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Kang WH, Mohamad Sithik MN, Khoo JK, Ooi YG, Lim QH, Lim LL. Gaps in the management of diabetes in Asia: A need for improved awareness and strategies in men's sexual health. J Diabetes Investig 2022; 13:1945-1957. [PMID: 36151988 DOI: 10.1111/jdi.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/22/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022] Open
Abstract
Sexual dysfunction, which is defined as 'difficulty during any stage of the sexual encounter that prevents or impairs the individual or couple from enjoying sexual activity', is globally prevalent in males with prediabetes and diabetes. It is an early harbinger of cardiovascular diseases and has a profound impact on one's physical, mental, and social health. Among patients with either prediabetes or diabetes, the most common male sexual dysfunctions are hypogonadism, erectile dysfunction, and premature ejaculation. In Asia, although sexual health is an important factor of men's health, it is rarely discussed freely in real-life practice. Addressing sexual health in Asian males has always been challenging with multiple barriers at the levels of patients and health care providers. Therefore, the assessment and management of sexual dysfunction in routine clinical practice should involve a holistic approach with effective patient-provider communication. In this review, we discuss the epidemiology, pathophysiology, and the management of hypogonadism, erectile dysfunction, and premature ejaculation among males with either prediabetes or diabetes (type 1 and type 2), as well as the evidence gaps across Asia.
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Affiliation(s)
- Waye-Hann Kang
- Department of Medicine, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Selangor, Malaysia
| | | | - Jun-Kit Khoo
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ying-Guat Ooi
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Quan-Hziung Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.,Asia Diabetes Foundation, Hong Kong SAR, China
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2
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Grunt-Mejer K. The history of the medicalisation of rapid ejaculation—A reflection of the rising importance of female pleasure in a phallocentric world. PSYCHOLOGY & SEXUALITY 2022. [DOI: 10.1080/19419899.2021.1888312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Katarzyna Grunt-Mejer
- Faculty of Psychology and Law in Poznań, SWPS University of Social Sciences and Humanities, Poznań, Poland
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3
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Single nucleotide polymorphisms in 5-HT receptors in the etiology of premature ejaculation. Rev Int Androl 2022; 20:217-224. [DOI: 10.1016/j.androl.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/16/2020] [Accepted: 02/14/2021] [Indexed: 11/20/2022]
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4
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Rowland DL, Althof SE, McMahon CG. The Unfinished Business of Defining Premature Ejaculation: The Need for Targeted Research. Sex Med Rev 2022; 10:323-340. [PMID: 34996746 DOI: 10.1016/j.sxmr.2021.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Fifteen years have passed since the International Society of Sexual Medicine first established the 3-pronged criteria for premature ejaculation (PE): a short ejaculation latency, lack of ejaculatory control, and bother/distress. Although the process of establishing valid criteria for any condition or disorder is an ongoing one, a dearth of targeted research on these criteria has hindered professional societies from updating and revising them. OBJECTIVES To review and critique existing criteria used in the diagnosis of PE, to identify specific problems with them, and to recommend studies that will address shortcomings. METHODS Each of the PE criteria was evaluated and compared against standard procedures for establishing validated measures. Following each analysis, targeted research to address the gaps has been recommended. RESULTS Each PE criterion has shortcomings and each can be improved by using standard validation procedures, as noted by the targeted research outcomes. Professional societies can play an important role by encouraging broad participation in research that generates new and relevant data supporting, validating, or challenging the existing criteria. CONCLUSION The concepts underlying the diagnostic criteria for PE have both broad consensus and functional utility. Nevertheless, much of the research investigating PE has uncritically adopted these criteria without concomitantly recognizing their limitations. These limitations prevent determining accurate prevalence rates, interpreting research findings with confidence, and establishing efficacious treatment outcomes. Rowland DL, Althof SE, McMahon CG. The Unfinished Business of Defining Premature Ejaculation: The Need for Targeted Research. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA.
| | - Stanley E Althof
- Center for Marital and Sexual Health of South Florida, Greenacres, FL, USA and Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Chris G McMahon
- Australian Centre for Sexual Health, St Leonards, New South Wales, Australia
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5
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Althof SE, McMahon CG, Rowland DL. Advances and Missteps in Diagnosing Premature Ejaculation: Analysis and Future Directions. J Sex Med 2022; 19:64-73. [PMID: 34895858 DOI: 10.1016/j.jsxm.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND There are several problems with diagnostic criteria for premature ejaculation (PE) that lack objectivity, clarity and precision. They hamper accurate determination of PE prevalence estimates, investigations into the etiology of the dysfunction, impact on partners, development of validated Patient Reported Outcomes, regulatory authority oversight, and which men might benefit from specific treatment interventions. AIM We sought to review, analyze and comment on the evolution of the definitions of PE and offer suggestions for future directions for PE definitions. Our goal is to propose strategies whereby the criterion sets are useful to researchers, clinicians and governmental oversight agencies alike and bring harmony and scientific rigor among the conflicting and confusing definitions. METHODS There are several premature ejaculation definitions published in the peer reviewed medical literature. The PUBMED electronic database from 1970 to 2021 was searched for published definitions. Search terms included the medical subject headings of premature ejaculation, definition and diagnosis. In chronological order, Table 1 lists the various diagnosis and criteria sets for PE. We discuss the process by which constructs, which make up diagnostic criteria sets, are operationalized and validated. RESULTS We review definitions of PE beginning with Masters and Johnson's focus on partner orgasmic attainment and move through the nebulous and subjective criterion sets found in the early Diagnostic and Statistical Manuals and International Classification of Disease series, to the more evidenced-based definitions found in International Society of Sexual Medicine, Diagnostic and Statistical Manuals-5 and the American Urological Association (AUA) definitions. Additionally, we discuss how constructs and criteria sets have been adopted to minimize errors of inclusion and exclusion in defining disease/dysfunction. STRENGTHS AND LIMITATIONS This manuscript offers a careful chronological analysis of the published definitions of PE. This historical lens allows the reader to perceive the shifting science underlying the development of PE definitions. The manuscript is limited regarding our comments on acquired PE as evidenced-based research is incomplete. CONCLUSION Over the past 50 years there has been considerable forward momentum in defining PE based on well conducted scientific studies. We support the American Urological Association's modification in Intravaginal ejaculatory latency time to 2-minutes for lifelong PE, concur with the 11th revision of the International Classification of Diseases recommendation for changing the terminology from premature ejaculation to early ejaculation. We also recommend ongoing validation of definitions, moving away from the current heterosexist definition of PE based on penile-vaginal sex and urge further population based research into acquired PE to develop stronger evidenced-based criterion sets for this subtype.
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Affiliation(s)
- Stanley E Althof
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Center for Marital and Sexual Health of South Florida, West Palm Beach, FL, USA
| | - Chris G McMahon
- Australian Centre for Sexual Health, St. Leonards, New South Wales, Australia
| | - David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA
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6
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Verze P, La Rocca R, Spirito L, Califano G, Venturino L, Napolitano L, Cardi A, Arcaniolo D, Rosati C, Palmieri A, Mirone V. Premature Ejaculation patients and their partners: arriving at a clinical profile for a real optimization of the treatment. ACTA ACUST UNITED AC 2021; 93:42-47. [PMID: 33754608 DOI: 10.4081/aiua.2021.1.42] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 11/23/2022]
Abstract
The aim of the study is to extrapolate clinical features of Premature Ejaculation (PE) patients and female partners of men affected with PE, in order to get a profile that can be of assistance for physicians within the dynamics of a couple, one of which is a PE patient. An observational, non-interventional, cross-sectional epidemiological study entitled IPER (Italian Premature Ejaculation Research) was conducted and included two different cohorts of subjects that were randomly sampled from a patient dataset of selected General Practitioners: 1. IPER-M sub-cohort (1.104 subjects) was made of male subjects in which they were then distinguished patients with or without PE based on the score of the PEDT questionnaire; IPER-F sub-cohort (1.109 subjects) was made of female subjects from an independent sample of women (therefore not the partners of the IPER-M males) in which they then distinguished those partners of a male subject with PE or not. In addition to an identical general questionnaire to explore demographic aspects and habits, each subcohort was then evaluated using validated questionnaires. No differences were noted between PE+/PE- patients in terms of alcohol consumption, smoking habits, physical activity nor stress condition in everyday life, employment, socio-economic class and marital status. While the prevalence of PE proportionally increased with age, excluding the 50-59 and 70-80 years decades, in the IPER-M group an overall statistically significant difference for the mean age between the PE+ and PE- groups (p = 0.002) was detected, but without reaching any difference amongst the different age classes in the IPER-F group. The PE+ patients reported a significantly lower frequency rate of sexual intercourse, worse QoL (p = 0.006 and p < 0.0001, respectively), and increased anxiety status (p < 0.0001 for both subgroups). This study shows that, rather than talking with a patient affected by PE it would be advisable to introduce the concept of couple counseling with the person patient and his partner, because it is only through classification of both partners as one couple and a full understanding of their mutual sexual experience that PE treatment can be optimized and its results measured accurately.
