Quality of life and Qmax were also significantly improved for the PUL compared to the sham control group. Based on these findings, the authors suggested that PUL can provide efficacious treatment in an outpatient setting under local anesthesia with minimal morbidity and zero alterations of sexual function. Fifty-three of the 66 (80%) sham control participants received the PUL treatment. At 3 months, the mean reduction of AUASI in the PUL cohort was 88% greater than it was in the sham control and PUL therapeutic effects were significantly better than control with regard to Qmax, quality of life and BPHII. Comprehensive review of the anatomy and physiology of male ejaculation: Premature ejaculation is not a disease The considerable amount of heterogeneity between included studies was not fully explained by the variables examined.Nonetheless, although the RCTs identified for inclusion were of unclear methodological quality, it could be considered unlikely that any additional unpublished data for the effects of tramadol compared with placebo would contribute significantly to the overall findings of this review.In an attempt to remedy the disparity among reported prevalence rates, the International Society for Sexual Medicine (ISSM) developed an evidence-based definition and established set operational criteria (2).PDE5 inhibitors enhance blood flow to the penis, aiding in achieving and maintaining erections, which can help with premature ejaculation.Our results align with several studies showing that TURP does not negatively impact erectile function and may lead to improvement 118,119,120,121,122.Empirical evidence from Britain’s 2000 National Survey of sexual attitudes and lifestyles.The current evidence base for alpha-blockers in the treatment of PE in terms IELT and other secondary outcomes is limited.This study differs from many retrospective cohort studies addressing this issue by providing a comprehensive summary of recent literature, allowing for a broad perspective on the somewhat contradictory nature of publications related to this topic.The current evidence base for acupuncture in the treatment of PE comprises two RCTs156,157 that compare acupuncture with SSRIs (citalopram and paroxetine) that are at overall unclear risk of bias. Serotonin (5 Hydroxytryptamine-5HT) inhibits ejaculation reflex leading to prolonged ejaculation latency time. 5HT1A, 5HT1B, 5HT2A, and 5HT7 receptor subtypes are mainly involved in the control of ejaculation. A “spinal ejaculatory generator” integrates peripheral and central stimuli and its function is important in the process of ejaculation. These muscles are important in the control of urination, ejaculation, penile rigidity, and hardness during erection (6). When learning to ride a bike, most people fall a few times. As you practice, you may lose control and come before you want. Sex therapists call this the “stop-start technique.” Practice stop-start—approaching ejaculation and backing away from it—until you can reliably last 30 minutes. Must-Have End Loaded Slowpitch Softball Bats for True Power Hitters Further clinical trials with sufficient number of subjects, and controlling for potential confounders, may shed further light on this association. These findings can be supported by the fact that fertilization rates are directly related to sperm progressive motility and inversely related to DNA fragmentation in vitro (71) with both parameters generally found to be improved with shorter abstinence periods. More recently, Bahadur et al. (70) showed in a pilot study that recurrent ejaculates successfully improved IUI pregnancy rates. With respect to the detoxyifying enzymes, however, we have observed in our laboratory that a short abstinence period of four hours led to a significant increase in SOD activity but did not change the activity of catalase in seminal plasma (unpublished data). Dadfar et al. reported that citalopram can be used in patients who did not respond to fluoxetine as a salvage drug (23). In clinical practice, follow-up side effects are an important part of the evaluation of treatment for PE (25). However, in our study, 480 patients in four groups of drugs were studied for 8 weeks, and rate of side effect was also assessed in each group separately. Turgay et al. compared the sertraline (50mg) and citalopram (20mg) daily in 80 patients with PE. No, it actually worsens the problem because it makes you more sensitive to sexual stimulation. Most people find relief using one or more of the treatments above. While alternative therapies also exist for PE treatment, there isn’t enough evidence to prove they’re effective. The HAM-D scale was used to measure depression and the Arizona Sexual Experience Scale to assess sexual dysfunction. Mirtazapine was studied in subjects who were stabilized on an SSRI but experienced SSRI-related sexual dysfunction.19 In all cases, subjects volunteered to be switched to an alternative antidepressant and were placed on mirtazapine. However, it is