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A phase II single-arm trial was conducted from June 2017 to October 2018 to evaluate the efficacy and safety of transcutaneous posterior tibial nerve stimulation (TPTNS) for premature ejaculation (PE) treatment. Twelve men with PE and no prior treatment were enrolled, one was withdrawn and 11 subjects provided data for the main outcome. TPTNS consisted of 30-min sessions of the application of 20 Hz with a pulse amplitude of 200 µsec. The intensity was adjusted based on individual sensibility. The participants received 3 weekly sessions for 12 consecutive weeks. Follow-up continued for 9 months after therapy completion. The main outcome was a threefold increase in the intravaginal ejaculation latency time (IELT) at week 12. Eleven patients completed therapy, and 54.5% (p = 0.037) showed tripled baseline IELT scores at week 12. The IELT increased 4.8-fold, 6.8-fold, and 5.4-fold at weeks 12, 24, and 48, respectively. One episode of constipation was reported, and one patient reported a sensation of heat in the leg during one therapy session. The findings suggest that TPTNS therapy delays ejaculation in patients with lifelong premature ejaculation, with no serious secondary effects. Controlled trials with larger sample sizes are needed to verify these results.

Although premature ejaculation (PE) is a common male sexual dysfunction, its pathophysiology has not been fully elucidated. Several medical problems such as erectile dysfunction, depression, anxiety, hormonal disorders and chronic prostatitis may play a role in the etiology of acquired PE. This study aims to evaluate the frequency of these etiologic factors among patients with acquired PE. Between May and July 2016, 53 men with acquired PE were included in the study. Self-estimated intravaginal ejaculation latency time (IELT) of these patients was recorded along with their medical history and physical examination findings. Moreover, 5-item version of the International Index of Erectile Function (IIEF-5), premature ejaculation profile (PEP), anxiety and depression scales (STAI-1, STAI-2, and BECK), and chronic prostatitis symptom index (NIH-CPSI) were administered. Fasting plasma glucose, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, total and free testosterone, total prostate specific antigen, thyroid and thyroid stimulating hormone levels were measured. Urine analysis and 2 cup tests were also studied. Mean age of the patients was 42.41 ± 11.14 (22–60). Mean duration of the PE complaint was 34.18 ± 36.76 (3–144) months. Mean IELT time of the patients was 38.28 ± 30.79 (3–180) s. Of the patients; 69.81%, 62.26%, 56.60%, 45.28%, 30.19%, 24.53%, 16.98%, 15.09%, and 7.55% had depression, chronic prostatitis, erectile dysfunction, anxiety, diabetes mellitus, abnormal FSH or LH, hypoprolactinemia, hyperthyroidism, and high testosterone levels, respectively. The results of our study revealed that anxiety disorders, depression, erectile dysfunction, and chronic prostatitis are common among patients with acquired PE and may play role in the etiology of this problem. There is a need for further researches related to the exact pathophysiology of acquired PE with larger number of patients.

As lifelong premature ejaculation (PE) and subjective PE are two different PE subtypes, the measurement of their characteristic features requires different objective measures. In this article, we address the differences between lifelong PE and subjective PE, in terms of the extent of variation of sexual performance and propose a new objective measure for research of subjective PE. By considering lifelong PE as a mainly “male” sex disorder and subjective PE as a mainly “man” sex disorder, we show that stopwatch-mediated intravaginal ejaculation latency time (IELT) measurement is most adequate for research of lifelong PE, but inadequate for research of subjective PE. Subjective PE needs another objective measure to capture its key characteristics. Arguments are provided to show that the characteristics of subjective PE are different from the key features of lifelong PE. The core issue in lifelong PE is the very short IELT with a very small variation in sexual performance. Subjective PE is characterized by a higher variation of sexual performance. Stopwatch-mediated IELT measurement is essential in case of small variation of sexual performance. In contrast, measurement of various parameters of penile intravaginal thrusting is suggested to be more appropriate in case of high variation of sexual performance observed in subjective PE. In conclusion, research of lifelong PE should be performed by stopwatch measurement of the IELT whereas research of subjective PE should be performed by movement tracker devices, designed to be bound to the males body and/or inserted into the women’s vagina with robust software to measure intravaginal thrusting variation performance. Future studies are warranted to provide scientific data to support this hypothesis.

