Neuromodulation for Premature Ejaculation.
Shockwave therapy, specifically focused shockwave therapy (FST), is an emerging treatment for various urological conditions, including erectile dysfunction and, to a lesser extent, premature ejaculation (PE).
While its use for PE is less studied and not as well-established as for erectile dysfunction, the proposed mechanism involves neuromodulation and tissue remodeling, which may indirectly influence ejaculatory control.
Shockwave therapy can neuromodulate the penis to help with premature ejaculation:
1. What is Focused Shockwave Therapy?
FST involves delivering low-energy electromagnetically generated shockwaves to targeted tissues to the penis using a specialized handheld wand.
The therapy is non-invasive, painless, and typically involves multiple sessions.
True shockwaves (focused or linear NOT radial or acoustic) stimulate biological responses in the targeted tissue, including blood vessels, nerves, and connective tissue.
2. Neuromodulation and Premature Ejaculation
Premature ejaculation is often linked to hypersensitivity of the penile nerves, overactive reflex pathways, or dysregulation of the ejaculatory reflex, which involves complex interactions between the peripheral and central nervous systems.
Neuromodulation refers to altering nerve activity to restore or improve function.
FST may influence the penile nerves and related pathways in the following ways:
a. Modulation of Nerve Sensitivity
- Mechanism: The acoustic waves from FST may stimulate sensory nerve endings in the penis, potentially desensitizing hyperactive nerves. This could reduce the hypersensitivity that contributes to rapid ejaculation.
- Effect: By altering the excitability of sensory nerves, FST may help prolong the latency of the ejaculatory reflex, allowing better control over ejaculation timing.
b. Stimulation of Neurogenesis and Nerve Repair
- Mechanism: FST promotes the release of growth factors such as vascular endothelial growth factor (VEGF) and brain-derived neurotrophic factor (BDNF). These factors may support nerve regeneration or remodeling in the penile tissue.
- Effect: Improved nerve function or reduced aberrant signaling in the penile nerves could help regulate the ejaculatory reflex, potentially addressing neurological contributors to PE.
c. Improved Blood Flow and Tissue Health
- Mechanism: FST enhances angiogenesis (new blood vessel formation) and improves microvascular circulation in the penile tissue. Better vascular health may support overall penile function, including the neural pathways involved in ejaculation.
- Effect: Enhanced tissue health may indirectly stabilize nerve signaling, reducing overstimulation that could trigger premature ejaculation.
d. Central Nervous System Effects
- Mechanism: While FST is applied locally to the penis, it may influence central nervous system pathways involved in ejaculation by modulating peripheral nerve inputs. This could affect the spinal and brain centers responsible for ejaculatory control.
- Effect: By altering the feedback loops between the penis and the central nervous system, FST may help recalibrate the ejaculatory reflex, potentially delaying ejaculation.
3. Scientific Evidence for PE
- Limited but Promising Data: Most research on FST focuses on erectile dysfunction, where it has shown benefits in improving penile blood flow and tissue health. For premature ejaculation, the evidence is less robust, but some studies suggest potential benefits, particularly in cases where PE is linked to penile hypersensitivity or poor neural regulation.
- Study Example: Small-scale clinical trials and pilot studies (e.g., those published in journals like Urology or Andrology) have explored FST for PE. Some report improvements in intravaginal ejaculation latency time (IELT) and patient-reported ejaculatory control, possibly due to neuromodulatory effects. However, larger, randomized controlled trials are needed to confirm efficacy.
- Combination Therapy: FST is sometimes used alongside other treatments for PE, such as behavioral therapy, SSRIs (selective serotonin reuptake inhibitors), or topical desensitizing agents, to enhance outcomes.
4. How the Therapy is Administered
- Procedure: A device delivers low-intensity shockwaves to specific areas of the penis (e.g., shaft, glans, or perineal region) over several sessions (typically 6–12 sessions, 1–2 times per week). Each session lasts about 15–20 minutes.
- Targeting Nerves: The shockwaves are directed at areas rich in sensory nerves (e.g., the glans penis) to modulate nerve activity and sensitivity.
- Safety: FST is generally well-tolerated, with minimal side effects (e.g., mild discomfort or temporary redness).
5. Limitations and Considerations
- Not a Primary Treatment: FST is not a first-line treatment for PE. Standard treatments like behavioral therapy, SSRIs, or topical anesthetics are more established.
- Individual Variability: The effectiveness of FST for PE may depend on the underlying cause of PE (e.g., neurological, psychological, or vascular). It may be more effective for PE caused by penile hypersensitivity than for psychological factors.
- Research Gaps: The exact mechanisms by which FST affects ejaculatory control are not fully understood, and more research is needed to standardize protocols and confirm benefits.
- Cost and Availability: FST can be expensive and is not always covered by insurance, especially for PE, as it is considered experimental for this indication.
6. Conclusion
Shockwave therapy (FST) may help with premature ejaculation by neuromodulating the penile nerves, reducing hypersensitivity, promoting nerve repair, and improving tissue health. These effects could prolong ejaculatory latency and enhance control. However, while promising, the evidence for FST in treating PE is preliminary, and it is not a standard treatment. Patients considering this therapy should consult a urologist or sexual health specialist to discuss its suitability, potential benefits, and integration with other treatments.
Evidence:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9399540/
https://www.mddionline.com/components/using-neuromodulation-to-treat-premature-ejaculation