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Affiliation(s)
- Paolo Verze
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Section, University of Naples Federico II, Naples.
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Section, University of Naples Federico II, Naples.
| | - Lorenzo Spirito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Section, University of Naples Federico II, Naples.
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Section, University of Naples Federico II, Naples.
| | - Luca Venturino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Section, University of Naples Federico II, Naples.
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Section, University of Naples Federico II, Naples.
| | | | | | - Claudia Rosati
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples.
| | - Alessandro Palmieri
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Section, University of Naples Federico II, Naples.
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Section, University of Naples Federico II, Naples.
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Colonnello E, Ciocca G, Limoncin E, Sansone A, Jannini EA. Redefining a sexual medicine paradigm: subclinical premature ejaculation as a new taxonomic entity. Nat Rev Urol 2021; 18:115-127. [PMID: 33442049 DOI: 10.1038/s41585-020-00417-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 01/29/2023]
Abstract
Premature ejaculation (PE) and poor ejaculatory control are multidimensional sexual symptoms estimated to affect almost one-third of men, severely impairing the overall quality of life of patients and their partners. However, patients who do not completely fulfil the definition criteria for PE rarely receive a diagnosis or adequate treatment, with the risk of subsequent progression from initial, subclinical symptoms to clinically overt PE, frequently with other sexual comorbidities. Thus, the current definitions of PE warrant review, in order to consider and propose a new taxonomy encompassing other unaddressed, crucial clinical aspects of PE. These newly proposed criteria include the recommendation for a primary screening for erectile dysfunction (ED), as PE and ED can be comorbid in up to 50% of patients but have never before been considered as a unified clinical entity. In order to facilitate clinical practice and improve clinical management of men with PE and comorbid conditions, we propose and define the new taxonomic clinical entities of subclinical PE (SPE) and loss of control of erection and ejaculation (LCEE). Application of these diagnoses to men who meet the criteria for SPE and/or LCEE, but not the overt conditions, could improve access to treatment for these patients and reduce progression to the more serious clinical disorder.
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Affiliation(s)
- Elena Colonnello
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giacomo Ciocca
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Clinical Psychosexology, Department of Dynamic and Clinical Psychology, University of Rome Sapienza, Rome, Italy
| | - Erika Limoncin
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Sansone
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emmanuele A Jannini
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Gao P, Gao J, Wang Y, Peng D, Zhang Y, Li H, Zhu T, Zhang W, Dai Y, Jiang H, Zhang X. Temperament-Character Traits and Attitudes Toward Premature Ejaculation in 4 Types of Premature Ejaculation. J Sex Med 2020; 18:72-82. [PMID: 33339761 DOI: 10.1016/j.jsxm.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although temperament-character traits and attitudes toward premature ejaculation (PE) are known to be associated with PE, it is of great significance to study them in PE. Moreover, few studies have evaluated these traits and attitudes in the new classification of 4 subtypes of PE. AIM We investigated the temperament-character traits and attitudes toward PE in 4 types of PE and their associations with PE. METHODS Between December 2018 and December 2019, we conducted a survey in our hospital, and enrolled 350 men who complained of PE and 252 men without any complaint of PE. Temperament-character traits and attitudes toward PE were independently assessed by the Temperament and Character Inventory-Revised and several targeted questions, respectively. The Index of Premature Ejaculation (IPE) was used to evaluate ejaculation control, sexual life satisfaction, and distress caused by PE. OUTCOMES The outcomes included differences of temperament-character traits and attitudes toward PE among 2 groups and their associations with PE. RESULTS Of the 2 groups, men with PE complaints had lower novelty seeking/self-transcendence (NS/ST) scores and higher harm avoidance (HA) scores vs men without any complaints of PE. Among the 4 types of PE, men with variable PE had the highest score of HA and lowest score of NS; the lowest score of ST was recorded in men with lifelong PE. Additionally, the total and subdomain scores of IPE in men with subjective PE were higher than the other subtypes of PE. After adjusting for age, positive correlations were observed in HA score and total and subdomain scores of IPE, whereas the inverse was true corresponding to NS and ST. CLINICAL IMPLICATIONS The current study has provided a new perspective for understanding the impact of psychological factors on PE. STRENGTHS & LIMITATIONS This is the first study to systematically assess the effects of personality traits and attitudes on PE, especially among the 4 types of PE. The main drawback is that the generalizability of this study may be limited by the fact that it was conducted in a single cultural/societal background. CONCLUSION Men who complained of PE tended to react with indifference or rejection to novelty, tended to feel unsatisfied, cannot effectively adapt to changes in the surrounding environment, and tended to avoid situations involving risk. These characteristics could lead to their becoming disheartened when faced with PE. Furthermore, the attitude of men with PE reflects the needs of the patient during treatment from one aspect. Gao P, Gao J Wang Y, et al. Temperament-Character Traits and Attitudes Toward Premature Ejaculation in 4 Types of Premature Ejaculation. J Sex Med 2021;18:72-82.
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Affiliation(s)
- Pan Gao
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jingjing Gao
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yunwu Wang
- Department of Urology, the second Affiliated Hospital of Wannan Medical college, Wuhui, Anhui, China
| | - Dangwei Peng
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yao Zhang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Hu Li
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Tianle Zhu
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wei Zhang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yutian Dai
- Department of Andrology, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
| | - Hui Jiang
- Department of Urology, Peking University Third Hospital, Beijing, China; Department of Human Sperm Bank, Peking University Third Hospital, Beijing, China; Department of Andrology, Peking University Third Hospital, Beijing, China.
| | - Xiansheng Zhang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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Panda SK, Nirvanashetty S, Parachur VA, Mohanty N. A Randomized Double-Blind Placebo-Control Study to Assess the Efficacy and Safety of OLNP-05 Versus Placebo for the Treatment of Subjects with Premature Ejaculation. J Med Food 2020; 23:1006-1013. [PMID: 32654580 DOI: 10.1089/jmf.2019.4661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Premature ejaculation (PE) is one of the foremost sex-related health problems among men. The global occurrence ranges from 20% to 30%, according to various studies. PE has a great impact on the men's quality of life, with deleterious effects such as embarrassment, frustration, and feeling of incompetence. Considering the necessity of treatment of PE, this study was planned to compare the efficacy and safety of OLNP-05 versus placebo for treating subjects suffering from PE. In this randomized clinical study, 60 men with PE were enrolled and randomly assigned to receive either OLNP-05 or placebo one capsule twice daily for a period of 8 weeks. Subjects were evaluated during visits on day 1, day 28, and day 56. Mean change from baseline in intravaginal ejaculatory latency time (IELT), improvement in premature ejaculation profile (PEP), and Clinical Global Impression-Improvement scale (CGI-I) were used to assess the efficacy of treatment. P-value <.05 was considered significant. At the end of the treatment, the improvement in IELT score in the OLNP-05 group was remarkably higher than the placebo. Subjects in the OLNP-05 treatment group also reported significantly greater improvement in PEP subscale score. Majority of OLNP-05-treated subjects were found to be in the "much improved" category as per CGI-I assessment. The result confirms the safety and efficacy of OLNP-05, therefore suggesting that OLNP-05 may be a safe and effective intervention for the management of PE. Trial registration: Clinical Trials Registry India (Registration No: CTRI/2017/08/009226, 02/08/2017).
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10
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Green TP, Saavedra-Belaunde J, Wang R. Ejaculatory and Orgasmic Dysfunction Following Prostate Cancer Therapy: Clinical Management. Med Sci (Basel) 2019; 7:medsci7120109. [PMID: 31835522 PMCID: PMC6950339 DOI: 10.3390/medsci7120109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023] Open
Abstract
The majority of sexual health research has focused on erectile dysfunction following prostate cancer treatment. Ejaculatory and orgasmic dysfunction are significant side effects following the treatment of prostate cancer. Orgasmic dysfunction covers a range of issues including premature ejaculation, anorgasmia, dysorgasmia, and climacturia. This review provides an overview of prevalence and management options to deal with orgasmic dysfunction. A Medline Pubmed search was used to identify articles relating to these problems. We found that orgasmic dysfunction has a very large impact on patients’ lives following prostate cancer treatment and there are ways for physicians to treat it. Management of patients’ sexual health should be focused not only on erectile dysfunction, but on orgasmic dysfunction as well in order to ensure a healthy sexual life for patients and their partners.
