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PubMed2006

Safety and efficacy of tramadol in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study.

PURPOSE: To evaluate the efficacy and safety of a new serotonergic centrally acting drug tramadol in delaying ejaculation in patients with premature ejaculation. MATERIALS AND METHODS: Sixty-four potent men with premature ejaculation were randomly assigned to receive 50 mg tramadol (group 1, n = 32) or placebo (group 2, n = 32) approximately 2 hours before planned sexual activity, for 8 weeks. Pretreatment evaluation included history and physical examination, intravaginal ejaculatory latency time, International Index of Erectile Function, and Meares-Stamey test. The efficacy of 2 treatments was assessed using responses to International Index of Erectile Function, intravaginal ejaculatory latency time evaluation, and several general assessment questions. RESULTS: Fifty-seven (89%) completed the whole treatment schedule. The mean intravaginal ejaculatory latency time after tramadol and placebo increased from 19 and 21 seconds to approximately 243 and 34 seconds, respectively (P < 0.001). The mean weekly intercourse episodes increased from pretreatment values of 1.07 and 1.1 to 2.3 and 1.3, for tramadol and placebo, respectively (P < 0.05). Baseline mean intercourse satisfaction domain values of International Index of Erectile Function 10 and 11 reached to 14 and 10 at 8-week treatment in groups 1 and 2, respectively (P < 0.05). There was no withdrawal caused by adverse effects with tramadol or placebo, but more adverse events were associated with tramadol treatment (P < 0.05). CONCLUSIONS: Tramadol seems to provide significantly better results in terms of intravaginal ejaculatory latency time and intercourse satisfaction versus placebo. Further studies are required to draw final conclusions on the efficacy of this drug in premature ejaculation.

Adult↗
PubMed2003

A prospective study of time and number of ejaculations to azoospermia after vasectomy by ligation and excision.

PURPOSE: We obtained detailed information on the time and number of ejaculations to azoospermia after vasectomy by ligation and excision. MATERIALS AND METHODS: Men seeking vasectomy at 3 public clinics in Mexico City were invited to participate in this prospective noncomparative study. Vasectomy was performed using the no-scalpel technique. The vas was occluded using 2 silk sutures and the segment of vas between the ligatures was excised. Men were followed biweekly up to 24 weeks after vasectomy or until azoospermia was confirmed. Semen was examined at each visit for sperm concentration and motility. The main outcome measure was azoospermia in uncentrifuged semen samples. RESULTS: The life table rate for time to azoospermia was 81.5/100 men (95% CI 76.2 to 86.9) by the end of the study. Cumulative Kaplan-Meier event probability attained a maximum of 79.5/100 men (95% CI 73.7 to 85.2) at 70 ejaculations. Only 60/100 and 27.9/100 men were azoospermic by 12 weeks and 20 ejaculations, respectively. These end points are the commonly recommended waiting periods when semen analysis is unavailable. Of the 217 men 36 (16.6%) did not achieve azoospermia by 24 weeks, of whom 25 (11.5% of all participants) were considered to have vasectomy failure. CONCLUSIONS: Our results suggest that it is not possible to develop guidelines for clearance based only on the time or number of ejaculations when ligation and excision are performed. In addition, of the methods for vas occlusion during vasectomy ligation and excision may not provide the best success rates.

Adult↗
PubMed2005

Epidemiology of premature ejaculation.

PURPOSE OF REVIEW: Accumulating evidence suggests that premature ejaculation is the most common sexual symptom. This review focuses on the epidemiology of premature ejaculation from geographical and medical perspectives. RECENT FINDINGS: In the past year many articles have been published using the data from the Global Study of Sexual Attitudes and Behaviors, a large survey that investigated various aspects of sex and relationships among 27 500 men and women aged 40-80 years. Despite some methodological bias, discussed herein, a prevalence of more than 21% seems a realistic figure for premature ejaculation. SUMMARY: Premature ejaculation is the most prevalent sexual dysfunction in every country.

Adolescent↗
PubMed1995

Male phenotype and ejaculate quality in the zebra finch Taeniopygia guttata.

