{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:20:59Z","timestamp":1790745659610,"version":"4.1.0"},"reference-count":126,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T00:00:00Z","timestamp":1693958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Ejaculatory dysfunction (EjD) is a common male sexual disorder that includes premature ejaculation, delayed ejaculation, retrograde ejaculation, and anejaculation. Although psychological and pharmacological treatments are available, traditional, complementary, and alternative medicine (TCAM) is reportedly used. However, the clinical evidence for TCAM in EjD remains unclear. Therefore, this study aims to systematically review human clinical trials investigating the use of TCAM to treat EjD. Materials and Methods: A systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted by searching Scopus and PubMed databases. Controlled clinical trials investigating a cohort of male patients diagnosed primarily with EjD and undergoing any TCAM intervention compared to any comparison group were included. Quality of the studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials. Results: Following article screening, 22 articles were included. Of these, 21 investigated TCAM in premature ejaculation, and only 1 investigated TCAM in retrograde ejaculation. Different TCAM categories included studies that investigated lifestyle, exercise and\/or physical activities (n = 7); herbal medicine supplements (n = 5); topical herbal applications (n = 4); acupuncture or electroacupuncture (n = 3); vitamin, mineral and\/or nutraceutical supplements (n = 1); hyaluronic acid penile injection (n = 1); and music therapy (n = 1). Only 31.8% (n = 7) of the included studies were found to have a low risk of bias. The available studies were widely heterogenous in the TCAM intervention investigated and comparison groups used. However, the included studies generally showed improved outcomes intra-group and when compared to placebo. Conclusions: Different TCAM interventions may have an important role particularly in the management of PE. However, more studies using standardized interventions are needed.<\/jats:p>","DOI":"10.3390\/medicina59091607","type":"journal-article","created":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T10:14:14Z","timestamp":1693995254000},"page":"1607","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Traditional, Complementary and Alternative Medicines in the Treatment of Ejaculatory Disorders: A Systematic Review"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3003-8048","authenticated-orcid":false,"given":"Kristian","family":"Leisegang","sequence":"first","affiliation":[{"name":"School of Natural Medicine, University of the Western Cape, Bellville 7535, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0804-2278","authenticated-orcid":false,"given":"Chinyerum Sylvia","family":"Opuwari","sequence":"additional","affiliation":[{"name":"Department of Medical Biosciences, University of the Western Cape, Bellville 7535, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0726-4263","authenticated-orcid":false,"given":"Faith","family":"Moichela","sequence":"additional","affiliation":[{"name":"Department of Medical Biosciences, University of the Western Cape, Bellville 7535, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5926-6407","authenticated-orcid":false,"given":"Renata","family":"Finelli","sequence":"additional","affiliation":[{"name":"Create Fertility, London EC2V 6ET, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1002\/rmb2.12289","article-title":"Clinical review of ejaculatory dysfunction","volume":"18","author":"Otani","year":"2019","journal-title":"Reprod. Med. Biol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s00345-004-0486-9","article-title":"Ejaculatory disorders: Epidemiology and current approaches to definition, classification and subtyping","volume":"23","author":"Jannini","year":"2005","journal-title":"World J. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1111\/j.1743-6109.2012.02824.x","article-title":"Standard operating procedures in the disorders of orgasm and ejaculation","volume":"10","author":"McMahon","year":"2013","journal-title":"J. Sex. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"592","DOI":"10.21037\/tau.2016.06.05","article-title":"Retrograde ejaculation, painful ejaculation and hematospermia","volume":"5","author":"Parnham","year":"2016","journal-title":"Transl. Androl. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"541","DOI":"10.21037\/tau.2016.05.10","article-title":"Epidemiology of delayed ejaculation","volume":"5","author":"Mollaioli","year":"2016","journal-title":"Transl. Androl. Urol."