A reassessment of penile sensory pathways and effects of prilocaine–lidocaine cream in primary premature ejaculation

Abstract

To assess the penile sensory pathway abnormalities of the patients with primary premature ejaculation (PPE) and effects of prilocaine-lidocaine (PLA) cream, we enrolled 82 PPE patients and 34 normal potent male volunteers. Somatosensory evoked potentials of dorsal nerve (DNSEP) and glans penis (GPSEP) were performed in each subject. In addition, among the 82 patients, 60 were selected and randomly divided into PLA and placebo subgroups, each with 30 patients. Cream was applied evenly on the glans penis for 10 min and washed off just before DNSEP and GPSEP were repeatedly measured. Mean latencies of DNSEP and GPSPE were both remarkably shorter in the patients than those in the normal potent men (P<0.001, both). Compared with the control group, the mean amplitudes of GPSEP were significantly greater in the patient group (P<0.001), but not considerably on the amplitudes of DNSEP (P=0.229). After cream application, the latencies and amplitudes of both DNSEP and GPSEP were significantly prolonged and reduced, respectively, in the PLA cream subgroup (P<0.001, all). These results showed that hyperexcitable ejaculatory reflex neurological factor was linked to PPE, because of hypersensitivity of the penile, accelerated conduction and cortical amplification of the genital stimuli. The PLA cream could delay sensory latency and decrease glans penile hyperexcitability, which may be the mechanism for PPE treatment.

No effect of abstinence time on nerve electrophysiological test in premature ejaculation patients

“… 19 The DNSEP is an electroencephalographic response that sends stimuli to the somatic sensory area of penile dorsal nerve, and the GPSEP is a modification of the DNSEP that sends stimuli to the glans penis. 6 The PSSR is widely considered as a functional test of the sympathetic nervous system, as an assessment of small fiber function, and is frequently used for the diagnosis of thin, unmyelinated fiber lesions in diabetic neuropathy and uremic neuropathy in clinical neurological practice. It is a multisynaptic somatic sympathetic reflex, and the central control is located in the brain.…”

“…In this study, the latencies of SEPs and PSSR of PE patients were shorter than those of control subjects; these findings correspond with our previous studies. 4 5 6 …”

“…The methods of the SEPs and PSSR were previously described in detail. 5 6 All the tests were carried out using the Nicolet Viking Quest Electromyograph/Evoked Potential machine (Natus Medical Inc., Middleton, WI, USA). SEPs consisted of DNSEP and GPSEP, with stimulatory electrodes on different places.…”

“…The efficacy of local anesthetics was better in patients with abnormal latency of GPSEP and/or DNSEP than those with normal latency, while the efficacy of selective serotonin reuptake inhibitors (SSRIs) was better in patients with abnormal latency of PSSR than those with normal result. 4 5 6 Interestingly, a study showed that longer ejaculatory abstinence may lead to a shorter intravaginal ejaculatory latency time (IELT) in healthy people. 7 In addition, there is a postejaculation refractory time (PERT), or male refractory period (MRP), even after a single ejaculation in most human males, during which erection and ejaculation is inhibited.…”

Oral dapoxetine versus topical lidocaine as on‐demand treatment for lifelong premature ejaculation: A randomised controlled trial

“…Different formulas and concentrations of topical anaesthetics were used with variable increases in the recorded IELT. Among these formulas are eutectic mixtures of local anaesthetic cream containing lidocaine and prilocaine (Atikeler, Gecit, & Senol, 2002; Busato & Galindo, 2004; Xia et al, 2014), topical eutectic‐like mixture spray containing lidocaine and prilocaine (Carson & Wyllie, 2010; Dinsmore et al, 2007; Dinsmore & Wyllie, 2009), lidocaine gel (Gameel et al, 2013), lidocaine spray (Dell’Atti, Galosi, & Ippolito, 2017; Steggall, Fowler, & Pryce, 2008) and fortacin (Porst & Burri, 2017, 2019). In their meta‐analysis, Jian et al (2018) showed a success rate of 90% of using topical anaesthetics in improving the IELT in PE cases.…”