Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

A reassessment of penile sensory pathways and effects of prilocaine–lidocaine cream in primary premature ejaculation

Abstract

To assess the penile sensory pathway abnormalities of the patients with primary premature ejaculation (PPE) and effects of prilocaine–lidocaine (PLA) cream, we enrolled 82 PPE patients and 34 normal potent male volunteers. Somatosensory evoked potentials of dorsal nerve (DNSEP) and glans penis (GPSEP) were performed in each subject. In addition, among the 82 patients, 60 were selected and randomly divided into PLA and placebo subgroups, each with 30 patients. Cream was applied evenly on the glans penis for 10 min and washed off just before DNSEP and GPSEP were repeatedly measured. Mean latencies of DNSEP and GPSPE were both remarkably shorter in the patients than those in the normal potent men (P<0.001, both). Compared with the control group, the mean amplitudes of GPSEP were significantly greater in the patient group (P<0.001), but not considerably on the amplitudes of DNSEP (P=0.229). After cream application, the latencies and amplitudes of both DNSEP and GPSEP were significantly prolonged and reduced, respectively, in the PLA cream subgroup (P<0.001, all). These results showed that hyperexcitable ejaculatory reflex neurological factor was linked to PPE, because of hypersensitivity of the penile, accelerated conduction and cortical amplification of the genital stimuli. The PLA cream could delay sensory latency and decrease glans penile hyperexcitability, which may be the mechanism for PPE treatment.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol 2010; 57: 804–814.

    Article  Google Scholar 

  2. McMahon CG, Althof SE, Waldinger MD, Porst H, Dean J, Sharlip ID et al. An evidence-based definition of lifelong premature ejaculation: report of the International Society for Sexual Medicine (ISSM) ad hoc committee for the definition of premature ejaculation. J Sex Med 2008; 5: 1590–1606.

    Article  Google Scholar 

  3. Godpodinoff ML . Premature ejaculation: clinical subgroups and etiology. J Sex Marital Ther 1989; 15: 130–134.

    Article  CAS  Google Scholar 

  4. Donatucci CF . Etiology of ejaculation and pathophysiology of premature ejaculation. J Sex Med 2006; 3: 303–308.

    Article  CAS  Google Scholar 

  5. Buvat J . Pathophysiology of premature ejaculation. J Sex Med 2011; 8: 316–327.

    Article  Google Scholar 

  6. Xin ZC, Choi YD, Rha KH, Choi HK . Somatosensory evoked potentials in patients with primary premature ejaculation. J Urol 1997; 158: 451–455.

    Article  CAS  Google Scholar 

  7. Perretti A, Catalano A, Mirone V, Imbimbo C, Balbi P, Palmieri A et al. Neurophysiologic evaluation of central-peripheral sensory and motor pudendal pathways in primary premature ejaculation. Urology 2003; 61: 623–628.

    Article  CAS  Google Scholar 

  8. Vanden Broucke H, Everaert K, Peersman W, Claes H, Vanderschueren D, Van Kampen M . Ejaculation latency times and their relationship to penile sensitivity in men with normal sexual function. J Urol 2007; 177: 237–240.

    Article  Google Scholar 

  9. Salonia A, Saccà A, Briganti A, Del Carro U, Dehò F, Zanni G et al. Quantitative sensory testing of peripheral thresholds in patients with lifelong premature ejaculation: a case-controlled study. J Sex Med 2009; 6: 1755–1762.

    Article  Google Scholar 

  10. Giuliano F, Clèment P . Pharmacology for the treatment of premature ejaculation. Pharmacol Rev 2012; 64: 621–644.

    Article  CAS  Google Scholar 

  11. Althof SE, Abdo CH, Dean J, Hackett G, McCabe M, McMahon CG et al. International Society for Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation. J Sex Med 2010; 7: 2947–2969.

    Article  Google Scholar 

  12. Yuan YM, Xin ZC, Jiang H, Guo YJ, Liu WJ, Tian L et al. Sexual function of premature ejaculation patients assayed with Chinese Index of Premature Ejaculation. Asian J Androl 2004; 6: 121–126.

    PubMed  Google Scholar 

  13. Rhoden EL, Telöken C, Sogari PR, Vargas Souto CA . The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction. Int J Impot Res 2002; 14: 245–250.

    Article  CAS  Google Scholar 

  14. Ernst N, Fernando LS . Electroencephalography: basic principles. Clinical Applications, and Related Fields 5th edn. Lippincott Williams & Wilkins: Philadelphia, PA, USA, 2004.

    Google Scholar 

  15. Nikiforidis G, Koutsojannis C, Giannoulis S, Barbalias G . Reduced variance of latencies in pudendal evoked potentials after normalization for body height. Neurourol Urodyn 1995; 14: 239–251.

    Article  CAS  Google Scholar 

  16. Shabsigh R . Diagnosing premature ejaculation: a review. J Sex Med 2006; 3: 318–323.

    Article  Google Scholar 

  17. Waldinger MD, Schweitzer DH . Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence-based definition of premature ejaculation. Part II—proposals for DSM-V and ICD-11. J Sex Med 2006; 3: 693–705.

    Article  Google Scholar 

  18. Halata Z, Spaethe A . Sensory innervation of the human penis. Adv Exp Med Biol 1997; 424: 265–266.

    Article  CAS  Google Scholar 

  19. Allard J, Truitt WA, McKenna KE, Coolen LM . Spinal cord control of ejaculation. World J Urol 2005; 23: 119–126.

    Article  Google Scholar 

  20. Xin ZC, Zhu YC, Yuan YM, Cui WS, Jin Z, Li WR et al. Current therapeutic strategies for premature ejaculation and future perspectives. Asian J Androl 2011; 13: 550–557.

    Article  Google Scholar 

  21. Waldinger MD . The neurobiological approach to premature ejaculation. J Urol 2002; 168: 2359–2367.

    Article  Google Scholar 

  22. Wyllie MG, Powell JA . The role of local anaesthetics in premature ejaculation. BJU Int 2012; 110: 943–948.

    Article  Google Scholar 

  23. Zhang GX, Yu LP, Bai WJ, Wang XF . Selective resection of dorsal nerves of penis for premature ejaculation. Int J Androl 2012; 35: 873–879.

    Article  Google Scholar 

  24. Dinsmore WW, Wyllie MG . 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. BJU Int 2009; 103: 940–949.

    Article  CAS  Google Scholar 

  25. Shi WG, Wang XJ, Liang XQ, Liu ZQ, Huang MJ, Li SQ et al. Selective resection of the branches of the two dorsal penile nerves for primary premature ejaculation. Zhonghua Nan Ke Xue 2008; 14: 436–438.

    PubMed  Google Scholar 

Download references

Acknowledgements

The study was supported by the National Natural Science Foundation of China (Grant no. 81170563 and no. 81270694).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Y-T Dai.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xia, JD., Zhou, LH., Han, YF. et al. A reassessment of penile sensory pathways and effects of prilocaine–lidocaine cream in primary premature ejaculation. Int J Impot Res 26, 186–190 (2014). https://doi.org/10.1038/ijir.2014.5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijir.2014.5

Keywords

This article is cited by

Search

Quick links