significant to note that the improvement in sexual dysfunction may be a by-product of further relief of depressive symptoms, which affect sexual dysfunction. These results imply that bupropion may have a role as an adjunct to SSRI therapy in subjects experiencing a decrease in sexual activity. Between-group differences in IELT and other outcomes were pooled across RCTs in a meta-analysis. We searched bibliographic databases including MEDLINE to August 2014 for RCTs. This mixture provides spermatozoa with a nutritive and protective milieu promoting their survival and movement during their run through the female reproductive tract to the ovule. The composition of the seminal fluid is complex and contains, besides spermatozoa, a variety of enzymes, sugars, lipids, oligo-elements, and other substances. A correct ejaculation can be defined as forceful propulsion of seminal fluid out of the body through the urethral meatus (antegrade ejaculation). Ethical approval and consent from patients Moreover, it may also be hypothesized that shared pornography use in couples may have a positive impact on sexual satisfaction as it could stimulate partners for more sexual exploration during real intercourse . On the other hand, one could also hypothesize that in some cases, use of pornography may increase sexual satisfaction by providing inspiration for real sex. It could be hypothesized that the frequent exposure to pornography can potentially impact sexual satisfaction. These contradictions may potentially arise from the complex nature of sexual desire in both men and women, which is influenced by a number of biological, psychological, relational, sexual and cultural factors 62,63. By ticking this box and submitting this review, you also accept that submitting fake reviews is a violation of ’s Terms of Use and such conduct will not be tolerated. Your review should be atleast 100 characters Together our researchers, journalists, dermatologists, and health experts have decades of pertinent experience generating and editing content for Health Insiders. According to 5 RCTs, all side effects were well tolerated. One RCT showed that the on-demand sildenafil group has better sexual satisfaction scores than the daily paroxetine group. All of the articles showed that paroxetine and tramadol have well-tolerated side effects 17, 20, 25. In addition, Alghobary et al. compared the efficacy of daily paroxetine and on-demand tramadol, paroxetine and tramadol increased IELT after 6 weeks by 11- and 7-fold, respectively. A slightly alkaline seminal fluid is necessary to neutralize the acidic environment of the vagina, which can negatively impact sperm function (10). Although numerous related articles have been published to this date, a systematic review has not been undertaken. Studies on the association of abstinence length with semen quality have examined a wide range of abstinence intervals. Interestingly, some studies have even challenged the recommended guidelines in favour of extremely shorter periods (i.e. 6-9). Doses that are effective in the treatment of PE usually are lower than those recommended in the treatment of depression, suggesting that the frequency and severity of adverse events also could be less. Dapoxetine, a drug that was specifically developed for the “on demand” treatment of PE, has now become the first and only treatment to be approved for this condition by Health Authorities in a growing number of countries around the world. It's available only in Korea and 8 studies demonstrated in Korea showed success rates of 89.2%. Topical anesthetics are contraindicated in patients who are either allergic themselves or have partners who are allergic to any component of the product. The information provided is for general informational purposes only and is not intended as medical advice, diagnosis, or treatment. If you have questions, please contact the manufacturer directly or consult a qualified healthcare professional. However, we recognize that digital representations can sometimes fall short of capturing every nuance of the product's physical attributes. Roberts M, Jarvi K. Steps in the investigation and management of low semen volume in the infertile man. Further, that study reported that men with LPE between the ages of 25 and 39 have higher FT levels than men with APE. In contrast, Corona et al reported that PE patients between the ages of 25 and 39 had high total testosterone (TT) and free testosterone (FT) levels. Hormones play a central role in ejaculation control, and therefore, any pathology in hormone levels may directly or indirectly affect ejaculation control. Paroxetine in a dose of 20 mg was an adequate treatment for primary PE, and a further increase in ejaculation latency may be achieved by increasing the dose .Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.In a study by Frendl et al., treatment failure after TURP was defined as cases in which patients experienced acute urinary retention or required retreatment for lower urinary tract symptoms.Overall, 6,081 men with a mean age of 40.6 years (range, 18–82 years) from 32 countries were enrolled with 4,232 (69.6%) subjects completed their study (Table 2).Increased stamina can help reduce fatigue and prolong intimacy, giving users greater control and confidence in the bedroom.The balanced swing feel makes it easy to control our hits and we’ve noticed a significant increase in our power.Evidence from four separate RCTs suggests that sexual satisfaction and measures of clinical improvement are improved with citalopram.70,72,93,96 AEs with citalopram appear to be nausea, headache, insomnia and dry mouth although the magnitude and severity are unclear.Men with acquired PE are older, and have cardiovascular disorders, comorbid illness and erectile dysfunction . Methods for reviewing effectiveness In a prostate cancer screening study of 26,126 men, 50 years and older or older than 40 with a history of prostate cancer or of black race, hemospermia was found in 0.5% on entry to the trial (72). If medical treatments fail, surgical operations such as transurethral resection of the prostate, transurethral resection of the ejaculatory duct and neurolysis of the pudendal nerve may be necessary (64-66). However, no obvious aetiology is found in a significant number of patients with the complaint of painful ejaculations, despite extensive investigation (62). Retrograde ejaculation feels the same as when semen comes out of your urethra (antegrade ejaculation). A healthcare provider will explain your risk if you have a condition or take medications that may cause retrograde ejaculation. If a medication causes retrograde ejaculation, it should go away shortly after a healthcare provider switches medications. But if you do, treatments are available for both retrograde ejaculation and infertility. A healthcare provider will monitor your blood pressure and heart rate if you take imipramine or pseudoephedrine to treat retrograde ejaculation. Intravaginal ejaculatory latency time was reported as being measured using a stopwatch in all but one RCT.55 When reported, duration of the RCTs included in the reviews ranged from 4 weeks to 4 months. Tuncel et al.107 reported that clomipramine, sertraline and terazosin were all significantly better than placebo on ejaculation control, but that there was no significant difference between the active treatments on this outcome. The reviewers reported a significant increase in latency for active treatment compared with baseline or placebo (p-values not reported). You can’t always prevent retrograde ejaculation. A healthcare provider will give you a better idea of what to expect according to your situation. But retrograde ejaculation may be long-lasting or even permanent if a severe condition, such as nerve damage, is the cause. If you don’t wish to have biological children, you may not even need treatment. According to more than one review, users have reported noticeable improvements in both erectile quality and ejaculatory control, highlighting the product’s potential to elevate multiple aspects of sexual function. While premature ejaculation is not considered a medical condition, it can have negative effects on a male’s self-confidence and can affect his sexual relationships. Premature ejaculation is the unwanted or uncontrollable early release of semen during sexual intercourse. Like citrulline, arginine is used as a remedy for poor erectile performance in volume pills as well as male enhancement products.19 But unlike citrulline, there’s a fair amount of evidence from human studies suggesting arginine can improve semen parameters. In humans, lysine also acts to improve the function of sperm tails through a process called lysine glutarylation.15 And, like B12, it appears as though those motility benefits translate to thawed sperm as well, at least in studies conducted on buffalo.16 Progressive motility describes a sperm cell’s straight-line swimming (a good thing), as compared to non-progressive motility, which describes a cell’s curved motion (a not-so-good thing). The root cause of this is mostly due to earlier versions of the protocol when patients were only blinded through the primary end point. Those reporting potential unblinding were more likely to correctly guess their treatment; those not reporting unblinding were not. Mean prostate size was 53 cc, and 91% of the subjects were sexually active. According to the research published by European Urology, Pantothenic Acid and Folic acid supplementation cures premature ejaculation more safely.Regardless of the temporal order, the presence of PE has a deleterious effect on male sexual functioning.The intra- and inter individual variation of the functional sperm parameters.It consistently affects about one in three men, although two in three men may be affected at some time in their lives.The greater efficacy of combination therapy is probably determined by the enhancement of NO synthase activity caused by the chronic administration