Does circumcision have a relationship with ejaculation time? Premature ejaculation evaluated using new diagnostic tools Free nerve ending density on skin extracted by circumcision and its relation to premature ejaculation. A multinational population survey of intravaginal ejaculation latency time. The global online sexuality survey (GOSS): The United States of America in 2011 Chapter III--Premature ejaculation among English-speaking male Internet users. Treatment of premature ejaculation with sertraline hydrochloride: a single-blind placebo controlled crossover study. Topical eutectic mixture for premature ejaculation (TEMPE): a novel aerosol‐delivery form of lidocaine‐prilocaine for treating premature ejaculation Optimum usage of prilocaine‐lidocaine cream in premature ejaculation Comparison of efficacy of sildenafil-only, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation. Treatment benefit of dapoxetine for premature ejaculation: results from a placebo‐controlled phase III trial The efficacy of fluoxetine in the treatment of premature ejaculation: a double-blind placebo controlled study. PSD502 improves ejaculatory latency, control and sexual satisfaction when applied topically 5 min before intercourse in men with premature ejaculation: results of a phase III, multicentre, double‐blind, placebo‐controlled study Relevance of serum nitric oxide levels and the efficacy of selective serotonin reuptake inhibitors treatment on premature ejaculation: decreased nitric oxide is associated with premature ejaculation Comparison Between Tadalafil Plus Paroxetine and Paroxetine Alone in the Treatment of Premature Ejaculation Effect of Fluoxetine Alone and in Combination with Sildenafil in Patients with Premature Ejaculation Topical anaesthetic use for treating premature ejaculation: a double‐blind, randomized, placebo‐controlled study Duloxetine, dual serotonin and norepinephrine reuptake inhibitor, versus paroxetine, selective serotonin reuptake inhibitor, in the treatment for premature ejaculation The effects of fluoxetine on several neurophysiological variables in patients with premature ejaculation. In vitro measurement of ejaculation latency time (ELT) and the effects of vardenafil on ELT on lifelong premature ejaculators: placebo-controlled, double-blind, cross-over laboratory setting The efficacy of citalopram in the treatment of premature ejaculation: a placebo-controlled study Efficacy of sertraline hydrochloride in treatment of premature ejaculation: a placebo-controlled study using a validated questionnaire The efficacy of duloxetine in the treatment of premature ejaculation Tadalafil and Fluoxetine in Premature Ejaculation: Prospective, Randomized, Double-Blind, Placebo-Controlled Study On-demand tramadol hydrochloride use in premature ejaculation treatment.
The aim of the study is to investigate whether there is an effect of adult circumcision on ejaculation parameters and to research the relationship between intravaginal ejaculation latency time ( IELT ) and premature ejaculation diagnostic tool ( PEDT ) . Adults who underwent voluntary circumcision between September 2010 and November 2011 were enrolled in this prospect i ve study . The IELT before and 3 months following circumcision was recorded . Also , PEDT was filled out before and 3 months after circumcision . During statistical evaluation , the comparison of situations before and after circumcision was made using IELT averages and PEDT total scores . Furthermore , the correlation between changes in IELT and PEDT has also been evaluated . A total of 30 volunteers ( mean age 21.25±0.44 ) were enrolled in the study . The volunteers ’ mean and median IELT before were 104.36±66.21 and 88 ( 26–307 ) seconds , whereas mean and median IELT after circumcision were 123.56±54.44 and 107.5 ( 67–300 ) seconds , respectively . The increase after circumcision was statistically significant ( P=0.001 ) . The mean and median PEDT score were 4.26±2.91 and 3 ( 1–12 ) before , and 2.63±1.82 and 2 ( 0–7 ) after circumcision . Improvement was statistically significant ( P<0.0001 ) . No correlation could be found between ejaculation time and PEDT scores . Circumcision during adulthood does not adversely affect ejaculatory function ; it may slightly improve . However , it could not be interpreted as a justification for circumcision in men with premature ejaculation ( PE ) Many studies have shown that skin tissue extracted by circumcision can cause differences in sexual function , especially at the time of ejaculation . Sensitivity changes in penile skin and sexual satisfaction deriving from circumcision starting from premature ejaculation ( PE ) are discussed . Furthermore , most of these studies rely on question naires . Extracted free