October 10, 2020
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Premature ejaculation (PE) is considered one of the most common sexual function disorders in men with a prevalence of 9-30%. PE is defined as ejaculation with minimal sexual stimulation before or shortly after penetration, resulting in anxiety and distress.
Patients have minimal or no voluntary control over PE. There are two types of PE: lifelong or primary, and acquired or secondary. Based on modern evidence, the causes of PE have been found to be psychogenic and performance anxiety. Organic factors have been suggested as significant predictors of PE. Genetic factors have also been listed among the factors affecting lifelong PE. Other common organic factors that have an impact on acquired PE include hormonal abnormalities, prostatitis, and erectile dysfunction (ED). It has been reported that in many cases of lifelong PE, the men do not suffer from ED; however, approximately one third of the patients with ED have PE. Similarly, in a recent large-scale survey in the Asian-Pacific region administered to 4997 heterosexual men aged 18 to 65 years in a stable sexual relationship, ED was found to accompany PE in more than 30% of the respondents.
Many studies have suggested that assessing the effect of PE treatment is to measure the time taken to achieve ejaculation using the intra-vaginal ejaculation latency time (IELT). IELT is based on self-report and measured by a chronometer. Besides medications, behavioral and pharmacological therapies are the common treatment options for PE. This study investigated the effect of 5mg daily tadalafil treatment on the time taken to achieve ejaculation, erectile function and lower urinary tract symptoms in patients diagnosed with ED.
Materials and Methods
A total of 60 patients who were referred to the urology policlinic of the hospital with the complaint of erectile dysfunction. The mean age of the 60 participants was 50.4±7.9 (range 36–67). The study was approved by the local ethics committee of Erzincan University and all patients gave informed consent for the treatment. All patients reported to be heterosexual and in a stable sexual relationship for more than six months. The exclusion criteria were neurological disorders such as depression, Parkinson’s disease, diabetic neuropathy, and cerebrovascular damage, an active urinary system infection, history of chronic prostate; alcohol, drug or substance abuse, organic diseases limiting the use of PDE5 inhibitors, pelvic trauma, anemia, thyroid disease, hypogonadism (total testosterone) end-stage renal failure; and having used medication affecting the sex hormone and/or vitamin metabolism or for the treatment of PE and ED within the last three months.
The information related to patient’s age, duration of sexual dysfunction, smoking status, and sexual and medical history was obtained and a complete physical examination was performed on all patients. PE was assessed by IELT, which is defined as the time from vaginal intromission to intravaginal ejaculation. IELT was measured using a self-report method. It was measured by the female sexual partner using a stopwatch and expressed in minutes. If ejaculation occurred before or during penis vaginal intromission, it was defined as 0 minute. The same company calibrated all the stopwatches. The erectile functions of the patients were evaluated using the five-item international index of erectile function questionnaire (IIEF-5). The patient’s intra-vaginal ejaculation times were recorded. The lower urinary system symptoms (LUTS) of the patients were assessed using the international prostate symptom score (IPSS).
For the treatment of ED, the patients were prescribed 5mg tadalafil daily for three months. At the end of this period, the patients were re-evaluated using IIEF-5, IELT and IPSS. In addition, the side effects of the treatment were recorded and the patient’s baseline and post-treatment scores were compared.
The mean baseline scores were 2.2±1.4 for IELTs, 9.5±3.7 for IIEF-5, and 14.1±4.5 for IPSS.
At the end of the three-month tadalafil treatment, the patient’s scores were found to be 3.4±1.9, 16.1±4.7 and 10.4±3.8 for IELTs, IIEF-5 and IPSS, respectively. The results indicated a statistical improvement in all parameters, a statistically significant increase was observed in the IELTs and IIEF-5 values whereas there was a significant decrease in IPSS (p<0.01).
A daily dose of 5mg tadalafil can be safely used in the treatment of erectile dysfunction and LUTS, that prolongs the ejaculatory latency time.
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Additional information for this article: Stellapharm J.V. Co., Ltd. – Branch 1
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