The patient-perceived intravaginal ejaculation latency time cut-off for lifelong premature ejaculation.

BACKGROUND: The current cutoff values of intravaginal ejaculation latency time for diagnosing lifelong premature ejaculation do not always match clinical practice, and the inconsistency in the cutoff values of intravaginal ejaculation latency time among different definitions has also posed challenges to both clinical management and research of premature ejaculation. OBJECTIVES: To re-evaluate the intravaginal ejaculation latency time and to find evidence-based cut-off values for diagnosing lifelong premature ejaculation that can be widely accepted and match clinical practice. MATERIALS AND METHODS: We addressed the flaws of previous studies. Lifelong premature ejaculation was diagnosed based on both patient self-report of premature ejaculation status and scores on the Premature Ejaculation Diagnostic Tool, with a control group consisting of non-premature ejaculation individuals included for comparison. Utilizing receiver operating characteristic curve analysis, the optimal self-estimated cutoff value for intravaginal ejaculation latency time in diagnosing lifelong premature ejaculation was determined. RESULTS: A total of 307 heterosexual participants (mean age = 30.7 ± 6.4) were included, comprising 187 lifelong premature ejaculation patients (mean age = 28.0 ± 4.6) and 120 non-premature ejaculation individuals (mean age = 35.0 ± 6.5). 2.7% of lifelong premature ejaculation patients experienced anteportal ejaculation. 59.9%, 92%, and 97.9% of lifelong premature ejaculation patients displayed intravaginal ejaculation latency times within 1, 2, and 3 min, respectively. The receiver-operating characteristic curve's area under the curve was 0.996 with a 95% confidence interval of 0.991-1.000 (p < 0.0001). The perceived intravaginal ejaculation latency time cut-off at 3.5 (sensitivity = 97.9%, specificity = 99.2%) showed the highest Youden index compared with other options. DISCUSSION: Although we found that 92.0% of lifelong premature ejaculation patients had a perceived intravaginal ejaculation latency time within 2 min, a perceived intravaginal ejaculation latency time cutoff value of less than 3.5 min for diagnosing lifelong premature ejaculation could encompass a larger proportion (97.9%) of patients seeking medical help for complaints of PE, and increasing the perceived intravaginal ejaculation latency time cutoff value to 3.5 min would not significantly increase the false-positive rate. CONCLUSION: The perceived intravaginal ejaculation latency time cutoff value for diagnosing lifelong premature ejaculation within a clinical practice context is 3.5 min.

Evaluation of efficacy and safety of Botulinum toxin-A injection at three deferent sites in treatment of premature ejaculation.

BACKGROUND: Premature ejaculation (PE) is a common sexual problem, resulting in adverse effects on the quality of life, of both the patient and the partner. The idea of muscular contraction inhibition during the ejection phase of ejaculation by Botulinum toxin-A injection may delay ejaculation. AIM OF STUDY: This study was performed to assess the efficacy and safety of Botulinum toxin-A injection in PE treatment. MATERIAL AND METHODS: This study included 45 married male patients diagnosed with primary PE. All included patients were injected with 75 units of Dysport equal efficacy of 25 units of Botulinum toxin-A (Botox) into three sites: the root of the penis (Group 1), glans penis (Group 2), and each side of the ischiocavernosus muscle (Group 3). All patients were subjected to an assessment of intravaginal ejaculation latency time (IELT) using a stopwatch and answering the Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire before and after treatment. RESULTS: There was a statistically significant improvement in IELT after treatment in all groups. The most significant improvement was shown in Group 3 (average 108% increase), followed by Group 1 (74%) and Group 2 (40%), respectively. There was a positive correlation between age and the improvement in improved IELT. There was a statistically significant improvement in PEDTq scores in Group 1 and Group 3. CONCLUSION: Botulinum toxin-A injection into the root of the penis and ischiocavernosus muscle could be recommended in the treatment of premature ejaculation.

[Primary premature ejaculation of kidney deficiency and liver stagnation treated with warm acupuncture of large-quantity moxibustion: a randomized controlled trial].