We tested the idea that female preference for relatively attractive extra-pair males arises because the morphological and behavioural features that females find attractive covary with ejaculate features: Sheldon's (Proc. R. Soc. Lond. B 257 25-30 (1994) phenotype-linked fertility insurance hypothesis. Two phenotypic traits that female zebra finches find attractive in males are song rate and symmetry of chest band plumage, but we found neither of these to be significantly related to any of the following ejaculate features: number of sperm, percentage of live sperm, absolute number of sperm, sperm length or sperm swimming velocity. Furthermore, and surprisingly, we did not find the predicted negative relationship between male song rate and fluctuating asymmetry of chest band plumage. Because most ejaculate features (except sperm numbers in rested males) show low levels of repeatability, it is unlikely that female zebra finches could reliably obtain a better quality ejaculate by choosing to copulate with a more attractive male. There was thus no evidence for the phenotype-linked fertility insurance hypothesis. Nor did we obtain evidence for the more general fertility insurance hypothesis: we found that female zebra finches paired to a vasectomized male, and hence receiving no sperm, were no more likely to seek an extra-pair copulation than females paired to an intact male.

Animals↗
PubMed2000

Strategic allocation of ejaculates by male Adélie penguins.

Sperm competition theory suggests that males should strategically allocate sperm to those females that will bring them the best possible genetic returns. Although males of a number of species of insects and fishes have been shown to allocate sperm strategically, we provide, to our knowledge, the first evidence that an avian species is also capable of allocating ejaculates. Male Adélie penguins (Pygoscelis adeliae) are more likely to transfer sperm during extra-pair copulations (EPCs) than during pair copulations. We investigated the question of how males allocate ejaculates within the constraints of limited sperm availability and found (i) that males that engaged in EPC attempts ejaculated less often when copulating with their social partner than males that made no EPC attempts, and (ii) that there was no difference between males that were involved in failed EPC attempts and those that were involved in successful EPCs in the proportion of copulations that resulted in sperm transfer. These results indicate that males achieve strategic allocation of sperm within the constraints of limited sperm availability by withholding ejaculates from their social partners.

Animals↗
PubMed2002

Adjustments of ejaculation rates in response to risk of sperm competition in a fish, the bitterling (Rhodeus sericeus).

Game theory models of sperm competition predict that within species, males should increase their sperm expenditure when they have one competitor, but decrease expenditure with increasing numbers of competitors. So far, there have been few tests or support for this prediction. Here, we show that males of a freshwater fish, the European bitterling, Rhodeus sericeus, do indeed adjust their ejaculation rate to the number of male competitors by first increasing and then decreasing their ejaculation rates as the number of competitors increases. However, this occurred only under restricted conditions. Specifically, the prediction was upheld as long as no female had deposited eggs in the live mussels that are used as spawning sites. After one or more females had spawned, males did not decrease their ejaculation rates with the number of competitors, but instead they became more aggressive. This indicates that decreased ejaculation rate and increased aggression are alternative responses to increased risk of sperm competition.

Aggression↗
PubMedDate not supplied

Motility and morphology of human spermatozoa in split ejaculates.

Sperm concentration and four motility characteristics (per cent motile spermatozoa, average velocity, average straight line approach and average speed constancy) were determined in three fractions of human split ejaculated from healthy volunteers. A semi-automatic analysis technique was used to determine sperm parameters from multiple exposure photographs (MEP). Sperm concentration and percentage motility were significantly higher in the first fraction as compared to the third fraction of split ejaculates. The average spermatozoal velocity, average speed constancy and average straight line approach were the same in all fractions. Differences in the percentage of motile spermatozoa were also found after collection of split ejaculates in culture medium. This phenomenon may have been caused by differences in sperm morphology. Significantly more normal spermatozoa were present in the first fractions of 19 split ejaculates as compared to the last fractions.

Ejaculation↗
PubMedDate not supplied

Oigarche: the age at first ejaculation.

In our study the mean age of the age at first ejaculation in Belgium is 13 yrs 2 mos, corresponding with a testicular volume of 10 ml with the orchidometer of Prader. These data are in agreement with those of Laron et al. (1980) and Richardson and Short (1978). The relationship between the age at first ejaculation and the testicular volume means that once this testicular volume (10 ml) has been reached, the question about the presence of ejaculations no longer need be posed "prematurely" (and becomes the possible cause of feelings of inferiority). The age at first ejaculation certainly can be used as an index of genital and sexual maturation in male puberty.

