Evaluation of the quality of life of patients with premature ejaculation (lifelong and acquired).

OBJECTIVE: The aim of this study was to evaluate the quality of life of patients with lifelong and acquired premature ejaculation and to examine its relationship with depression and anxiety. METHODS: Between February 2017 and January 2018, a total of 175 patients with premature ejaculation and 132 control men who applied to the urology department of the training and research hospital with the complaint of Premature Ejaculation were included. Patients were divided into three groups according to International Society for Sexual Medicine (ISSM) criteria as follows: Group 1, lifelong premature ejaculation; Group 2, acquired premature ejaculation, and Group 3, control group without premature ejaculation. A detailed medical history of patients was obtained and physical examinations were performed. Intravaginal ejaculation latency time (IELT) was recorded and patients were administered International Erectile Function Index-5 (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT), Sexual Health Inventory for Men (SHIM), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI)-1 and STAI-2, and Short Form-36 (SF-36). RESULTS: The mean mental component score (MCS) of the SF-36 was 51.65±6.57 in the lifelong premature ejaculation group, 49.33±8.65 in the acquired premature ejaculation group, and 61.12±11.09 in the control group (p<0.0001). The mean physical component score (PCS) was 50.99±7.43 in the lifelong premature ejaculation group, 48.32±11.58 in the acquired premature ejaculation group, and 55.17±8.10 in the control group (p<0.0001). Quality of life of premature ejaculation patients as assessed by SF-36 was lower in the subscales of physical functioning, general health perception, vitality, and role limitations due to emotional functioning, compared to the control group. CONCLUSIONS: Lifelong and acquired premature ejaculation patients deteriorate their quality of life: the deterioration in these patients' quality of life also negatively affects their depression and anxiety states.

Impact of infertility duration on male sexual function and mental health.

PURPOSE: This study aimed to explore whether infertility duration has an impact on the sexual function and mental health of men from infertile couples. METHODS: We conducted a case-control study of 558 men from infertile couples, and the participants were divided into four groups based on their infertility duration: group I: ≤ 2 years; group II: 2-5 years; group III: 5-8 years; and group IV: > 8 years. Sexual function and mental disorders were measured using the International Index of Erectile Function-15 (IIEF-15), Premature Ejaculation Diagnostic Tool (PEDT), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire (PHQ-9) separately. RESULTS: As the years of infertility duration increase, the total IIEF-15 score and four domains (sexual desire, orgasmic function, erectile function, and intercourse satisfaction) significantly decrease (p < 0.05). The PEDT score gradually increases significantly (p < 0.05). Increased infertility duration is an independent risk factor for erectile dysfunction and premature ejaculation (p < 0.05). However, increased infertility duration is not a risk factor for depression and anxiety (p > 0.05). CONCLUSIONS: Our study is the first time to use the infertility duration as an independent variable and group this variable to analyze its impact on the sexual function and mental health of men from infertile couples comprehensively and systematically. The increased infertility duration is an independent risk factor for the occurrence of sexual dysfunction but not for mental disorders. In the process of infertility treatment, sexual health and mental health cannot be ignored, especially for patients with prolonged infertility.

Nomogram for stratifying patients with lifelong premature ejaculation before using the PHQ-9: An observational study.