OBJECTIVE: To explore the clinical effect of warm acupuncture with large-quantity moxibustion on primary premature ejaculation (kidney deficiency and liver stagnation). METHODS: A total of 240 patients with primary premature ejaculation (kidney deficiency and liver stagnation) were randomly divided into a warm acupuncture group (80 cases, 5 cases dropped out), an acupuncture group (80 cases, 4 cases dropped out) and a western medication group (80 cases, 6 cases dropped out). In the warm acupuncture group, a large quantity of moxibustion was delivered after acupuncture at Baihui (GV 20), Qihai (CV 6), Guanyuan (CV 4) and Zhongji (CV 3), as well as bilateral Fengchi (GB 20), lateral line 3 of forehead (MS 4), neishengzhiqi (TF2), Ganshu (BL 18), Shenshu (BL 23), and etc. One treatment with warm acupuncture took 40 min, once daily; five treatments were given per week and 4 weeks of treatment was required. In the acupuncture group, moxibustion was not delivered, and the rest operation of acupuncture was same as the warm acupuncture group. In the western medication group, dapoxetine hydrochloride tablets were administered orally, 30 mg each time, taken with warm water 1 h to 3 h before sexual intercourse. Medication was administered at most once within 24 h, twice per week, and 6 times within 4 weeks. Before and after treatment, the score of TCM symptoms, the score of premature ejaculation diagnostic tool (PEDT), intravaginal ejaculation latency time (IELT) and the serum sex hormone content (testosterone [T], luteinizing hormone [LH] and follicule stimulating hormone [FSH]) were observed and the clinical effect was evaluated in the three groups. RESULTS: After treatment, the scores for less duration of intercourse (<1 min), post-ejaculation fatigue, low spirit and decreased libido, and the total scores of TCM symptoms, as well as PEDT scores were reduced when compared with those before treatment in each group (P<0.01, P<0.05), and IELT was prolonged (P<0.01) in the three groups. The serum T content was increased when compared with that before treatment in the warm acupuncture group (P<0.05). After treatment, in comparison with the acupuncture group and the western medication group, the scores for post-ejaculation fatigue, soreness and weakness in the lumbar region and knee joints, decreased libido, insomnia, dream-disturbed sleep and frequent nocturnal enuresis, as well as the total score of TCM symptoms were lower (P<0.05, P<0.01) and the serum T content was increased (P<0.05) in the warm acupuncture group. When compared with the acupuncture group, PEDT scores were lower and IELT prolonged in the warm acupuncture group and the western medication group (P<0.05, P<0.01). The total effective rate was 82.7% (62/75) in the warm acupuncture group, higher than that of the acupuncture group (68.4%, 52/76) and the western medication group (64.9%, 48/74, P<0.05) respectively. CONCLUSION: Warm acupuncture with large-quantity moxibustion ameliorates the clinical symptoms and increases intravaginal ejaculation latency time and the levels of sex hormone in the patients with primary premature ejaculation (kidney deficiency and liver stagnation).

Clinical efficacy and safety of hyaluronic acid gel injection in the glans penis for treatment of premature ejaculation: systematic review and meta-analysis.

BACKGROUND: In recent years, there has been growing interest in the use of hyaluronic acid (HA) for the treatment of premature ejaculation (PE). The efficacy of this treatment is quite controversial. AIM: This study intended to evaluate the efficacy and safety of glans penis augmentation with HA gel for PE. METHODS: This systematic review includes randomized controlled trials (RCTs), primary clinical trials, prospective and retrospective studies, case series, and case reports. Searches in Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov were performed blindly by 2 reviewers. OUTCOMES: Intravaginal ejaculation latency time (IELT), questionnaires about PE, glans circumference (millimeters), and adverse events. RESULTS: Thirteen studies were included in the evaluation: 4 RCTs, 8 prospective observational studies, and 1 restrospective study. The number of patients who received HA gel on the glans penis was 706. According to the results of 2 placebo-controlled RCTs, HA gel treatment significantly improved IELT at the end of the first month (mean difference [MD], 65.44 seconds). In the first month after the HA gel injection procedure, IELT increased vs before the procedure (MD, 176.18 [95% CI, 146.89-205.48]; P < .001, I2 = 83%). When the IELT values ​​were compared at 6 months after HA gel application, IELT improved vs before the procedure (MD, 143.93 [95% CI, 124.78-163.09]; P < .001, I2 = 82). The glans circumference expanded by approximately 1.5 cm after the procedure (MD, 14.82 mm [95% CI, 12.75-16.90]; P < .001, I2 = 65%). When the side effect profile of other studies was examined, side effects were observed in 91 patients after HA gel injection applied to 598 patients (15.22%). Among these side effects, the most common were pain (n = 46, 7.69%), bulla/nodule formation (n = 25, 4.18%), and ecchymosis (n = 20, 3.34%). CONCLUSION: While HA shows promise as a therapeutic option for PE, ongoing research is essential to elucidate its clinical utility, mechanisms of action, and comparative efficacy.

Recommendations for the diagnosis and evaluation of premature ejaculation.