nerve endings ( FNE ) on the foreskin , which can detect temperature , mechanical stimuli ( touch , pressure , stretch ) or pain ( nociception ) , have not been research ed . Our aim is to determine FNEs in foreskin and the affects on sexual function , especially PE . This prospect i ve study was done on adults who voluntarily applied to be circumcised between September 2010 and October 2011 . The ejaculation latency times ( ELT ) before circumcision have been assessed , and a PE diagnostic tool ( PEDT ) form was filled out by the urologist according to the answers given by the volunteers . The proximal and distal ends of the foreskin were marked before circumcision , and the extracted foreskin was sent to the pathology department to determine FNEs . Twenty volunteers ( average age 21.25 ± 0.44 years ) were included in the study .  The average ELT was 103.55 ± 68.39 seconds , and the average PE score was 4.35 ± 3.13 . Proximal , middle , and distal tip nerve densities were compared . Proximal and distal ( P = .003 ) and proximal and middle ( P = .011 ) segments differed from each other , whereas middle and distal were similar ( P = .119 ) . There were not any correlations between PEDT scores and total nerve endings number ( r = .018 , P = .942 ) . Also there were not any correlations between mean ELT and PEDT scores ( r = .054 , P = .822 ) . The tissue extracted by circumcision has intensive FNEs , yet FNE intensity has no relation to PE 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 . Prospect ively , stopwatch assessment of IELTs has superior accuracy compared with retrospective question naire 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 r and om male cohorts of different countries . METHODS A total of 500 couples were recruited from five countries : the Netherl and s , 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 result ed 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 INTRODUCTION The Global Online Sexuality Survey ( GOSS ) is a worldwide epidemiologic study of sexuality and sexual disorders . In 2010 , the first report of GOSS came from the Middle East . AIM This report studies the prevalence rate of premature ejaculation ( PE ) in the U.S. as of 2011 - 2012 and evaluates risk factors for PE . METHODS GOSS was r and omly deployed to English-speaking male web surfers in the USA via paid advertising on Facebook ® , comprising 146 questions . MAIN OUTCOME MEASURES Prevalence of PE as per the International Society of Sexual Medicine 's ( ISSM ) definition . RESULTS With a mean age of 52.38 years ± 14.5 , 1,133 participants reported on sexual function . As per the ISSM definition of PE , the prevalence rate of PE in the USA as of 2011 was 6.3 % . This is in contrast to 49.6 % as per the Premature Ejaculation Diagnostic Tool ( PEDT ) , 77.6 % as per unfiltered subjective reports , and 14.4 % as per subjective reporting on more consistent basis . 56.3 % of the latter reported lifelong PE . 63.2 % could be classified as having natural variable PE . Erectile dysfunction is a possible predisposing factor for acquired PE , while genital size concerns may predispose to lifelong PE . Age , irregular coitus , circumcision , and the practice of masturbation did not pose a risk for PE , among other risk factors . Oral treatment for PE was more frequently used and reported to be more effective than local anesthetics , particularly in those with lifelong PE . CONCLUSION Applying the ISSM definition , prevalence of PE is far less than diagnosed by other methods , 6.3 % among Internet users in USA as of the year 2011 . PEDT measures both lifelong and acquired PE , in addition to 35 % men with premature-like ejaculatory dysfunction  , making it inaccurate for isolating lifelong and acquired PE cases PURPOSE The efficacy of sertraline hydrochloride for the treatment of  premature ejaculation  is evaluated . MATERIAL S AND METHODS A total of 37 potent men , 19 to 70 years old ( mean age 41 ) , with premature ejaculation were treated with 50 mg . oral sertraline and placebo in a controlled r and omized single-blind crossover trial . All men were either married or in a stable relationship . None of the patients received any formal psychosexual therapy . Chronic open label treatment with sertraline was continued in 29 patients who had achieved an increase in ejaculatory latency times over pretreatment levels with active drug in the initial crossover study . In an attempt to identify which patients could maintain the improved ejaculatory control after withdrawal of the active drug , serial drug withdrawal was conducted every 4 weeks with drug initiation after a further 2 weeks if improved ejaculatory control was not maintained . RESULTS The mean pretreatment ejaculatory