Recently, the ICD-11 for Mortality and Morbidity Statistics (ICD-11-MMS, 2018 Version) has been published with a new definition of premature ejaculation (PE), including a third PE subtype. This definition differs from Diagnostic and Statistical Manual of Mental Disorders (DSM-5) definition of PE. We hereby address the similarities and differences between ICD-11-MMS and DSM-5 definition of PE and call attention to the illogical policy of some European (EU) National Regulatory Agencies to remain with a 1-min cut-off point of ejaculation time for Lifelong, Acquired and Subjective PE. The advantage of ICD-11-MMS is the inclusion of a third PE subtype, which is congruent with Subjective PE. A serious disadvantage of DSM-5 is that a 1-min criterion is used for both Lifelong and Acquired PE, and that a third PE subtype is not mentioned. Despite the incomplete DSM-5 definition of PE, some EU regulatory agencies adhere to a definition of PE which relies only on the 1-min ejaculation time cut-off point of DSM-5, and do not recognize the more recent PE definitions of ICD-11-MMS and International Society for Sexual Medicine. There is no scientific evidence for this illogical position. The continued use of a 1-min cut-off point for all subgroups of PE ignores the existence of Acquired PE (Intravaginal Ejaculation Latency Time (IELT)

Data regarding the relation between premature ejaculation (PE) and post-circumcision mucosal cuff length are controversial. The aim of this study is to analyze the relation between post-circumcision mucosal cuff length/penile length ratio (MCR) and PE. After exclusion of patients with erectile dysfunction, penile deformity, history of penile surgery and severe lower urinary tract symptoms, 49 circumcised men with PE were included. The control group is constituted of 50 healthy volunteers with normal ejaculatory function. Self-estimated intravaginal ejaculation latency time (IELT) and premature ejaculation profile (PEP) measures of all subjects were recorded, and the MCRs of patients and controls were compared. The mean age of PE patients and controls was 35.82 ± 7.73 (range 23-54) and 38.78 ± 13.42 (range 19-71) years, respectively (P=0.183). Although mucosal cuff length was not associated with either self-estimated IELT (r=-0.185, P=0.067) or PEP (r=-0.098, P=0.336), there was a negative correlation between MCR and self-estimated IELT (r=-0.205, P=0.0001) and PEP measures (r=-0.308, P=0.002). The length of the mucosal cuff after circumcision may have an impact on ejaculatory function. Surgeons should avoid leaving excessive amount of mucosa during circumcision.

Premature ejaculation is a sexual debilitating condition affecting a large number of men worldwide and leading to important dysfunctions influencing the patients’ affective and emotional life. Hyaluronic acid is a natural and safe compound that has been widely used not only in the aesthetic medicine clinic, but also for treatment of osteoarthritis. The present study shows the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation. A hundred and ten male patients were treated with hyaluronic acid injections in the deep dermis of their glans penis to increase the volume and the circumference of their penis to prevent male premature ejaculation and improve the patients’ and their partners’ sexual satisfaction. The intravaginal ejaculation latency time increased significantly from a baseline value of 88.34±3.14 s to 293.14±8.16 s after 6 months from the procedure. Maximal glandular circumference increased from 98.51±0.71 mm to 114.35±0.66 mm after 6 months from the procedure. At 6-month follow-up, patients’ self-rated satisfaction was 5.3±0.07 (range: 4–6). At the follow-up, partners’ self-rated satisfaction was 5.1±0.09 (range: 3–6). The present clinical study showed that hyaluronic acid injection is a promising treatment for premature ejaculation. The effect of the procedure in the long-term follow-up needs to be clarified.

To evaluate the adequate therapeutic dosage of clomipramine 15 mg/day and clomipramine 30 mg/day in male patients with premature ejaculation (PE), this study enrolled men aged 20–65 years who met diagnostic criteria for PE including Intravaginal Ejaculation Latency Time (IELT) less than 2 min for at least 75% of their sexual intercourses. Subjects received placebo, clomipramine 15 mg, or clomipramine 30 mg prn (2~6 h before intercourse) for 4 weeks. Efficacy was assessed using fold change, percentile change, and mean change of IELT, as well as Drug Coitus Interval Time (DCIT). A total of 101 patients were randomized into the placebo group, clomipramine 15 mg group, and clomipramine 30 mg group. Analyses of fold changes of IELT in each group revealed that the IELT of both the clomipramine 15 mg group and clomipramine 30 mg group was significantly increased 4 weeks after administration than the placebo group. Adverse events were reported by 11.76, 32.35, and 57.57% of patients in the placebo group, clomipramine 15 mg group, and clomipramine 30 mg group, respectively. Most common adverse events in the clomipramine treatment groups were gastrointestinal disorders and psychiatric disorders of mild to moderate severity. On-demand regimen of clomipramine 15 mg resulted in a significant improvement in IELT and was superior to a regimen of clomipramine 30 mg in terms of risk-to-benefit ratio.