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Affiliation(s)
- Travis P. Green
- Division of Urology, Department of Surgery, University of Texas Health Science Center – McGovern Medical School at Houston, Houston, TX 77030, USA; (T.P.G.); (J.S.-B.)
| | - Jose Saavedra-Belaunde
- Division of Urology, Department of Surgery, University of Texas Health Science Center – McGovern Medical School at Houston, Houston, TX 77030, USA; (T.P.G.); (J.S.-B.)
- MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
| | - Run Wang
- Division of Urology, Department of Surgery, University of Texas Health Science Center – McGovern Medical School at Houston, Houston, TX 77030, USA; (T.P.G.); (J.S.-B.)
- MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
- Correspondence:
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11
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Russo GI, Serefoglu EC. Premature Ejaculation: 2020 Update. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00232-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Dai H, Li H, Wang J, Bao B, Yan Y, Wang B, Sun S. Effectiveness comparisons of acupuncture for premature ejaculation: Protocol for a network meta-analysis. Medicine (Baltimore) 2019; 98:e14147. [PMID: 30702567 PMCID: PMC6380762 DOI: 10.1097/md.0000000000014147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND As one of the common male sexual dysfunction diseases, the treatment effect of premature ejaculation is often difficult to guarantee. In China, there are many randomized clinical trials that confirm that acupuncture has a good therapeutic effect on premature ejaculation. The aim of this study was to compare the efficacy and safety of acupuncture for premature ejaculation from intravaginal ejaculation latency (IELT), premature ejaculation diagnostic tool (PEDT), Arab premature ejaculation index (AIPE), and premature ejaculation index (IPE). METHODS We will use PubMed, EMBASE, Nursing and Related Health Literature Cumulative Index, Joint and Supplemental Drug Database, Cochrane Center Controlled Trials Registry (CENTRAL), China Biomedical Literature Database (CBM) and China Knowledge Infrastructure (CNKI), The Chinese Science and Technology Periodical Database (VIP), and Wanfang Database conduct systematic searches until October 31, 2018. At the same time, manually search for gray documents, including unpublished meeting articles. The primary outcome included intravaginal ejaculation latency (IELT). Secondary outcomes were premature ejaculation diagnostic tools (PEDT), Arab premature ejaculation index (AIPE), and premature ejaculation index (IPE). The quality and evidence that the risk of inclusion of the BiB tool will be assessed will be assessed on a scale. RESULTS This study will generate a comprehensive review of current evidence of acupuncture for premature ejaculation. CONCLUSION The study will provide updated evidence to evaluate the efficacy and safety of acupuncture for premature ejaculation. ETHICS AND COMMUNICATION Because this research is based on a meta-analysis of published research, ethical recognition and patient consent are unnecessary. AGREEMENT REGISTRATION NUMBER PROSPERO CRD42018111661.
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Affiliation(s)
- Hengheng Dai
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine
| | - Haisong Li
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine
| | - Jisheng Wang
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine
| | - Binghao Bao
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine
| | - Yubing Yan
- Graduate School of Beijing University of Chinese Medicine
| | - Bin Wang
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine
| | - Song Sun
- Chinese Medicine Hospital, Changping District, Beijing, China
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13
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Verze P, Arcaniolo D, Imbimbo C, Cai T, Venturino L, Spirito L, Califano G, La Rocca R, Mirone V. General and sex profile of women with partner affected by premature ejaculation: results of a large observational, non-interventional, cross-sectional, epidemiological study (IPER-F). Andrology 2018; 6:714-719. [PMID: 30120814 DOI: 10.1111/andr.12545] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
- P. Verze
- Department of Neurosciences; Sciences of Reproduction and Odontostomatology; Urology Unit; University of Naples “Federico II”; Naples Italy
| | - D. Arcaniolo
- Urology Unit; Department of Woman, Child and General and Specialized Surgery; University of Campania “L. Vanvitelli”; Naples Italy
| | - C. Imbimbo
- Department of Neurosciences; Sciences of Reproduction and Odontostomatology; Urology Unit; University of Naples “Federico II”; Naples Italy
| | - T. Cai
- Department of Urology; Santa Chiara Regional Hospital; Trento Italy
| | - L. Venturino
- Department of Neurosciences; Sciences of Reproduction and Odontostomatology; Urology Unit; University of Naples “Federico II”; Naples Italy
| | - L. Spirito
- Department of Neurosciences; Sciences of Reproduction and Odontostomatology; Urology Unit; University of Naples “Federico II”; Naples Italy
| | - G. Califano
- Department of Neurosciences; Sciences of Reproduction and Odontostomatology; Urology Unit; University of Naples “Federico II”; Naples Italy
| | - R. La Rocca
- Department of Neurosciences; Sciences of Reproduction and Odontostomatology; Urology Unit; University of Naples “Federico II”; Naples Italy
| | - V. Mirone
- Department of Neurosciences; Sciences of Reproduction and Odontostomatology; Urology Unit; University of Naples “Federico II”; Naples Italy
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14
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Bhat GS, Shastry A. Use of a stopwatch to measure ejaculatory latency may not be accurate among Indian patients. Indian J Urol 2017; 33:300-303. [PMID: 29021654 PMCID: PMC5635671 DOI: 10.4103/iju.iju_56_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Although the use of a stopwatch is recommended to record intravaginal ejaculatory latency time (IELT) for premature ejaculation, there is no Indian literature which assesses the reliability of this method among our patients. Hence, we assessed the accuracy of stopwatch-measured IELT and compared it with other methods such as number of thrusts and self-assessed IELT in an Indian context. METHODS Between January 2015 and December 2015, couples with premature ejaculation (PE) confirmed with the Premature Ejaculation Diagnostic Tool were enrolled in this study. They were asked to report self-assessed IELT for the first 2 weeks, number of thrusts before ejaculation following vaginal penetration for the next 2 weeks, and stopwatch-clocked IELT for the last 2 weeks. At each 2-week interval, the couples answered erectile/ejaculatory performance anxiety index questionnaire (EPAI). The data were analyzed at the end of 6 weeks. RESULTS A total of 42 couples with an average married life of 5.53 years were included in the study. Average stopwatch-clocked IELT was almost 1 min more than the self-reported IELT, which was statistically significant. The average number of thrusts reported was 6.31. Anxiety on the EPAI scale was maximum while using stopwatch to measure IELT. CONCLUSION Use of stopwatch to clock the IELT does not appear to represent true IELT in Indian patients. Self-assessed IELT correlated more accurately with symptoms of PE.
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Affiliation(s)
- Gajanan Shripad Bhat
- Department of Urology, General Hospital, Honavar, Uttara Kannada, Karnataka, India
| | - Anuradha Shastry
- Department of Urology, T.S.S Shripad Hegde Kadave Institute of Medical Sciences, Sirsi, Uttara Kannada, Karnataka, India
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Chung CM, Lu MZH, Wong CYT, Goh SGK, Azhar MIM, Lim YM, Rusli BN, Khalid BAK. The SAD-MEN questionnaire: a new and reliable questionnaire for assessing sexual dysfunction in Asians with diabetes. Diabet Med 2016; 33. [PMID: 26202696 PMCID: PMC5057321 DOI: 10.1111/dme.12864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIM The aim of this study is to construct a new tool for the assessment of sexual dysfunction among men with diabetes that is valid and reliable across different ethnicities, languages and socio-economic backgrounds in South East Asia. METHODS Focus group interviews were conducted to determine the construct of the questionnaire. Content and face validity were assessed by a panel of experts. A pilot study was conducted to validate the Sexual Dysfunction in Asian Men with Diabetes (SAD-MEN) questionnaire in English and Malay. The International Index of Erectile Function-5 (IIEF-5) was used for comparison. Construct validity was assessed using exploratory factor analysis, reliability was determined using Cronbach's α (> 0.700), and test-retest reliability using Spearman's rank correlation coefficient. RESULTS The SAD-MEN questionnaire yielded moderate face and content validity, with high reliability as shown by Cronbach's α values of 0.949 for sexual performance and 0.775 for sexual desire for the English version. The Malay language questionnaire had a Cronbach's α value of 0.945 for sexual performance and 0.750 for sexual desire. Test-retest reliability using Spearman's test gave correlation coefficients of r = 0.853, P = 0.000 for the English language questionnaire and r = 0.908, P = 0.000 for the Malay language questionnaire. CONCLUSION The SAD-MEN questionnaire is a valid and reliable tool by which to assess sexual dysfunction in English- and Malay-speaking Malaysian and South East Asian men with diabetes.
