Abstract and Introduction
Abstract
Premature ejaculation is a sexual debilitating condition affecting a large number of men worldwide and leading to important dysfunctions influencing the patients' affective and emotional life. Hyaluronic acid is a natural and safe compound that has been widely used not only in the aesthetic medicine clinic, but also for treatment of osteoarthritis. The present study shows the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation. A hundred and ten male patients were treated with hyaluronic acid injections in the deep dermis of their glans penis to increase the volume and the circumference of their penis to prevent male premature ejaculation and improve the patients' and their partners' sexual satisfaction. The intravaginal ejaculation latency time increased significantly from a baseline value of 88.34±3.14 s to 293.14±8.16 s after 6 months from the procedure. Maximal glandular circumference increased from 98.51±0.71 mm to 114.35±0.66 mm after 6 months from the procedure. At 6-month follow-up, patients' self-rated satisfaction was 5.3±0.07 (range: 4–6). At the follow-up, partners' self-rated satisfaction was 5.1±0.09 (range: 3–6). The present clinical study showed that hyaluronic acid injection is a promising treatment for premature ejaculation. The effect of the procedure in the long-term follow-up needs to be clarified.
Introduction
Premature ejaculation (PE) is a common sexual debilitating dysfunction affecting 20–30% of all men worldwide. A definition of PE has not been standardized yet because of the large and controversial debate surrounding this term. However, in medical practice, this term is commonly defined as 'the ejaculation that regularly occurs at or around initial vaginal penetration', and it is not the result of a prolonged absence from sexual activity. To achieve a precise diagnosis, the specialist often relies only on the patient's history without further laboratory or physiological tests. PE pharmacological treatment includes the use of antidepressants, local anesthetic agents and phosphodiesterase type 5 inhibitors; currently, dapoxetine represents the only short-acting selective serotonin reuptake inhibitor licensed for PE treatment. Filler materials have been extensively used for soft tissue augmentation in aesthetic surgery, but it is only recently that they have found an important application in the field of glans penis augmentation allowing to achieve a volume sufficient to prevent PE. Abdallah et al. evaluated the effect of hyaluronic acid in 60 men affected by PE, demonstrating that intravaginal ejaculation latency time (IELT) increased 1 month after the injection of the compound in their penis. Furthermore, in 2008, another study reported positive results in a 5-year long-term study in which hyaluronic acid gel was injected in 38 men. They demonstrated that IELT decreased if compared to 6-month follow-up, but it was still higher if compared with the pretreatment period. The patients and their partners reported high satisfaction for the procedure consisting in 76% and 63%, respectively.
Aim
The aim of this study was to investigate the effectiveness of hyaluronic acid injection in the deep dermis of the glans penis to increase the volume and the circumference of the penis to prevent male PE and improve the patients' and their partners' sexual satisfaction. The rationale for this procedure is to increase the dermis thickness of the glans embedding the nervous fibres in highly cross-linked hyaluronic acid atmosphere to reduce sensitivity of penile reflexes.