of tadalafil 5 mg in the presence of a greater concentration of a NO source for the concomitant administration of a sufficient dosage of L-arginine.Premature ejaculation (PE) is a highly prevalent male sexual dysfunction that is often neglected, presenting a currently unmet therapeutic need.However, we recognize that digital representations can sometimes fall short of capturing every nuance of the product's physical attributes.All participants in the trials were diagnosed premature ejaculation or with IVELT of about 0.5–1.5 min more than 1 year. The conventional parameters of semen analysis provide fundamental information for the initial diagnosis of male infertility, but none is reliable enough to predict pregnancy (38). These studies consistently reported no association of abstinence duration with either intracellular ROS production or seminal ROS levels. Three studies (7,14,32) did not find any effect while half of the studies (15, 27, Ayad et al. 28, 66) showed an increase in sperm DNA fragmentation rates with prolonged abstinence. Eight studies (7,9,14,15,27,28,32,66) had investigated the relationship between the abstinence period and sperm DNA fragmentation. It has been shown that high proportions of spermatozoa with DNA fragmentation above 20% increase the risk of infertility regardless of having normal basic semen parameters (61). Of note, sexual function remained intact as none of the patients developed sustained erectile dysfunction or ejaculatory dysfunction. Five year results of the prospective, randomized controlled prostatic urethral L.I.F.T. study were recently published.17 At the 5-year interval, 104 of the 140 participants who received the PUL treatment were available for data collection (74.3%). Various assessment methods in terms of ejaculation control, patient/partners sexual satisfaction, anxiety and other patient-reported outcomes have been used across RCTs to measure the effectiveness of tramadol. One reviewer performed data extraction of each included study. In patients with PE, we have to consider the time taken to ejaculate (ejaculate latency), the ability to control ejaculation, and the psychological (frustration) distress and its impact on the quality of life. DE, anejaculation, and anorgasmia are among the least common and least understood male sexual health dysfunctions. There are three studies reporting on combined pharmacological and behavioral treatment for PE (95-97) and one study reporting on consecutive treatment with pharmacotherapy followed by behavior therapy (98). Lower urinary tract symptoms and depressive symptoms among patients presenting for distressing early ejaculation Other supplements for prolonging ejaculation include SSRIs like sertraline, topical numbing agents, and herbal remedies. This medication helps you maintain an erection but doesn’t notably prolong the time it takes to ejaculate. Always consult your doctor to find the best treatment for your specific needs. Herbal options such as maca root, ashwagandha, and ginseng are also believed to enhance sexual performance and stamina. Typically, a sex therapist or healthcare provider will guide you through the process. A further RCT (Yuan et al.) reported that BT (stop-start technique) combined with citalopram was more effective at improving sexual satisfaction than citalopram alone, though significance level was not reported. However, these were diverse across the included trials and were not reported in sufficient detail to permit any pooling across trials. With the exception of the RCT by Pastore et al. , all of the included trials were reported as evaluating one or more outcomes other than IELT (Table 3). Combined therapy gave a greater increase in IELT at 6 weeks, though the difference was only 1 minute, and the measurement method was not reported (MD 1.11 minutes, 95% CI 0.86 to 1.36; P 2 and Figure 2). These data could not be presented on the forest plot as no standard deviations were reported. But there’s no specific age at which ejaculation stops. Many people see a reduction in their sex drive (libido) and sexual activity as they get older. Your body absorbs any sperm you don’t release. But for some, the lack of visible semen during an orgasm can feel awkward or disappointing. Talk to a healthcare provider about whether these approaches may be appropriate for you. Factors such as age, health status, diet, and lifestyle habits all play a role in determining individual outcomes. Another benefit noted in more than one review is the supplement’s potential to support natural hormonal balance. Increased stamina can help reduce fatigue and prolong intimacy, giving users greater control and confidence in the bedroom. The main symptom of premature ejaculation is not being able to delay ejaculation for more than three minutes after penetration. Premature ejaculation is a common sexual complaint. Premature ejaculation occurs in men when semen leave the body (ejaculate) sooner than wanted during sex. With the exception of the RCTs by Pastore et al.48 and Trudel and Proulx45 all of the included trials were reported as evaluating one or more other outcomes. A paired analysis could not be undertaken for approximation purposes for this study. CIPE5, Chinese Index of Premature Ejaculation 5 premature ejaculation-related items; df, degrees of freedom; IV, inverse variance; SD, standard deviation. Controversies in surgical treatment with LPE The results of some studies investigating the relationship between MetS and PE are presented in Table 2. 