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MESH Headings
- Adult
- Aged
- China/ethnology
- Cohort Studies
- Culturally Competent Care
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/psychology
- Focus Groups
- Humans
- India/ethnology
- Malaysia
- Male
- Middle Aged
- Pilot Projects
- Psychiatric Status Rating Scales
- Reproducibility of Results
- Self Report
- Severity of Illness Index
- Sexual Dysfunction, Physiological/complications
- Sexual Dysfunction, Physiological/diagnosis
- Sexual Dysfunction, Physiological/ethnology
- Sexual Dysfunction, Physiological/physiopathology
- Sexual Dysfunctions, Psychological/complications
- Sexual Dysfunctions, Psychological/diagnosis
- Sexual Dysfunctions, Psychological/ethnology
- Sexual Dysfunctions, Psychological/physiopathology
- Socioeconomic Factors
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Affiliation(s)
- C. M. Chung
- Clinical School Johor BahruJeffrey Cheah School of Medicine and Health SciencesMonash UniversityJohorMalaysia
| | - M. Z. H. Lu
- Clinical School Johor BahruJeffrey Cheah School of Medicine and Health SciencesMonash UniversityJohorMalaysia
| | - C. Y. T. Wong
- Clinical School Johor BahruJeffrey Cheah School of Medicine and Health SciencesMonash UniversityJohorMalaysia
| | - S. G. K. Goh
- Jeffrey Cheah School of Medicine and Health SciencesMonash UniversityBandar SunwayMalaysia
| | - M. I. M. Azhar
- Clinical School Johor BahruJeffrey Cheah School of Medicine and Health SciencesMonash UniversityJohorMalaysia
| | - Y. M. Lim
- Clinical School Johor BahruJeffrey Cheah School of Medicine and Health SciencesMonash UniversityJohorMalaysia
| | - B. N. Rusli
- Clinical School Johor BahruJeffrey Cheah School of Medicine and Health SciencesMonash UniversityJohorMalaysia
| | - B. A. K. Khalid
- Jeffrey Cheah School of Medicine and Health SciencesMonash UniversityBandar SunwayMalaysia
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Štulhofer A, Šević S, Doyle DM. Comparing the Prevalence and Correlates of Sexual Health Disturbances Among Heterosexual and Nonheterosexual Men: An Overview of Studies. Sex Med Rev 2014; 2:102-111. [DOI: 10.1002/smrj.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Gao J, Zhang X, Su P, Shi K, Tang D, Hao Z, Zhou J, Liang C. Prevalence and impact of premature ejaculation in outpatients complaining of ejaculating prematurely: using the instruments of intravaginal ejaculatory latency time and patient-reported outcome measures. Int J Impot Res 2014; 26:94-9. [PMID: 24384563 DOI: 10.1038/ijir.2013.42] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 06/08/2013] [Accepted: 10/21/2013] [Indexed: 11/09/2022]
Abstract
This study was designed to assess the impact of premature ejaculation (PE) on a large population of men and their female partners using the instruments of intravaginal ejaculatory latency time (IELT) and patient-reported outcome (PRO) measures. A non-interventional, observational and cross-sectional field survey enrolled 2704 men with self-reported PE and their female partners from January 2010 to January 2012. PE was diagnosed by the International Society for Sexual Medicine (ISSM) criterion. IELT and sexual dysfunction were measured using a stopwatch and PRO measures, respectively. The incidence of PE in this study was 19.27%. PE negatively impacted on subjects and their partners, including reduced ejaculatory control and sexual satisfaction, and increased personal distress and interpersonal difficulty (P<0.001 for all). The severity of PE was considered worse by subjects than by their female partners (P<0.001). Reduced ejaculatory control and sexual satisfaction were considered the central themes of PE. Furthermore, a correlation was observed among the outcomes of IELT and PRO measures for subjects and their partners (absolute correlation coefficient ranged from 0.33 to 0.67). This in-depth qualitative study provides valuable insight into the PE status in Chinese men. Further research is needed to confirm and extend these results.
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Affiliation(s)
- J Gao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - X Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - P Su
- Academy of Public Health of Anhui Medical University, Hefei, China
| | - K Shi
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - D Tang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Z Hao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - J Zhou
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - C Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Altunoluk B, BAğCIOĞLU E, Efe E, Bahçeci B, Söylemez H. Temperament and Character Differences in Patients with Premature Ejaculation. Noro Psikiyatr Ars 2013; 50:332-336. [PMID: 28360566 DOI: 10.4274/npa.y6443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 03/27/2012] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The debate on the etiology of premature ejaculation is still ongoing although there was huge amount of biological and psychological theories. We aimed to investigate the personality structure of patients with premature ejaculation via temperament and character inventory. METHODS Forty patients with premature ejaculation and a matched number of healthy people were included. Participants were asked to fill out a questionnaire booklet with separate sections for general demographic information and the temperament and character inventory. RESULTS Total novelty seeking scores and subscale 1 (exploration-excitability) scores in premature ejaculation patients were significantly higher than in control groups (p<0.05). Total harm avoidance scores and harm avoidance subscale 2 (fear of uncertainty) scores in premature ejaculation patients was found significantly lower than in control group (p<0.05). Beck depression score was significantly higher in patients with premature ejaculation than in control groups. DISCUSSION Men with premature ejaculation are more impulsive (excitant), more tempered, more excitable and less prone to harmful behavior. Current findings tend to reinforce premature ejaculation based upon combination of neurobiological and psychological reasons.
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Affiliation(s)
- Bülent Altunoluk
- Kahramanmaraş Sütcü İmam University, Faculty of Medical, Department of Urology Kahramanmaraş, Turkey
| | - Erman BAğCIOĞLU
- Afyon Kocatepe University Faculty of Medical, Department of Psychiatry, Afyonkarahisar, Turkey
| | - Erkan Efe
- Kahramanmaraş Sütcü İmam University, Faculty of Medical, Department of Urology Kahramanmaraş, Turkey
| | - Bülent Bahçeci
- Rize University Faculty of Medical Department of Psychiatry, Rize, Turkey
| | - Haluk Söylemez
- Dicle University Faculty of Medical, Department of Urology, Diyarbakır, Turkey
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Serum Leptin and 5-Hydroxytryptamine Measurements for the Diagnosis and Treatment of Premature Ejaculation. Urology 2013; 82:1336-40. [DOI: 10.1016/j.urology.2013.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/22/2013] [Accepted: 08/04/2013] [Indexed: 11/22/2022]
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20
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Eassa BI, El-Shazly MA. Safety and efficacy of tramadol hydrochloride on treatment of premature ejaculation. Asian J Androl 2013; 15:138-42. [PMID: 23103596 PMCID: PMC3739134 DOI: 10.1038/aja.2012.96] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 05/17/2012] [Accepted: 07/25/2012] [Indexed: 01/02/2023] Open
Abstract
Premature ejaculation (PE) is the most common sexual disorder. It affects 20%-30% of adult men; the aetiology of this condition has not yet been elucidated. The aim of this study is to evaluate the efficacy, safety, tolerability, undesirable effects and improved satisfaction with sexual intercourse with tramadol hydrochloride at different dosages for the treatment of PE. A total of 300 patients who presented with lifelong (primary) PE were included in this study. The study was performed for 28 weeks, in which placebo (starch tablet) was given for 4 weeks, and active ingredient (tramadol hydrochloride) was administered at different therapeutic dosages for 24 weeks. Patients were divided into three equal groups, each consisting of 100 patients. The first group (A) was given tramadol hydrochloride capsule 25 mg. The second group (B) was given tramadol hydrochloride capsule 50 mg. The third group (C) was given tramadol hydrochloride capsule 100 mg. All of the 300 participants included completed the study voluntarily. The age of the patients varied from 25 to 50 years. After the treatment period, the recorded data were collected for each group and analysed. The results showed a highly significant increase in the mean intravaginal ejaculatory latency time (IELT) in all groups compared to baseline data (P<0.0001). We concluded that using tramadol hydrochloride at different doses on demand for the treatment of PE is effective, safe and tolerable, with minimal undesirable effects, and approval for this indication should be sought.
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Affiliation(s)
- Bayoumy I Eassa
- Department of Dermatology, Venereology and Andrology, Al-Azhar University, Cairo 11884, Egypt.
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21
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McMahon CG, Jannini E, Waldinger M, Rowland D. Standard Operating Procedures in the Disorders of Orgasm and Ejaculation. J Sex Med 2013; 10:204-29. [DOI: 10.1111/j.1743-6109.2012.02824.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Finotelli Júnior Í, Capitão CG. Tradução e adaptação cultural do Index of Premature Ejaculation (IPE) para o português do Brasil. PSICO-USF 2012. [DOI: 10.1590/s1413-82712012000300013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O presente estudo traduziu e adaptou o Index of Premature Ejaculation (IPE) para o português do Brasil, por método de equivalência semântica. O IPE é uma escala em autorrelato composta por 10 itens que avaliam critérios como senso de controle, satisfação sexual e sofrimento. Compuseram esse processo 11 profissionais qualificados para tal método e uma amostra de 50 participantes para avaliação quanto à inteligibilidade. As etapas foram: tradução, retrotradução, avaliação da equivalência semântica, crítica final por especialistas e pré-teste da versão. Os resultados para avaliação da equivalência apresentaram concordância significativa entre os juízes. Essa avaliação classificou os itens como inalterados ou pouco alterados. A crítica final por especialista avaliou qualitativamente as divergências e consolidou a versão aplicada na amostra. Após essa aplicação, algumas sugestões foram incorporadas e constituíram a versão final. Os resultados foram satisfatórios na compreensão da linguagem empregada. Para essa versão, conservou-se o nome em inglês, acrescido ao final de "adaptação brasileira".