OBJECTIVES: The Association Interdisciplinaire Post-Universitaire de Sexologie (AIUS) has brought together a panel of experts to draw up French recommendations for the management of premature ejaculation. This article presents the recommendations for the diagnosis and evaluation of premature ejaculation. METHODS: Systematic review of the literature between 01/1995 and 02/2022. Using the method of recommendations for clinical practice (RPC). RESULTS: We recommend using the SIAMS definition for everyday clinical practice. PE is defined as: (i) a persistent and recurrent subjective perception of loss of control (management) of the ejaculatory mechanism in the presence of appropriate erotic stimuli; (ii) subjective, PE-related distress induced in the patient and sexual dissatisfaction or PE-related anorgamy in the partner; (iii) a short intravaginal ejaculatory latency time, whether subjectively perceived by the patient and the partner or objectively measured as less than 180seconds (generally). We suggest that the same definition be applied to practices other than vaginal penetration, such as masturbation, oral or anal intercourse, as well as to non-heterosexual contexts. We suggest using information reported by the patient, possibly supplemented by assessment tests/questionnaires (IPE, PEP, PEDT). We recommend investigating the presence of other sexual dysfunctions, in particular erectile dysfunction (ED), as well as any sexual dysfunctions of partners. We recommend taking a medical and psychosexological history, and carrying out a targeted physical examination in patients complaining of PE. CONCLUSION: These recommendations should help to improve the management of PE.

The association between shift work, shift work sleep disorders and premature ejaculation in male workers.

OBJECTIVE: Shift work and Shift Work Sleep Disorder (SWSD) are known to affect the secretion of several neurotransmitters and hormones associated with premature ejaculation (PE). However, their specific influence on the regulation of male ejaculation remains unclear. This study explores the relationship between shift work, SWSD, and PE. METHODS: From April to October 2023, a cross-sectional survey was conducted across five regions of China to explore the work schedules, sleep quality, and sexual function of male workers. Participants' sleep quality was evaluated using a validated SWSD questionnaire, and their erectile function and ejaculatory control were assessed with the International Inventory of Erectile Function (IIEF-5) scores and Premature Ejaculation Diagnostic Tool (PEDT) scores, respectively. Univariate and multivariate linear regression analyses were employed to identify risk factors associated with PE. Confounders were controlled using multiple regression models, and clinical prediction models were developed to predict PE onset and assess the contribution of risk factors. RESULTS: The study included 1239 eligible participants, comprising 840 non-shift workers and 399 shift workers (148 with SWSD and 251 without SWSD). Compared to non-shift working males, those involved in shift work (ß 1.58, 95% CI 0.75 - 2.42, p < 0.001) and those suffering from SWSD (ß 2.86, 95% CI 1.86 - 3.85, p < 0.001) they had significantly higher PEDT scores. Additionally, we identified daily sleep of less than six hours, depression, anxiety, diabetes, hyperlipidemia, frequent alcohol consumption (more than twice a week), and erectile dysfunction as risk factors for PE. The predictive model for PE demonstrated commendable efficacy. CONCLUSION: Both shift work and SWSD significantly increase the risk of premature ejaculation, with the risk magnifying in tandem with the duration of shift work. This study reveals the potential impact of shift work and SWSD on PE and provides new theoretical foundations for the risk assessment and prevention of this condition.

Stigma and its associations with self-confidence and sexual relations in 4 types of premature ejaculation.

BACKGROUND: Although men with premature ejaculation (PE) always show more negative emotions, including embarrassment, guilt and worry, this may be related to the stigma of PE. To investigated stigma and its associations with self-confidence and sexual relations in 4 PE syndromes, a survey was conducted in our hospital from December 2018 to December 2019 among 350 men with self-reported PE and 252 men without self-reported PE. The stigma, self-confidence and sexual relations were assessed by the Social Impact Scale (SIS) and Self-Esteem and Relationship questionnaire (SEAR), respectively. Ejaculation control, sexual life satisfaction and distress caused by PE were evaluated by the Index of PE. RESULTS: Men with self-reported PE had higher internalized shame and social isolation scores and lower SEAR scores than control subjects. The highest score of internalized shame and social isolation and the lowest score of SEAR appeared in men with lifelong PE (LPE). After age adjustment, the positive relationships were stronger between distress about PE and internalized shame. Whereas, the stronger negative associations were found between social isolation and sexual satisfaction. The strongest association was observed between social isolation and sexual relationship. Therefore, the stigma associated with PE adversely affects the self-confidence, self-esteem, and sexual relationships of men with PE. CONCLUSION: Men with PE, especially LPE, have a high level of stigma and disharmonious sexual relations, and often lack self-confidence and self-esteem, which have a certain negative impact on their physical and mental health and life. These will be the key issues to be considered when we formulate a personalized treatment plan for PE.