latency time was 0.3 minute ( range 0 to 1 ) . The mean ejaculatory interval after 4 weeks of treatment was 3.2 minutes ( range 1 minute to anejaculation ) with sertraline and 0.5 minute ( range 0 to 1 ) with placebo ( p < 0.001 ) . Intravaginal ejaculation was achieved for the first time in 5 patients with primary premature ejaculation and 2 patients experienced anejaculation . One patient described minor drowsiness and anorexia , and 2 patients described mild , transient gastrointestinal upset . Staged drug withdrawal allowed 20 of the 29 patients ( 67 % ) on chronic open label treatment with sertraline to discontinue the drug after a mean interval of 7.3 months with a mean ejaculatory latency time of 4.1 minutes ( range 1 to 12 ) . CONCLUSIONS Sertraline appears to be a useful agent in the pharmacological treatment of premature ejaculation To evaluate , in a phase II study , the efficacy and safety of a topical eutectic mixture for premature ejaculation ( TEMPE ) , a metered‐dose aerosol spray containing a eutectic mixture of lidocaine and prilocaine , as a treatment for PE Summary . Premature ejaculation is a common male sexual disorder in which orgasm and ejaculation occur before the desired moment . The primary therapeutic approach to premature ejaculation has been behavioural and pharmacotherapy . In this study , we evaluated the efficacy and optimum usage of lidocaine‐prilocaine cream 5 % in preventing premature ejaculation . Forty patients were examined in the study group and r and omized into four groups , each comprising 10 patients . Patients in group 1 applied lidocaine‐prilocaine cream 5 % for 20 min , the patients in group 2 applied it for 30 min , and the patients in group 3 applied the cream for 45 min before sexual contact , with all patients covering the penis with a condom . Patients in the fourth group applied a base cream as placebo . In group 1 , the pre‐ejaculation period increased to 6.71 ± 2.54 min without any adverse effects . In group 2 , although the pre‐ejaculation period increased in four patients up to 8.70 ± 1.70 min , six patients in this group and all patients in group 3 had erection loss because of numbness . In the placebo group , there was no change in their pre‐ejaculation period . Therefore , lidocaine‐prilocaine cream 5 % is effective in premature ejaculation and 20 min of application time before sexual contact is the optimum period OBJECTIVES To compare the efficacy of sildenafil ( Viagra ) only , sildenafil plus topical anesthetic cream ( EMLA ) , and topical EMLA-cream-only to that of placebo in treating  premature ejaculation .  METHODS A total of 84 patients were enrolled in this study . The duration of premature ejaculation in the patients ranged from 9 to 60 months ( mean 32.5 + /- 14.6 ) . Patients were r and omized into four groups . Group 1 consisted of 20 patients who took placebo for 2 months . Groups 2 and 3 consisted of 20 and 22 patients , respectively , and they received 50 mg sildenafil 45 minutes before coitus for 2 months . In addition , patients in group 3 applied topical EMLA cream to the glans penis 15 minutes before coitus . The 22 patients in group 4 used topical EMLA-cream-only . After at least eight sexual attempts , the patients ' clinical responses were assessed using the patient self-description method . Effectiveness was described as improvement plus cure . RESULTS The effectiveness was 40 % in group 1 , 55 % in group 2 , 86.4 % in group 3 , and 77.3 % in group 4 . Of the groups , a significant difference was found in the effectiveness of the treatments ( Pearson chi-square= 0.00 ) . No significant difference was found between groups 1 and 2 ( P = 0.26 ) . Efficacy was more successful in groups 3 and 4 than in the others ( P = 0.00 ) . The difference between groups 3 and 4 was not significant ( Pearson chi-square = 0.42 ) . CONCLUSIONS Sildenafil-only was not superior to placebo or combination treatment . Topical EMLA-cream-only had equal effectiveness to that of sildenafil plus topical EMLA treatment . The use of topical EMLA-cream-only seems to be an effective treatment of premature ejaculation To evaluate the overall treatment benefit of dapoxetine for  premature ejaculation ( PE )  , with specific emphasis on improvements in personal distress and interpersonal difficulty related to ejaculation .  