},{"key":"ref_6","first-page":"E523","article-title":"The role of ejaculatory dysfunction on male infertility","volume":"171","author":"Mazzilli","year":"2020","journal-title":"Clin. Ter."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1002\/sm2.27","article-title":"An evidence-based unified definition of lifelong and acquired premature ejaculation: Report of the Second International Society for Sexual Medicine ad hoc committee for the definition of premature ejaculation","volume":"2","author":"Serefoglu","year":"2014","journal-title":"Sex. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1111\/j.1743-6109.2005.00070.x","article-title":"A multinational population survey of intravaginal ejaculation latency time","volume":"2","author":"Waldinger","year":"2005","journal-title":"J. Sex. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/j.1464-410X.2008.08041.x","article-title":"The premature ejaculation profile: Validation of self-reported outcome measures for research and practice","volume":"103","author":"Patrick","year":"2009","journal-title":"BJU Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1038\/sj.ijir.3901567","article-title":"Further evidence of the reliability and validity of the premature ejaculation diagnostic tool","volume":"19","author":"Symonds","year":"2007","journal-title":"Int. J. Impot. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1111\/j.1743-6109.2006.00213.x","article-title":"Development and evaluation of the Arabic index of premature ejaculation (AIPE)","volume":"4","author":"Arafa","year":"2007","journal-title":"J. Sex. Med."},{"key":"ref_12","first-page":"121","article-title":"Sexual function of premature ejaculation patients assayed with Chinese Index of Premature Ejaculation","volume":"6","author":"Yuan","year":"2004","journal-title":"Asian J. Androl."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.urology.2007.02.036","article-title":"Development and validation of four-item version of Male Sexual Health Questionnaire to assess ejaculatory dysfunction","volume":"69","author":"Rosen","year":"2007","journal-title":"Urology"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Jern, P., Piha, J., and Santtila, P. (2013). Validation of three early ejaculation diagnostic tools: A composite measure is accurate and more adequate for diagnosis by updated diagnostic criteria. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0077676"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"470","DOI":"10.21037\/tau.2016.05.04","article-title":"Patient reported outcomes in the assessment of premature ejaculation","volume":"5","author":"Althof","year":"2016","journal-title":"Transl. Androl. Urol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.fertnstert.2011.11.019","article-title":"The management of retrograde ejaculation: A systematic review and update","volume":"97","author":"Jefferys","year":"2012","journal-title":"Fertil. Steril."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s11930-006-0016-4","article-title":"Retrograde ejaculation: Etiology, diagnosis, and management","volume":"3","author":"Kendirci","year":"2006","journal-title":"Curr. Sex. Health Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1016\/j.fertnstert.2015.09.029","article-title":"Delayed orgasm and anorgasmia","volume":"104","author":"Jenkins","year":"2015","journal-title":"Fertil. Steril."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Nguyen, V., Dolendo, I., Uloko, M., Hsieh, T.C., and Patel, D. (Int. J. Impot. Res., 2023). Male delayed orgasm and anorgasmia: A practical guide for sexual medicine providers, Int. J. Impot. Res., online ahead of print.","DOI":"10.1038\/s41443-023-00692-7"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"686","DOI":"10.21037\/tau.2018.06.20","article-title":"Contemporary management of ejaculatory dysfunction","volume":"7","author":"Gray","year":"2018","journal-title":"Transl. Androl. Urol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1177\/1756287211424172","article-title":"Medical therapy for premature ejaculation","volume":"3","author":"Mohee","year":"2011","journal-title":"Ther. Adv. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1111\/imj.12344","article-title":"Management of ejaculatory dysfunction","volume":"44","author":"Mcmahon","year":"2014","journal-title":"Intern. Med. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.sxmr.2020.10.005","article-title":"Botanical medicine and natural products used for erectile dysfunction","volume":"9","author":"Sin","year":"2021","journal-title":"Sex. Med. Rev."},{"key":"ref_24","first-page":"3","article-title":"Recent studies on aphrodisiac herbs for the management of male sexual dysfunction\u2014A review","volume":"68","author":"Malviya","year":"2011","journal-title":"Acta Pol. Pharm.