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U. Erkut1, D. Karagözoğlu Coşkunsu2, K. Erkut3, A.V. Özden4
1Institute of Health Sciences/Bahçeşehir University, Physiotherapy and Rehabilitation, Istanbul, Turkey, 2Faculty of Health Sciences/Fenerbahçe University, Physiotherapy and Rehabilitation, Istanbul, Turkey, 3Kurbaa Education and Consultant Center, Istanbul, Turkey, 4Faculty of Health Sciences/Bahçeşehir University, Physiotherapy and Rehabilitation, Istanbul, Turkey
Background: Premature ejaculation (PE) is defined as an intravaginal ejaculation latency time (IELT) of less than 60 seconds and the most common sexual dysfunction among men. There is no published study researching the effect of diafragmatic breathing exercises (DBE) on PE and also no optimal training protocol has been identified.
Purpose: Investigate the effect of DBE on PE and to create a new treatment protocol.
Methods: Sixty two men with PE aged between 20-45 years were included in the study and randomly divided into Group I or Group II (n=1:1). Both groups underwent the treatment protocol includes behavioral therapy (BT) and pelvic floor rehabilitation (PFR) in 4 steps: 1) awareness of the pelvic floor muscles (PFM), 2) PFM specific contraction, 3) using the BT for learning the timing of pre-orgasmic sensation and maintenance of PFM contraction during sensation of pre-orgasm, 4) PFM strengthening exercises. PFM strengthening exercises were given 3 days/week, 2 times/day for 8 weeks. Group I also underwent DBE that were given as 3 s inspiration-7 s expiration, at least 10 times/session for each day, 2 sessions/day, for 8 weeks.
For awareness and specific contraction of PFM, patient was asked to contract his PFM with the cue to stop to urine while performing a digital rectal examination in supine. In order to learn the timing of pre-orgasmic sensation, masturbation exercises were given to the patient with start-stop tecnique. During the cycle of the pre-orgasmic sensation contraction of PFM was requested. After 4 or 5 cycles the patient can let himself reach ejaculation. Result of this training discussed with the patient once a month by phone-call. PFM strengthening exercises comprised sustained for slow (10 s submax. contraction-10 s relaxation x15 times) and fast twitch muscle fibers (1 s contraction-10 s relaxation x10 times).
Outcome measurements were made by a blinded assessor at pre-treatment and at the end of the 8 week (post-treatment). Stop watch was used to calculate IELT, Ultrasound was used to measure PFM strength (US-S) and PFM endurance (US-E) and Elite-HRV device was used to measure autonomic nervous system parameters (Root mean square of successive differences (RMSSD), proportion of NN50 (PNN50), Low frequency power (LF-Power), High frequency power (HF-power), Low frequency/high frequency ratio (LF/HF-ratio)).
For awareness and specific contraction of PFM, patient was asked to contract his PFM with the cue to stop to urine while performing a digital rectal examination in supine. In order to learn the timing of pre-orgasmic sensation, masturbation exercises were given to the patient with start-stop tecnique. During the cycle of the pre-orgasmic sensation contraction of PFM was requested. After 4 or 5 cycles the patient can let himself reach ejaculation. Result of this training discussed with the patient once a month by phone-call. PFM strengthening exercises comprised sustained for slow (10 s submax. contraction-10 s relaxation x15 times) and fast twitch muscle fibers (1 s contraction-10 s relaxation x10 times).
Outcome measurements were made by a blinded assessor at pre-treatment and at the end of the 8 week (post-treatment). Stop watch was used to calculate IELT, Ultrasound was used to measure PFM strength (US-S) and PFM endurance (US-E) and Elite-HRV device was used to measure autonomic nervous system parameters (Root mean square of successive differences (RMSSD), proportion of NN50 (PNN50), Low frequency power (LF-Power), High frequency power (HF-power), Low frequency/high frequency ratio (LF/HF-ratio)).
Results: Twenty nine (mean age=31.4±6.5) in Group I and 30 (mean age=31.3±7.6) in Group II (total 59) completed the study. There was no significant difference between the groups in terms of demographic characteristics and pre-treatment IELT. Both groups showed significant improvement in all measurement parameters (all p<0.001), except LF/HF at post-treatment. When the differences between pre-treatment and posttreatment were compared, IELT (p=0.016), RMSDD (p<0.001), PNN50 (p=0.001), LF Power (p=0.001), HF Power (p=0.006), US-S (p<0.001), US-E (p<0.001) were significant in favor of Group I.
Conclusions: BT and PFR combined protocol, showed increase in IELT, PFM strentgh and endurance and improvements at autonomic nervous system parameters. Adding DBE to this protocol showed better improvements in all parameters.
Implications: This study supported to use of DBE combined with BT and PFR for increasing IELT.
Funding acknowledgements: There is no funding support to declaire
Keywords:
Premature Ejaculation
Diafragmathic Breathing Exercises
Pelvic Floor Rehabilitation
Premature Ejaculation
Diafragmathic Breathing Exercises
Pelvic Floor Rehabilitation
Topics:
Pelvic, sexual and reproductive health
Pelvic, sexual and reproductive health
Did this work require ethics approval? Yes
Institution: Bahcesehir University
Committee: Research Ethics Committee of the Bahcesehir University
Ethics number: approval no: 2021-19/01
All authors, affiliations and abstracts have been published as submitted.
