Effect of Respiratory Exercises On The Intravaginal Ejaculation Latency Time
Condition: Premature Ejaculation
MeSH terms: Premature Birth; Premature Ejaculation
Study type: Interventional

Summary: 
      According to recent epidemiological studies, premature ejaculation (PE) is accepted as the
      most common sexual dysfunction in men, with a frequency of up to 20%.According to the
      definition made by the International Society for Sexual Medicine (ISSM) in 2014, PE:
      'Ejaculation (lifelong PE) that is always or almost always around 1 minute after the first
      sexual experience, or, ejaculation time can be reduced to 3 minutes.

      Male pelvic floor muscle function also plays a role in coordinating ejaculation. Pelvic floor
      therapy has been found to improve control over ejaculation and increase intravaginal
      ejaculatory delay times (IELT) in men with premature ejaculation and pelvic floor muscle
      dysfunction.

      Behavioral treatments consist of physical techniques that will help men's sexual development,
      delaying ejaculation and increasing sexual self-confidence. Specific physical techniques
      include: The "stop-start" technique developed by Semans involves the person or their partner,
      the penis is stimulated until you feel the urge to ejaculate, then it stops until the feeling
      goes away and the feeling goes away; this is repeated several times before allowing
      ejaculation to occur.

      The pelvic floor muscles have respiratory functions, and most of them have been investigated
      in studies on urological diseases. Focusing on lower abdominal respiration, it was observed
      that it was associated with a significant increase in whole blood serotonin
      5-hydroxytryptamine (5-HT) levels . One hypothesis proposed for the pathophysiology of
      premature ejaculation is that high 5-HT is associated with ejaculatory control.

      Our purpose is to investigate the effect of adding breathing exercises in addition to pelvic
      floor rehabilitation and behavioral treatment methods on ejaculation time in individuals with
      premature ejaculation.
    

Detailed description: 
      INTRODUCTION According to recent epidemiological studies, premature ejaculation (PE) is
      accepted as the most common sexual dysfunction in men, with a frequency of up to 20%.
      According to the definition made by the International Society for Sexual Medicine (ISSM) in
      2014, PE: 'Ejaculation (lifelong PE) that is always or almost always around 1 minute after
      the first sexual experience, or, ejaculation time can be reduced to 3 minutes. A male sexual
      dysfunction characterized by clinically significant and bothersome shortening (acquired PE)
      up to and including an inability to always or almost always delay ejaculation at vaginal
      penetrations, and negative personal problems such as stress, distress, frustration, and/or
      sexual avoidance.

      Ejaculation is a highly complex process that requires the coordination and efferent nerve
      interaction of the motor and sensory areas of the brain and spinal motor areas, as well as
      sensory receptors and afferent nerve pathways. Ejaculation is controlled by various
      neurotransmitters distributed throughout the supraspinal and spinal nuclei. In animal
      studies, serotonin [5-hydroxytryptophan (5-HT)], dopamine (DA) and oxytocin (OT), opioids,
      gamma aminobutyric acid (GABA), nitric oxide (NO) and norepinephrine (NE); GABA, OT, 5-HT and
      Substance P at the spinal cord level; Peripheral NE, acetylcholine (Ach), NO, OT, purines
      (P2), 5-HT and sensory receptors have been shown to be involved in ejaculation.

      Despite pelvic floor physiotherapy, which represents a conservative, modifiable,
      non-invasive, non-pharmacological and non-surgical intervention in the treatment of male
      sexual dysfunction, the biological relationship between pelvic floor function and male sexual
      function is rarely emphasized.

      Male pelvic floor dysfunction has been associated with ejaculation and orgasm dysfunction as
      well as erectile dysfunction. Male pelvic floor muscle function also plays a role in
      coordinating ejaculation. Pelvic floor therapy has been found to improve control over
      ejaculation and increase intravaginal ejaculatory delay times (IELT) in men with premature
      ejaculation and pelvic floor muscle dysfunction.

      Behavioral treatments consist of physical techniques that will help men's sexual development,
      delaying ejaculation and increasing sexual self-confidence. Specific physical techniques
      include: The "stop-start" technique developed by Semans involves the person or their partner,
      the penis is stimulated until you feel the urge to ejaculate, then it stops until the feeling
      goes away and the feeling goes away; this is repeated several times before allowing
      ejaculation to occur. The goal is to learn and recognize feelings of arousal and to improve
      control over ejaculation. The "squeeze" technique proposed by Masters and Johnson, stimulates
      the penis until you feel the urge to ejaculate, then tightens the glans penis until the urge
      to ejaculate passes; this is repeated without allowing ejaculation to occur.