-Drug Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1002\/ptr.5074","article-title":"Traditional Plant Aphrodisiacs and Male Sexual Dysfunction","volume":"28","author":"Bella","year":"2014","journal-title":"Phyther. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1080\/2090598X.2021.1926753","article-title":"Alternative medicine and herbal remedies in the treatment of erectile dysfunction: A systematic review","volume":"19","author":"Leisegang","year":"2021","journal-title":"Arab. J. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1515\/chem-2022-0204","article-title":"Ethnopharmacological study of medicinal plants in Kastamonu province (T\u00fcrkiye)","volume":"20","author":"Sen","year":"2022","journal-title":"Open Chem."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.pld.2022.03.005","article-title":"An ethnobotanical study of medicinal plants in G\u00fcce district, north-eastern Turkey","volume":"44","year":"2022","journal-title":"Plant Divers."},{"key":"ref_29","first-page":"7160","article-title":"Medicinal plants used in folk medicine of Ak\u00e7aabat district (Turkey)","volume":"31","author":"Akbulut","year":"2022","journal-title":"Fresenius Environ. Bull."},{"key":"ref_30","unstructured":"(2023, July 03). WHO Traditional Medicine Strategy: 2014\u20132023. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241506096."},{"key":"ref_31","first-page":"50","article-title":"Development and classification of an operational definition of complementary and alternative medicine for the Cochrane Collaboration","volume":"17","author":"Manheimer","year":"2011","journal-title":"Altern. Ther. Health Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Ng, J.Y., Dhawan, T., Dogadova, E., Taghi-Zada, Z., Vacca, A., Wieland, L.S., and Moher, D. (2022). Operational definition of complementary, alternative, and integrative medicine derived from a systematic search. BMC Complement. Med. Ther., 22.","DOI":"10.1186\/s12906-022-03556-7"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"489","DOI":"10.2147\/nedt.2006.2.4.489","article-title":"New agents in the treatment of premature ejaculation","volume":"2","author":"McMahon","year":"2006","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.53730\/ijhs.v6nS6.10294","article-title":"The role of vitamin D supplementation in lifelong premature ejaculation","volume":"6","author":"Attia","year":"2022","journal-title":"Int. J. Health Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/j.eururo.2013.08.018","article-title":"Results from a prospective observational study of men with premature ejaculation treated with dapoxetine or alternative care: The PAUSE study","volume":"65","author":"Mirone","year":"2014","journal-title":"Eur. Urol."},{"key":"ref_38","first-page":"89","article-title":"Retarded ejaculation: Adjunctive treatment by hypnotically induced dreams in the context of sex therapy","volume":"10","author":"Pettitt","year":"1982","journal-title":"Aust. J. Clin. Exp. Hypn."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.mehy.2010.11.006","article-title":"Folic acid supplementation as adjunctive treatment premature ejaculation","volume":"76","author":"Yin","year":"2011","journal-title":"Med. Hypotheses"},{"key":"ref_40","first-page":"181","article-title":"Ejaculatio deficiens treated with acupuncture. Report of 110 cases","volume":"4","author":"Zhang","year":"1984","journal-title":"J. Tradit. Chin. Med."},{"key":"ref_41","first-page":"286","article-title":"Treatment of functional retrograde ejaculation with acupuncture and TCM herbal drugs","volume":"22","author":"Xiao","year":"2002","journal-title":"J. Tradit. Chin. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2506","DOI":"10.1111\/jsm.12272","article-title":"Safety and efficacy of epelsiban in the treatment of men with premature ejaculation: A randomized, double-blind, placebo-controlled, fixed-dose study","volume":"10","author":"Shinghal","year":"2013","journal-title":"J. Sex. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1016\/j.jsxm.2019.12.014","article-title":"A double blind, placebo controlled, randomized trial to evaluate the efficacy and tolerability of on-demand oral Pregablin (150 mg and 75 mg) in treatment of premature ejaculation","volume":"17","author":"Ramadan","year":"2020","journal-title":"J. Sex. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jsxm.2020.09.012","article-title":"A double-blind, placebo-controlled parallel group study to evaluate the effect of a single oral dose of 5-HT1A antagonist GSK958108 on ejaculation latency time in male patients suffering from premature ejaculation","volume":"18","author":"Migliorini","year":"2021","journal-title":"J. Sex. Med."