UNASSIGNED: Premature ejaculation (PE) is a nosologic entity with issues in its conceptualization and definition.
UNASSIGNED: To understand if the altered sexual response in men with PE is in the orgasm phase, as currently assumed, or the arousal phase with difficulties in modulating, regulating, or decreasing sexual arousal.
UNASSIGNED: Men were recruited who looked for help for PE and met the diagnostic criteria according to clinical standards. The participants completed a sociodemographic survey and the Premature Ejaculation Diagnostic Tool. They also performed a masturbation exercise with a maximum of 5 stops, with the intention of prolonging the arousal phase. The time of the exercise was measured from the beginning of genital masturbation to ejaculation.
UNASSIGNED: We calculated the total time of the exercise, the median time at each start, and the number of dropouts. We performed a pairwise comparison analysis between starts and made a survival curve representing the percentage of men who remained in the exercise.
UNASSIGNED: A total of 481 men with PE participated (mean ± SD; age, 29.25 ± 8.72 years). We found that the expected median survival time until ejaculation was 317.00 seconds (95% CI, 288.34-345.65). However, the average time during stimulation decreased as the exercise progressed, and statistically significant differences were observed in their pairwise comparison (P < .001). Also, the chances of ejaculation increased as the exercise progressed, with 62.16% of the participants ejaculating before the end of the exercise. The results indicated increasing sexual arousal, where stops in stimulation were progressively less effective at maintaining ejaculation times at starts.
UNASSIGNED: We showed that the arousal phase is altered in PE, not the orgasm phase, and this could finally have implications in the diagnosis and/or treatment of this condition.
UNASSIGNED: The analysis of the times at starts and stops in a masturbation exercise in men with PE, had been barely addressed before. In the future, it would be important to verify the effect of stops during sexual intercourse and to incorporate a control group of men without PE.
UNASSIGNED: We propose a new conceptualization and definition for PE: progressive arousal disorder is the inability to modulate, regulate, or decrease arousal during any sexual activity, even with brief stops during sexual stimulation, causing unwanted ejaculation.

BACKGROUND: Among male sexual dysfunctions, erectile dysfunction and early ejaculation have the highest prevalence rates. Here, we tested the influence of lisdexamfetamine dimesylate (Vyas®) on early ejaculation. To this end, we performed a double-blind randomized clinical trial among males with early ejaculation.
METHODS: A total of 46 males with early ejaculation (mean age: 35.23 years) and in stable marital relationships with regular weekly penile-vaginal intercourse were randomly assigned either to the lisdexamfetamine dimesylate condition (30 mg) or to the placebo condition. Compounds were taken about six hours before intended penile-vaginal intercourse. At baseline and four weeks later at the end of the study, participants completed a series of self-rating questionnaires covering early ejaculation. Female partners also rated participants\' early ejaculation profile.
RESULTS: Compared to the placebo condition, dimensions of early ejaculation improved over time in the lisdexamfetamine condition, though improvements were also observed in the placebo condition.
CONCLUSIONS: Among male adults in stable marital relationships with regular weekly penile-vaginal intercourse, lisdexamfetamine dimesylate improved dimensions of early ejaculation. Given that improvements were also observed in the placebo condition, psychological factors such as increased attention to early ejaculation and favorable expectations of the compound should be considered.

BACKGROUND: Comparative studies on differences in sexual function outcomes between homosexual and heterosexual men are sparse and inconclusive.
OBJECTIVE: To systematically evaluate whether, and to what extent, a statistically significant difference exists in the odds of erectile dysfunction (ED) and premature ejaculation (PE) between homosexual and heterosexual men.
METHODS: A thorough search of Medline, SCOPUS, CINAHL, and Web of Science databases was carried out to identify case-control studies comparing the prevalence of ED and PE in homosexual and heterosexual men. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Odds ratios (ORs) of reporting ED and PE were combined using random effect models. The Cochrane Q and I2 tests were carried out to analyze the between-studies heterogeneity. Funnel plots and trim-and-fill analysis were used to assess publication bias.
METHODS: The relationship between sexual orientation and odds of ED and PE was assessed by calculating pooled ORs with a 95% CI.
RESULTS: 4 studies included in the quantitative analysis collectively provided information on 1,807 homosexual and 4,055 heterosexual men. The pooled ORs indicated that homosexual orientation was associated with 1.5-fold higher odds of reporting ED (OR = 1.49, 95% CI = 1.03-2.16; P = .04) and 28.0% lower odds of reporting PE in comparison to the heterosexual orientation (OR = 0.72, 95% CI = 0.52-1.00; P = .05). However, a significant heterogeneity among the studies was observed. Funnel plots revealed a possible publication bias only for the ED analysis, where the trim-and-fill test detected a putative missing study. Nevertheless, even when the pooled estimate was adjusted for publication bias, there was a significantly higher risk of ED in the homosexual group (adjusted OR = 1.60, 95% CI = 1.10-2.30; P = .01).
CONCLUSIONS: These findings can drive future studies on sexual needs and concerns of homosexual men, which might not exactly match those of heterosexual individuals.
UNASSIGNED: This is the first meta-analysis exploring the differences in the prevalence of ED and PE between homosexual and heterosexual men. However, the results should be interpreted with caution, because their generalization could be hindered by the non-probabilistic nature of the samples, and a measurement bias could result from the use of different non-standardized indicators of sexual dysfunctions.
CONCLUSIONS: Homosexual orientation is associated with higher odds of ED and lower odds of PE compared with heterosexual orientation. Further studies are warranted to elucidate the clinical significance of these findings and whether they reflect differences in patterns of sexual lifestyle. Barbonetti A, D\'Andrea S, Cavallo F, et al. Erectile Dysfunction and Premature Ejaculation in Homosexual and Heterosexual Men: A Systematic Review and Meta-Analysis of Comparative Studies. J Sex Med 2019;16:624-632.