RéSUMé: CONTEXTE: Bien que les hommes atteints d'éjaculation précoce (EP) montrent plus d'émotions négatives toujours, notamment de l'embarras, de la culpabilité et de l'inquiétude, cela peut être lié à la stigmatisation de l'EP. Afin d'étudier la stigmatisation et ses associations avec la confiance en soi et les relations sexuelles dans 4 syndromes d'EP, une enquête a été menée dans notre hôpital de décembre 2018 à décembre 2019 auprès de 350 hommes atteints d'EP autodéclarée et de 252 hommes sans EP autodéclarée. La stigmatisation, la confiance en soi et les relations sexuelles ont été évaluées respectivement à l'aide de l'échelle d'impact social (SIS) et du questionnaire sur l'estime de soi et les relations (SEAR). Le contrôle de l'éjaculation, la satisfaction de la vie sexuelle et la détresse causée par l'EP ont été évalués par l'indice d'EP. RéSULTATS: Les hommes ayant une EP autodéclarée avaient des scores de honte intériorisée et d'isolement social plus élevés, et des scores SEAR inférieurs, à ceux des sujets témoins. Le score le plus élevé de honte intériorisée et d'isolement social, et le score le plus bas de SEAR, sont apparus chez les hommes atteints d'EP à vie (EPL). Après ajustement sur l'âge, les relations positives étaient plus fortes entre la détresse due à l'EP et la honte intériorisée. Les associations négatives les plus fortes ont été trouvées entre l'isolement social et la satisfaction sexuelle. Par conséquent, la stigmatisation associée à l'EP affecte négativement la confiance en soi, l'estime de soi et les relations sexuelles des hommes atteints d'EP. CONCLUSION: Les hommes atteints d'EP, en particulier ceux atteints d'EPL, ont un niveau élevé de stigmatisation et de relations sexuelles disharmonieuses, et ils manquent souvent de confiance en soi et d'estime de soi; ce qui a un impact négatif certain sur leur santé physique et mentale, et sur leur vie. Ce seront les questions clés à prendre en compte lorsque nous formulerons un plan de traitement personnalisé pour l'EP.

Lower Urinary Tract Symptoms Correlate with Erectile Dysfunction and Premature Ejaculation but Not with Men's Sexual Activity: Results from a Large Population-Representative Study.

BACKGROUND: Lower urinary tract symptoms (LUTS) contribute to erectile dysfunction (ED) and premature ejaculation (PE). However, only a few studies have been conducted with representative groups of men that had well-balanced demographic characteristics. Thus, we aimed to confirm the effect of LUTS on ED and PE and to analyze the association between LUTS and men's sexual activity in a large representative cohort. In addition, we evaluated the sex-specific and overall quality of life of men who had LUTS with either ED or PE. METHODS: We used the latest census and estimated the sample size to build a group of men representative of the population. LUTS, ED, and PE were evaluated with reliable instruments. Regression models were used to analyze the data. RESULTS: All included men were representative in relation to their age and residential location (n = 3001). ED and PE were more common in men who reported LUTS compared with men who did not have LUTS (p < 0.001). Age, comorbidity, and lifestyle did not affect the negative effect of LUTS on ED or PE (regression coefficients of 0.159 and 0.528 for ED and PE, respectively, p < 0.001). However, regression models did not validate the impact of LUTS on sexual activity, defined by intercourse frequency and number of sexual partners (odds ratio of 0.981, CI 0.961-1.001, p = 0.061). Nevertheless, men with LUTS and either ED or PE had worse quality of sexual life and general quality of life compared with the remaining respondents. CONCLUSION: LUTS worsened ED and PE but had no impact on men's sexual activity. Our findings confirm the recommendations to assess for LUTS in men reporting ED or PE. CLINICAL TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (NCT05462171).

Male genital self-image, premature ejaculation, and affecting factors.

Background: Negative genital self-image is associated with sexual unresponsiveness and dysfunction. Aim: This study aims to determine the relationship between men's genital self-image and premature ejaculation, with identifying influencing factors. Methods: The research is designed as a descriptive and correlational study. The sample consists of 188 men aged 18 to 60 years who volunteered to participate in the study. Outcomes: A negative correlation was observed between genital self-image and premature ejaculation (P < .05). Results: The average age of the participating men was 39.5 ± 9.79 years (mean ± SD), with 91.5% being married. The average age of the participants' first sexual encounter was 20.43 ± 4.01 years, and 38.3% reported experiencing premature ejaculation. The mean score for the Male Genital Self-image Scale was 21.10 ± 5.59, and that for the Premature Ejaculation Diagnostic Tool was 6.96 ± 3.73. As a result of the study, it was revealed that participants who experienced premature ejaculation were not at peace with their bodies and were dissatisfied with their sexual experiences and their genital size and function, with significantly lower levels of genital self-image (P < .05). Clinical Implications: Identifying factors that affect men's genital self-image is crucial for maintaining sexual functions. Strengths and Limitations: In Turkey, sexuality is a taboo subject, often considered shameful and rarely discussed, making it challenging to find participants willing to engage in research. Conclusion: Men's genital self-image influences the characteristics of premature ejaculation.