},{"key":"ref_45","first-page":"484","article-title":"A new sperm collection method for treatment of retrograde ejaculation","volume":"89","author":"Tsai","year":"1990","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2486","DOI":"10.1016\/S0022-5347(05)64174-2","article-title":"A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation","volume":"168","author":"Salonia","year":"2002","journal-title":"J. Urol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1038\/ijir.2013.13","article-title":"A clinical study to assess the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation","volume":"25","author":"Littara","year":"2013","journal-title":"Int. J. Impot. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"397","DOI":"10.3349\/ymj.1995.36.5.397","article-title":"Sensory evoked potential and effect of SS-cream in premature ejaculation","volume":"36","author":"Xin","year":"1995","journal-title":"Yonsei Med. J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3349\/ymj.2000.41.1.29","article-title":"Penile vibratory threshold changes with various doses of SS-cream in patients with primary premature ejaculation","volume":"41","author":"Xin","year":"2000","journal-title":"Yonsei Med. J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"631","DOI":"10.4103\/aja.aja_34_19","article-title":"Regular penis-root masturbation, a novel behavioral therapy in the treatment of primary premature ejaculation","volume":"21","author":"Ma","year":"2019","journal-title":"Asian J. Androl."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0003-9993(95)80044-1","article-title":"Vibratory stimulation for treatment of anejaculation in quadriplegic men","volume":"76","author":"Pryor","year":"1995","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.3892\/etm.2016.3595","article-title":"Rhodiola rosea, folic acid, zinc and biotin (EndEP \u00ae) is able to improve ejaculatory control in patients affected by lifelong premature ejaculation: Results from a phase I-II study","volume":"12","author":"Cai","year":"2016","journal-title":"Exp. Ther. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/MJT.0b013e318209e006","article-title":"Efficacy and safety of two polyherbal combinations: E-MA-H and E-MA-HP in male sexual dysfunction","volume":"18","author":"Kulkarni","year":"2011","journal-title":"Am. J. Ther."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"12139","DOI":"10.1155\/2014\/121396","article-title":"Alga Ecklonia bicyclis, Tribulus terrestris, and glucosamine oligosaccharide improve erectile function, sexual quality of life, and ejaculation function in patients with moderate mild-moderate erectile dysfunction: A prospective, randomized, placebo-contr","volume":"2014","author":"Sansalone","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.jsxm.2016.03.372","article-title":"Erectile and ejaculatory function preserved with convective water vapor energy treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: Randomized controlled study","volume":"13","author":"McVary","year":"2016","journal-title":"J. Sex. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1038\/sj.ijir.3900630","article-title":"Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation","volume":"13","year":"2001","journal-title":"Int. J. Impot. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e13915","DOI":"10.1111\/and.13915","article-title":"Safety and efficacy of traditional Chinese medicine, Qiaoshao formula, combined with dapoxetine in the treatment of premature ejaculation: An open-label, real-life, retrospective multicentre study in Chinese men","volume":"53","author":"Guo","year":"2021","journal-title":"Andrologia"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.1111\/j.1743-6109.2007.00603.x","article-title":"Yoga in premature ejaculation: A comparative trial with fluoxetine","volume":"4","author":"Dhikav","year":"2007","journal-title":"J. Sex. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e12799","DOI":"10.1111\/and.12799","article-title":"Impact of physical activity on patient self-reported outcomes of lifelong premature ejaculation patients: Results of a prospective, randomised, sham-controlled trial","volume":"50","author":"Kilinc","year":"2018","journal-title":"Andrologia"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1111\/j.1365-2605.2011.01243.x","article-title":"A prospective randomized study to compare pelvic floor rehabilitation and dapoxetine for treatment of lifelong premature ejaculation","volume":"35","author":"Pastore","year":"2012","journal-title":"Int. J. Androl."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.esxm.2020.05.003","article-title":"Smartphone-based therapeutic exercises for men affected by premature ejaculation: A pilot study","volume":"8","author":"Optale","year":"2020","journal-title":"Sex. