Effectiveness mechanism of chlomipramine by neurophysiological tests in subjects with true premature ejaculation

Colpi, Giovanni M.; Fanciullacci, F.; Aydos, Kaan; Grugnetti, C.

doi:10.1111/j.1439-0272.1991.tb02494.x

Cited by 28 publications

(7 citation statements)

References 7 publications

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“…Treatment with daily fluoxetine or clomipramine in two independent studies showed significantly increased penile sensory thresholds in men with PE [9,10]. In both cases, there was no change in either the amplitude or latencies of sacral evoked response and cortical SEPs.…”

Section: Data From Clinical Trials Exploring Drug Treatmentsmentioning

confidence: 95%

“…The measurement of intravaginal ELT (IELT) in the male population shows a skewed distribution, and the question of where to apply a particular threshold that defines a particular IELT as being premature or not has been largely academic, as previous definitions of PE did not include such a threshold point. As a result, the population of men with PE in many clinical trials and neurobiological evaluations [9–11] have been largely self‐diagnosed, are somewhat heterogeneous and, in many cases, poorly defined, making comparative evaluations difficult.…”

Section: Aetiology Of Pementioning

confidence: 99%

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The link between penile hypersensitivity and premature ejaculation

Wyllie

2011

BJU International

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Study Type – Aetiology (case control) Level of Evidence 3b What’s known on the subject? and What does the study add? Very little is known about the aetiology of premature ejaculation. This analysis shows that many PE patients have a heightened penile sensitivity. This information could result in the design and development of new drugs. OBJECTIVES To investigate the correlation between penile hypersensitivity and premature ejaculation (PE), as defined by the criteria identified by the International Society of Sexual Medicine (ISSM). Penile hypersensitivity as a cause of PE is based on historical clinical neurophysiological data and clinical efficacy of the topical desensitizing agent PSD502 in the treatment of PE. PSD502 is a eutectic‐like mixture of two local anaesthetics, lidocaine and prilocaine, whose primary action is to reduce neuronal conduction in sensory afferents. METHODS Historical neurophysiological data was reviewed, together with data from the recent PSD502 clinical trials, including the first published double‐blind clinical trial data evaluating a topical desensitizing agent in a population of men with PE, as per the new ISSM definition. The clinical profile of PSD502, based on its local anaesthetic properties, is used as a surrogate index of the role of sensory afferents in the ejaculatory reflex. RESULTS The published data does not support unequivocally penile hypersensitivity as the cause of PE. Interpretation of the data is hampered by the variability of the populations described as having PE across studies. Data from the PSD502 clinical trials clearly shows that PSD502 increases ejaculatory latency, and improves control and sexual satisfaction when applied topically to men with PE 5 min before intercourse, enabling subjects to delay ejaculation up to six times longer than those who used a placebo. CONCLUSION The clinical profile of PSD502 lends credibility to the penile hypersensitivity hypothesis for PE. The predominant action of local anaesthetics is to reduce neuronal firing in sensory afferents; the clinical profile of PSD502, which shows improvement of ejaculatory function in the absence of a generalized reduction in penile sensitivity, can most readily be explained based on an underlying hypersensitivity in patients with PE.

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Section: Data From Clinical Trials Exploring Drug Treatmentsmentioning

confidence: 95%

Section: Aetiology Of Pementioning

confidence: 99%

The link between penile hypersensitivity and premature ejaculation

Wyllie

2011

BJU International

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“…Two findings of further interest have, however, resulted from this line of research: the use of topical anesthetic creams increases the latency of the SSEP wave in men with PE, indicating their direct effect on the penile sensory pathways [27,28]. In contrast, clomipramine does not affect SSEP latency or amplitude, thus supporting the idea that serotonin reuptake inhibitors exert their effects through central (rather than afferent spinal) mechanisms [29].…”

Section: Comment and Conclusionmentioning

confidence: 99%

Standard Operating Procedures for Neurophysiologic Assessment of Male Sexual Dysfunction