5-HT2C receptor agonists have been reported to improve glucose tolerance and insulin sensitivity in obese and diabetic mice . Recent experimental animal studies have shown that 5-HT2C receptors play a role in glucose homeostasis . Hyposensitivity of the serotonin neurotransmitter receptor 5-HT2C has also been reported in the etiopathogenesis of PE . However, despite detecting lower FBS in patients with PE compared to controls, they did not determine any relationship between the two. After some studies showed a possible biological link between glycemic metabolism and ejaculation control, more studies were conducted with the goal of evaluating the prevalence of PE among men with preDM. Results of that study showed that the prevalence of PE in young patients with T1DM was not different from that of age-matched controls . Canat et al reported no significant difference in serum TT, FT, and FSH levels between PE patients and controls. Similarly, Mohseni et al found that serum FT and follicle stimulating hormone (FSH) levels were higher in PE patients compared to controls, but there were no significant differences in serum TT and luteinizing hormone (LH) levels between PE patients and controls. The systematic literature review search occurred on February 21st, 2022. Thus, this meta-analysis would fill a much-needed gap in the scientific literature. For this paper, sexual activity was defined as either sexual intercourse or masturbation. Several scientific reviews have been published attempting to address this topic20–24. In this review, we summarize the etiology, diagnosis, and treatment of DO/AO. There is no standardized treatment plan for DO/AO, though common treatments plans are often multidisciplinary and may include adjustment of offending medications and sex therapy. The patient should realize that with any approach for sperm recovery there is some risk of hematoma, infection, or pain, all of which are likely to resolve with time. In the vast majority of these men, motile spermatozoa can be obtained through assisted ejaculation. Assisted ejaculation in the form of PVS is the next choice for sperm retrieval in idiopathic AE and is the first choice in neurogenic AE because it is noninvasive and inexpensive . Reviewing 28 publications published since the year 2000, the authors conclude that the impact of abstinence on sperm quality is complex and inconclusive.In China, the horny goat weed (Figure 9) is currently still popular and may have some scientific merit (11) for enhancing sexual drive.Therefore, this review aims to discuss the underlying causes of PE and ED and the correlations between them, as well as the causes and treatments of PE combined with ED, which will help improve the clinical diagnosis and treatment and provide better treatment strategies.We did not have information on patients' social history including relationship status, which could affect outcomes of therapy with cabergoline.Second, analysis of semen could have been conducted prior to and after drug meetings, instead of assessing patient-reported outcomes.Premature ejaculation must not be classified as a male sexual dysfunction.The female partners of the selected men did not present hormonal dysfunctions, tubal obstruction or reproductive system infections. Figure 5. Forest plot showing the meta-analysis outcomes of the effect of zinc supplementation on sperm motility. In fact, during the early stages of sperm development, spermatogenic cells reside within the seminiferous tubules, which have a Zn content similar to or lower than that of other organs, such as the liver or kidneys.Doses that are effective in the treatment of PE usually are lower than those recommended in the treatment of depression, suggesting that the frequency and severity of adverse events also could be less.Sometimes, these problems develop with a new partner, after a divorce, during periods of stress or when dealing with infertility issues.But SSRIs often cause a side effect, delayed—sometimes completely inhibited—ejaculation.The aim of this study was to systematically review the evidence base for tramadol in the management of PE, by summarising evidence from randomised controlled trials (RCTs) and reporting a mean difference meta-analysis of RCT IELT data.They can retrieve sperm through a pee sample or a procedure such as microsurgical testicular sperm extraction (microTESE). TCAs, and their derivatives, have been a cornerstone in medical treatment of depression. Masters