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e13473","DOI":"10.1111\/and.13473","article-title":"The efficacy of regular penis-root masturbation, versus Kegel exercise in the treatment of primary premature ejaculation: A quasi-randomised controlled trial","volume":"52","author":"Jiang","year":"2020","journal-title":"Andrologia"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez, J.E., Marzo, J.C., and Piqueras, J.A. (2019). Efficacy of Sphincter Control Training (SCT) in the treatment of premature ejaculation, a new cognitive behavioral approach: A parallel-group randomized, controlled trial. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0212274"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1007\/s10508-019-01520-0","article-title":"Vibrator-assisted start\u2013stop exercises improve premature ejaculation symptoms: A randomized controlled trial","volume":"49","author":"Ventus","year":"2020","journal-title":"Arch. Sex. Behav."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Asgari, S.A., Falahatkar, S., Sharifi, S.H.H., Enshaei, A., Jalili, M.F., and Allahkhah, A. (2010). Safety and efficacy of the herbal drug hypericum perforatum for the treatment of premature ejaculation. UroToday Int. J., 3.","DOI":"10.3834\/uij.1944-5784.2010.06.21"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"171","DOI":"10.4081\/aiua.2016.3.171","article-title":"A combination of tryptophan, Satureja montana, Tribulus terrestris, Phyllanthus emblica extracts is able to improve sexual quality of life in patient with premature ejaculation","volume":"88","author":"Sansalone","year":"2016","journal-title":"Arch. Ital. Urol. Androl."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1089\/jmf.2019.4661","article-title":"A randomized double-blind placebo-control study to assess the efficacy and safety of OLNP-05 versus placebo for the treatment of subjects with premature ejaculation","volume":"23","author":"Panda","year":"2020","journal-title":"J. Med. Food"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1007\/s11655-016-2456-7","article-title":"Efficacy and safety of Qiaoshao Formula on patients with lifelong premature ejaculation of Gan (Liver) depression and Shen (Kidney) deficiency syndrome: A randomized controlled trial","volume":"22","author":"Guo","year":"2016","journal-title":"Chin. J. Integr. Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s11655-007-0185-7","article-title":"Clinical study on the treatment of premature ejaculation by Uighur medicine gu-jing-mai-si-ha tablet","volume":"13","author":"Song","year":"2007","journal-title":"Chin. J. Integr. Med."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"603","DOI":"10.4314\/ahs.v17i3.2","article-title":"Efficacy of combined traditional Chinese medicine spray with premature ejaculation desensitization therapy for the treatment of primary premature ejaculation","volume":"17","author":"Cui","year":"2017","journal-title":"Afr. Health Sci."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/sj.ijir.3900431","article-title":"Safety and efficacy study with various doses of SS-cream in patients with premature ejaculation in a double-blind, randomized, placebo controlled clinical study","volume":"11","author":"Choi","year":"1999","journal-title":"Int. J. Impot. Res."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/S0090-4295(99)00415-X","article-title":"Clinical study of SS-cream in patients with lifelong premature ejaculation","volume":"55","author":"Choi","year":"2000","journal-title":"Urology"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.aimed.2020.09.002","article-title":"Effect of a topical polyherbal formulation for premature ejaculation: A randomized triple-blind placebo-controlled trial","volume":"8","author":"Shirzad","year":"2021","journal-title":"Adv. Integr. Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.eururo.2011.01.019","article-title":"Acupuncture versus paroxetine for the treatment of premature ejaculation: A randomized, placebo-controlled clinical trial","volume":"59","author":"Sunay","year":"2011","journal-title":"Eur. Urol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"8331688","DOI":"10.1155\/2022\/8331688","article-title":"Study on the efficacy of electric acupuncture in the treatment of premature ejaculation based on testosterone level","volume":"2022","author":"Lu","year":"2022","journal-title":"J. Healthc. Eng."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1159\/000445253","article-title":"A prospective randomized controlled study to compare acupuncture and dapoxetine for the treatment of premature ejaculation","volume":"97","author":"Sahin","year":"2016","journal-title":"Urol. Int."