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Somatosensory evoked potentials assess the efficacy of circumcision for premature ejaculation

Abstract

To assess the efficacy and mechanism of circumcision in the treatment of premature ejaculation (PE) with redundant prepuce, we enrolled a total of 81 PE patients who received circumcision. The patients’ ejaculatory ability and sexual performances were evaluated before and after circumcision by using questionnaires (Intravaginal ejaculation latency time (IELT), Chinese Index of PE with 5 questions (CIPE-5) and International Index of Erectile function- 5 (IIEF-5)). Furthermore, somatosensory evoked potentials (SEPs) including dorsal nerve (DNSEP) and glans penis (GPSEP) of the patients were also measured. The mean IELTs of preoperation and post operation were 1.10±0.55 and 2.48±2.03 min, respectively (P<0.001). In addition, the geometric mean IELT after operation was 2.16 min, compared with the baseline 1.07 min before the operation, the fold increase of the IELT was 2.02. Compared with the uncircumcised status, scores of CIPE-5 showed a significant increase after circumcision (P<0.001). The mean latencies (and amplitudes) of GPSEP and DNSEP were 38.1±4.0 ms (3.0±1.9 uV) and 40.5±3.4 ms (2.8±1.6 uV) before circumcision, respectively; and 42.8±3.3 ms (2.8±1.6 uV) and 40.5±4.1 ms (2.4±1.2 uV) in the follow-up end point after circumcision. Only the latencies of GPSEP showed significant prolongation before and after circumcision (P<0.001). The ejaculation time improvement after circumcision is so small, and equal to placebo response, therefore it could not be interpreted as a therapeutic method in men with PE.

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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. Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G et al. An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second international society for sexual medicine ad hoc committee for the definition of premature ejaculation. Sex Med 2014; 2: 41–59.

    Article  Google Scholar 

  4. Serefoglu EC, Saitz TR . New insights on premature ejaculation: a review of definition, classification, prevalence and treatment. Asian J Androl 2012; 14: 822–829.

    Article  Google Scholar 

  5. Laumann EO, Masi CM, Zuckerman EW . Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice. JAMA 1997; 277: 1052–1057.

    Article  CAS  Google Scholar 

  6. Alp BF, Uguz S, Malkoc E, Ates F, Dursun F, Okcelik S et al. Does circumcision have a relationship with ejaculation time? Premature ejaculation evaluated using new diagnostic tools. Int J Impot Res 2014; 26: 121–123.

    Article  CAS  Google Scholar 

  7. Senkul T, Iseri C, Sen B, Karademlr K, Saracoglu F, Erden D . Circumcision in adults:effect on sexual function. Urology 2004; 63: 155–158.

    Article  Google Scholar 

  8. Namavar MR, Robati B . Removal of foreskin remnants in circumcised adults for treatment of premature ejaculation. Urol Ann 2011; 3: 87–92.

    Article  Google Scholar 

  9. O’Hara K, O’Hara J . The effect of male circumcision on the sexual enjoyment of the female partner. BJU Int 1999; 83: 79–84.

    Article  Google Scholar 

  10. Payne K, Thaler L, Kukkonen T, Carrier S, Binik Y . Sensation and sexual arousal in circumcised and uncircumcised men. J Sex Med 2007; 4: 667–674.

    Article  Google Scholar 

  11. Krieger JN, Mehta SD, Bailey RC, Agot K, Ndinya-Achola JO, Parker C et al. Adult male circumcision: effects on sexual function and sexual satisfaction in Kisumu, Kenya. J Sex Med 2008; 5: 2610–2622.

    Article  Google Scholar 

  12. Zhang SJ, Zhao YM, Zheng SG, Xiao HW, He YS . [Correlation between premature ejaculation and redundant prepuce]. Zhonghua Nan Ke Xue 2006; 12: 225–227.

    CAS  PubMed  Google Scholar 

  13. 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 

  14. Xia JD, Zhou LH, Han YF, Chen Y, Wang R, Dai YT . A reassessment of penile sensory pathways and effects of prilocaine-lidocaine cream in primary premature ejaculation. Int J Impot Res 2014; 26: 186–190.

    Article  Google Scholar 

  15. Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M . A multinational population survey of intravaginal ejaculation latency time. J Sex Med 2005; 4: 492–497.

    Article  Google Scholar 

  16. 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 

  17. Rhoden EL, Teloken 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 

  18. Xia JD, Han YF, Pan F, Zhou LH, Chen Y, Dai YT . Clinical characteristics and penile afferent neuronal function in patients with primary delayed ejaculation. Andrology 2013; 1: 787–792.

    Article  Google Scholar 

  19. Ramos-Arguelles F, Morales G, Egozeue S, Pabon RM, Alonso MT . Basic techniques of electroencephalography: principles and clinical applications. An Sist Sanit Navar 2009; 32: 69–82.

    Article  Google Scholar 

  20. Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH . Geometric mean IELT and premature ejaculation: appropriate statistics to avoid overestimation of treatment efficacy. J Sex Med 2008; 5: 492–499.

    Article  Google Scholar 

  21. Tang WS, Khoo EM . Prevalence and correlates of premature ejaculation in a primary care setting: a preliminary cross-sectional study. J Sex Med 2011; 8: 2071–2078.

    Article  Google Scholar 

  22. Dinsmore WW, Hackett G, Goldmeier D, Waldinger M, Dean J, Wright P et al. Topical eutectic mixture for premature ejaculation (TEMPE): a novel aerosol-delivery form of lidocaine-prilocaine for treating premature ejaculation. BJU Int 2007; 99: 369–375.

    Article  CAS  Google Scholar 

  23. Riess TH, Achieng MM, Bailey RC . Women's beliefs about male circumcision, HIV prevention, and sexual behaviors in Kisumu, Kenya. PloS One 2014; 9: e97748.

    Article  Google Scholar 

  24. Yang C, Bradley WE . Peripheral distribution of the human dorsal nerve of the penis. J Urol 1998; 159: 1912–1917.

    Article  CAS  Google Scholar 

  25. Fink KS, Carson CC, DeVellis RF . Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction. J Urol 2002; 167: 2113–2116.

    Article  Google Scholar 

  26. 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 

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Acknowledgements

The study was supported by the National Natural Science Foundation of China (Grant No. 81270694 and No. 81501245).

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Correspondence to J-D Xia or Y-T Dai.

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Appendix

Appendix

Chinese Index of Sexual Function for Premature Ejaculation with 5 questions (CIPE-5):16

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Xia, JD., Jiang, HS., Zhu, LL. et al. Somatosensory evoked potentials assess the efficacy of circumcision for premature ejaculation. Int J Impot Res 28, 127–132 (2016). https://doi.org/10.1038/ijir.2016.21

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