Although these factors are key elements of numerous sets of diagnostic criteria for PE , they have rarely been evaluated as outcome measures in clinical trials PURPOSE The efficacy of the selective serotonin re-uptake inhibitor fluoxetine in the treatment of premature ejaculation was examined . MATERIAL S AND METHODS The study comprised 17 patients with premature ejaculation who presented to the urology clinic of our medical school . In this double-blind study the patients were r and omized into treatment groups receiving 20 mg . fluoxetine daily for 1 week and 40 mg . daily afterward ( group 1 ) or 1 capsule placebo daily for 1 week and 2 capsules daily afterward ( group 2 ) . The groups were evaluated according to the latent period of intravaginal ejaculation . RESULTS The latent period of intravaginal ejaculation in group 1 was significantly longer than that in group 2 . Nausea , headache and insomnia were reported side effects . CONCLUSIONS Fluoxetine may be regarded as a safe and effective alternative in the treatment of premature ejaculation To determine the effect of PSD502 applied topically 5 min before intercourse on the Index of Premature Ejaculation ( IPE ) and intravaginal ejaculatory latency time ( IELT ) of men with lifelong premature ejaculation ( PE ) defined according to the International Society of Sexual Medicine ( ISSM ) definition ; secondary objectives were to evaluate the safety and tolerability of PSD502 in patients with PE , and their sexual partners The aim of the present study was to determine the relevance of serum nitric oxide levels and the efficacy of selective serotonin reuptake inhibitors ( SSRI ) treatment on  premature ejaculation . Sixty married men ( aged 20–50 ) with lifelong premature ejaculation and forty healthy men ( aged 24–48 ) as control group were included in this study . The patients were evaluated by  intravaginal ejaculation latency time ( IELT ) for premature ejaculation ( PE ) . IELT<1 min is accepted PE . Patients with diabetes mellitus , chronic disorders or erectile dysfunction and heavy smokers were excluded . All patients were evaluated with history , physical examination , International Index of Erectile Dysfunction‐5 ( IIEF‐5 ) score and IELT by stopwatch  method . Nitric oxide levels were measured by Griess reaction , and all sample s were frozen at −80 ° C . Patients were r and omly categorised 4 group to receive fluoxetine 20 mg day−1 ( Group 1 ) , paroxetine 20 mg day−1 ( Group 2 ) , sertraline 50 mg day−1 ( Group 3 ) and healthy control ( Group 4 ) for 4 weeks . Baseline and post‐treatment findings were compared between the four groups . At the end of 4 weeks , in fluoxetine , paroxetine , sertraline  groups mean IELT values showed a statistically significant improvement from the baseline values ( P < 0.001 , P < 0.001 , P = 0.03 ; respectively ) . Baseline and 1st month follow‐up mean IIEF scores were 24.5 and 23.05 , 24.70 and 23.60 ( P < 0.05 ) in group 1 and group 3 respectively ; also 23.09 and 23.32 ( P > 0.05 ) in group 2 . Baseline serum NO levels were 31.8 , 30.44 , 30.8 and 42.84 in fluoxetine , paroxetine , sertraline and healthy control groups respectively . NO levels were statistically lower in patients with PE . After treatment of fluoxetine , paroxetine and sertraline , NO levels were increased baseline ( 35.8 , 36.4 , 38.08 ) ( P < 0.05 ) . Our findings indicated that PE is associated with decreased serum NO levels . After the SSRI treatment increased , NO may retard ejaculation presumably by central peripheral mechanism . Further studies are needed to confirm this suggestion and the role of NO in pathophysiology and treatment for premature ejaculation Background : Several recent studies have investigated the therapeutic role of phosphodiesterase type 5 ( PDE5 ) inhibitors in premature ejaculation ( PE ) used in the treatment of erectile dysfunction . Objectives : In the present research , the efficacy of paroxetine alone and paroxetine plus tadalafil was compared in patients referred because of premature ejaculation . Patients and Methods : This quasi-experimental study was performed on 100 consecutive 17 to 49-year-old potent men with premature ejaculation and without any clear organic disease . All patients had lifelong PE with an intravaginal ejaculation latency time ( IELT ) shorter than 1.5 minutes . Informed consent was obtained from all patients who were r and omly divided into two groups using a computer-generated r and om tabulation list . In group A , patients received 10 mg paroxetine daily , in addition to four hours before planned sexual activity . In group B , 10 mg paroxetine was taken daily , plus 10 mg tadalafil one hour before planned sexual activity . The duration of the intervention was six months and patients were evaluated for IELT three and six months after the beginning of therapy . Results : The mean age of patients in groups A and B were 33 ± 9.6 and 31.2 ± 9.3 years , respectively ( P = 0.368 ) . The mean number of intercourses were 1.08 ± 0.6 and 1.12 ± 0.6 per week in groups A and B , respectively ( P = 0.791 ) . Mean IELT at the 3-month follow up in groups A and B was 4.5 ± 1.5 