and Johnson reported success rate of up to 98% of men with PE treated with the start/stop and squeeze techniques at a 5-years follow-up. When the male assumes control with the hand of his partner, intercourse can be done, with the female on top, then lateral, and finally male on top position. These techniques focus on distraction and reduction of sexual excitement or stimulation, which may reduce overall sexual satisfaction. However, couples can be averse to using them, with some women reluctant to squeeze their partner’s penis and some couples unwilling to interrupt sexual interaction once initiated . However, it can also be used to increase sperm production in men. Your doctor may prescribe testosterone replacement therapy, which involves taking testosterone through injections, gels, or patches. Testosterone is a hormone responsible for many things, including sperm production. The first step in hormone therapy is to find out if you have a hormonal imbalance. A schematic summary of some components of the central control of ejaculation. Finally, nuclei of the ventral medulla have been identified as a source of inhibitory control of ejaculation . There is evidence to suggest that humans may also contain an SGE, which may provide a new target for therapeutic treatment of ejaculatory disorders . Finally, somatic fibres carried by the pudendal nerve are thought to play a role in ejaculation through control of pelvic striated muscles . It is thought that the sympathetic effect is dominant during ejaculation, responsible for controlling the contractile activity of seminal tract smooth muscle . Upon ejaculation, sperm are rapidly conveyed along the vas deferens and into the urethra via the ejaculatory ducts.A 2023 study showed that partnered sex with orgasm helped participants fall asleep faster and experience better sleep quality.The trial was reported in conference poster format and treatment duration was unclear (possibly eight weeks).The visits included IPSS, uroflow measurements, quality of life, adverse events and blinding assessment.Additionally, sexual function was preserved with no significant change in erectile function (IIEF-5) or ejaculatory function (MSHQ-EjD Function) and zero cases of de novo sustained sexual dysfunction were reported.In males with SCIs, disruptions to these sympathetic pathways, such as those caused by nerve damage or lesions, can prevent proper bladder neck closure, resulting in semen being redirected into the bladder instead of being expelled through the urethra .Simsek et al studied 150 patients with PE and compared the effects of paroxetine and dapoxetine in the treatment of PE.This recommendation supports the principles of evidence-based realistic medicine, which uses relevant scientific evidence base along with clinical judgement and patients’ values and preferences.82 When you sign up for the first time, you have to pay a $5 setup fee for your subscription plan.The American Urological Association recommends it as an effective off-label treatment for premature ejaculation.The RCT by Leaker et al.133 was conducted in the UK and inhaled clomipramine 1 mg or placebo (not described) before intercourse for a maximum of five occasions was compared with inhaled clomipramine 2 mg or placebo before intercourse for a maximum of five occasions in a randomised crossover design study.Hypospermia or aspermia should highlight to the clinician the possibility of retrograde ejaculation.Non-progressive motility is sometimes described as no progression, sluggish, and equivalent to Grade C or Grade 1.Search ((((Premature ejaculationTitle/Abstract OR PETitle/Abstract OR sexual dysfunction Title/Abstract))) AND (FluoxetineTitle/Abstract OR Selective Serotonin Reuptake Inhibitors Title/Abstract OR SSRIs Title/Abstract))Positive outcomes were noted, challenging the historical association of BPH surgeries with ejaculatory dysfunction.This theory stated that some men with DE tend to prefer unusual methods of masturbation over heterosexual intercourse with their partner.New treatments are certainly warranted to overcome this exasperating sexual dysfunction.Compared to these studies, our study revealed that the patients who recovered from ejaculatory dysfunction were more satisfied with using an intermittent dose of tamsulosin than with the standard dose. Likewise, patient acceptability of treatment was not reported. However, reporting of the methodological quality is limited in terms of concealment of group allocation and blinding of the outcome assessment across all RCTs included by this review. The pharmacokinetic properties of paroxetine may also account for the diverse results for the effects of tramadol compared with paroxetine on IELT. However, concealment of allocation and blinded outcome assessment were not reported by either RCT, and treatment duration was relatively short (six and four weeks respectively). Eurycoma Longifolia - This compound has been shown to not only increase natural testosterone levels, but