Giuliano

Rowland

2013

The Journal of Sexual Medicine

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Introduction Can neurophysiological testing in male patients with sexual dysfunction benefit the decision-making process? The answer remains unclear. Aim To provide standard operating procedures for the neurophysiologic assessment of male sexual dysfunction. Methods Medical literature was reviewed and combined with expert opinion of the authors. Results Bulbocavernosus reflex latency time, pudendal somatosensory evoked potentials, and sympathetic skin responses have been considered as potential candidates for the diagnosis and assessment of erectile dysfunction (ED). Currently, there is no consensus on a standardized methodology for these neurophysiological investigations in the overall assessment of ED. These procedures are unable to assess the integrity of the efferent parasympathetic proerectile penile innervation; accordingly, none of these assessment procedures is recommended for ED patients. Corpus cavernosum electromyography (CC-EMG) can detect abnormalities in cavernous smooth muscle although these alterations can be attributed both to damage to autonomic penile innervation and to degenerative processes of the cavernous smooth muscle. CC-EMG is still considered experimental. Evidence does not support that men with premature ejaculation (PE) are consistently characterized by penile hypersensitivity; accordingly, penile threshold determination is not recommended to in the diagnosis of PE. Neurophysiological investigation of other components of the penile sensory pathways in PE patients has not provided any definitive contribution to the diagnosis. Conclusion No neurophysiological assessment procedures yield additional information that consistently aids in the assessment of PE and ED.

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“…because of the unclarified mechanism and systemic side effects. [5][6][7][8] Attempting to elucidate the etiologic bases of PE, we had investigated penile sensory threshold changes in patients with primary PE, and found that patients with PE…”

Section: The Bcrap Changesmentioning

confidence: 99%

“…[5][6][7][8] Recently, neurobiological studies have made it likely that PE is not only a psychological disorder but a neurobiological phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Effects of Renewal SS-cream on the Bulbocavernosus Reflex (BCR) in Rabbits

Tian

Jin

et al. 2008

Chonnam Med J

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Renewal SS-cream is a topical agent modified from the original SS-cream which is effective in the treatment of premature ejaculation. In this study, the efficacy of renewal SS-cream on premature ejaculation caused by the bulbocavernosus reflex (BCR) was investigated in rabbits. Sixty male New Zealand white rabbits (weights: 2.5∼3.0 kg) were divided into 3 groups randomly. Either renewal or original SS-cream or placebo (provided by CJ Co. LTD) was topically applied to the glans penis of rabbits in a double-blind manner. The bulbocavernosus reflex (BCR) was elicited by electrical stimulation of the glans penis. The latency of BCR (BCRLT) and the amplitude of BCR (BCRAP) were recorded on an electrophysiograph (Poseidomn, Shanghai, China) before and at 10, 30 and 60 min after application of the test agents. Representative tracings of BCRLT and BCRAP were recorded and analyzed. The mean BCRLT values were significantly prolonged in post-application groups of SS-cream Ⓡ and renewal SS-cream Ⓡ , compared with those in pre-application and placebo groups (p＜0.05). There was no significant difference in efficacy between SS-cream Ⓡ and renewal SS-cream Ⓡ groups (p＞0.05). The mean BCRAP showed decreasing tendency following application of SS-cream Ⓡ and renewal SS-cream Ⓡ ; however, they were not significantly different (p＞0.05). Both of original SS-cream Ⓡ and renewal SS-cream Ⓡ prolonged the BCRLT after their application to the glans penis in rabbits. The results indicate that they have local desensitizing effects on the sensory receptors of the dorsal nerve of the glans penis and may help control the ejaculatory reflex in patients with premature ejaculation.

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Effectiveness mechanism of chlomipramine by neurophysiological tests in subjects with true premature ejaculation

Cited by 28 publications

References 7 publications

The link between penile hypersensitivity and premature ejaculation

The link between penile hypersensitivity and premature ejaculation

Standard Operating Procedures for Neurophysiologic Assessment of Male Sexual Dysfunction

Effects of Renewal SS-cream on the Bulbocavernosus Reflex (BCR) in Rabbits

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