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. Adult male circumcision: effects on sexual function and sexual satisfaction in Kisumu, Kenya. Topical anaesthetic use for treating premature ejaculation: a double‐blind, randomized, placebo‐controlled study A multinational population survey of intravaginal ejaculation latency time. 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 Improved ejaculatory latency, control and sexual satisfaction when PSD502 is applied topically in men with premature ejaculation: results of a phase III, double-blind, placebo-controlled study. A qualitative study of sexual behavior change and risk compensation following adult male circumcision in urban Swaziland HIV Risk Reduction Intervention Among Traditionally Circumcised Young Men in South Africa: A Cluster Randomized Control Trial 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 Optimum usage of prilocaine‐lidocaine cream in premature ejaculation Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial HIV Risk Reduction Intervention Among Medically Circumcised Young Men in South Africa: A Randomized Controlled Trial Effect of Text Messaging to Deter Early Resumption of Sexual Activity After Male Circumcision for HIV Prevention: A Randomized Controlled Trial Adult male circumcision: results of a standardized procedure in Kisumu District, Kenya Factors Associated with the Early Resumption of Sexual Activity Following Medical Male Circumcision in Nyanza Province, Kenya The efficacy of citalopram in the treatment of premature ejaculation: a placebo-controlled study
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 Male circumcision is being promoted for HIV prevention in high-risk heterosexual population s. However , there is a concern that circumcision may impair sexual function . AIM To assess adult male circumcision 's effect on men 's sexual function and pleasure . METHODS Participants in a controlled trial of circumcision to reduce HIV incidence in Kisumu , Kenya were uncircumcised , HIV negative , sexually active men , aged 18 - 24 years , with a hemoglobin > or=9.0 mmol/L. Exclusion criteria included foreskin covering less than half the glans , a condition that might unduly increase surgical risks , or a medical indication for circumcision . Participants were r and omized 1:1 to either immediate circumcision or delayed circumcision after 2 years ( control group ) . Detailed evaluations occurred at 1 , 3 , 6 , 12 , 18 , and 24 months . MAIN OUTCOME MEASURES ( i ) Sexual function between circumcised and uncircumcised men ; and ( ii ) sexual satisfaction and pleasure over time following circumcision . RESULTS Between February 2002 and September 2005 , 2,784 participants were r and omized , including the 100 excluded from this analysis because they crossed over , were not circumcised within 30 days of r and omization , did not complete baseline interviews , or were outside the age range . For the circumcision and control groups , respectively , rates of any reported sexual dysfunction decreased from 23.6 % and 25.9 % at baseline to 6.2 % and 5.8 % at month 24 . Changes over time were not associated with circumcision status . Compared to before they were circumcised , 64.0 % of circumcised men reported their penis was " much more sensitive , " and 54.5 % rated their ease of reaching orgasm as " much more " at month 24 . CONCLUSIONS Adult male circumcision was not associated with sexual dysfunction . Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm . These data indicate that integration of male circumcision into programs to reduce HIV risk is unlikely to adversely effect male sexual function To assess the use of a topical anaesthetic mixture to improve  premature ejaculation ( PE )  , for which penile hypersensitivity might be a cause 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 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 INTRODUCTION PSD502 is a novel aerosolized , lidocaine-prilocaine , spray being developed for the treatment of lifelong premature ejaculation . The clinical profile of PSD502 is described in one of two double-blind , placebo-controlled , phase III studies . AIM To determine the effect of PSD502 on the Index of Premature Ejaculation ( IPE ) and intravaginal ejaculatory latency ( IELT ) of men with lifelong PE . METHODS Men with lifelong PE who documented an IELT ≤ 1 minute with two or more of the first three sexual encounters during a 4-week baseline period were r and omized to receive double-blind treatment with PSD502 or placebo for 3 months . Patients completed IPE and Premature Ejaculation Profile question naires at entry and monthly visits , and recorded stop-watch timed IELT during each encounter . Safety was assessed by collecting adverse event data and st and ard safety measures . MAIN OUTCOME MEASURES Stopwatch timed IELT recordings and a patient-reported outcome question naire the IPE were used in this study to determine the effect of PSD502 applied topically 5 minutes before intercourse . RESULTS Two hundred fifty-six men with PE were r and omized from 38 centers in the U.S. , Canada , and Pol and .  