Adolescent↗
PubMed2006

A three-step statistical procedure to identify sperm kinematic subpopulations in canine ejaculates: changes after cryopreservation.

Strong evidences suggest that many different sperm subpopulations co-exist within the mammalian ejaculate. These subpopulations have been identified in a number of species; however, to the best of our knowledge, no data exist regarding the existence of sperm subpopulations within the canine ejaculate. Ejaculates were obtained by masturbation from four mongrels and processed using a standard freezing protocol. Motility data were analysed before and after cryopreservation using a computer assisted sperm analysis (CASA) system ISAS. On raw data, a principal component analysis (PCA) was performed to reduce the number of motility descriptors to a few informative variables, and then a K-means cluster procedure was performed and then a regression analysis to validate the clusters obtained in the second analysis. ANOVAs and chi-squared analyses were used to compare clusters and males. PCA revealed that two principal components represented more that the 88% of the variance with eigenvalues of 3.25 and 3.02, respectively. The clustering and discriminant analysis using curvilinear velocity and linear velocity as variables revealed the existence of 11 sperm subpopulations--four of them characterized by high velocities, two by medium values and five by low velocities. After freezing-thawing, nine subpopulations were found--four of high velocities, two of medium and three of low velocities. It is concluded that freezing-thawing not only impairs sperm motility but also produces changes in the sperm subpopulation structure in the canine ejaculate, that the evaluation of the sperm structure subpopulations is a better indicator of semen quality and freezeability than the use of mean values, and that two sperm motility quality indexes can be used to resume of the variables obtained from the CASA analysis.

Analysis of Variance↗
PubMed1985

Surgical correction of post-operative retrograde ejaculation.

Retrograde ejaculation is a known complication of bladder neck surgery. Revision of a bilharzial bladder neck obstruction accentuates the incidence of this complication. Some of the difficulties in the surgical correction of retrograde ejaculation are directly related to pathological changes caused by bilharziasis. In this study a new length of premontanal urethra is formed using the trigonal urothelium and the trigonal muscles with their intact sympathetic innervation to correct retrograde ejaculation following bladder neck surgery. Normal (antegrade) ejaculation was restored in four of five men using this procedure. The physiological basis of the procedure is discussed.

Adult↗
PubMed1985

Ejaculation and sexual function after endoscopic bladder neck incision.

Endoscopic incision of the bladder neck, performed to relieve outflow obstruction, was evaluated as regards effects on ejaculation and orgasm in 61 men (mean age 48 years) by analyses of seminal fluid and a questionnaire. Relief of obstruction was confirmed by post-operative normalisation of urinary flow. In 47 cases there was unchanged antegrade ejaculation, while reduced semen volume was reported by 11 men and retrograde ejaculation by only 3. The quality of orgasm and sexual satisfaction were not permanently changed by the operation. Post-operative analysis of seminal fluid was performed in 27 patients, with normal results in 26. In 16 men who provided specimens both before and after bladder neck incision, no consistent change was found in the semen. An incision completely splitting the bladder neck but not extending distal to the verumontanum will relieve outlet obstruction. Maintenance of antegrade ejaculation can be expected in most patients undergoing this operation.

Adult↗
PubMed2005

A multinational population survey of intravaginal ejaculation latency time.

INTRODUCTION: Intravaginal ejaculation latency time (IELT), defined as the time between the start of vaginal intromission and the start of intravaginal ejaculation, is increasingly used in clinical trials to assess the amount of selective serotonin reuptake inhibitor-induced ejaculation delay in men with premature ejaculation. Prospectively, stopwatch assessment of IELTs has superior accuracy compared with retrospective questionnaire and spontaneous reported latency. However, the IELT distribution in the general male population has not been previously assessed. AIM: To determine the stopwatch assessed-IELT distribution in large random male cohorts of different countries. METHODS: A total of 500 couples were recruited from five countries: the Netherlands, United Kingdom, Spain, Turkey, and the United States. Enrolled men were aged 18 years or older, had a stable heterosexual relationship for at least 6 months, with regular sexual intercourse. The surveyed population were not included or excluded by their ejaculatory status and comorbidities. This survey was performed on a "normal" general population. Sexual events and stopwatch-timed IELTs during a 4-week period were recorded, as well as circumcision status and condom use. MAIN OUTCOME MEASURES: The IELT, circumcision status, and condom use. RESULTS: The distribution of the IELT in all the five countries was positively skewed, with a median IELT of 5.4 minutes (range, 0.55-44.1 minutes). The median IELT decreased significantly with age, from 6.5 minutes in the 18-30 years group, to 4.3 minutes in the group older than 51 years (P<0.0001). The median IELT varied between countries, with the median value for Turkey being the lowest, i.e., 3.7 minutes (0.9-30.4 minutes), which was significantly different from each of the other countries. Comparison of circumcised (N=98) and not-circumcised (N=261) men in countries excluding Turkey resulted in median IELT values of 6.7 minutes (0.7-44.1 minutes) in circumcised compared with 6.0 minutes (0.5-37.4 minutes) in not-circumcised men (not significant). The median IELT value was not affected by condom use. CONCLUSION: The IELT distribution is positively skewed. The overall median value was 5.4 minutes but with differences between countries. For all five countries, median IELT values were independent of condom usage. In countries excluding Turkey, the median IELT values were independent of circumcision status.