OBJECTIVE: A PHQ-9 score ≥ 15, represented as PHQ-9+ , indicates major depressive disorder (MDD). On using PHQ-9, the psychological burden of several patients with lifelong premature ejaculation (LPE) gets aggravated, which may lead to LPE development. We aim to construct a nomogram for predicting the individual risk of PHQ-9+ in patients with LPE and discerning those with low risks, who should avoid the PHQ-9. METHODS: The nomogram was constructed by analysing data of 802 patients from Xijing Hospital and Northwest Women's & Children's Hospital. The LASSO and multivariable logistic regressions were used to identify independent predictors of PHQ-9+ , used for developing the nomogram. The discrimination, calibration and clinical usefulness of the nomogram were assessed in the derivation cohort and an independent validation cohort, which was composed of 505 prospectively enrolled patients from Daxing Hospital and Xijing Hospital. RESULTS: The duration of PE, IELT, a history of PE exacerbation, IIEF-5 score, urinary frequency and physical pain score were identified as independent predictors. The nomogram showed excellent calibration, discrimination and clinical usefulness in the derivation and validation cohorts, with a predictive accuracy of 0.781 and 0.763, respectively. Based on this nomogram, patients were divided into not recommended, recommended and strongly recommended PHQ-9 filling groups, with PHQ-9+ rates of 3.5%, 9.3% and 30.7%, respectively. CONCLUSION: A nomogram to discern LPE patients with low risks of PHQ-9+ was established. This tool can increase the positivity of MDD screening and may improve the therapeutic outcomes of those in the low-risk group.

Effects of HPV Positivity in Women on Couples Sexual Behavior.

We aimed to analyze the effect of HPV positivity in women, on women's psychology, sexual health, and male sexuality. Participants in the study were sexually active patients with high-risk HPV positivity and without any cancerous and precancerous lesions in the pathological examination. Participants and their partners' sexual health were evaluated with the FSFI questionnaire and the International Index of Erectile Function (IIEF) Score. The Beck anxiety inventory (BAI) form was used to determine participants' anxiety status. The presence of premature ejaculation was analyzed using the premature ejaculation diagnosis tool (PEDT) form. Comparison of FSFI scores at the time of diagnosis and one month later revealed a significant decrease (18.1 vs 15.1, p = 0.001). Partners' IEFF score decreased from 27.7 at diagnosis to 25.5(p = 0.001). The mean BAI score rose from 13.9 at diagnosis to 25.5 one month later (p = 0.001). Participants' partners had a significantly worse PEDT score one month after diagnosis (6.0 vs 10.8, p = 0.001). The present study demonstrated a significant deterioration in female psychological and sexual health caused by HPV positivity. Moreover, after their partner's diagnosis with HPV positivity, men were significantly more likely to suffer from erectile dysfunction and premature ejaculation.

Disorders of Ejaculation: An AUA/SMSNA Guideline.

PURPOSE: Men who ejaculate before or shortly after penetration, without a sense of control, and who experience distress related to this condition may be diagnosed with premature ejaculation (PE), while men who experience difficulty achieving sexual climax may be diagnosed with delayed ejaculation (DE). The experience of many clinicians suggest that these problems are not rare and can be a source of considerable embarrassment and dissatisfaction for patients. The role of the clinician in managing PE and DE is to conduct appropriate investigation, to provide education, and to offer available treatments that are rational and based on sound scientific data. MATERIALS AND METHODS: The systematic review utilized to inform this guideline was conducted by a methodology team at the Pacific Northwest Evidence-based Practice Center. A research librarian conducted searches in Ovid MEDLINE (1946 to March 1, 2019), the Cochrane Central Register of Controlled Trials (through January 2019) and the Cochrane Database of Systematic Reviews (through March 1, 2019). An update search was conducted on September 5, 2019. Database searches resulted in 1,851 potentially relevant articles. After dual review of abstracts and titles, 223 systematic reviews and individual studies were selected for full-text dual review, and 8 systematic reviews and 59 individual studies were determined to meet inclusion criteria and were included in the review. RESULTS: Several psychological health, behavioral, and pharmacotherapy options exist for both PE and DE; however, none of these pharmacotherapy options have achieved approval from the United States Food and Drug Administration and their use in the treatment of PE and DE is considered off-label. CONCLUSION: Disturbances of the timing of ejaculation can pose a substantial impediment to sexual enjoyment for men and their partners. The Panel recommends shared decision-making as fundamental in the management of disorders of ejaculation; involvement of sexual partner(s) in decision making, when possible, may allow for optimization of outcomes.