      The pelvic floor muscles have respiratory functions, and most of them have been investigated
      in studies on urological diseases. Focusing on lower abdominal respiration, it was observed
      that it was associated with a significant increase in whole blood serotonin
      5-hydroxytryptamine (5-HT) levels. One hypothesis proposed for the pathophysiology of
      premature ejaculation is that high 5-HT is associated with ejaculatory control. Psychological
      comorbidities such as depression, anxiety, and extreme stress are associated with premature
      ejaculation. It has been observed that pelvic and perineal muscles that have not been fully
      relaxed may cause premature ejaculation.

      PURPOSE To investigate the effect of adding breathing exercises in addition to pelvic floor
      rehabilitation and behavioral treatment methods on ejaculation time in individuals with
      premature ejaculation.

      METHOD 62 individuals between the ages of 18-45 with premature ejaculation problems will be
      included in the study. Participating in the study will be randomly divided into two groups.
      To the 1st group (n=32), 1) awareness of the pelvic floor muscles, 2) teaching the specific
      contraction of the pelvic floor muscles, 3) teaching the timing of the contraction and
      maintenance of the pelvic floor muscles during the intercourse pre-orgasmic sensation with
      start stop technique, 4) the strengthening exercises of the pelvic floor muscles. A 4-step
      treatment protocol will be applied. Pelvic floor muscle strengthening exercises will be given
      for both slow-twitch and fast-twitch fibers. For slow twitch fibers, 15 repetitive exercises
      including 10 seconds of submaximal contraction followed by 10 seconds of relaxation, and 10
      repetitive exercises including 1 second submaximal contraction followed by 1 second
      relaxation for fast-twitch fibers will be given 2 times a day, 3 days a week. Slow and fast
      twitch fiber contraction exercises will require maximum contraction of the specific pelvic
      floor muscles without contraction of the gluteal and abdominal and adductor muscles. In the
      second group (n=32), breathing exercises will be given in addition to this treatment
      protocol. Diaphragmatic breathing exercises will be given 6 breaths/minute, expiration and
      inspiration times of 7 seconds and 3 seconds, respectively, and at least 10 diaphragmatic
      breaths will be given in each session, 3 times a day, 8 weeks. All individuals to be included
      in the study will be selected, according to The International Society for Sexual Medicine
      (ISSM), who always or almost always ejaculate 1 minute or more before vaginal penetration.
      Intravaginal ejaculation time (IELT) will be evaluated for both groups before and after the
      application. Before the application, pelvic floor muscle strength and endurance of both
      groups will be evaluated by ultrasound.

      Inclusion criteria for the study:

        -  IELT < 60 seconds

        -  PEDT > 11

        -  Persons included in the study have been in a stable relationship with a partner for at
           least 6 months and have sexual intercourse once a week or more

      Exclusion criteria from the study:

        -  Individuals with erectile dysfunction

        -  Individuals with prostatitis

        -  Those who have a psychiatric disorder and take medication for this reason
    

Intervention name(s): Pelvic floor exercises and behavioral therapy; Respiratory exercises
Intervention type(s): Other; Other
Intervention description(s): Pelvic floor exercises and behavioral therapy interventions include a 4-step treatment protocol: 1) awareness of the pelvic floor muscles, 2) teaching the specific contraction of the pelvic floor muscles, 3) teaching the timing of the contraction and maintenance of the pelvic floor muscles during the intercourse pre-orgasmic sensation with start-stop behavioral therapy, 4) the strengthening exercises of the pelvic floor muscles. For slow twitch fibers, 15 repetitive exercises including 10 seconds of submaximal contraction followed by 10 seconds of relaxation, and 10 repetitive exercises including 1 second submaximal contraction followed by 1 second relaxation for fast-twitch fibers will be given 2 times a day, 3 days a week, 8 weeks.; Pelvic floor exercises and behavioral therapy interventions include a 4-step treatment protocol: 1) awareness of the pelvic floor muscles, 2) teaching the specific contraction of the pelvic floor muscles, 3) teaching the timing of the contraction and maintenance of the pelvic floor muscles during the intercourse pre-orgasmic sensation with start-stop behavioral therapy, 4) the strengthening exercises of the pelvic floor muscles. For slow twitch fibers, 15 repetitive exercises including 10 seconds of submaximal contraction followed by 10 seconds of relaxation, and 10 repetitive exercises including 1 second submaximal contraction followed by 1 second relaxation for fast-twitch fibers will be given 2 times a day, 3 days a week, 8 weeks.
Respiratory exercises will be given 6 breaths/minute with expiration and inspiration times of 7 seconds and 3 seconds, respectively. At least 10 diaphragmatic breaths will be given in each session, 2 times a day, 7 days a week, 8 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 62 participants will randomly divided into two groups.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: premature ejaculation; respiratory exercises; pelvic floor muscles endurance; pelvic floor muscles strength; parasympathetic activity; behavioral therapy