This study compared the prevalence of premature ejaculation (PE) diagnosed by the PE diagnostic tool (PEDT) score, self-reporting and stopwatch-recorded intravaginal ejaculation latency time (IELT). It examined the characteristics of males diagnosed with PE by each criterion. A questionnaire survey enrolled 2081 subjects from March to October, 2010. Stopwatch-recorded IELT was measured in 1035 of the 2081 subjects. We aimed to determine whether PE has an influence on the frequency and satisfaction of sexual intercourse, the degree of libido/erectile function and the satisfaction. These factors were evaluated according to different definitions of PE to assess whether the definition used yielded differences in the data. The prevalence of PE, based on a PEDT score of ≥11, self-reporting and stopwatch-recorded IELT of ≤1 min was 11.3%, 19.5% and 3%, respectively. The prevalence of PE diagnoses based on PEDT score and self-reporting increased with age, but stopwatch-recorded IELT-based diagnoses did not. Males experiencing PE showed lower levels of libido, erectile function and frequency and satisfaction of sexual intercourse compared with non-PE males. PE males felt that they did not satisfy their partners in terms of the partners' sexual satisfaction and frequency of orgasm, in comparison with non-PE males. PE is a highly prevalent sexual dysfunction in males. Regardless of whether the PE diagnosis was made on the basis of self-reporting, PEDT score or stopwatch-recorded IELT, subjective symptoms were similar among PE males.

The aim of the study is to investigate whether there is an effect of adult circumcision on ejaculation parameters and to research the relationship between intravaginal ejaculation latency time (IELT) and premature ejaculation diagnostic tool (PEDT). Adults who underwent voluntary circumcision between September 2010 and November 2011 were enrolled in this prospective study. The IELT before and 3 months following circumcision was recorded. Also, PEDT was filled out before and 3 months after circumcision. During statistical evaluation, the comparison of situations before and after circumcision was made using IELT averages and PEDT total scores. Furthermore, the correlation between changes in IELT and PEDT has also been evaluated. A total of 30 volunteers (mean age 21.25±0.44) were enrolled in the study. The volunteers' mean and median IELT before were 104.36±66.21 and 88 (26-307) seconds, whereas mean and median IELT after circumcision were 123.56±54.44 and 107.5 (67-300) seconds, respectively. The increase after circumcision was statistically significant (P=0.001). The mean and median PEDT score were 4.26±2.91 and 3 (1-12) before, and 2.63±1.82 and 2 (0-7) after circumcision. Improvement was statistically significant (P

Premature ejaculation (PE) is a common ejaculatory complaint. The estimated rates among Turkish men reached 20%, although the severest type of PE (lifelong PE) usually does not exceed 2.3%. This could be seen in line with two survey studies involving five nations. They revealed that 2.5% of men had an intravaginal ejaculation latency time of

In the last decade, an increasing number of drug studies on premature ejaculation have been published. The methodology used in these studies differed widely. In this review, it is therefore questioned as to how far the differences in methodology could have influenced clinical outcomes. The aim of the present review was to compare the different methodologies that were used in drug studies on premature ejaculation. The majority of these studies were conducted between 1973 and 2003 and were strikingly different in study design and in the quantification of clinical outcomes. It appeared that in some of these studies, placebo and active drug effects were neglected due to an erroneous methodology. The few studies that were using stopwatch assessment at each intercourse at baseline and during treatment and in which the intravaginal ejaculation latency time (IELT) was included appeared to be comparable in their results. The use of a well-defined definition of premature ejaculation, for example, an IELT of less than 1 min revealed reproducible results. Finally, the retrospective use of a questionnaire or a subjective report on ejaculation time induced higher effects with regard to placebo effects and an underestimation of active drug effects. In conclusion, for drug treatment research of premature ejaculation it is recommended to use a randomized double-blind prospective design, the use of the IELT, the use of a stopwatch at each coitus both during a baseline period and during drug treatment and a definition of premature ejaculation as an ejaculation that occurs within 1 min after vaginal penetration.