Efficacy of Sphincter Control Training and medical device in the treatment of premature ejaculation: A multicenter randomized controlled clinical trial.

A new line of treatment for premature ejaculation (PE) based on the use of masturbation aid device in combination with behavioral techniques has emerged in recent years. We report a multicenter randomized clinical trial with a parallel group design to determine the effectiveness of an electronic device called Myhixel I© in the treatment of PE. Forty patients who met the criteria for the diagnosis of lifelong PE, were assigned to two treatment groups completed the Sphincter control training (SCT) program in eight weeks. The only difference between groups was the use of the device. The main measure was the "fold increase" (FI) of the intravaginal ejaculatory latency time (IELT). The geometric means of IELT show, at the end of the treatment at week 8, a superiority of the device group. The mean FI 4.27 (SD 2.59) at the end of treatment for the device group was clearly higher than obtained in the previous clinical trial, in which a specific medical device was not used. No side effects were observed and it required little therapeutic input and no partner involvement. The SCT program in combination with the Myhixel I© is an effective treatment for PE.

Nueva terapia conductual en el tratamiento de la eyaculación precoz adquirida: un estudio comparativo de escuchar música / New behavioral therapy in the treatment of acquired premature ejaculation: a comparative study of listening to music

Objetivos: La eyaculación precoz (EP) es una de las causas más frecuentes de disfunción sexual en los hombres. El objetivo de este estudio es investigar si la musicoterapia es eficaz en el tratamiento de la EP adquirida y comparar el tiempo de latencia de la eyaculación intravaginal (IELT), la herramienta de diagnóstico de la eyaculación precoz (PEDT) y las puntuaciones de ansiedad de pacientes con síntomas deEP adquirida que se sometieron a musicoterapia a pacientes que fueron tratados con 30 mg de dapoxetina.Materiales y métodos: Los criterios de inclusión del estudio fueron los siguientes: rango de edad de 20 a 35 años, casado, tiene relaciones sexuales regulares, no fuma y no tiene comorbilidades conocidas. Todos losparticipantes del estudio fueron diagnosticados con EP adquirida según los criterios de la Sociedad Internacional de Medicina Sexual. El grupo experimental (grupo 1) incluyó a 60 pacientes a los que se les pidió que escucharan música relajante y meditaran durante 45 minutos antes de la relación sexual mientras continuaban con su rutina diaria. Este grupo se seleccionó deforma aleatoria y prospectiva entre individuos jóvenes sanos. Mientras tanto, el grupo de control (grupo 2) incluyó a 60 pacientes que fueron tratados con 30 mg de dapoxetina para EP y cuyos datos fueron recolectados del archivo del hospital. Los pacientes fueron evaluados antes del tratamiento y reevaluados (PEDT, IELT, nivel de ansiedad) después de 60 días. Se utilizó el Inventario de Ansiedad Estado-Rasgo para evaluar el estado y el rasgo de ansiedad. Resultados: En ambos grupos, se observó una diferencia significativa (p<0,001) en las puntuaciones deIELT, PEDT y ansiedad antes y después del tratamiento. Aunque el grupo 2 mostró una mejora en las puntuaciones de IELT y PEDT, no hubo diferencias significativas entre los dos grupos.(AU)

