compared them among the three groups of patients.

RESULTSThe IELT was dramatically prolonged in groups A, B, and C after 4 weeks ([1.08 ± 0.29], [0.93 ± 0.28] and [1.21 ± 0.27] min), 8 weeks ([1.43 ± 0.30], [1.20 ± 0.33] and [1.72 ± 0.42] min) and 12 weeks of treatment ([2.12 ± 0.63], [1.90 ± 0.65] and [2.67 ± 0.82] min) as compared with the baseline ([0.63 ?0.14] , [0.60 ?0.14] and [0.62 ?0.11] min) (P < 0.05), even longer in group C than in A and B (P < 0.05). The CIPE-5 scores were markedly improved in groups A, B and C after 4 weeks ([15.17 ± 1.74], [14.57 ± 1.94] and [15.60 ± 1.63] min), 8 weeks ([17.13 ± 1.63], [16.37 ± 1.97] and [18.00 ± 1.05] min) and 12 weeks of intervention ([18.93 ± 1.57], [18.53 ± 1.67] and [20.00 ± 1.46] min ) as compared with the baseline ([12.57 ± 2.05], [13.20 ± 2.51] and [13.07 ± 2.01] min) (P < 0.05), even higher in group C than in A and B (P < 0.05).

CONCLUSIONSertraline hydrochloride combined with four-spot caressing, with its definite efficacy and rare adverse reactions, deserves wide clinical application in the treatment of primary PE.

Adult ; Coitus ; Ejaculation ; Female ; Humans ; Male ; Premature Ejaculation ; drug therapy ; Sertraline ; therapeutic use ; Young Adult

Premature ejaculation (PE) is a most common type of ejaculatory dysfunction, which has significant adverse effects on the life quality of the patients and their partners. Medication is currently the first choice for PE and psycho-behavior therapy is sometimes used as an adjuvant means. It is reported in a number of studies that medication alone or combined with psycho-behavior therapy has a great short-term efficacy and a very low risk of side effects. Conservative therapies for PE, however, have some obvious disadvantages such as easy recurrence after drug withdrawal, ineffectiveness in some cases, and so on. Thus, clinicians in China and abroad have developed and tried various surgical methods for the treatment of PE, most of which are reportedly safe and effective. However, International Society for Sexual Medicine guidelines for the diagnosis and treatment of PE recommended against surgical methods because of possible permanent loss of sexual function and insufficient reliable data, though without support from evidence or relevant literature. Although controversial, surgical treatment remains an effective and feasible strategy for refractory PE that does not respond to any conservative therapies. This review summarizes a variety of surgical techniques for PE, along with their basic principles, indications, effects and safety.
Behavior Therapy ; China ; Conservative Treatment ; Ejaculation ; Humans ; Male ; Premature Ejaculation ; drug therapy ; surgery ; Quality of Life ; Recurrence ; Sexual Partners

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.
Adult ; Behavior Therapy/methods* ; Humans ; Male ; Masturbation ; Penis ; Premature Ejaculation/therapy*

OBJECTIVETo investigate the clinical value of Paroxetine combined with mid-frequency electrical pulse acupoint stimulation (EPAS) in the treatment of premature ejaculation (PE).

METHODSTotally 69 PE patients were equally assigned to receive oral Paroxetine 20 mg/d, mid-frequency EPAS, or oral Paroxetine 10 mg/d combined with mid-frequency EPAS (P + EPAS) , all for 8 weeks. We obtained the intravaginal ejaculation latency time (IELT) and Chinese Index of Premature Ejaculation (CIPE-5) scores of the patients before and after treatment, and compared adverse reactions among the three groups of patients.