also improves libido, fertility and sperm count in men. Our results successfully shed light on the efficacy differences of oral drugs for the treatment of PE. PE oral drugs mainly included serotonin reuptake inhibitors (SSRIs) and phosphodiesterase type 5 inhibitors (PDE5i). Although clinical and animal studies indicate that hormones play a role in controlling the ejaculation process, the precise endocrine mechanisms are unclear. Premature ejaculation (PE) is the most common male sexual dysfunction, with 30% of men experiencing PE worldwide. Finally, some aspects of sexual functioning, such as subjective satisfaction and sexual pain, were not evaluated, since they are not included in the PRSexDQ-SALSEX Questionnaire, but could be taken into consideration in further studies . Additionally, since it is a naturalistic design in real-life clinical practice, there was no control group of patients who continued with the same treatment as previously, so a comparison of both groups is not possible. On the other hand, patients were informed of the objectives of the study including the evaluation of sexual functioning before participating in the study. Emission is the process of ejection of spermatozoa along with the products of accessory sexual gland secretion into the posterior urethra by smooth muscle contraction. Although PE was reported in the medical literature years back in 1887, its first acceptable clinical definition was proposed in 1970 by Masters and Johnson as “the inability of a man to delay ejaculation long enough for his partner to reach organism on 50% of intercourse attempts” (1). It affects about 20-30% of men in the sexually active age group leading to psychological stress and loss of self-esteem, resulting in significant adverse effects on the quality of life, of both the patient and the partner. Premature ejaculation (PE) is a common sexual problem encountered by men in day-to-day clinical practice. In the RCT by van Lankveld et al.,50 an internet-based sex therapy based on the Masters and Johnson sensate focus technique was compared with waiting list control and 40 patients were randomised. An overall results summary from this assessment report for outcomes of IELT, sexual satisfaction, control over ejaculation and other secondary outcomes, plus AEs, following treatment with behavioural techniques anaesthetic creams and sprays, TCAs, SSRIs including dapoxetine, PDE5 inhibitors, analgesics (tramadol) and other interventions in the management of PE is provided in Table 2. When possible, data were pooled in a meta-analysis from RCTs reported in the existing reviews along with data extracted from additional RCTs not captured by the existing reviews. Owing to the time constraints of this short report, if RCTs were included in existing reviews, data were extracted from the review and not from the original RCT publication. Comparators included other interventions, waiting list control, placebo or no treatment. In a recent study of 115 patients presenting with hematospermia, all patients had a benign finding on TRUS (85.2% had calcification, 7% hypoechoic area, 30.4% had a seminal vesical abnormality) (89). In an observational study of 300 consecutive patients over a 30-month period, 81% had no cause of their hematospermia identified. Psychotherapy or relationship counselling, withdrawal of suspected agents (drugs, toxins, or radiation) (28,29,41,42) or the prescription of appropriate medical treatment (antibiotics, α-blockers, anti-inflammatory agents) may ameliorate painful ejaculations (63). Meanwhile, Abdelrahman et al. found that systemic toxicity from BoNT-A injections did not occur in any study population, nor were there any other severe local side effects. The increased frequency of adverse events in our analysis proposes that careful patient selection and monitoring are essential when considering BoNT-A as a treatment for PE. In terms of sexual satisfaction, our analysis showed no significant difference between two groups. Numbing sprays provide an effective treatment for premature ejaculation. ECS is a consultant and share-holder of a company which develops electrical patchs for the treatment of premature ejaculation (Virlity Medical, Haifa, Israel). However, more clinical data are necessary before surgical treatment options can be recommended to patients with PE. This result shows that alfuzosin is arguably superior to other α1-blockers by providing LUTS relief without any adverse sexual side effects. While the baseline severity of symptoms was variable in this patient group, influencing the outcome of MCID, none of the studies indicated a decrease in ejaculatory function. Despite using a validated questionnaire, the review assumes that a given change in score represents a similar improvement in ejaculatory function. BT (stop-start plus psychotherapy) combined with chlorpromazine was reported by one RCT as being more effective than chlorpromazine alone on a self-rated measure of anxiety and CIPE measures of