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Prause N. A response to Brody, Costa and Hess (2012): theoretical, statistical and construct problems perpetuated in the study of female orgasm. SEXUAL AND RELATIONSHIP THERAPY 2012. [DOI: 10.1080/14681994.2012.732262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Francischi FBD, Ayres DC, Itao RE, Spessoto LCF, Arruda JGFD, Facio Junior FN. Premature ejaculation: is there an efficient therapy? EINSTEIN-SAO PAULO 2011; 9:545-9. [PMID: 26761263 DOI: 10.1590/s1679-45082011rb1929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 11/03/2011] [Indexed: 11/22/2022] Open
Abstract
Premature ejaculation is the most frequent male sexual dysfunction, estimated to affect 20 to 30% of men at some time in their life. A Pubmed search from the year 2000 to the present was performed to retrieve publications related to management or treatment of premature ejaculation. Behavioral techniques have been the mainstay of premature ejaculation management for many years, although evidence of their short-term efficacy is limited. Topical therapies for premature ejaculation act by desensitizing the penis and do not alter the sensation of ejaculation. Selective serotonin reuptake inhibitors (SSRIs), commonly used in the treatment of depression, are often used to treat premature ejaculation, based on the observation that delayed ejaculation is a frequent side effect of this drug class. Dapoxetine is a short-acting SSRI formulated to treat premature ejaculation, and results seem very promising.
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Affiliation(s)
- Fábio Barros de Francischi
- Hospital de Base, Faculdade de Medicina de São José do Rio Preto - FAMERP, São José do Rio Preto, SP, BR
| | - Daniel Cernach Ayres
- Hospital de Base, Faculdade de Medicina de São José do Rio Preto - FAMERP, São José do Rio Preto, SP, BR
| | - Ricardo Eidi Itao
- Hospital de Base, Faculdade de Medicina de São José do Rio Preto - FAMERP, São José do Rio Preto, SP, BR
| | - Luis Cesar Fava Spessoto
- Hospital de Base, Faculdade de Medicina de São José do Rio Preto - FAMERP, São José do Rio Preto, SP, BR
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Rowland DL. Genital and heart rate response to erotic stimulation in men with and without premature ejaculation. Int J Impot Res 2010; 22:318-24. [PMID: 20861844 DOI: 10.1038/ijir.2010.22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study compared genital and penile response patterns in men with and without premature ejaculation (PE) so as to identify the potential anomalous psychosomatic relationships among men with PE. Genital and heart rate response profiles of 25 men with PE were compared with those of 13 age-matched sexually functional counterparts during visual sexual stimulation presented in combination with vibrotactile penile stimulation. Although no differences were found between men with PE and controls on maximum penile circumference change, overall penile response was significantly lower in the PE group and PE men who ejaculated during the session exhibited shorter latencies to maximum circumference change. Furthermore, significant differences were found between groups in patterns of heart rate. These findings indicate differences in physiological responses between men with PE and sexually functional counterparts during erectile tumescence and progression toward ejaculation. Such differences might be explained by 'premature' sympathetic activation during the sexual response cycle in men with PE, thereby diminishing parasympathetically controlled penile response and triggering sympathetically mediated seminal emission prematurely.
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Affiliation(s)
- D L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN 46383, USA.
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Segraves RT. Considerations for an evidence-based definition of premature ejaculation in the DSM-V. J Sex Med 2010; 7:672-9. [PMID: 20492416 DOI: 10.1111/j.1743-6109.2009.01682.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The Diagnostic and Statistical Manual of Mental Disorders, 4th Ed., text revision (DSM-IV-TR) criteria for premature ejaculation (PE) have been criticized on multiple grounds including that the criteria lack precision, that the requirement of marked distress is inappropriate, and that the specification of etiological subtypes should be deleted. Since these criteria were originally adopted, there has been a tremendous gain in knowledge concerning PE. AIM The goal of this manuscript is to review evidence relevant to diagnostic criteria for PE published since 1990. METHOD Medline searches from 1990 forward were conducted using the terms PE, rapid ejaculation, ejaculatory disorder, and intravaginal ejaculatory latency. Early drafts of proposed alterations in diagnostic criteria were submitted to advisors. MAIN OUTCOME MEASURE Expert opinion was based on review of evidence-based medical literature. RESULTS The literature search indicated possible alterations in diagnostic criteria for PE. CONCLUSIONS It is recommended that the Diagnostic and Statistical Manual committee adopt criteria similar to those adopted by the International Society of Sexual Medicine. It is proposed that lifelong PE in heterosexual men be defined as ejaculation occurring within approximately 1 minute of vaginal penetration on 75% of occasions for at least 6 months. Field trials will be necessary to determine if these criteria can be applied to acquired PE and whether analogous criteria can be applied to ejaculatory latencies in other sexual activities. Serious consideration should be given to changing the name from PE to rapid ejaculation. The subtypes indicating etiology should be eliminated.
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Rowland D, McMahon CG, Abdo C, Chen J, Jannini E, Waldinger MD, Ahn TY. Disorders of orgasm and ejaculation in men. J Sex Med 2010; 7:1668-86. [PMID: 20388164 DOI: 10.1111/j.1743-6109.2010.01782.x] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Ejaculatory/orgasmic disorders are common male sexual dysfunctions, and include premature ejaculation (PE), inhibited ejaculation, anejaculation, retrograde ejaculation, and anorgasmia. AIM To provide recommendations and guidelines concerning current state-of-the-art knowledge for management of ejaculation/orgasmic disorders in men. METHODS An international consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 25 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge of disorders of orgasm and ejaculation represent the opinion of seven experts from seven countries developed in a process over a 2-year period. MAIN OUTCOME MEASURE Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. RESULTS Premature ejaculation management is largely dependent upon etiology. Lifelong PE is best managed with PE pharmacotherapy (selective serotonin re-uptake inhibitor [SSRI] and/or topical anesthetics). The management of acquired PE is etiology specific and may include erectile dysfunction (ED) pharmacotherapy in men with comorbid ED. Behavioral therapy is indicated when psychogenic or relationship factors are present and is often best combined with PE pharmacotherapy in an integrated treatment program. Retrograde ejaculation is managed by education, patient reassurance, pharmacotherapy, or bladder neck reconstruction. Delayed ejaculation, anejaculation, and/or anorgasmia may have a biogenic and/or psychogenic atiology. Men with age-related penile hypoanesthesia should be educated, reassured, and instructed in revised sexual techniques which maximize arousal. CONCLUSIONS Additional research is required to further the understanding of the disorders of ejaculation and orgasm.
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Affiliation(s)
- David Rowland
- Valparaiso University, Psychology, Valparaiso, IN, USA
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McMahon CG. Clinical trial methodology in premature ejaculation observational, interventional, and treatment preference studies--part I--defining and selecting the study population. J Sex Med 2008; 5:1805-16. [PMID: 18507717 DOI: 10.1111/j.1743-6109.2008.00836.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Large, well-designed observational or clinical efficacy and safety randomized clinical trials are required to identify the prevalence of premature ejaculation (PE) and its associated risk factors, to characterize the dimensions of PE and the basis for treatment-seeking behaviour, and to achieve regulatory approval of new drug treatments. AIMS The objective of this article was to make recommendations for the criteria for defining and selecting the study population. MAIN OUTCOME MEASURES Contemporary published data on clinical trial design and the epidemiology, definitions, dimensions, and psychological impact of PE. METHODS Contemporary data on the epidemiology, definitions, dimensions, and psychological impact of PE were reviewed, critiqued using the principles of evidence-based medicine, and incorporated into a series of evidence-based recommendations for standardization of patient selection for clinical trials in PE. RESULTS Data from PE observational, interventional, and treatment preference studies are only reliable, interpretable, and capable of being generalized to patients with PE when study populations are defined by the constructs of an ejaculatory latency time of less than about 1 minute on all or nearly all occasions, the inability to delay ejaculation, and the presence of negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy. CONCLUSION These constructs can be incorporated into a multidimensional evidence-based definition of PE and/or single-item questions or multi-item diagnostic questionnaires. The International Society of Sexual Medicine definition of PE reflects the contemporary understanding of PE, represents the state-of-the-art multidimensional definition of PE, and is recommended as the basis of diagnosis of PE for all PE clinical trials.