RESULTSOne patient of the Paroxetine group gave up treatment because of abdominal pain and nausea. Compared with the baseline, the patients in the Paroxetine, EPAS, and P + EPAS groups all showed markedly increased IELT ([0.92 ± 0.11] vs [4.07 ± 0.11] min, P < 0.01; [0.92 ± 0.12] VS [2.78 ± 0.17] min P < 0.05; [0.91 ± 0.09] vs [5.31 ± 0.13], P < 0.01) and decreased CIPE-5 scores (12.5 ± 3.0 vs 22.0 ± 2.1, P < 0.01; 12.8 ± 2.9 vs 19.5 ± 1.9, P > 0.05; 13.1 ± 2.8 vs 25.2 ± 2.1, P 0.01), with statistically significant differences between the P + EPAS group and the other two (P < 0.05). The total effectiveness rate was 95.7% in the P + EPAS group, remarkably higher than in the Paroxetine (72.7%, P < 0.05) and the EPAS group (47.8, P < 0.01).

CONCLUSIONOral Paroxetine combined with mid-frequency EPAS has a higher safety and efficacy than either Paroxetine or EPAS alone in the treatment of PE.

Acupuncture Points ; Aged ; Combined Modality Therapy ; methods ; Ejaculation ; Electroacupuncture ; methods ; Humans ; Male ; Paroxetine ; therapeutic use ; Premature Ejaculation ; therapy ; Serotonin Uptake Inhibitors ; therapeutic use ; Treatment Outcome

Premature ejaculation (PE) is a common male sexual disorder with an incidence rate of 20-30%. Recent clinical trials have demonstrated that phosphodiesterase type 5 inhibitors (PDE5i), as the first-line drug for erectile dysfunction (ED), can improve ejaculatory function probably by acting on the peripheral and central adrenergic nerves. The possible action mechanisms of PDE5i may involve lessening of the central sympathetic output, modulation of the contractile responses from the vas deferens, seminal vesicles, prostate and urethra, induction of peripheral analgesia, and prolonging of the total erectile duration, increasing the confidence of ejaculation control, and reducing the post-ejaculation refractory time. This review discusses the possible mechanisms and clinical application of PDE5i in the treatment of PE.
Ejaculation ; drug effects ; Erectile Dysfunction ; drug therapy ; Humans ; Male ; Muscle Contraction ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Premature Ejaculation ; drug therapy ; Seminal Vesicles ; physiology ; Vas Deferens ; physiology

OBJECTIVETo observe the clinical effectiveness of Qilin Pills combined with sertraline in the treatment of secondary non-consolidated kidney qi premature ejaculation (PE).

METHODSA total of 120 patients with secondary non-consolidated kidney qi PE were randomly assigned to groups A (aged [35.5 ± 5.4] yr), B (aged [36.2 ± 5.7] yr), and C (aged [35.2 ± 5.3] yr) in the ratio of 1:1:1 to receive Qilin Pills (once 6 g, bid), sertraline (once 50 mg, qd), and Qilin Pills plus sertraline, respectively, all for 4 weeks. The intravaginal ejaculatory latency time (IELT) and PE diagnostic tool (PEDT) scores were obtained before and after medication and at 1 month after drug withdrawal, and comparative analyses were made among the three groups of patients.

RESULTSThe IELT was dramatically prolonged in groups A, B, and C after treatment ([3.23 ± 1.84], [3.87 ± 2.43], and [5.92 ± 3.11] min) and at 1 month after drug withdrawal ([1.85 ± 1.27], [1.52 ± 1.06], and [ 4.26 ± 1.88 ] min) as compared with the baseline ([0.88 ± 0.45], [0.84 ± 0.47], and [0.85 ± 0.50] min) (P < 0.01), even longer in group C than in A and B (P < 0.01). The PEDT scores of the three groups were 5.1 ± 1.8, 4.9 ± 1.7, and 3.8 ± 1.2 after treatment and 8.2 ± 2.4, 8.1 ± 2.4, and 6.5 ± 2.1 at 1 month after drug withdrawal, significantly improved in comparison with 13.2 ± 3.2, 12.8 ± 3.1, and 13.1 ± 3.4 before treatment (P < 0.01), even more significantly in group C than in A and B (P < 0.01).

CONCLUSIONQilin Pills combined with sertraline has a definite efficacy in the treatment of secondary non-consolidated kidney qi PE and therefore deserves wide clinical application.