Possible pathophysiologic roles of neurotransmitter systems in men with lifelong premature ejaculation: a scoping review.

INTRODUCTION: Lifelong premature ejaculation (LPE) is a subtype of premature ejaculation. Genetic research on LPE has primarily focused on neurotransmitters such as serotonin, dopamine, and norepinephrine, whereas LPE treatment studies have focused on drugs such as selective serotonin reuptake inhibitors. However, findings from genetic association and pharmacotherapeutic studies have been inconsistent. OBJECTIVES: To provide a quality overview of neurobiological targets that are potentially associated with LPE by investigating genetic association and pharmacotherapeutic studies. METHODS: This scoping review was conducted per the PRISMA-ScR tool (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews). Five databases were searched in March 2023 without timeline- or language-related restrictions. RESULTS: After deduplication, 3949 records were obtained for review. Following screening and full-text review with citation tracking, 52 studies were included: 18 genetic and 34 pharmacotherapy studies. Serotonergic targets, such as the serotonin transporter and pre- and postsynaptic serotonergic receptors, were most often associated with LPE in genetic and pharmacotherapeutic studies. Mixed results were found among polymorphisms within genetic studies. This mechanism is in accordance with pharmacotherapeutic studies, as the highest efficacy was found for potent serotonergic antidepressants. Successful treatment was also observed with medication acting on phosphodiesterase-5 enzyme, such as tadalafil and vardenafil. Analyses of other genetic association studies did not yield any further evidence for associated targets. CONCLUSIONS: This review is the first comprehensive scoping review on LPE. We found that serotonergic targets are most often associated with LPE, suggesting that the serotonergic pathway is a predisposing factor in LPE. Furthermore, there is some evidence for phosphodiesterase 5 inhibitors, which should be investigated. Other previously investigated neurobiological targets appear less likely to contribute to LPE. Future studies should focus on multiple targets, ideally in a genome-wide association study design.This review has been registered with the Open Science Framework (doi:10.17605/OSF.IO/JUQSD).

Topological differences of striato-thalamo-cortical circuit in functional brain network between premature ejaculation patients with and without depression.

INTRODUCTION: Premature ejaculation (PE), a common male sexual dysfunction, often accompanies by abnormal psychological factors, such as depression. Recent neuroimaging studies have revealed structural and functional brain abnormalities in PE patients. However, there is limited neurological evidence supporting the comorbidity of PE and depression. This study aimed to explore the topological changes of the functional brain networks of PE patients with depression. METHODS: Resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired from 60 PE patients (30 with depression and 30 without depression) and 29 healthy controls (HCs). Functional brain networks were constructed for all participants based on rs-fMRI data. The nodal parameters including nodal centrality and efficiency were calculated by the method of graph theory analysis and then compared between groups. In addition, the results were corrected for multiple comparisons by family-wise error (FWE) (p < .05). RESULTS: PE patients with depression had increased degree centrality and global efficiency in the right pallidum, as well as increased degree centrality in the right thalamus when compared with HCs. PE patients without depression showed increased degree centrality in the right pallidum and thalamus, as well as increased global efficiency in the right precuneus, pallidum, and thalamus when compared with HCs. PE patients with depression demonstrated decreased degree centrality in the right pallidum and thalamus, as well as decreased global efficiency in the right precuneus, pallidum, and thalamus when compared to those without depression. All the brain regions above survived the FWE correction. CONCLUSION: The results suggested that increased and decreased functional connectivity, as well as the capability of global integration of information in the brain, might be related to the occurrence of PE and the comorbidity depression in PE patients, respectively. These findings provided new insights into the understanding of the pathological mechanisms underlying PE and those with depression.

Is sexual identity associated with the risk of premature ejaculation? / Czy tozsamosc seksualna zwiazana jest z ryzykiem diagnozy wytrysku przedwczesnego?

OBJECTIVES: Some studies suggest that homosexual identity, compared to heterosexual, may be associated with a reduced risk of premature ejaculation (PE). The aim of this study was to test this relationship and to investigate possible underlaying mechanisms. METHODS: The present study drew on a database obtained from a cross-sectional online study of the sexuality of Polish heterosexual (HM; N = 1,121), gay (GM; N = 1,789) and bisexual (BM; N = 743) men. The dependent variable was the PE diagnosis based on the PEDT questionnaire. The explanatory variables were characteristics of sexual and partnership patterns, health and minority stress among GM and BM. Statistical one- and multifactor analyses were performed. RESULTS: Homosexual identity proved to be an independent negative predictor of PE diagnosis. The preference for insertive penetration activity (including vaginal), performance anxiety and financial difficulties increased the risk of PE, while the experience of insertive and receptive forms of oral and anal sex but not vaginal sex, a higher level of education, better general sexual functioning and regular physical activity reduced such risk. The predictive meaning of homosexual identity has not been present in multifactor models for group of men in relationships. CONCLUSIONS: Homosexual identity is associated with a lower risk of PE diagnosis. This may be due to the differences in sexualities of GM and HM, as well as other psychosocial factors.