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Affiliation(s)
- Chris G McMahon
- University of Sydney, Australian Centre for Sexual Health, St Leonards, New South Wales, Australia.
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Safarinejad MR. Safety and efficacy of dapoxetine in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. Neuropsychopharmacology 2008; 33:1259-65. [PMID: 17625501 DOI: 10.1038/sj.npp.1301500] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The aim of the study was to evaluate the efficacy and safety of a selective serotonin reuptake inhibitor (SSRI) drug dapoxetine in delaying ejaculation in patients with premature ejaculation (PE). A total of 212 potent men with PE were randomly assigned to receive 30 mg orally dapoxetine (group 1, N=106) twice daily or similar regimen of placebo (group 2, N=106) during a 12-week period for each agent. Pretreatment evaluation included history and physical examination, geometric mean intravaginal ejaculatory latency time (IELT, primary outcome measure), and International Index of Erectile Function (IIEF). The efficacy of two treatments was assessed every 2 weeks during treatment, at the end of study, and in 3-month follow-up after cessation of treatment. We measured geometric mean IELT. Thus, the IELT values were logarithmically transformed before statistical analysis, and the results are reported as fold increases from baseline with associated 95% confidence intervals (CI). The independent sample two-tailed t-test was used to compare the IELTs. At the end of 12-week treatment, the dapoxetine group had a 2.9- (95% CI, 1.84-4.16) fold increase of the geometric mean IELT, while after placebo the geometric mean IELT did not increase significantly (1.4-fold increase; 95% CI, 0.84-1.63) (p=0.001). The mean weekly intercourse episodes increased from pretreatment values of 1.16 and 1.14 to 2.2 and 1.4, for dapoxetine and placebo, respectively (p=0.04). Baseline mean intercourse satisfaction domain values of IIEF, 12 and 11, reached to 16 and 10 at the 12-week treatment in groups 1 and 2, respectively (p=0.04). At the end of 3-month follow-up period, the geometric mean IELT in dapoxetine and placebo group demonstrated 1.4- (95% CI, 0.66-1.46) and 1.3- (95% CI, 0.77-1.63) fold increase, respectively (p=0.1). Three-month intercourse satisfaction domain value of IIEF was 11 in group 1 and 10 in group 2 (p=0.1). Mean number of adverse events was 19 for dapoxetine and 7 for placebo (p=0.02). Dapoxetine has moderately better results in terms of IELT and intercourse satisfaction vs placebo without long-term benefit for the patient after it is withdrawn. Further studies are necessary to draw final conclusions on the efficacy of this drug in PE.
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Affiliation(s)
- Mohammad R Safarinejad
- Urology and Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
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Rosen RC, Althof S. Impact of premature ejaculation: the psychological, quality of life, and sexual relationship consequences. J Sex Med 2008; 5:1296-307. [PMID: 18422496 DOI: 10.1111/j.1743-6109.2008.00825.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Premature ejaculation (PE) has been associated with a range of negative psychological effects, including anxiety, depression, and distress in men and their female partners. AIM To review evidence of the psychosocial concomitants of premature ejaculation in recent observational studies, and to consider the psychosocial and quality of life outcomes associated with PE, including effects on the partner relationship. MAIN OUTCOME MEASURE Psychosocial and quality of life consequences related to premature ejaculation. METHODS A literature search was performed to retrieve publications relating to management or treatment of PE or male sexual dysfunction. Publications were included if they reported the impact of PE on the man, his partner or relationship, or the impact of male sexual dysfunction and included PE in the analysis. RESULTS Eleven observational studies were selected. All these studies found evidence for an association between PE and adverse psychosocial and quality of life consequences, including detrimental effects on the partner relationship. Comparative analyses were restricted by major differences across the studies. CONCLUSIONS PE significantly negatively impacts men and their partners and may prevent single men forming new partner relationships. Men are reluctant to seek treatment from their physicians, although they may be more encouraged to do so through their partner's support and the availability of effective treatments. There is a need for validated diagnostic screening criteria and validated, reliable, brief patient-reported outcome measures that can be used to assess men with PE and their partners. These factors would allow further studies with more complete and accurate assessment of the impact of PE.
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Ejaculatory disorders: pathophysiology and management. ACTA ACUST UNITED AC 2008; 5:93-103. [DOI: 10.1038/ncpuro1016] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 11/09/2007] [Indexed: 01/24/2023]
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Abstract
Information concerning the epidemiology, etiology and treatment of premature (rapid) ejaculation is reviewed. Evidence concerning the prevalence of premature ejaculation indicates that subjective concern about rapid ejaculation is a common concern worldwide. Hypotheses concerning the pathogenesis of premature ejaculation include: (1) that it is a learned pattern of ejaculation maintained by interpersonal anxiety, (2) that it is the result of dysfunction in central or peripheral mechanisms regulating ejaculatory thresholds and (3) that it is a normal variant in ejaculatory latency. Current evidence based treatment interventions include behavioral psychotherapy and the use of pharmacological agents, including topical anesthetic agents and selective serotonin reuptake inhibitors.
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Affiliation(s)
- R T Segraves
- Case School of Medicine, and MetroHealth Medical Center, Cleveland, OH 44109, USA.
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Abstract
In sexual health surveys, premature ejaculation (PE) is frequently the most common condition reported by men. Men with symptoms of PE often report a significant impact of the condition on their lives, experiencing personal distress and interpersonal difficulty related to their condition. Unfortunately, PE is highly ignored by the patients and the healthcare community. Most of the men do not seek medical treatment for their PE. Survey data indicate that men are reluctant to discuss sexual issues with physicians and that the physicians generally do not initiate discussions of such issues. The aim of this article was to discuss the prevalence of this condition and the impact that it has on the patient as well as on the partner. We will address the characteristics of PE, discuss interview techniques to identify the condition, and outline ways to differentiate PE from erectile dysfunction. It is our conclusion that the recognition and diagnosis of sexual dysfunctions may subsequently lead to treatment opportunities, which, in turn, may improve the quality of life for patients with such disorders.
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Affiliation(s)
- M T Rosenberg
- Mid-Michigan Health Centers, Jackson, MI 49201, USA.
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Patrick DL, Rowland D, Rothman M. Interrelationships among measures of premature ejaculation: the central role of perceived control. J Sex Med 2007; 4:780-788. [PMID: 17419817 DOI: 10.1111/j.1743-6109.2007.00464.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Domains of premature ejaculation (PE) include short intravaginal ejaculatory latency time (IELT), poor perceived control over ejaculation, decreased satisfaction with sexual intercourse, and personal distress and interpersonal difficulty related to ejaculation. How these measures interrelate is unknown. AIM Here, we evaluated the interrelationships between these PE-specific variables, applying cross-sectional data from a large U.S. observational study of men with PE. METHODS We analyzed data from men with PE identified in a previously reported observational study. PE was diagnosed by experienced clinicians using the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. MAIN OUTCOME MEASURES Subjects reported their stopwatch-measured IELT, perceived control over ejaculation, satisfaction with sexual intercourse, personal distress related to ejaculation, and interpersonal difficulty related to ejaculation. Relationships between variables were assessed using bivariate correlations, and the strength and significance of direct or indirect effects between variables were evaluated using a form of regression analysis known as path analysis. RESULTS Bivariate Pearson correlation coefficients for all relationships were significant at the P <or= 0.05 level, with the exception of IELT and interpersonal difficulty related to ejaculation. When all variables were included in the model, IELT showed a significant direct effect on perceived control over ejaculation but did not show a significant direct effect on ejaculation-related personal distress or satisfaction with sexual intercourse. Perceived control over ejaculation showed a significant direct effect on both ejaculation-related personal distress and satisfaction with sexual intercourse, which each showed direct effects on interpersonal difficulty related to ejaculation. CONCLUSIONS The patient's perception of control over ejaculation is central to understanding how PE is associated with satisfaction with sexual intercourse and ejaculation-related distress. In contrast, the association of IELT with satisfaction with sexual intercourse and distress related to ejaculation is mediated by perceived control over ejaculation.
