Skip to main content

Thank you for visiting 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.

  • Article
  • Published:

Hyaluronic acid injection in glans penis for treatment of premature ejaculation: a randomized controlled cross-over study

A Comment to this article was published on 23 September 2019


This randomized controlled cross-over study aimed to assess the efficacy and safety of glans penis injection with hyaluronic acid (HA) in treating premature ejaculation (PE). A total of 30 patients with PE were randomly allocated into two groups: group 1 (n = 15) which was subjected to glans penis HA injection and group 2 (n = 15) which was injected with saline as a control then both groups were subjected to follow-up at 1 week and 1 month after injection. These subjects were evaluated by intra-vaginal ejaculation latency time (IELT) and the Arabic validated index of premature ejaculation (AIPE). After a wash-out period, cross-over and re-evaluation of both groups were carried. Additionally, patients with reported improvement after 1 month of HA injection (n = 20) were subjected to extended evaluation by IELT at 3, 6, and 9 months intervals. Two-way repeated measures ANOVA indicated significant improvement after HA in comparison with saline across the follow-up periods (F(1.66: 91.37) = 24.85, p = 0.001). Post-hoc Bonferroni test indicated no significant difference after 1 week period in comparison with baseline IELT, but a significant difference after 1 month of injection in comparison with baseline IELT (p < 0.001) and after 1 week (p < 0.001). After 1 month of HA, IELT increased by a median of 2.6 folds while 1.1 folds increase was observed after 1 month of saline injection. Total AIPE scores improved significantly after HA injection compared with baseline (p = 0.003) and saline scores (p = 0.002). Reported adverse effects were minimal and self-limited. It could be concluded that glans penis injection with HA for treatment of PE is a safe method that ensures a modest but significant increase in IELT and improves couple sexual satisfaction.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Porst H, Montorsi F, Rosen RC, Gaynor L, Grupe S, Alexander J. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking. Eur Urol. 2007;51:816–23.

    Article  Google Scholar 

  2. Saitz TR, Serefoglu EC. The epidemiology of premature ejaculation. Transl Androl Urol. 2016;5:409–15.

    Article  Google Scholar 

  3. Althof SE, Abdo CH, Dean J, Hackett G, McCabe M, McMahon CG. International Society for Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation. J Sex Med. 2010;7:2947–69.

    Article  Google Scholar 

  4. Kalejaiye O, Almekaty K, Blecher G, Minhas S. Premature ejaculation: challenging new and the old concepts. F1000Res. 2017;6:2084.

    Article  Google Scholar 

  5. McMahon CG, Jannini E, Waldinger M, Rowland D. Standard operating procedures in the disorders of orgasm and ejaculation. J Sex Med. 2013;10:204–29.

    Article  Google Scholar 

  6. Sridharan K, Sivaramakrishnan G, Sequeira RP, Al-Khaja KAJ. Pharmacological interventions for premature ejaculation: a mixed-treatment comparison network meta-analysis of randomized clinical trials. Int J Impot Res. 2018;30:215–23.

    Article  CAS  Google Scholar 

  7. Saitz TR, Serefoglu EC. Advances in understanding and treating premature ejaculation. Nat Rev Urol. 2015;12:629–40.

    Article  CAS  Google Scholar 

  8. Kim JJ, Kwak TI, Jeon BG, Cheon J, Moon DG. Effects of glans penis augmentation using hyaluronic acid gel for premature ejaculation. Int J Impot Res. 2004;16:547–51.

    Article  CAS  Google Scholar 

  9. Abdallah H, Abdelnasser T, Hosny H, Selim O, Al-Ahwany A, Shamloul R. Treatment of premature ejaculation by glans penis augmentation using hyaluronic acid gel: a pilot study. Andrologia. 2012;44(Suppl 1):650–3.

    Article  Google Scholar 

  10. Littara A, Palmieri B, Rottigni V, Iannitti T. A clinical study to assess the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation. Int J Impot Res. 2013;25:117–20.

    Article  CAS  Google Scholar 

  11. McMahon CG. The design and methodology of premature ejaculation interventional studies. Transl Androl Urol. 2016;5:508–25.