The Association Between Atypical Masturbation and Male Sexual Dysfunction: A Study Based on Men in Heterosexual Relationships.

We aimed to establish the prevalence of atypical masturbation in the general population and explore the association between atypical masturbation and male sexual dysfunction in heterosexual males. Atypical masturbation refers to stimulation significantly distinct from that encountered during partnered sexual activity. We posted questionnaires that contained the abridged International Index of Erectile Function (IIEF-6) and the premature ejaculation diagnostic tool on social media in China. We collected 2743 valid questionnaires from December 9, 2020, to April 18, 2021. We found that the prevalence of atypical masturbation in the general population was 10.97%. Men with atypical masturbation had lower IIEF-6 scores and higher rates of erectile dysfunction (ED) than men with typical masturbation. The prevalence of premature ejaculation and estimated intravaginal ejaculatory latency time were not significantly different among men with different patterns of masturbation. Our study demonstrated that atypical masturbation is associated with ED, and a clinician dealing with sexual issues should inquire more fully about masturbation patterns than has been done to date.

Evaluation of information accuracy and clarity: ChatGPT responses to the most frequently asked questions about premature ejaculation.

Background: Premature ejaculation (PE) is the most prevalent sexual dysfunction in men, and like many diseases and conditions, patients use Internet sources like ChatGPT, which is a popular artificial intelligence-based language model, for queries about this andrological disorder. Aim: The objective of this research was to evaluate the quality, readability, and understanding of texts produced by ChatGPT in response to frequently requested inquiries on PE. Methods: In this study we used Google Trends to identify the most frequently searched phrases related to PE. Subsequently, the discovered keywords were methodically entered into ChatGPT, and the resulting replies were assessed for quality using the Ensuring Quality Information for Patients (EQIP) program. The produced texts were assessed for readability using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), and DISCERN metrics. Outcomes: This investigation has identified substantial concerns about the quality of texts produced by ChatGPT, highlighting severe problems with reading and understanding. Results: The mean EQIP score for the texts was determined to be 45.93 ± 4.34, while the FRES was 15.8 ± 8.73. Additionally, the FKGL score was computed to be 15.68 ± 1.67 and the DISCERN score was 38.1 ± 3.78. The comparatively low average EQIP and DISCERN scores suggest that improvements are required to increase the quality and dependability of the presented information. In addition, the FKGL scores indicate a significant degree of linguistic intricacy, requiring a level of knowledge comparable to about 14 to 15 years of formal schooling in order to understand. The texts about treatment, which are the most frequently searched items, are more difficult to understand compared to other texts about other categories. Clinical Implications: The results of this research suggest that compared to texts on other topics the PE texts produced by ChatGPT exhibit a higher degree of complexity, which exceeds the recommended reading threshold for effective health communication. Currently, ChatGPT is cannot be considered a substitute for comprehensive medical consultations. Strengths and Limitations: This study is to our knowledge the first reported research investigating the quality and comprehensibility of information generated by ChatGPT in relation to frequently requested queries about PE. The main limitation is that the investigation included only the first 25 popular keywords in English. Conclusion: ChatGPT is incapable of replacing the need for thorough medical consultations.

Updating, correcting, and calibrating the narrative about premature ejaculation.

INTRODUCTION: The narrative surrounding premature ejaculation (PE) has developed and solidified over the past 25 years. Unfortunately, portions of that narrative are outdated and do not reflect more recent conceptualizations or empirical findings regarding this disorder. OBJECTIVE: In this review we sought to identify existing narratives about PE in need of updating and to provide revised narratives based on the recent research literature. METHOD: Five PE narratives in need of revision were identified, including: the prevalence of PE, age-related differences in PE prevalence, a validated ejaculation latency (EL) for diagnosing PE, differences between lifelong and acquired PE subtypes, and the application of PE definitions beyond penile-vaginal intercourse. Extensive literature searches provided information supporting both the original narrative and the need for a revised narrative based on both consideration of more recent studies and reinterpretation of studies conducted since the establishment of the original narratives. RESULTS: For each selected topic, the prevailing narrative based on the extant literature was first presented, followed by discussion of accumulating evidence that challenges the existing narrative. Each section ends with a suggested revised PE narrative. In 2 instances, the revised narrative required significant corrections (eg, PE prevalence, validated EL for diagnosing PE); in 2 instances, it expanded on the existing narrative (eg, PE subtype differences, inclusion of partnered sexual activities beyond penile-vaginal intercourse); and in 2 other instances, it backed off prior conclusions that have since required rethinking (eg, age-related changes in PE, PE subtype differences). Finally, a brief review of the 3-pronged criteria for PE (EL, ejaculatory control, and bother/distress) is presented and discussed. CONCLUSION: This review reiterates the dynamic state of research on PE and demonstrates the need for and value of ongoing research that not only addresses new issues surrounding this dysfunction but also challenges and revises some of the existing narratives about PE.