Adult ; Drug Therapy, Combination ; methods ; Drugs, Chinese Herbal ; therapeutic use ; Ejaculation ; drug effects ; physiology ; Humans ; Male ; Premature Ejaculation ; drug therapy ; Qi ; Sertraline ; therapeutic use

PURPOSE: Pharmacotherapy using selective serotonin reuptake inhibitors(SSRls) for men with primary premature ejaculation(PE) is promising. Specially, a strategy taking a pill "as needed" may offer an attractive option. To investigate the possibility of self therapy, patients treated for PE with sertraline "as needed" basis were evaluated. MATERIALS AND METHODS: Since 1996 we have treated 24 males with sertraline "as needed" basis for primary PE. We chose sertraline among SSRIs because alarge dose need not to be divided and peak plasma levels occurring 4-8 hours after oral administration makes 5 p.m. suitable for the time of administration. Five p.m. is the time the ordinary men usually fix their evening schedule including intercourses. Each patient was started on 50mg qd for 2 weeks and then the dose was adjusted to 50 or 100mg only on the day of intercourse. RESULTS: After 6 weeks, 18 men continued to take medication and 6 had dropped out. Of 18 men, mean ejaculation latency were 23 +/-19sec before treatment, 5.9 +/-4.2min after 2wks 50mg qd, 5.1 +/-3.8min after 2wks 50/100mg pm and 4.5 +/-2.7min after 4wks 50/100mg prn and mean sexual satisfaction scores ('5"=extremely satisfied, "0"=extremely unsatisfied) of men were 0.8 +/-0.8 before treatment, 3.8 +/-1.2 after 2wks 50mg qd, 3.4 +/-1.0 after 2wks 50/100mg pm and 3.2 +/-0.7 after 4wks 50/100mg pm. And mean sexual satisfaction scores of partners were 1.1 +/-0.7 before treatment, 3.2 +/-1.6 after 2wks 50mg qd,3.1 +/-1.4 after 2wks 50/100mg pm and 3.3 +/-1.2 after 4wks 50/100mg pm. Side effects were intermittent excessive delay in 1 patient, fatigue in 2 patients, numbness in 1 patient. CONCLUSIONS: If our results were supported by additional clinical long term study, self therapy with sertraline given pm at 5 pm in treatment of PE could be as attractive as self injection therapy in the treatment of erectile dysfunction.
Administration, Oral ; Appointments and Schedules ; Drug Therapy ; Ejaculation ; Erectile Dysfunction ; Fatigue ; Follow-Up Studies* ; Humans ; Hypesthesia ; Male ; Plasma ; Premature Ejaculation* ; Serotonin ; Sertraline*

Premature ejaculation (PE) is the most common form of male sexual dysfunction. Until very recently, scientific investigation of PE has been hampered by a lack of standardized definitions and objective, validated questionnaires. In recent years both the definition and the management of PE have changed from the traditional authority-based to a more evidence-based approach. In 2007, the International Society for Sexual Medicine (ISSM) established an ad hoc committee consisting of 21 internationally recognized experts, to establish a new definition of PE including intravaginal ejaculation latency time (IELT). As diagnostic tools, a brief self-administered questionnaire, the premature ejaculation diagnostic tool (PEDT), was developed and validated. Current accepted treatment options of PE include behavior therapy, topical desensitizing agents, selective serotonin reuptake inhibitors (SSRIs), clomipramine, tramadol, PDE-5 inhibitors. However, it should be noted that all of the medications currently used for treatment of PE were originally developed to treat other medical disorders such as depression or erectile dysfunction. Dapoxetine, a new SSRI, has a unique pharmacokinetic profile, with a short time to maximum serum concentration, and rapid elimination. By 24 hours, plasma concentrations are less than 5% of peak values. These attributes make Dapoxetine suitable for on-demand therapy of PE. This paper reviewed new diagnostic tools and treatment options for PE.
Behavior Therapy ; Benzylamines ; Clomipramine ; Depression ; Ejaculation ; Erectile Dysfunction ; Humans ; Male ; Naphthalenes ; Phosphodiesterase 5 Inhibitors ; Plasma ; Premature Ejaculation ; Surveys and Questionnaires ; Serotonin Uptake Inhibitors ; Tramadol