Objectives: Premature ejaculation (PE) is one of the most frequently seen causes of sexual dysfunction in males. The aim of this study is to investigate whether the music therapy is effective in the treatment of acquired PE and compare the intravaginal ejaculation latency time (IELT), premature ejaculation diagnostic tool (PEDT), and anxiety scores of patients with acquired PE symptoms that underwent music therapy to patients that were treated with 30 mg dapoxetine. Materials and Methods: The study’s inclusion criteria was as following: age range from 20-35, married,has regular sexual intercourse, non-smokers, and has no known comorbidities. All participants of the study were diagnosed with acquired PE based on the International Society for Sexual Medicine criteria. Experimental group (group 1) included 60 patients that were asked to listen to relaxing music and meditate for 45 minutes before the sexual intercourse while continuing their daily routine. This group was selected randomly and prospectively from young healthy individuals. Meanwhile, control group (group 2) included 60 patients who were treated with 30 mg dapoxetine for PE and whose datas were collected from the hospital archive. The patients were evaluated before treatment and re-evaluated (PEDT, IELT, anxiety level) after 60 days. State-Trait Anxiety Inventory was used to assess state and trait anxiety. Results: In both groups, a significant difference (p<0.001) was observed in pre and post-treatment IELT, PEDT, and anxiety scores. Although group 2 showed better improvement in both IELT and PEDT scores, there was no significant difference between two groups. Conclusions: Listening to music and other similar anxiety decreasing methods can be a part of treatment plan for PE.(AU)

Selective serotonin re-uptake inhibitors for premature ejaculation in adult men.

BACKGROUND: Premature ejaculation (PE) is a common problem among men that occurs when ejaculation happens sooner than a man or his partner would like during sex; it may cause unhappiness and relationship problems. Selective serotonin re-uptake inhibitors (SSRIs), which are most commonly used as antidepressants are being used to treat this condition. OBJECTIVES: To assess the effects of SSRIs in the treatment of PE in adult men. SEARCH METHODS: We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, CINAHL), clinical trial registries, conference proceedings, and other sources of grey literature, up to 1 May 2020. We applied no restrictions on publication language or status. SELECTION CRITERIA: We included only randomized controlled clinical trials (parallel group and cross-over trials) in which men with PE  were administered SSRIs or placebo. We also considered 'no treatment' to be an eligible comparator but did not find any relevant studies. DATA COLLECTION AND ANALYSIS: Two review authors independently classified and abstracted data from the included studies. Primary outcomes were participant-perceived change with treatment, satisfaction with intercourse and study withdrawal due to adverse events. Secondary outcomes included self-perceived control over ejaculation, participant distress about PE, adverse events and intravaginal ejaculatory latency time (IELT). We performed statistical analyses using a random-effects model. We rated the certainty of evidence according to GRADE. MAIN RESULTS: We identified 31 studies in which 8254 participants were randomized to receiving either SSRIs or placebo. Primary outcomes: SSRI treatment probably improves self-perceived PE symptoms (defined as a rating of 'better' or 'much better') compared to placebo (risk ratio (RR) 1.92, 95% confidence interval (CI) 1.66 to 2.23; moderate-certainty evidence). Based on 220 participants per 1000 reporting improvement with placebo, this corresponds to 202 more men per 1000 (95% CI 145 more to 270 more) with improved symptoms with SSRIs.  SSRI treatment probably improves satisfaction with intercourse compared to placebo (defined as a rating of 'good' or 'very good'; RR 1.63, 95% CI 1.42 to 1.87; moderate-certainty evidence). Based on 278 participants per 1000 reporting improved satisfaction with placebo, this corresponds to 175 more (117 more to 242 more) per 1000 men with greater satisfaction with intercourse with SSRIs. SSRI treatment may increase treatment cessations due to adverse events compared to placebo (RR 3.80, 95% CI 2.61 to 5.51; low-certainty evidence). Based 11 study withdrawals per 1000 participants with placebo, this corresponds to 30 more men per 1000 (95% CI 17 more to 49 more) ceasing treatment due to adverse events with SSRIs.  Secondary outcomes: SSRI treatment likely improve participants' self-perceived control over ejaculation (defined as rating of 'good' or 'very good') compared to placebo (RR 2.29, 95% CI 1.72 to 3.05; moderate-certainty evidence). Assuming 132 per 1000 participants perceived at least good control, this corresponds to 170 more (95 more to 270 more) reporting at least good control with SSRIs.  SSRI probably lessens distress (defined as rating of 'a little bit' or 'not at all') about PE (RR 1.54, 95% CI 1.26 to 1.88; moderate-certainty evidence). Based on 353 per 1000 participants reporting low levels of distress, this corresponds to 191 more men (92 more to 311 more) per 1000 reporting low levels of distress with SSRIs.  SSRI treatment probably increases adverse events compared to placebo (RR 1.71, 95% CI 1.48 to 1.99; moderate-certainty evidence). Based on 243 adverse events per 1000 among men receiving placebo, this corresponds to 173 more (117 more to 241 more) men having an adverse event with SSRIs.  SSRI treatment may increase IELT compared to placebo (mean difference (MD) 3.09 minutes longer, 95% CI 1.94 longer to 4.25 longer; low-certainty evidence). AUTHORS' CONCLUSIONS: SSRI treatment for PE appears to substantially improve a number of outcomes of direct patient importance such as symptom improvement, satisfaction with intercourse and perceived control over ejaculation when compared to placebo. Undesirable effects are a small increase in treatment withdrawals due to adverse events as well as substantially increased adverse event rates. Issues affecting the certainty of evidence of outcomes were study limitations and imprecision.

