Clinical application study of neuromuscular electrical stimulation for premature ejaculation

Estudio de aplicación clínica de la estimulación eléctrica neuromuscular para la eyaculación prematura

Premature ejaculation (PE) is a highly prevalent male sexual dysfunction that significantly impairs psychological well-being, interpersonal relationships, and quality of life. Although pharmacological treatments, such as selective serotonin reuptake inhibitors and topical anesthetics, remain the mainstay of therapy, their clinical effectiveness is often limited by adverse effects, suboptimal efficacy, and poor long-term adherence. In recent years, neuromuscular electrical stimulation (NMES) has emerged as a potential non-pharmacological therapeutic option for PE, attracting increasing clinical and research interest. This narrative review provides a comprehensive overview of the neurophysiological mechanisms underlying ejaculation and the pathophysiology of PE, with a particular focus on the theoretical rationale and clinical evidence supporting NMES therapy. We summarize findings from available animal experiments and human clinical studies evaluating low-frequency electrical stimulation, highlighting its effects on intravaginal ejaculatory latency time, ejaculatory control, and patient-reported outcomes. In addition, we discuss the proposed peripheral and central mechanisms of action of NMES, including modulation of pelvic floor muscle activity, alteration of penile sensory thresholds, regulation of autonomic nervous system balance, modulation of spinal and supraspinal reflex pathways and neurotransmitter signaling, and improvement of pelvic microcirculation. Integrative perspectives from traditional Chinese medicine are also briefly discussed. Overall, existing evidence suggests that NMES may offer a safe and well-tolerated adjunctive approach for the management of PE. However, the current literature is limited by small sample sizes, heterogeneous stimulation protocols, insufficient standardization, and a lack of high-quality randomized controlled trials. Further large-scale, rigorously designed studies are required to establish standardized treatment parameters, clarify underlying mechanisms, and define the long-term efficacy and safety of NMES. Until such evidence is available, NMES should be regarded as an exploratory or adjunctive therapy rather than a first-line treatment for premature ejaculation.

Resumen

La eyaculación prematura (EP) es una disfunción sexual masculina altamente prevalente que afecta significativamente el bienestar psicológico, las relaciones interpersonales y la calidad de vida. Aunque los tratamientos farmacológicos como los inhibidores selectivos de la recaptación de serotonina y los anestésicos tópicos siguen siendo la base principal del tratamiento, su utilidad clínica suele estar limitada por efectos adversos, eficacia subóptima y mala adherencia a largo plazo. En los últimos años, la estimulación neuromuscular eléctrica (ENME) ha surgido como una opción terapéutica no farmacológica potencial para la EP, atrayendo un creciente interés clínico e investigativo. Esta revisión narrativa ofrece una visión integral de los mecanismos neurofisiológicos subyacentes a la eyaculación y la fisiopatología de la EP, con un enfoque particular en la justificación teórica y la evidencia clínica que respalda el tratamiento con ENME. Resumimos los hallazgos de los experimentos animales disponibles y estudios clínicos humanos que evalúan la estimulación eléctrica de baja frecuencia, destacando sus efectos en el tiempo de latencia intravaginal de eyaculación, el control eyaculatorio y los resultados reportados por los pacientes. Además, discutimos los mecanismos periféricos y centrales propuestos de acción de la ENME, incluyendo la modulación de la actividad del suelo pélvico, la alteración de los umbrales sensoriales penianos, la regulación del equilibrio del sistema nervioso autónomo, la modulación de las vías reflejas espinales y supraspinales y la señalización de neurotransmisores, así como la mejora de la microcirculación pélvica. También se discuten brevemente perspectivas integrativas de la medicina tradicional china. En general, la evidencia existente sugiere que la ENME podría ofrecer un enfoque adyuvante seguro y bien tolerado para el manejo de la EP. Sin embargo, la literatura actual está limitada por tamaños de muestra pequeños, protocolos heterogéneos de estimulación, insuficiente estandarización y una falta de ensayos controlados aleatorizados de alta calidad. Se requieren estudios más a gran escala y diseñados rigurosamente para establecer parámetros de tratamiento estandarizados, aclarar los mecanismos subyacentes y definir la eficacia y seguridad a largo plazo de la ENME. Hasta que se disponga de tal evidencia, la ENME debe considerarse como una terapia exploratoria o adjunta, en lugar de un tratamiento de primera línea para la EP.

PE; Ejaculatory response; Physiological mechanisms; NMES therapy

Palabras Clave

PE; Respuesta eyaculatoria; Mecanismos fisiológicos; Terapia con estimulación neuromuscular eléctrica

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