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Affiliation(s)
- Donald L Patrick
- University of Washington-Department of Health Services and Epidemiology, Seattle, WA, USA;.
| | - David Rowland
- Valparaiso University-Kretzmann Hall, Valparaiso, IN, USA
| | - Margaret Rothman
- Johnson and Johnson Pharmaceutical Services, LLC- Patient-Reported Outcomes, Raritan, NJ, USA
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Rowland DL, Patrick DL, Rothman M, Gagnon DD. The psychological burden of premature ejaculation. J Urol 2007; 177:1065-70. [PMID: 17296413 DOI: 10.1016/j.juro.2006.10.025] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Indexed: 01/23/2023]
Abstract
PURPOSE Premature ejaculation is characterized by short ejaculatory latency, inability to control ejaculation and resultant overall decreased sexual satisfaction for the man and his partner. Diagnostic criteria typically include aspects of psychological well-being. To motivate and justify treatment for premature ejaculation a more comprehensive understanding of its impact on men, their partners and their overall relationship is needed. MATERIALS AND METHODS In a community based, observational study of 1,587 men and their female partners clinicians diagnosed premature ejaculation using Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision criteria. For purposes of this analysis this group was further restricted to subjects with a stopwatch measured intravaginal ejaculatory latency time of 2 minutes or less. Responses to the Premature Ejaculation Profile, Self-Esteem and Relationship questionnaire, Golombok-Rust Inventory of Sexual Satisfaction and Medical Outcomes Study SF-36 were compared between premature ejaculation and nonpremature ejaculation groups. Correlations between responses of men and partners were assessed for the Premature Ejaculation Profile and Golombok-Rust Inventory of Sexual Satisfaction. Correlations among patient reported measures enabled the assessment of independence of outcome variables. RESULTS AND CONCLUSIONS Of 207 men who met Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision criteria 89 had an intravaginal ejaculatory latency time of 2 minutes or less. Lower levels of sexual functioning and satisfaction, and higher levels of personal distress and interpersonal difficulty were reported by men with premature ejaculation and their partners. In addition, men with premature ejaculation rated their overall quality of life lower than that of men without premature ejaculation. Consequently premature ejaculation has a significant psychological burden on men, their partners and the male/partner relationship.
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Rosen RC, McMahon CG, Niederberger C, Broderick GA, Jamieson C, Gagnon DD. Correlates to the clinical diagnosis of premature ejaculation: results from a large observational study of men and their partners. J Urol 2007; 177:1059-64; discussion 1064. [PMID: 17296411 DOI: 10.1016/j.juro.2006.10.044] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Indexed: 01/23/2023]
Abstract
PURPOSE A recent observational study characterized intravaginal ejaculatory latency time and single item patient reported outcome measures in a large population of males with and without premature ejaculation, as well as their female partners. In the current analysis we assessed the relative influence of those measures in identifying premature ejaculation as diagnosed by the clinician. MATERIALS AND METHODS Data were from a 4-week, multicenter, observational study of men with (207) and without (1,380) premature ejaculation (diagnosed using The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision criteria), as well as their female partners. Estimated and measured intravaginal ejaculatory latency time, age, and responses to single item (control over ejaculation, personal distress, satisfaction with sexual intercourse and interpersonal difficulty) and multiple item (male and female Golombok-Rust Inventory of Sexual Satisfaction, male Self-Esteem and Relationship questionnaire, and Short Form 36) measures were evaluated with stepwise logistic regression analysis. RESULTS Self-estimated and stopwatch measured intravaginal ejaculatory latency time were interchangeable, correctly assigning premature ejaculation status with 80% sensitivity and 80% specificity, increasing to 80% sensitivity and 96% specificity when combined with single item patient reported outcomes. Subject reported control over ejaculation and personal distress most strongly indicated premature ejaculation status. Partner personal distress was more influential in determining premature ejaculation status than estimated or measured intravaginal ejaculatory latency time, and single item measures were more influential than multiple item measures. Age was not influential in assigning premature ejaculation status. CONCLUSIONS Neither self-estimated nor stopwatch measured intravaginal ejaculatory latency time alone was optimal for assigning premature ejaculation status. Subject and partner responses to single item measures, particularly control over ejaculation and personal distress, were important. Results suggest that a combination of estimated intravaginal ejaculatory latency time and the 4 single item patient reported outcome measures can adequately identify premature ejaculation status.
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Affiliation(s)
- Raymond C Rosen
- New England Research Institutes, Watertown, Massachusetts 02472, USA.
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Abstract
Premature ejaculation (PE) is a common male sexual disorder. Recent normative data suggests that men with an intravaginal ejaculatory latency time (IELT) of less than 1 minute have "definite" PE, while men with IELTs between 1 and 1.5 minutes have "probable" PE. Although there is insufficient empirical evidence to identify the etiology of PE, there is limited correlational evidence to suggest that men with PE have high levels of sexual anxiety and inherited altered sensitivity of central 5-HT (5-hydroxytryptamine, serotonin) receptors. Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors is well tolerated and offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains. Investigational drugs such as the ejaculo-selective serotonin transport inhibitor, dapoxetine represent a major development in sexual medicine. These drugs offer patients the convenience of on-demand dosing, significant improvements in IELT, ejaculatory control and sexual satisfaction with minimal adverse effects.
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Affiliation(s)
- Chris G. McMahon
- Australian Centre For Sexual Health Suite 2-4, Berry Road Medical Centre 1a Berry Rd St. Leonards, Australia
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Quek KF, Sallam AA, Ng CH, Chua CB. Prevalence of sexual problems and its association with social, psychological and physical factors among men in a Malaysian population: a cross-sectional study. J Sex Med 2007; 5:70-6. [PMID: 17362280 DOI: 10.1111/j.1743-6109.2006.00423.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Sexual problems are common in the general population. Studies have shown that most of these sexual problems are related to their social lives, medical illnesses, and psychological status. Among the sexual problems in men, premature ejaculation (PE) is one of the most frequent, yet it is the least well-understood of the sexual dysfunctions of men. AIM To determine the prevalence of sexual problem particularly PE and erectile dysfunction (ED) among people living in urban areas and to investigate the characteristics associated with these sexual problems in a Malaysian population. MAIN OUTCOME MEASURE The PE which is defined as an intravaginal ejaculation latency time less than 2 minutes was assessed in the ED and non-ED group. METHODS The Hospital Anxiety and Depression scale is used as a measure of the psychological status [30]. The ED status was assessed using the International Index of Erectile Function questionnaire. RESULTS The prevalence of self-reported sexual problems for ED and PE were 41.6% and 22.3%, respectively. In those subjects with ED, 33.5% reported to have PE. Of the total of 430 subjects, anxiety was present in 8.1%, while depression was 5.3%. The prevalence of PE accounted for 25% anxiety and 14.6% for depression respectively in the population. EDs were associated with diabetes and hypertension (OR [95% CI]: 5.33 [2.33, 10.16], 3.40 [1.76, 6.57], P < 0.05), respectively, while factors associated with PE were anxiety and depression (OR [95% CI]: 1.29 [0.68, 2.45], 1.39 [0.69, 2.78]), respectively. CONCLUSION Prevalence of ED is associated with medical symptoms such as diabetes and hypertension and a rise in the prevalence of age while psychological distress such as anxiety and depression also contribute to a higher PE rate.
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Affiliation(s)
- Kia Fatt Quek
- School of Medicine and Health Sciences, Monash University Malaysia, Petaling Jaya, Selangor Darul Ehsan, Malaysia.
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Wang WF, Wang Y, Minhas S, Ralph DJ. Can sildenafil treat primary premature ejaculation? A prospective clinical study. Int J Urol 2007; 14:331-5. [PMID: 17470165 DOI: 10.1111/j.1442-2042.2007.01606.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, sildenafil has been demonstrated to be effective in treating premature ejaculation (PE). However, these studies ignored female factors and could not exclude the probability of drug interaction when combined with paroxetine. Therefore, the aim of this study was to evaluate the efficacy and safety of sildenafil alone in the treatment of primary PE, taking female factors into consideration. METHODS One hundred and eighty potent men with primary PE were randomly divided into three groups and followed up for 6 months. Group A were treated with 50 mg sildenafil as needed, group B with 20 mg paroxetine daily and group C with squeeze technique daily. Intravaginal ejaculatory latency time (IELT), PE grade, intercourse satisfactory score (ISS), frequency of intercourse, and adverse effects of drugs were recorded before treatment, and 3 and 6 months after treatment. RESULTS Compared with pretreatment, the three groups had significant differences in all the parameters after 3 or 6 months treatment, except the frequency of intercourse in Group C (all P = 0.00). However, there were no significant differences between 3 and 6 months. Compared with paroxetine and squeeze technique, after 3 or 6 months, sildenafil had significant differences in all the parameters (all P = 0.00). After 6 months, 1.7%, 18.3% and 36.7% patients in groups A, B and C, respectively, withdrew from the study and 86.7%, 60.0% and 45.0% patients, respectively, wanted to be treated further with the original administration, and this was statistically significant (both P = 0.00). CONCLUSION Sildenafil is very effective and safe to treat PE, and has much higher efficacy than paroxetine and squeeze technique.
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Affiliation(s)
- Wei-Fu Wang
- Department of Urology, People's Hospital of Hainan Province, Haikou, China.