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1590\/s1677-5538.ibju.2016.0468","article-title":"Randomized crossover trial of amoxapine versus vitamin B12 for retrograde ejaculation","volume":"43","author":"Hu","year":"2017","journal-title":"Int. Braz. J. Urol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1038\/s41443-018-0104-9","article-title":"Hyaluronic acid injection in glans penis for treatment of premature ejaculation: A randomized controlled cross-over study","volume":"31","author":"Alahwany","year":"2019","journal-title":"Int. J. Impot. Res."},{"key":"ref_79","first-page":"519","article-title":"Nueva terapia conductual en el tratamiento de la eyaculaci\u00f3n precoz adquirida: Un estudio comparativo de escuchar m\u00fasica","volume":"74","author":"Micoogullari","year":"2021","journal-title":"Arch. Esp. Urol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.esxm.2016.08.002","article-title":"Complementary and alternative medicine for management of premature ejaculation: A systematic review","volume":"5","author":"Cooper","year":"2017","journal-title":"Sex. Med."},{"key":"ref_81","first-page":"376","article-title":"Yimusake alone or combined with trazodone hydrochloride for primary premature ejaculation","volume":"18","author":"Xu","year":"2012","journal-title":"Zhonghua Nan Ke Xue"},{"key":"ref_82","first-page":"13","article-title":"Control study on acupuncture and medication for treatment of primary simple premature ejaculation","volume":"29","author":"Chen","year":"2009","journal-title":"Zhongguo Zhen Jiu"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/jcpt.12115","article-title":"An improved dosage regimen of sertraline hydrochloride in the treatment for premature ejaculation: An 8-week, single-blind, randomized controlled study followed by a 4-week, open-label extension study","volume":"39","author":"Xu","year":"2014","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_84","first-page":"443","article-title":"Efficacy of Qilin Pills combined with sertraline in the treatment of secondary non-consolidated kidney qi premature ejaculation","volume":"21","author":"Li","year":"2015","journal-title":"Zhonghua Nan Ke Xue"},{"key":"ref_85","first-page":"43","article-title":"Clinical study on treatment of premature ejaculation with fluoxetine hydrochloride and tamsulosin","volume":"24","author":"Sun","year":"2010","journal-title":"Chin. J. Androl."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"42","DOI":"10.4103\/0974-8520.115445","article-title":"Evaluation of Stambhanakaraka Yoga and counseling in the management of Shukragata Vata (premature ejaculation)","volume":"34","author":"Kulkarni","year":"2013","journal-title":"AYU Int. Q. J. Res. Ayurveda"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.sxmr.2015.10.001","article-title":"The role of pelvic floor muscles in male sexual dysfunction and pelvic pain","volume":"4","author":"Cohen","year":"2016","journal-title":"Sex. Med. Rev."},{"key":"ref_88","first-page":"402","article-title":"From Kegel exercises to pelvic floor rehabilitation: A physiotherapeutic perspective","volume":"78","author":"Rodas","year":"2018","journal-title":"Rev. Mex. Urol."},{"key":"ref_89","first-page":"1","article-title":"Trends in the use of complementary health approaches among adults: United States, 2002\u20132012","volume":"79","author":"Clarke","year":"2015","journal-title":"Natl. Health Stat. Report"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1007\/s10865-015-9618-5","article-title":"Who practices yoga? A systematic review of demographic, health-related, and psychosocial factors associated with yoga practice","volume":"38","author":"Park","year":"2015","journal-title":"J. Behav. Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"3460","DOI":"10.1111\/j.1743-6109.2010.01930.x","article-title":"Yoga in male sexual functioning: A noncompararive pilot study","volume":"7","author":"Dhikav","year":"2010","journal-title":"J. Sex. Med."},{"key":"ref_92","first-page":"495","article-title":"Role of yoga in the management of premature ejaculation","volume":"37","author":"Joshi","year":"2019","journal-title":"World J. Mens. Health"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/jebm.12204","article-title":"Effect of Hatha yoga on anxiety: A meta-analysis","volume":"9","author":"Hofmann","year":"2016","journal-title":"J. Evid. Based. Med."},{"key":"ref_94","first-page":"620","article-title":"Depression and anxiety disorders: Benefits of exercise, yoga, and meditation","volume":"99","author":"Saeed","year":"2019","journal-title":"Am. Fam. Physician"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1055\/s-0043-108999","article-title":"From pharmacognosia to DNA-based medicinal plant authentication\u2014Pharmacognosy through the centuries","volume":"83","author":"Heinrich","year":"2017","journal-title":"Planta Med."