Addressing the unspoken: sexual dysfunction in men with systemic lupus erythematosus, a call to action for rheumatologists.

INTRODUCTION: Sexual dysfunction (SD) is highly prevalent and multifactorial; nevertheless, recent research has shed light on a notable phenomenon: male patients with systemic lupus erythematosus (SLE) exhibit an elevated prevalence of sexual function disorders compared with the general population. Despite this recognition, the precise nature and extent of this association remain incompletely understood. OBJECTIVES: This comprehensive review aims to clarify the link by providing an overview of the fundamental components of normal male sexual function, delving into the pathogenesis of male SD and exploring the primary factors predisposing male SLE patients to SD. Additionally, the review offers insights into potential screening, diagnostic, and treatment strategies based on the current body of literature. METHODS: A meticulous search of relevant literature was conducted using the PubMed and Google Scholar databases. RESULTS: Studies exploring the correlation between SLE and SD in both genders have revealed a nearly 2-fold increased risk of SD among individuals with SLE compared with healthy counterparts. Moreover, these studies suggest that male SLE patients may have a higher susceptibility to SD, with reported prevalence ranging from 12% to 68%, compared with 0% to 22% in healthy individuals. Male patients with SLE are influenced by a spectrum of pathological factors, including pharmacological, psychological, and disease-related determinants, which, through their intricate interplay, elevate the likelihood of developing SD. CONCLUSION: Healthcare professionals must remain vigilant in understanding the intricacies of human sexuality and its dysfunction, particularly in males with SLE. The objective is to establish effective and potentially standardized methods for promptly diagnosing and optimally managing SD, recognizing its significant impact on the quality of life for males living with SLE. The pivotal role of rheumatologists in initiating discussions about sexual health, diagnosing SD, investigating causes, and implementing tailored strategies is underscored as crucial in addressing this multifaceted issue.

Prevalence and associated factors of premature ejaculation and erectile dysfunction in young, single men who have sex with men in Lima, Peru.

Background: While there is literature on erectile dysfunction (ED) and premature ejaculation (PE) in men, conclusive evidence regarding these sexual health issues and potential associated factors in the young, single men who have sex with men (MSM) population is lacking. Aim: The study sought to determine the prevalence and factors associated with PE and ED in young single MSM in the capital of Peru. Methods: This was an analytical cross-sectional study in MSM using an online questionnaire. The presence of ED and PE was assessed using the 5-item International Index of Erectile Function and 5-item Premature Ejaculation Diagnostic Tool questionnaires, respectively. In addition, their association with personal, physical health, and sexual behavior variables was evaluated. Prevalence ratios (PRs) were estimated through regression models. Outcomes: Premature ejaculation and Erectile dysfunction in MSM. Results: Of 315 participants, most were between 20 to 29 years of age (71.8%), 43.5% identified as homosexual, 59.1% had between 2 and 5 sexual partners, and 40.6% reported that the duration of their sexual relationship was between 1 and 12 months. The prevalence of ED was 53.3% (95% confidence interval [CI], 47.66%-58.95%), and PE was present in 8.3% (95% CI, 5.46%-11.86%). Factors associated with a higher prevalence of ED were having between 6 and 9 sexual partners (PR, 1.48; 95% CI, 1.05-2.11) and having a sexual relationship lasting 13 to 24 months (PR, 0.70; 95% CI, 0.50-0.98). Furthermore, for each additional year from the onset of the first sexual encounter with another man, the prevalence of PE increased by 7% (PR, 1.07; 95% CI, 1.02-1.13). Clinical Implications: These findings suggest that there is a relationship between an increased number of sexual partners and a higher prevalence of ED. It also suggests that relationships that last for some time may have a protective effect against ED. Strengths and Limitations: Strengths include the use of validated instruments, adequate sample size, robust multivariate analysis, and being one of the few studies in Latin America assessing PE and ED in the MSM population. Limitations include the cross-sectional design, nonprobability sampling, and access to participants. Conclusion: Having more sexual partners is associated with increased ED, while relationships lasting 13 to 24 months are associated with decreased ED. Each additional year from the onset of the first sexual relationship increases the prevalence of PE. These findings can guide the design of health policies and programs tailored to the MSM community to enhance their well-being and sexual quality of life.