and 5 ± 2.4 minutes , respectively ( P = 0.285 ) and at the 6-month follow up was 4.8 ± 1 and 5.3 ± 2 minutes , respectively ( P = 0.278 ) . Conclusions : The results of the study show that tadalafil can increase the mean IELT and can be used for treatment of premature ejaculation in combination with paroxetine Introduction : The aim of this study was to compare the efficacy of fluoxetine alone and combined with sildenafil in patients complaining of premature ejaculation . Patients and Methods : Ninety-one married potent men , 21–43 years old , with premature ejaculation but without any obvious organic cause were enrolled . Pretreatment evaluation included history , physical examination , and self-administration of the International Index of Erectile Function question naire . The patients were r and omly divided into two groups : group A patients ( n = 48 ) received 20 mg fluoxetine daily for 4 weeks and then 20 mg as needed 2–3 h before sexual activity for 4 months , and group B patients ( n = 43 ) received group A regimen plus 50 mg sildenafil as needed 1 h before sexual activity for 4 months . Results : Ejaculatory latency time and intercourse satisfaction significantly improved in group B as compared with group A ( p < 0.05 ) . Conclusion : Fluoxetine combined with sildenafil seems to provide significantly better ejaculatory latency time and intercourse satisfaction as compared with fluoxetine alone in patients with premature ejaculation To assess the use of a topical anaesthetic mixture to improve  premature ejaculation ( PE )  , for which penile hypersensitivity might be a cause Abstract Purpose In the current analysis due to the mechanism of effect , we evaluated the treatment benefit of duloxetine 40 mg comparing with paroxetine 20 mg , based on its effects on personal distress and interpersonal difficulty related to ejaculation , perceived control over ejaculation , and satisfaction with sexual intercourse , as well as the patient-reported global impression of change in premature ejaculation ( PE ) and the effect on intravaginal ejaculatory latency times ( IELT ) in men with premature ejaculation . Material s and methods The study included 80 married male patients diagnosed with lifelong PE . A total of 80 patients were r and omly distributed into two groups of 40 patients each . Group 1 patients received 40 mg duloxetine once a day for a month . Group 2 patients received 20 mg paroxetine once a day for a month . International index of erectile function question naire ( IIEF ) and IELT and PE profile were recorded before and after treatment . Results Comparing the groups ’ mean treatment IELT , there was no difference between groups . The IELT increase from baseline to treatment was 117 % in the duloxetine group ( P < 0.001 ) and 126 % in the paroxetine group ( P < 0.001 ) . There was no statistical difference between two groups in terms of IELT increase ( P > 0.05 ) . Also , there was no statistically significant difference between two groups at baseline IIEF to treatment IIEF scores . All PEP measures improved significantly with duloxetine and paroxetine groups ( P < 0.001 ) . Conclusion We think that duloxetine is safe and effective for the treatment for premature ejaculation PURPOSE Fluoxetine , a selective serotonin re-uptake inhibitor , has been shown to increase the intravaginal latency of patients with premature ejaculation . We demonstrated the effects of fluoxetine on intravaginal latency , penile sensory threshold , and variables of sacral evoked response and cortical somatosensorial evoked potential in patients with premature ejaculation . MATERIAL S AND METHODS Of 48 patients 40 who presented to our clinic with premature ejaculation met the study criteria , gave written or oral consent , and were divided r and omly in a double-blind fashion into 2 groups of 20 patients . The study group received 20 mg . fluoxetine daily and the control group received placebo for 1 month . The patients were evaluated during visits before and after treatment for intravaginal latency , penile sensory threshold values , and the variables of sacral evoked response and cortical somatosensory evoked potential tests . RESULTS Patient ages , intravaginal latencies , penile sensory threshold values , and amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential tests in both groups were not significantly different at the beginning of treatment ( p > 0.05 ) . At the end of treatment intravaginal latencies and penile sensory threshold values were increased in the study group compared to before treatment and the control group ( p < 0.05 ) . No change was observed in either group for the amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential tests ( p > 0.05 ) . CONCLUSIONS