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Abstract
Premature ejaculation (PE) is a common male sexual disorder. Recent normative data suggest that men with an intravaginal ejaculatory latency time (IELT) of less than 1 minute have "definite" PE, while men with IELTs between 1 and 1.5 minutes have "probable" PE. Although there is insufficient empirical evidence to identify the etiology of PE, there is limited correlational evidence to suggest that men with PE have high levels of sexual anxiety and inherited altered sensitivity of central 5-HT (serotonin) receptors. Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors (SSRIs) offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains and is well tolerated. Investigational drugs such as the ejaculo-selective serotonin transport inhibitors (ESSTIs) such as dapoxetine and UK-390,957 represent a major development in sexual medicine. These drugs offer patients the convenience of on-demand dosing, significant improvements in IELT, ejaculatory control, and sexual satisfaction with minimal adverse effects.
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Abstract
This review discusses treatment options for men with premature ejaculation (PE), a common sexual dysfunction characterized by short ejaculatory latency, decreased sexual satisfaction, and distress. For a number of reasons, including embarrassment and the belief that PE is a normal part of aging, has no effective treatment, or will resolve itself, few men with PE seek treatment. Although several treatment options exist (eg, behavioral, cognitive, and sex therapy methods; desensitizing drugs; off-label use of antidepressants and/or phosphodiesterase type 5 inhibitors or alpha-blockers), the majority of men with PE generally are not satisfied with their results. New pharmacologic drugs, specifically for the treatment of PE, are undergoing evaluation in clinical trials. As an example, recent clinical research studies have revealed on-demand administration of one such drug, dapoxetine, which achieved significant improvements in ejaculatory latency, control over ejaculation, and satisfaction with sexual intercourse. In addition, partners of men who received dapoxetine likewise reported improved satisfaction with sexual intercourse. Future studies may reveal that integration of pharmacologic drugs with psychologic and/or behavioral therapy techniques may be the optimal approach to the management of PE. PE is a treatable condition, and new drugs in development may provide benefits over those available.
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Affiliation(s)
- Wayne J G Hellstrom
- Tulane University Medical Center, Department of Urology, 1430 Tulane Avenue, New Orleans, LA 701120-2632, USA.
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Treatment of premature ejaculation: New drugs and treatment strategies. CURRENT SEXUAL HEALTH REPORTS 2006. [DOI: 10.1007/s11930-006-0008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fatt QK, Atiya AS, Heng NC, Heng NGC, Beng CC. Validation of the Hospital Anxiety and Depression Scale and the psychological disorder among premature ejaculation subjects. Int J Impot Res 2006; 19:321-5. [PMID: 17136103 DOI: 10.1038/sj.ijir.3901528] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Premature ejaculation (PE) is a common sexual dysfunction among the general population. PE has often been associated with a psychological state of mind. Hospital Anxiety and Depression Scale (HADS) can be used as an instrument to assess the emotional and psychological state. The present study was designed to assess the reliability and validity of the HADS in a Malaysian population. The validity and reliability were studied in subjects with and without PE. Test-retest methodology was used to assess the reliability whereas Cronbach's alpha was used to assess the internal consistency. In the control and the PE groups, the internal consistency was good and a high degree of internal consistency was observed for all 14 items. In the control group, the Cronbach's alpha values at baseline were from 0.811 to 0.834, whereas for retest, the Cronbach's alpha values were from 0.821-0.838 items. Intraclass correlation coefficient (ICC) was high for the control (0.797-0.868: baseline and 0.805-0.872: retest) and PE group (0.822-0.906: baseline and 0.785-0.887: retest). The high value of ICC and the internal consistency was due to high reliability and consistency of the items at 2-week interval. A degree of significance between the baseline and week-2 scores was observed across all items in the PE group but not in the control group. The HADS is a suitable, reliable, valid and sensitive instrument to measure the clinical change for anxiety and depression in the Malaysian population.
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Affiliation(s)
- Q K Fatt
- School of Medicine & Health Sciences, Monash University Malaysia, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia.
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Abstract
INTRODUCTION Premature ejaculation (PE) is one of the most prevalent male sexual dysfunctions, yet it is frequently misdiagnosed or overlooked as a result of numerous patient and physician barriers. In particular, there is no universally used definition of the condition. There are no validated assessments or laboratory assays which distinguish men with PE from men without PE, and there are no risk factors or definitive correlates identified for this condition. Patients fail to seek medical help because of the stigma and embarrassment over the condition. In addition, patients (and clinicians) often misdiagnose PE as erectile dysfunction (ED). AIM To review the barriers to diagnosing PE, the factors to consider in diagnosing PE and how to diagnose PE. METHODS The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24-26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives. MAIN OUTCOME MEASURE Data were utilized from the American Urological Association (AUA) Guideline on the Pharmacologic Management of Premature Ejaculation. RESULTS The AUA recommends the diagnosis of PE be based solely upon sexual history. In addition to a shortened latency time, recent research has identified three key factors associated with--and necessary for--a diagnosis of PE: (i) patient reports of reduced control over ejaculation; (ii) patient (and/or partner) reports of reduced satisfaction with sexual intercourse; and (iii) patient (and/or partner) distress over the condition. CONCLUSIONS The diagnosis of PE is based upon sexual history of a shortened latency time, poor control over ejaculation, low satisfaction with intercourse, and distress regarding the condition.
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Abstract
Premature ejaculation (PE) is likely the most common sexual dysfunction in men, with a worldwide prevalence of approximately 30%. To date, the lack of a universally acknowledged definition of PE has complicated the examination and analysis of PE in clinical and research-related settings. The impact of PE on men and their partners also needs to be clearly defined. Clearly, a better understanding of the epidemiology of this disorder, especially with regard to prevalence and risk factors, is necessary. The prevalence of PE appears to vary across socio-cultural and geographic populations. The elucidation of the etiology of PE and risk factors associated with PE has been difficult. However, several risk factors for PE exist that have strong support in the literature. Clearly, an improved and universal definition and understanding of PE and its epidemiology will improve the clinical management of PE and the success of future epidemiologic studies and clinical trials.
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Affiliation(s)
- C Carson
- Department of Urology, University of North Carolina, Chapel Hill, NC 27599-7235, USA.
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Abstract
INTRODUCTION Premature ejaculation (PE) and its individual and relationship consequences have been recognized in the literature for centuries. PE is one of the most common male sexual dysfunctions, affecting nearly one in three men worldwide between the ages of 18 and 59 years. Until recently, PE was believed to be a learned behavior predominantly managed with psychosexual therapy; however, the past few decades have seen significant advances in understanding its etiology, diagnosis, and management. There is, as yet, no one universally agreed upon definition of PE. AIM To review five currently published definitions of PE. METHODS The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24-26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives. MAIN OUTCOME MEASURE Data were utilized from the World Health Organization, the American Psychiatric Association, the European Association of Urology, the Second International Consultation on Sexual Dysfunctions, and the American Urological Association. RESULTS The current published definitions of PE have many similarities; however, none of these provide a specific "time to ejaculation," in part because of the absence of normative data on this subject. While investigators agree that men with PE have a shortened intravaginal ejaculatory latency time (IELT; i.e., time from vaginal penetration to ejaculation), there is now a greater appreciation of PE as a multidimensional dysfunction encompassing several components, including time and subjective parameters such as "control,""satisfaction," and "distress." CONCLUSION There is a recent paradigm shift away from PE as a unidimensional disorder of IELT toward a multidimensional description of PE as a biologic dysfunction with psychosocial components.
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Affiliation(s)
- Gregory A Broderick
- Department of Urology, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA.
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Corona G, Jannini EA, Maggi M. Inventories for male and female sexual dysfunctions. Int J Impot Res 2006; 18:236-50. [PMID: 16267565 DOI: 10.1038/sj.ijir.3901410] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Several illnesses can distress sexual health and disrupt sexuality, an integral part of being human. These illnesses are not different in origin from those affecting other health areas, but, because sexuality is involved, effective communication and empathy between the physician and the patient may be severely hindered by negative feelings such as anxiety and guilt. A detailed general and sexual history is, however, an essential step in evaluating patients for sexual dysfunction (SD). Finding the correct way to ask questions and to decode answers on sexual health and disease might be difficult and, in some way, embarrassing. Hence, validated and standardized sexual inventories might help physicians confront SD. These case-history tools have the advantage of being standardized, easy to administer and score, relatively unobtrusive and substantially inexpensive. This review describes the main sexual inventories hitherto described and validated in different sexual areas of health and disease, and the advantages of the two main formats available to clinicians, that is, structured interviews (SIs) and self-report questionnaires (SRQs). Both types of inventories are composed of a set of standardized, written probe questions requiring a finite number of responses, driven by an interviewer (SIs) or by the patients themselves (SRQs). SRQs allow more time and intimacy to organize and develop answers to delicate questions, as are those on sexual life. In addition, SRQs could also be very useful in quantifying disease severity and treatment outcome. On the other hand, SIs help achieve a better patient-physician relationship and reduce the risk of misunderstandings.
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Affiliation(s)
- G Corona
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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