Redefining a sexual medicine paradigm: subclinical premature ejaculation as a new taxonomic entity.

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.

Management of premature ejaculation: a clinical guideline from the Italian Society of Andrology and Sexual Medicine (SIAMS).

Premature ejaculation (PE) is the most prevalent male sexual dysfunction, and the most recently defined. PE is often mistakenly considered a purely psychosexological symptom by patients: the lacking awareness in regards to the pathophysiology and treatments often lead to resignation from the patients' side, making PE the most underdiagnosed sexual complaint. However, an ever-growing body of evidence supporting several organic factors has been developed in the last decades and several definitions have been suggested to encompass all defining features of PE. In the present document by the Italian Society of Andrology and Sexual Medicine (SIAMS), we propose 33 recommendations concerning the definition, pathophysiology, treatment and management of PE aimed to improve patient care. These evidence-based clinical guidelines provide the necessary up-to-date guidance in the context of PE secondary to organic and psychosexological conditions, such as prostate inflammation, endocrine disorders, and other sexual dysfunctions, and suggest how to associate pharmacotherapies and cognitive-behavioral therapy in a couple-centered approach. New therapeutic options, as well as combination and off-label treatments, are also described.

Psychosocial stress, somatoform dissociative symptoms and free testosterone in premature ejaculation.

One of the most common sexual dysfunctional diseases in adult males is premature ejaculation. So far, there is no evidence of how premature ejaculation is associated with psychosocial stress. We tested the relationship between neuroendocrine changes in patients with premature ejaculation and indicators of stress experience as a new psychosomatic hypothesis where psychosocial stress may significantly contribute to the aetiology of premature ejaculation. A total of 55 patients with premature ejaculation were included in the study. The control group consisted of 55 healthy men. The diagnosis of premature ejaculation was confirmed by a sexology examination, a history of patients and the values of the premature ejaculation diagnostic tool questionnaire. Comprehensive biochemical serum analysis was focused on the values of total testosterone, free testosterone, luteinising hormone, thyroid-stimulating hormone, dehydroepiandrosterone sulphate, sex hormone-binding globulin and a premature ejaculation diagnostic tool score with trauma symptom checklist and somatoform dissociation questionnaire. The results show significant Spearman correlations of trauma symptom checklist with the premature ejaculation diagnostic tool score (R = 0.84) and free testosterone (R = 0.62) and somatoform dissociation questionnaire with the premature ejaculation diagnostic tool score (R = 0.53) and free testosterone (R = 0.57). Spearman correlations of trauma symptom checklist with somatoform dissociation questionnaire show significant correlation (R = 0.54).

Do women's Relationship Satisfaction and Sexual Functioning Vary as a Function of Their Male Partners' Premature Ejaculation Symptoms?