These findings suggest that fluoxetine is effective treatment for premature ejaculation probably due to its effect of increasing the penile sensory threshold , without changing the amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential Objective The aim of this study is to measure the ejaculation latency time ( ELT ) and to evaluate the effects of vardenafil on ELT and rigidity parameters of patients with lifelong premature ejaculation ( PE ) in a laboratory setting . Material s and methods Double-blind , placebo-controlled , cross-over laboratory study was performed with 40 males with lifelong PE . As the subject ingested the placebo or vardenafil , real-time penile tumescence and rigidity monitoring began . Audiovisual sexual stimulation ( AVSS ) was performed 45 min later . The patient began vibratory stimulation to the frenular area at 8th minute of AVSS till ejaculation . A button has been placed under the cover where the patient presses to operate the vibrator . ELT was calculated in seconds with a chronometer . Following ejaculation , AVSS was stopped . The test was repeated with second medication in 7–15 days . Results Among 40 patients , the results of 17 could be evaluated . When the patient took placebo and vardenafil , mean ELTs were 62.7 and 189.5 s , respectively . When compared with placebo , vardenafil  improved ELT significantly ( P = 0.04 ) . After the beginning of AVSS , time to first recorded base or tip rigidities was shorter and time to last recorded tip or base rigidities following ejaculation was longer than placebo ; however , these differences were not significant ( P > 0.05 for each ) . Conclusions This laboratory design might be used to evaluate the effects of drugs on patients with ejaculation disorders . In this laboratory setting study , vardenafil exerted a threefold increase in ejaculation delay outside the vagina in patients with lifelong PE Background : Despite the limited number of available study comparing of their efficacy , selective serotonin re-uptake inhibitors ( SSRI ) have been thought to have beneficial effects for the patients with premature ejaculation . In the present study , we decided to examine the efficacy of citalopram , an SSRI , in the treatment of premature ejaculation . Method : The study was consisted of 26 married patients diagnosed with premature ejaculation according to Diagnostic and Statistical Manual of Mental Disorders Third Revised Version ( DSM-III-R ) . The patients were r and omly assigned to two groups , citalopram ( group I ) and placebo ( group II ) , each consisting of 13 patients . The effects of drug on the ejaculatory function were assessed by the intravaginal ejaculation latency time . Additionally , all patients were screened by using Clinical Global Impression-Improvement Scale ( CGI-I ) and Yonsei Sexual Function Inventory-II ( YSFI-II ) . Results : The increase in the intravaginal ejaculation latency time in the citalopram group was statistically significant than that of placebo group . In addition , with respect to the subscales of the YSFI-II scale , similar overall significant improvements were seen in the patients given citalopram compared to those given placebo . Of group I patients , five ( 38.5 % ) were considered as ‘ very much improved ’ and four ( 30.8 % ) ‘ much improved ’ by CGI-I and only one of group II patients ( 7.7 % ) showed ‘ much improved ’ . Conclusion : The patients treated with citalopram showed significantly greater improvement compared to the patients receiving placebo Selective serotonin reuptake inhibitors ( SSRIs ) are increasingly used to treat premature ejaculation . We report a large prospect i ve placebo-controlled crossover study of sertraline in premature ejaculation ( PE ) using Arabic Index of Premature Ejaculation ( AIPE ) . One hundred and forty-seven men suffering from PE were enrolled in a r and omized single-blinded crossover study of sertraline hydrochloride and placebo .  Patients were r and omized into group 1 ( n=77 ) and group 2 ( n=70 ) . Both groups received sertraline and placebo interchangeably for 4 weeks . Overall , 127 ( 81 % ) of 157 subjects experienced a significant increase in their AIPE total score after sertraline treatment . Sixty-six ( 66 % ) of 100 patients available for follow-up experienced relapse of PE within 6 months after sertraline withdrawal . The active drug was generally well tolerated . Our relatively large study , using a vali date d question naire ( AIPE ) , confirmed the useful effect of sertraline on PE Abstract Aim : Though premature ejaculation ( PE ) has been overshadowed by current attention given to erectile dysfunction , it is the most widespread form of male sexual dysfunction . Delayed or inhibited ejaculation , a known side effect of selective serotonin reuptake inhibitors ( SSRIs ) , has made SSRIs potentially useful in the treatment of this disorder . In the present study , we examined the efficacy of duloxetine , an SSRI , in the treatment of PE . Method : The study included 20 married patients diagnosed with PE . The patients were r and omly assigned to two groups , duloxetine ( group I ) and placebo ( group II ) , each consisting of 10 patients . The effects on the ejaculatory function were estimated by the intravaginal ejaculation latency time . All patients were evaluated by using clinical global impression-improvement Scale ( CGI-I ) . Results : The increase in the intravaginal ejaculation latency time in the duloxetine group was statistically significant than that of placebo group . Of group I patients , four ( 40 % ) were considered as “ very much improved ” and four ( 40 % ) “ much improved ” by CGI-I and only one of group II patients ( 10 % ) showed “ much improved ” . Conclusion : Duloxetine appears to be superior to placebo in the pharmacological treatment of PE when administered on a chronic basis Introduction : Premature ejaculation ( PE ) is a common male sexual disorder . An ideal , reliable and effective treatment is desired by many men and couples affected by this condition . Aim : Evaluate if the association of a phosphodiesterase-5 inhibitor , tadalafil , and a selective serotonin reuptake inhibitor , fluoxetine , can prolong the intravaginal ejaculatory latency time ( IELT ) in men with lifelong premature ejaculation . Methods : Sixty patients with lifelong premature ejaculation and without erectile dysfunction ( ED ) with IELT less than 90 s were enrolled in the protocol and r and omized into 4 groups to use a combination of medications : ( 1 ) tadalafil 20 mg plus fluoxetine 90 mg , ( 2 ) fluoxetine 90 mg plus placebo , ( 3 ) tadalafil 20 mg plus placebo , and ( 4 ) two different placebo capsules ( control ) . Before starting the medications , each man timed his IELT with a stopwatch , and likewise during the treatment period . Fluoxetine 90 mg or placebo was taken once a week plus tadalafil 20 mg or placebo within a 36-hour frame of intended sexual intercourse with a steady partner . Patients were prospect ively followed for 12 weeks . One-way ANOVA was used for statistical comparisons of IELT results in each group . Results : Mean IELT before starting treatment was 51.3 ± 23 s. Withone-way ANOVA , a statistically significant difference in post-treatment IELT was seen with combination treatment compared to placebo ( p < 0.001 ) . There were increases in IELT from baseline in patients using fluoxetine plus tadalafil ( 49.57 ± 25.87 to 336.13 ± 224.77 ) ( p < 0.001 ) , fluoxetine ( 56.55 ± 18.55 to 233.62 ± 105.08 ) ( p < 0.001 ) and tadalafil ( 49.26 ± 19.43 to 186.53 ± 159.05 ) ( p = 0.001 ) . The increases in each group were statistically significant compared to the placebo ( 49.86 ± 19.43 to 67.82 ± 46.18 ) ( p = 0.042 ) . Conclusion : Fluoxetine plus tadalafil significantly increased the IELT from baseline in men with lifelong premature ejaculation when compared to placebo , tadalafil or fluoxetine OBJECTIVES To determine the efficacy of tramadol in premature ejaculation ( PE ) treatment compared with placebo . METHODS A single-blind , placebo-controlled , crossover study was conducted with 60 lifelong ( primary ) patients with PE . The patients were r and omized into 2 groups , each consisting of 30 patients , who took tramadol or placebo on dem and . PE was defined as an intravaginal ejaculation latency time of ≤60 seconds in 90 % of intercourse episodes . The efficacy of the drugs was assessed using the intravaginal ejaculation latency time , ability of ejaculation control , and sexual satisfaction scores after an 8-week treatment period . RESULTS All participants completed the study voluntarily . Two groups were similar in terms of the patient demographics . Increases in the intravaginal ejaculation latency time , ability of ejaculation control , and sexual satisfaction score between the placebo and tramadol groups were compared with the baseline values in both groups . At the end of study period , the tramadol group had significantly ( P<.001 ) greater values for all 3 parameters compared with those in the placebo group . CONCLUSIONS On-dem and use of low-dose tramadol is effective for lifelong PE . Currently , selective seratonin reuptake inhibitors such as dapoxetine , are a more popular treatment option for PE . However , tramadol might be considered an alternative agent for primary PE treatment
Based on these findings , circumcision does not have effect on PE
We attempted to evaluate whether circumcision has an effect on  premature ejaculation .