High-intensity interval training (HIIT) and slow breathing interventions alleviate premature ejaculation (PE) symptoms.

Background: Physical exercise may alleviate premature ejaculation symptoms, a prevalent male sexual dysfunction linked to a series of negative outcomes for men and their partners. Objective: We investigated the effectiveness of high-intensity interval training (HIIT) and slow breathing interventions on premature ejaculation symptoms and their relation to autonomic activity and attention regulation. Method: Chinese adult men (N = 76, M = 21.89, SD = 3.32) with premature ejaculation completed one of the two-week interventions in their homes or as participants in a normal breathing control group; they reported their age, height, weight, physical activity level, premature ejaculation symptoms, and attention regulation. In the HIIT group, 26 participants engaged in a 7-minute HIIT each day. In the slow breathing group, 25 participants performed 7-minute slow breathing exercises per day while the 25 participants in the normal breathing group similarly performed normal breathing exercises. All participants measured their heart rate once before and five times (with one-minute intervals) after the intervention. When participants had penile-vaginal sex with their partners, they measured their heart rate once after ejaculation. Results: Time × Intervention interaction was significant with lower levels of premature ejaculation symptoms on Days 12, 13, and 14 in the HIIT group (M ± SD = 16.19 ± 3.45, 15.96 ± 3.43, and 15.15 ± 3.62) compared to the normal breathing group (M ± SD = 17.68 ± 3.06, 17.68 ± 3.15, and 17.44 ± 3.25). Higher levels of attention regulation were associated with fewer premature ejaculation symptoms. We also found that a larger increase in heart rate from resting to after sex was associated with fewer premature ejaculation symptoms. Conclusion: Compared to the control group, the efficacy of two weeks of HIIT exercise in mitigating PE symptoms suggests its potential as a novel treatment for PE.

Repeated sexual intercourse as a coping strategy for men with premature ejaculation.

BACKGROUND: Patients with premature ejaculation (PE) are often concerned and distressed about their sexual performance. Hence, they may be more willing to exploit their refractory period to employ sexual coping strategies in order to improve their unsatisfactory sexual intercourse compared with patients without PE. AIM: The study sought to verify the sexual coping strategies of patients with PE in the daily sexual activities. METHODS: We included both patients with PE and individuals without PE and analyzed their sexual behaviors and attitudes by means of detailed interviews and questionnaires. OUTCOMES: The main outcomes were perceived intravaginal ejaculatory latency time recording, Premature Ejaculation Diagnostic Tool score, and sexual frequency, attitudes, and behavior log. RESULTS: A total of 182 young patients with PE (age 31.2 ± 6.2 years) and 92 individuals without PE (age 30.7 ± 5.1 years) were included in the study. A total of 53.3% of patients with PE vs 17.4% of individuals without PE reported engaging in multiple sexual intercourse sessions within a single day in the past 4 weeks. PE patients who engaged in multiple intercourse sessions displayed better performance during the second attempt but performed poorly compared with individuals without PE. Scores for the first attempt in PE vs second attempt in individuals with PE vs without PE were the following: intravaginal ejaculatory latency time, 2.4 ± 1.6 vs 4.8 ± 5.7 vs 9.9 ± 9.4 (P < .001); Premature Ejaculation Diagnostic Tool, 14.9 ± 3.1 vs 12.7 ± 4.8 vs 5.2 ± 2.5 (P < .001); satisfaction, 2.9 ± 1.0 vs 3.1 ± 0.8 vs 3.7 ± 1.4 (P < .001). A total of 57.1% of patients held a negative attitude toward precoital masturbation, for reasons such as a reduced sexual desire (21.2%), the belief that masturbation is harmful (17.6%), concerns about erectile function (15.7%), fatigue (9.8%), and other mixed reasons (35.3%). CLINICAL IMPLICATIONS: Engaging in multiple intercourse sessions within a day is more common among the young PE population, and using precoital masturbation as a coping strategy is not universally applicable among patients with PE. STRENGTHS AND LIMITATIONS: This is the first study to explore symptom-coping strategies in patients with PE compared with individuals without PE. However, the conclusions cannot be generalized to the entire male population. CONCLUSION: Patients with PE, compared with individuals without PE, are more inclined to engage in multiple sexual intercourse sessions within a single sexual session, likely in an attempt to compensate for their first unsatisfactory sexual encounter. Moreover, the majority of patients with PE here studied hold a negative attitude toward using precoital masturbation as a coping strategy for symptoms.