The present study investigated how women's sexual functioning and relationship satisfaction are associated with their partner's premature ejaculation (PE) symptoms, and whether prevalence rates of PE differ when women report on their male partners compared to male self-report. The sample comprised of responses from 1,779 Finnish women (mean age 33.3 years) and a control group of 1,024 Finnish men. Women who reported that their male partners had symptoms of PE were less satisfied with their relationships, and reported lower levels of arousal, orgasm, satisfaction, lubrication, and pain, but not desire. Effect sizes of these associations were small. Men and women report similar base rates of PE, suggesting that on a population level prevalence estimates are remarkably similar irrespective of whether men report on PE symptoms themselves, or women report on their partners.

Oral dapoxetine versus topical lidocaine as on-demand treatment for lifelong premature ejaculation: A randomised controlled trial.

This trial aimed to assess the efficacy of on-demand oral dapoxetine versus topical lidocaine treatments for lifelong PE. Cases with lifelong PE were randomised to start treatment by oral dapoxetine 60 mg or topical lidocaine 10% spray. The intravaginal ejaculatory latency time (ILET), validated Arabic Index for PE (AIPE), Sexual Health Inventory for Men (SHIM) and frequency of intercourse/week were recorded at the baseline and after 12 weeks treatment period of the first medication before two weeks washout period and then crossing over to the other one for another 12 weeks. Results showed that both medications significantly increased both IELT and AIPE scores compared with the baseline being significantly better with topical lidocaine (63.44 s, 179.4 s versus 21.87 s, p < .05). Significant decrease of SHIM score was recorded with lidocaine but not with dapoxetine. Global Efficacy Question for the patient's assessment of the effectiveness of drugs showed that lidocaine was described as being effective by 43 cases and ineffective by 12 cases, oral dapoxetine was described as being effective by 16 cases and ineffective by 39 cases. From these accumulated data, it is concluded that topical lidocaine is more effective on-demand therapy for lifelong PE compared with oral dapoxetine.

Evaluation of sexual dysfunction prevalence in infertile men with non-obstructive azoospermia.

OBJECTIVES: To determine the prevalence of sexual dysfunction in male partners of infertile couples and evaluate the effect of childlessness on erectile dysfunction (ED) and sexual relationship stress. MATERIALS AND METHODS: We collected datas of couples who attended our clinics for infertility between 2009 and 2016. Erectile dysfunction was investigated with the Questionnaires of International Index of Erectile Function-15 (IIEF-15) whereas premature ejaculation (PE) status with the Premature Ejaculation Diagnostic Tool (PEDT). The stress status of the childlessness in terms of sexual intercourse was scored by the Visual analogue scale (VAS) questionnaire. These scores were measured before and after a successful assisted reproductive treatment with the birth of the child. RESULTS: The median age of the 193 male patients was 31 years (range 23-48). Erectile dysfunction was found in 68 (35.2%) and PE in 42 (21.7%) subjects. One hundred and forty-one couples were treated with assisted reproductive treatments. Forty eight couples had successful pregnancy. The IIEF-15 test was repeated after the birth of the child to the male partners of these couples. We observed that the IIEF-15 scores increased from 16 to 21 (p = 0.014). However there were no significant improvement on their ejaculation status (p > 0.05). The mean VAS scores of male partners was 5.2 (3-10) in the treatment period while it decreased to 4.1 (0-8) after the birth of the chils (p = 0.02). Statistically analysis showed a correlation between VAS and infertility as did IIEF-15. CONCLUSIONS: We observed that having children has a reducing effect on sexual relationship stress. Infertility is absolutely blamed on the women and men. This condition may have negative effects on male sexual performance and it is closely related with some emerging female sexual disorders. It should be taken into consideration that infertile couples may have sexual dysfunction.

Exploring the Role of Sexual Avoidance in Male Sexual Dysfunction.