The geometric mean IELT over the 3-month treatment period increased from a baseline of 0.56 minute and 0.53 minute in the PSD502 and placebo group respectively to 2.60 and 0.80 minute . There were significantly greater increases in the scores for the IPE domains of ejaculatory control , sexual satisfaction and distress in the PSD502 group than in the placebo group , with a mean 5.0 point difference between treatments in change from baseline in the IPE domain for ejaculatory control , 4.6 point difference in change from baseline in the IPE domain for sexual satisfaction , and a 2.5 point difference in change from baseline in the IPE domain for distress . This was supported by improvements in all secondary endpoints . CONCLUSION In this study , PSD502 applied topically to the glans penis 5 minutes before intercourse showed significantly improved ejaculatory latency , ejaculatory control , sexual satisfaction and distress and was shown to be well tolerated by patients and partners Male circumcision has been shown to reduce the risk of heterosexual transmission of HIV infection in men by up to 60 % in three r and omized controlled trials . Less is known , however , about sexual behavior change in men who have been circumcised and whether male circumcision 's protective effect leads to riskier sexual behaviors . This study used qualitative in-depth interviews to underst and men 's  sexual behavior after circumcision  and to determine whether and how men participated in riskier sexual behaviors  following male circumcision . Men in urban Swazil and , circumcised in the previous 12 months , were recruited and asked about their perceptions of sexual risk and sexual behavior  post-circumcision .  Results showed that following circumcision , men experience changes in both their sexual attitudes and behavior , which can be considered both protective and risky for HIV transmission . Most of them described protective changes ( e.g. , more responsible attitudes towards safe sex , reducing sexual temptation and partners , easier condom use ) . A minority , however , experienced increased sexual risk-taking , typically during a brief period of sexual experimentation shortly after circumcision . HIV counseling and counseling throughout the circumcision process is shown to be critical in influencing protective behaviors . Findings in this study confirm the existence of risk compensation following circumcision ; however , this study adds important context ual insight about precisely when and why such risk-taking occurs . Nevertheless this study suggests that male circumcision scale-up as an HIV prevention strategy is likely to foster protective behavior change among men . The integration of HIV counseling with circumcision provision remains critical for effectively mitigating HIV risk behavior as male circumcision gains momentum as a viable HIV prevention tool & NA ; The aim of this study was to test a 180‐minute group HIV risk – reduction counseling intervention trial with men undergoing traditional circumcision in South Africa to reduce behavioral disinhibition ( false security ) as a result of the procedure . A cluster r and omized controlled trial design was employed using a sample of 160 men , 80 in the experimental group and 80 in the control group . Comparisons between baseline and 3‐month follow‐up assessment s on key behavioral outcomes were completed . We found that behavioral intentions , risk‐reduction skills , and male role norms did not change in the experimental compared to the control condition . However , HIV‐related stigma beliefs were significantly reduced in both conditions over time . These findings show that one small‐group HIV risk – reduction intervention did not reduce sexual risk behaviors in recently traditionally circumcised men at high risk for behavioral disinhibition 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 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 BACKGROUND Male circumcision could provide substantial protection against acquisition of HIV-1 infection . Our aim was to determine whether male circumcision had a protective effect against HIV infection , and to assess safety and changes in sexual behaviour related to this intervention . METHODS We did a r and omised controlled trial of 2784 men aged 18 - 24 years in Kisumu , Kenya . Men were r and omly assigned to an intervention group ( circumcision ; n=1391 ) or a control group ( delayed circumcision , 1393 ) , and assessed by  HIV testing , medical examinations , and behavioural interviews during follow-ups at 1 , 3 , 6 , 12 , 18 , and 24 months . HIV seroincidence was estimated in an intention-to-treat analysis . This trial is registered with Clinical Trials.gov , with the number NCT00059371 . FINDINGS The trial was stopped early on December 12 , 2006 , after a third interim analysis review ed by the data and safety monitoring board . The median length of follow-up was 24 months . Follow-up for HIV status was incomplete for 240 ( 8.6 % ) participants . 