    Article  Google Scholar 

  12. 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. J Sex Med. 2014;11:1423–41.

    Article  Google Scholar 

  13. McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD, et al. Risk factors for sexual dysfunction among women and men: a consensus statement from the fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016;13:153–67.

    Article  Google Scholar 

  14. Shamloul R, Ghanem H, Abou-zeid A. Validity of the Arabic version of the sexual health inventory for men among Egyptians. Int J Impot Res. 2004;16:452–5.

    Article  CAS  Google Scholar 

  15. Burchard AE, Ellis DA. The Canadian experience with fillers. Facial Plast Surg. 2009;25:129–34.

    Article  CAS  Google Scholar 

  16. Arafa M, Shamloul R. Development and evaluation of the Arabic Index of Premature Ejaculation (AIPE). J Sex Med. 2007;4:1750–6.

    Article  Google Scholar 

  17. Gibbs DA, Merrill EW, Smith KA, Balazs EA. Rheology of hyaluronic acid. Biopolymers. 1968;6:777–91.

    Article  CAS  Google Scholar 

  18. Moon DG, Kwak TI. Glans penis augmentation by filler. In: Park NC, Kim SW, Moon DG, editors. Penile augmentation. Berlin, Heidelberg: Springer Berlin Heidelberg; 2016. p. 175–83. pp

    Google Scholar 

  19. Weindl G, Schaller M, Schafer-Korting M, Korting HC. Hyaluronic acid in the treatment and prevention of skin diseases: molecular biological, pharmaceutical and clinical aspects. Skin Pharmacol Physiol. 2004;17:207–13.

    Article  CAS  Google Scholar 

  20. Serefoglu EC, Yaman O, Cayan S, Asci R, Orhan I, Usta MF, et al. The comparison of premature ejaculation assessment questionnaires and their sensitivity for the four premature ejaculation syndromes: results from the Turkish society of Andrology sexual health survey. J Sex Med. 2011;8:1177–85.

    Article  Google Scholar 

  21. Arron ST, Neuhaus IM. Persistent delayed-type hypersensitivity reaction to injectable non-animal-stabilized hyaluronic acid. J Cosmet Dermatol. 2007;6:167–71.

    Article  Google Scholar 

  22. Lupton JR, Alster TS. Cutaneous hypersensitivity reaction to injectable hyaluronic acid gel. Dermatol Surg. 2000;26:135–7.

    Article  CAS  Google Scholar 

  23. Moon DG, Kwak TI, Cho HY, Bae JH, Park HS, Kim JJ. Augmentation of glans penis using injectable hyaluronic acid gel. Int J Impot Res. 2003;15:456–60.

    Article  CAS  Google Scholar 

  24. Greene JJ, Sidle DM. The hyaluronic acid fillers. Facial Plast Surg Clin North Am. 2015;23:423–32.

    Article  Google Scholar 

  25. Kwak TI, Jin MH, Kim JJ, Moon DG. Long-term effects of glans penis augmentation using injectable hyaluronic acid gel for premature ejaculation. Int J Impot Res. 2008;20:425–8.

    Article  CAS  Google Scholar 

  26. Waldinger MD, Zwinderman AH, Schweitzer DH, Olivier B. Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis. Int J Impot Res. 2004;16:369–81.

    Article  CAS  Google Scholar 

  27. Busato W, Galindo CC. Topical anaesthetic use for treating premature ejaculation: a double-blind, randomized, placebo-controlled study. BJU Int. 2004;93:1018–21.

    Article  CAS  Google Scholar 

  28. Arafa M, Shamloul R. Efficacy of sertraline hydrochloride in treatment of premature ejaculation: a placebo-controlled study using a validated questionnaire. Int J Impot Res. 2006;18:534–8.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Mohamed W. Ragab.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alahwany, A., Ragab, M.W., Zaghloul, A. et al. Hyaluronic acid injection in glans penis for treatment of premature ejaculation: a randomized controlled cross-over study. Int J Impot Res 31, 348–355 (2019).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links