Theoretical models of male sexual dysfunction highlight the role of sexual avoidance as a maintaining factor. However, little empirical research has directly tested the role of sexual avoidance in samples of men with sexual problems. The goals of the current study were to A) assess the association between sexual avoidance, sexual function, and subjective sexual well-being, and B) explore possible predictors of sexual avoidance, including insecure attachment, activation of negative sexual schemas, and trait experiential avoidance. One hundred and fifty eight men with self-identified impairments in sexual function (low desire, erectile function, and/or premature/delayed ejaculation) completed validated self-report measures in a secure online survey. Sexual avoidance was uniquely predicted by most aspects of sexual function, and was correlated with poorer subjective sexual well-being. Higher levels of attachment avoidance and activation of negative schemas uniquely predicted more frequent sexual avoidance. Alternatively, interaction models suggested that impaired erectile function was less likely to be associated with sexual avoidance for those with high levels of attachment anxiety and for those with high levels of trait experiential avoidance. Theoretical and practical implications are discussed.

Effect of psychiatric symptoms and male sexual function of couples on the success of treatment for vaginismus.

Background This study evaluated psychiatric factors and sexual functions of women with vaginismus and their partners during the treatment process. METHODS: The study was performed on 110 women diagnosed with vaginismus and their partners. The women underwent cognitive behavioural therapy (CBT), and couples were divided into two groups: successful and unsuccessful therapy. Sexual function in couples was evaluated using the Golombok Rust Index of Sexual Satisfaction (GRISS) in men and the Female Sexual Function Index in women. The psychopathological symptoms of participants were evaluated using the Symptom Check List-90-Revised (SCL-90-R). RESULTS: Of the 110 women in this study, 98 completed CBT and treatment was successful for 59 (60.2%). GRISS scores pertaining to the subscales of infrequency (66.7% and 39.0%), non-communication (56.4% and 22.0%), avoidance (76.9% and 52.5%), impotence (56.4% and 33.9%) and premature ejaculation (64.1% and 32.2%) before treatment were significantly lower in the successful than unsuccessful treatment group (P < 0.05). Furthermore, there was a positive correlation between complaints of impotence and premature ejaculation in men and symptoms of depression and anxiety in men. In the successful treatment group, pretreatment values were lower for the SCL-90-R subscales of anxiety and depression in men and anxiety, depression, phobic anxiety and obsessive compulsiveness in women than in the unsuccessful treatment group. CONCLUSIONS: The psychiatric symptoms and sexual functions of couples were found to affect the success of treatment for vaginismus. As such, treatments should be administered in accordance with other symptoms present in couples.

Vibrator-Assisted Start-Stop Exercises Improve Premature Ejaculation Symptoms: A Randomized Controlled Trial.

Premature ejaculation (PE) is associated with decreased quality of life, lower confidence and self-esteem, and higher levels of depression, anxiety, and interpersonal difficulties. Here we investigated the effectiveness of vibrator-assisted start-stop exercises for treatment of PE, and whether the treatment effect could be enhanced by an additional psychobehavioral intervention. Fifty participants with a mean age of 41.7 years were included and randomized into two treatment groups and a waiting list control group. Participants were instructed to perform start-stop exercises while stimulating the penis with a purpose-made vibrator, 3 times a week for 6 weeks. Additionally, participants in one of the treatment groups received additional psychoeducation and performed mindfulness meditation-based body scan exercises three times a week. Data were gathered through online questionnaires before and after treatment, as well as 3 and 6 months after treatment. The interventions reduced PE symptoms with large effect sizes (partial η2 = .20 across the three groups, d [95% CI] = 1.05 [.27, 1.82] and 1.07 [.32, 1.82] for treatment groups compared to waiting list control group). The additional psychobehavioral intervention did not further reduce PE symptoms, but did decrease PE-associated negative symptoms such as levels of sexual distress, anxiety, and depression. No side effects were reported. Vibrator-assisted start-stop exercises can be offered as an adequate treatment option for PE.