Adolescent↗
PubMed2005

Efficacy of sildenafil citrate (Viagra) in men with premature ejaculation.

OBJECTIVES: Premature ejaculation (PE) is the most common ejaculatory dysfunction. We assessed the efficacy of sildenafil to increase the time to ejaculation, improve ejaculatory control, and decrease the postejaculatory erectile refractory time in men with PE. DESIGN AND METHODS: The main study was an 8-week, double-blind, placebo-controlled, parallel group study in men between 18 and 65 years of age with diagnosed PE. A substudy was also conducted using a subset of patients (two-way crossover, one center) before entry to the main study. The primary study measured intravaginal ejaculatory latency (IELT) and responses to the Index of Premature Ejaculation (IPE) questionnaire. The substudy measured vibrotactile stimulation ejaculatory latency time (VTS-ELT) and postejaculatory erectile refractory time. Differences between treatment groups were determined by ancova at the 5% level of significance. RESULTS: The change in IELT (1.6 +/- 6.08 vs. 0.6 +/- 2.07 minutes) and VTS-ELT (2.9 +/- 0.4 vs. 2.4 +/- 0.4 minutes) were higher after taking sildenafil, compared with placebo, but did not reach statistical significance. However, patients who took sildenafil (vs. placebo) reported significantly (P < 0.05) increased ejaculatory control (1.8 +/- 0.3 vs. 1.5 +/- 0.3), increased ejaculatory confidence (2.2 +/- 0.2 vs. 1.9 +/- 0.2), and improved overall sexual satisfaction scores (3.1 +/- 0.2 vs. 2.8 +/- 02) on the IPE, and had a decreased postejaculatory erectile refractory time (3.2 +/- 0.7 vs. 6.4 +/- 0.7 minutes). The most common adverse events for sildenafil (vs. placebo) were headache (15% vs. 1%), flushing (15% vs. 0%), dyspepsia (5% vs. 1%), abnormal vision (5% vs. 0%), and rhinitis (5% vs. 0%). CONCLUSIONS: Although IELT and VTS-ELT were not significantly improved, sildenafil increased confidence, the perception of ejaculatory control, and overall sexual satisfaction, and decreased the refractory time to achieve a second erection after ejaculation in men with PE.

Adolescent↗
PubMed2005

The burden of premature ejaculation: the patient's perspective.

Premature ejaculation (PE) remains an underdetected and under-treated condition, despite the advances in available treatment options. Men with PE often feel stigmatized by the condition and embarrassment is a key barrier to discussing the problem with healthcare professionals. Men with PE perceive themselves as having little control over ejaculation and this lack of control is mirrored in diminished satisfaction with sexual intercourse. The burden of PE is both emotional and physical. Premature ejaculation is associated with low self-esteem, anxiety, and feelings of shame and inferiority. In some studies there is an association with depression. Premature ejaculation places a significant burden on the patient-partner relationship and there is evidence to suggest that there is a higher prevalence of female sexual dysfunction associated with PE. Patients with PE often view the condition as purely psychological or as a problem that will resolve with time and many are unaware that medical treatment could be of benefit. This endorses the particularly important role of healthcare professionals in recognizing the barriers to patient diagnosis and promoting the view that PE is not only a common but also a treatable medical condition.