22 men in the intervention group and 47 in the control group had tested positive for HIV when the study was stopped . The 2-year HIV incidence was 2.1 % ( 95 % CI 1.2 - 3.0 ) in the circumcision group and 4.2 % ( 3.0 - 5.4 ) in the control group ( p=0.0065 ) ; the relative risk of HIV infection in circumcised men was 0.47 ( 0.28 - 0.78 ) , which corresponds to a reduction in the risk of acquiring an HIV infection of 53 % ( 22 - 72 ) . Adjusting for non-adherence to treatment and excluding four men found to be seropositive at enrollment , the protective effect of circumcision was 60 % ( 32 - 77 ) . Adverse events related to the intervention ( 21 events in 1.5 % of those circumcised ) resolved quickly . No behavioural risk compensation after circumcision was observed . INTERPRETATION Male circumcision significantly reduces the risk of HIV acquisition in young men in Africa . Where appropriate , voluntary , safe , and affordable circumcision services should be integrated with other HIV preventive interventions and provided as expeditiously as possible Background Medical male circumcision ( MMC ) is now considered one of the best available evidence -based biomedical HIV prevention interventions . However , there is some concern about risks for behavioural disinhibition , or risk compensation , following MMC . Purpose The aim of this study was to test a brief one-session ( 180 min ) group culturally tailored HIV risk reduction counselling intervention among men undergoing medical circumcision in South Africa in order to limit behavioural disinhibition . Methods A r and omized controlled trial design was employed using a sample of 150 men , 75 in the experimental group and 75 in the control group . Comparisons between baseline and 3-month follow-up assessment s on several key behavioural outcomes addressed by the intervention were done . Results Our study found that behavioural intentions and risk reduction skills significantly increased and sexual risk behaviour ( reduction of the number of sexual partners and the number of unprotected vaginal sexual intercourse occasions ) significantly decreased in the experimental compared to the control condition . However , male role norms did not change among the intervention conditions over time , while AIDS-related stigma beliefs significantly reduced in both conditions over time . ConclusionS tudy findings show that a relatively brief ( one session ) and focused HIV risk reduction counselling can have at least short-term effects on reducing sexual risk behaviours in population s at high risk for behavioural disinhibition following medical male circumcision Background : Resumption of sex before complete wound healing after male circumcision may increase risk of postoperative surgical complications , and HIV acquisition and transmission . We aim ed to determine the effect of text messaging to deter resumption of sex before 42 days postcircumcision . Methods : We conducted a r and omized trial where men older than18 years who owned mobile phones and had just undergone circumcision were r and omized to receive a series of text messages ( n = 600 ) or usual care ( n = 600 ) . The primary outcome was self-reported resumption of sex before 42 days . Results : Sex before 42 days was reported by 139 of 491 ( 28.3 % ) men in the intervention group and 124 of 493 ( 25.2 % ) men in the control group [ relative risk = 1.13 , 95 % confidence interval ( CI ) : 0.91 to 1.38 , P = 0.3 ] . Men were more likely to resume early if they were married or had a live-in sexual partner [ adjusted relative risk ( aRR ) 1.57 , 95 % CI : 1.18 to 2.08 , P < 0.01 ] ; in the month before circumcision had 1 ( aRR : 1.50 , 95 % CI : 1.07 to 2.12 , P = 0.02 ) or more than 1 ( aRR : 1.81 , 95 % CI : 1.24 to 2.66 , P < 0.01 ) sexual partner(s ) ; had primary school or lower education ( aRR : 1.62 , 95 % CI : 1.33 to 1.97 , P < 0.001 ) ; were employed ( aRR : 1.35 , 95 % CI : 1.05 to 1.72 , P = 0.02 ) ; or were 21–30 years old ( aRR : 1.58 , 95 % CI : 1.01 to 2.47 , P = 0.05 ) , 31–40 years old ( aRR : 1.91 , 95 % CI : 1.18 to 3.09 , P < 0.01 ) , or older than 40 years ( aRR : 1.76 , 95 % CI : 1.04 to 2.97 , P = 0.03 ) compared with younger than 21 years . Conclusions : Text messaging as used in this trial did not reduce early resumption of sex after circumcision . We identified key risk factors for early resumption that need to be considered in circumcision programs In a combined study from the USA and Kenya , the safety of adult male circumcision  in the latter country was review ed , particularly with the purported association between this procedure and a lower incidence of HIV and other sexually‐transmitted infections . It was found that safe and acceptable adult male circumcision services could be delivered in developing countries should this be advocated as a public health measure Research has established that voluntary medical male circumcision ( VMMC ) reduces HIV acquisition in heterosexual men by approximately 60 % ; however , engaging in sexual activity before the wound is healed may attenuate this protective effect . This prospect i ve study included  VMMC clients who were circumcised in Kenya between November , 2008 and March , 2010 , aged ≥18 years , and r and omly selected for an interview and genital examination 28–45 days post-VMMC ( N = 1,344 ) . At the time of the interview , 91.3 % participants were healed . Overall , 30.7 % reported engaging in early sexual activity , usually 3–4 weeks post-VMMC . In a multivariable analysis , being married or cohabitating was the strongest predictor of engaging in early sexual activity . Strategies to reduce engaging in sexual activity during the recommended 42-day abstinence period following VMMC should be explored including re-energizing the effort to include female partners in counseling , mass education campaigns , and targeted text messaging programs for VMMC clients 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
Based on these findings , circumcision does not have effect on PE
We attempted to evaluate whether circumcision has an effect on  premature ejaculation .