Compliance With Fluoxetine Use in Men With Primary Premature Ejaculation.

BACKGROUND: Premature ejaculation (PE) is a common sexual dysfunction for which selective serotonin reuptake inhibitors (SSRIs) have been used effectively for treatment. However, compliance with therapy and predictors of long-term SSRI use in the treatment of PE are not well known. AIM: To analyze our experience with drop-out rates with fluoxetine in the primary PE population and to identify predictors of continued use of this agent. METHODS: Men with primary PE constituted who used fluoxetine and had at least 12 months follow-up constituted the study population. Subjects underwent a comprehensive interview to ascertain self-reported (non-stopwatch) intravaginal ejaculatory latency time (IELT), self-rated control over ejaculation, and personal and patient-reported partner distress due to PE. Patients were treated with fluoxetine 20 mg daily, with the possibility of dose titration up or down based on efficacy and side effects. OUTCOMES: The PE parameters of interest included self-reported IELT, self-rated control over ejaculation, personal and partner distress due to PE, and medication adherence. RESULTS: 130 men were included in the study. Dropout rates at 6 and 12 months were 56% and 72%. Self-rated "poor" ejaculatory control decreased from 98%-41% (P < .01), high personal distress from 47%-11% (P < .01), and high partner distress rates from 72%-27% (P < .01). Predictors of continued use at 12 months included high partner distress, being unpartnered, and having a post-treatment IELT ≥5 minutes (P < .01). Overall side effects included headache (5%), dizziness (4%), nausea (5%), nervousness (5%), and sleepiness (8%); however, moderate to severe side effects reported included nausea (2%), sleepiness (2%), headache (2%), and dizziness (2%). CLINICAL IMPLICATIONS: Compliance with SSRIs is a well-described problem in the depression literature, but data are sparse regarding continued use of SSRIs in the treatment of PE. STRENGTHS AND LIMITATIONS: We report on 12-month compliance with SSRIs for the treatment of PE. Our early compliance rates were more encouraging than what has been reported in the past. However, IELT was self-reported and not measured objectively, and we did not use validated patient-reported outcomes but rather self-reported ejaculatory control and distress levels, which have limitations. CONCLUSIONS: Fluoxetine is an effective agent for the treatment of PE with significant improvement realized in IELT, ejaculatory control, and distress levels for both men and their partners. Despite its efficacy, continued use of fluoxetine beyond 6 months is poor. Jenkins LC, Gonzalez J, Tal R, et al. Compliance with Fluoxetine Use in Men with Primary Premature Ejaculation. J Sex Med 2020;16:1895-1899.

Effect of premature ejaculation on depression and sexual functions in female partners: A report from Eastern Turkey.

BACKGROUND: Premature ejaculation (PE) is a sexual dysfunction causing female sexual dissatisfaction that eventually leads to poor quality of life in both partners. AIMS: To show the presence of depression, anxiety, sexual function disorders and their prevalence in spouses of males with PE living in Eastern Turkey. MATERIALS AND METHODS: Ninety male patients suffering from PE who referred to the andrology clinic between January 2016 and March 2017 and diagnosed with PE (Acquired Premature ejaculation) according to the DSM-IV criteria and their partners were included in the study. Male patients answered the PE Profile, Arabic Index of PE, PE Diagnostic Tool, and Arizona Sexual Experiences Scale (ASEX) Questionnaires. Spouses of male patients with PE answered the Arizona Sexual Experiences Scale, Beck Depression Inventory, and Beck Anxiety Inventory Questionnaires. SPSS software version 21.0 was used for statistical analysis. RESULTS: Our study revealed a positive correlation between the PE profile and partners' depression levels (P = 0.03). Also, the average ASEX Scale score of the both genders suggest that patients and partners believe they did not have a severe sexual function disorder. CONCLUSIONS: PE can cause psychological problems in both males and females. However, reflection of this pathology can vary from one society to another.