Coitus↗
PubMed2006

Development and validation of a new questionnaire to assess sexual satisfaction, control, and distress associated with premature ejaculation.

INTRODUCTION: No validated questionnaires to assess the subjective aspects of premature ejaculation (PE) are currently in use. Clinical trials have generally only considered time, measured by ejaculatory latency, as an indicator of efficacy, but ejaculatory control, sexual satisfaction, and distress are important aspects of PE, which impact both the patient and his partner. The objective of this study was to develop and validate a new questionnaire to measure the overall experience of PE. METHODS: The questionnaire was developed using four stages: item pool development, initial psychometric analyses, patient interviews, and final psychometric analyses. RESULTS: An item pool of 17 was generated and reduced to 10 items through the initial psychometric analyses. Patient interviews did not require addition of further items and resulted in only minor modifications to item wording for clarity. Final psychometric analyses of the 10-item measure confirmed a three-factor solution: sexual satisfaction, control, and distress. Reliability was good, both internal consistency and test-retest reliability. Convergent validity using intravaginal ejaculatory latency time was excellent: control domain (0.75), sexual satisfaction domain (0.60), and distress domain (0.68). Known-groups validity was very good, all domain mean scores being statistically significantly worse in men with PE compared with the men reporting no PE problems. CONCLUSION: The Index of Premature Ejaculation is a reliable and valid questionnaire for the assessment of control over ejaculation, satisfaction with sex life, and distress in men with PE. This tool has the potential to add value to interpretations of improvements in ejaculation latency resulting from new treatments of PE.

Adult↗
PubMed2006

Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence-based definition of premature ejaculation. Part I--validity of DSM-IV-TR.

BACKGROUND: In former days, information obtained from randomized well-controlled clinical trials and epidemiological studies on premature ejaculation (PE) was not available, thereby hampering the efforts of the consecutive DSM Work Groups on Sexual Disorders to formulate an evidence-based definition of PE. The current DSM-IV-TR definition of PE is still nonevidence based. In addition, the requirement that persistent self-perceived PE, distress, and interpersonal difficulties, in absence of a quantified ejaculation time, are necessary to establish the diagnosis remains disputable. AIM: To investigate the validity and reliability of DSM and ICD diagnosis of premature ejaculation. METHODS: The historical development of DSM and ICD classification of mental disorders is critically reviewed, and two studies using the DSM-IV-TR definition of PE is critically reanalyzed. RESULTS: Reanalysis of two studies using the DSM-IV-TR definition of PE has shown that DSM-diagnosed PE can be accompanied by long intravaginal ejaculation latency time (IELT) values. The reanalysis revealed a low positive predictive value for the DSM-IV-TR definition when used as a diagnostic test. A similar situation pertains to the American Urological Association (AUA) definition of PE, which is practically a copy of the DSM-IV-TR definition. CONCLUSION: It should be emphasized that any evidence-based definition of PE needs objectively collected patient-reported outcome (PRO) data from epidemiological studies, as well as reproducible quantifications of the IELT.

Coitus↗
PubMed2006

Premature ejaculation: on defining and quantifying a common male sexual dysfunction.

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.

Adult↗
PubMed2006

Guidelines for the diagnosis and management of premature ejaculation.

INTRODUCTION: Until recently, premature ejaculation (PE) was believed to have a psychologic etiology requiring psychosexual therapy. Recognition of a neurobiologic component to the etiology of PE has since highlighted the need for diagnostic and management guidelines for this common sexual problem. One major medical organization-the American Urological Association (AUA)--has established such guidelines. In addition, the Second International Consultation on Sexual Dysfunctions (ICSD) in 2003 developed a set of recommendations for PE, as well as for other sexual dysfunctions. AIM: To review the current guidelines for the diagnosis and treatment 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 from the AUA Guideline on the Pharmacologic Management of Premature Ejaculation and the Second ICSD. RESULTS: Both documents emphasize the importance of a sexual history in diagnosing PE, and each of these two documents recognizes that diagnosis involves a shortened intravaginal latency time as well as patient reports of poor control over ejaculation and patient distress over the condition. CONCLUSIONS: Condensed guidelines for the diagnosis and treatment of PE are presented. Once diagnosis is suspected, optimal treatment regimens should be established utilizing randomized placebo-controlled trials.

Adult↗