sexual anxiety, sexual satisfaction, and ejaculatory control (Li et al.) . Three studies compared behavioral and drug combination therapy vs. drug treatment alone; all showed small but significant differences in IELT or ejaculatory latency favoring the combined approach 19–21. Eight studies 11,16,18–23 were considered at low risk of bias for completeness of outcome data (, were unclear on this point. All studies scored low for selective reporting (based on the fact that they reported IELT or ejaculatory latency as well as all outcomes referred to in the methods sections), with the exception of one study that did not report IELT or ejaculatory latency. Zinc acts as a growth factor, an immune-regulator, and a cryoprotectant with anti-inflammatory effects, and decreased zinc levels cause hypogonadism, decreases in the testis volume, inadequate development of secondary sexual characteristics, and atrophy of seminiferous tubules, with negative effects on sperm development61,62,63. Third, zinc exerts an in vitro effect on oxidative changes in human semen and is considered a scavenger of excessive O2 production by defective spermatozoa and/or leukocytes after ejaculation60. Six of twenty articles studied the curative effects of zinc supplementation in the treatment of male infertility and its effect on sperm parameters. Although tails coiled more than 360° suggest epididymal dysfunction.15 Abnormal sperm head (cephal) defects include tapered, pyriform, round (no acrosome or small), amorphous, vacuolated, small acrosomal area or double heads. However, observing many sperm with a single abnormality normally indicates a structural defect (e.g. globozoospermia). Note that sperm can have none, one or multiple abnormalities (i.e. defects). The percentage of sperm with normal morphology is at least 4% or more among men who successfully conceive within 12 months. Strengthening your pelvic floor may give you greater control over when you ejaculate. These procedures may include microsurgical testicular sperm extraction (microTESE) or testicular sperm aspiration (TESA). This means the medication doesn’t specifically treat delayed ejaculation but has approval for another condition and may help in your situation. But some healthcare providers may prescribe medications on an “off-label” basis with some success. Expulsion is the second phase of ejaculation in which there is a passage of seminal fluid from the posterior urethra to the external urethral meatus. It occurs concomitant with the contraction of the internal urethral sphincter, which closes the bladder neck and prevents retrograde passage of semen into the bladder. Emission is the first phase of ejaculation characterized by the passage of seminal fluid from the prostate, seminal vesicles, and vas deferens into the posterior urethra. The fact that the questionnaires go straight across is 1 thing, but the fact that the history can help you differentiate who might have a slight decrease over time and who can be very beneficial for a physician to counsel patients. In this study, we focused on the men who are in the trial and sexually active, measuring their erectile function. Erectile and ejaculatory dysfunction are prominent post-operative symptoms in men who are treated for benign prostatic hyperplasia (BPH) with traditional prostate surgeries, such as transurethral resection of the prostate (TURP). Premature ejaculation is often easily treated with a few simple steps, so it’s important to see your provider if you’re experiencing premature ejaculation. In the past, PE was defined as the inability to exert voluntary control over the ejaculatory reflex.26 Hastings27 defined PE as a condition in which a man reaches orgasm and ejaculates before he desires to do so. Definitions of premature ejaculation adopted by scientific committees/authorities Aspects such as a patient's assessment of self-efficacy, extent of sexual satisfaction of patients or their partners, quantitative measures of intercourse, and the level of bother or distress noted are the principle areas that constitute most of the available definitions of PE (Table 2). Stimuli from genitalia, essentially those reflecting the degree of activation of the sensory receptors that are mainly located in the glans penis, are integrated at the spinal level and stimulate emission.17 The emission phase of ejaculation is under considerable cerebral control and may be elicited following visual and physical erotic stimulations.18 Normal antegrade ejaculation is a highly coordinated physiological process comprising emission and expulsion phases, which are under the control of the autonomic and somatic nervous systems, respectively (Table 1). Under normal conditions, in males, orgasm is in the same time as ejaculation. Studies have reported that silodosin is the most uroselective and effective agent for ejaculation 5, 6, 11, 13. In the literature, a pathophysiological link between LUTS/BPO and sexual dysfunction (particularly ED) has been suggested .