Differential efficacy of pelvic floor muscle training in primary versus acquired premature ejaculation: an 8-week comparative study using non-invasive biomechanical assessment.

BACKGROUND

Premature ejaculation (PE), including lifelong (LPE) and acquired (APE) subtypes, negatively affects men's sexual, psychological, and relational well-being.

AIM: This study aimed to investigate pelvic floor muscle function differences between healthy individuals and premature ejaculation patients and evaluate the efficacy of pelvic floor muscle training in improving premature ejaculation subtype symptoms using an innovative assessment approach.

METHODS

In this 8-week prospective study, 199 men were enrolled (LPE, n = 66; APE, n = 83; healthy controls [HC], n = 50). PE participants received PFMT comprising PFM awareness, biofeedback-based strengthening, and integration into sexual activity. PFM function was measured with a perineometry/biofeedback device; anxiety and depression with 7-item Generalized Anxiety Disorder scale (GAD-7) and 9-item Patient Health Questionnaire (PHQ-9); and intravaginal ejaculatory latency time (IELT) by stopwatch.

OUTCOME: The primary outcomes were improvements in pelvic floor muscle function, ejaculatory latency time, and premature ejaculation symptom severity.

RESULTS

After 8 weeks of PFMT, significant improvements were observed in both groups. In the APE group, IELT increased from a median of 120 s to 180 s, and premature ejaculation diagnostic tool (PEDT) scores decreased by 2 points (P < 0.001). In the LPE group, IELT increased from 30 s to 60 s, and PEDT scores decreased by 1.5 points (P < 0.001). Reductions in PHQ-9 (APE: -3.0; LPE: -2.0) and GAD-7 (APE: -3.0; LPE: -1.0) scores were also observed, with APE showing greater overall benefits. No significant baseline differences were found in PFM strength; however, both groups showed post-training increases in maximum contraction pressure and sustained contraction average pressure (all P < 0.001).

CLINICAL IMPLICATIONS: Pelvic floor muscle training appears effective in addressing psychological and physical symptoms of premature ejaculation, particularly for acquired premature ejaculation.

STRENGTHS AND LIMITATIONS: This study is the first to use a non-invasive biomechanical approach to compare pelvic floor muscle function between healthy individuals and PE patients. It also uniquely examines how PFM training affects different PE subtypes, offering insights for more targeted treatment strategies. However, the research is limited by the absence of sham controls, which are necessary to distinguish placebo effects, and it also lacks long-term follow-up to assess enduring outcomes.

CONCLUSION

Pelvic floor muscle training improves ejaculatory control and psychological outcomes in premature ejaculation patients, with greater efficacy observed in acquired premature ejaculation; further research is needed to explore long-term effects and underlying mechanisms.