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"32","DOI":"10.3945\/an.110.000117","article-title":"Herbal extracts and phytochemicals: Plant secondary metabolites and the enhancement of human brain function","volume":"2","author":"Kennedy","year":"2011","journal-title":"Adv. Nutr."},{"key":"ref_97","first-page":"1045","article-title":"Hypericum perforatum: Traditional uses, clinical trials, and drug interactions","volume":"26","author":"Nobakht","year":"2022","journal-title":"Iran. J. Basic Med. Sci."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.jad.2016.12.048","article-title":"Clinical use of Hypericum perforatum (St John\u2019s wort) in depression: A meta-analysis","volume":"210","author":"Ng","year":"2017","journal-title":"J. Affect. Disord."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.pnpbp.2008.10.018","article-title":"Efficacy and tolerability of Hypericum perforatum in major depressive disorder in comparison with selective serotonin reuptake inhibitors: A meta-analysis","volume":"33","author":"Rahimi","year":"2009","journal-title":"Prog. Neuro-Psychopharmacol. Biol. Psychiatry"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/and.12179","article-title":"Relevance of serum nitric oxide levels and the efficacy of selective serotonin reuptake inhibitors treatment on premature ejaculation: Decreased nitric oxide is associated with premature ejaculation","volume":"46","author":"Otunctemur","year":"2014","journal-title":"Andrologia"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.2527\/2004.8251494x","article-title":"Semen characteristics and libido in boars treated repeatedly with PGF 2\u03b1","volume":"82","author":"Estienne","year":"2004","journal-title":"J. Anim. Sci."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"6","DOI":"10.4103\/2277-9175.124633","article-title":"Serum testosterone and gonadotropins levels in patients with premature ejaculation: A comparison with normal men","volume":"3","author":"Alizadeh","year":"2014","journal-title":"Adv. Biomed. Res."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.jep.2010.10.058","article-title":"Experimental study on Satureja montana as a treatment for premature ejaculation","volume":"133","author":"Zavatti","year":"2011","journal-title":"J. Ethnopharmacol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"43","DOI":"10.4103\/0976-500X.92512","article-title":"Evaluation of the aphrodisiac activity of Tribulus terrestris Linn. in sexually sluggish male albino rats","volume":"3","author":"Singh","year":"2012","journal-title":"J. Pharmacol. Pharmacother."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1418634","DOI":"10.1155\/2020\/1418634","article-title":"Network pharmacology-based strategy to investigate pharmacological mechanisms of Qiaoshao formula for treatment of premature ejaculation","volume":"2020","author":"Wang","year":"2020","journal-title":"Evid. Based Complement. Altern. Med."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3349\/ymj.1997.38.2.91","article-title":"Efficacy of a topical agent SS-cream in the treatment of premature ejaculation: Preliminary clinical studies","volume":"38","author":"Xin","year":"1997","journal-title":"Yonsei Med. J."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"312","DOI":"10.3349\/ymj.1996.37.5.312","article-title":"The effects of SS-cream and its individual components on rabbit corpus cavernosal muscles","volume":"37","author":"Xin","year":"1996","journal-title":"Yonsei Med. J."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1007\/s11916-016-0552-1","article-title":"The role of acupuncture in pain management","volume":"20","author":"Patil","year":"2016","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Linde, K., Vickers, A., Hondras, M., ter Riet, G., Thorm\u00e4hlen, J., Berman, B., and Melchart, D. (2001). Systematic reviews of complementary therapies\u2014An annotated bibliography. Part 1: Acupuncture. BMC Complement. Altern. Med., 1.","DOI":"10.1186\/1472-6882-1-3"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"17547","DOI":"10.1038\/srep17547","article-title":"Influence of age, gender, and race on nitric oxide release over acupuncture points-meridians","volume":"5","author":"Ma","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_111","first-page":"1469","article-title":"Understandings of acupuncture application and mechanisms","volume":"14","author":"Lin","year":"2022","journal-title":"Am. J. Transl. Res."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.pneurobio.2008.05.004","article-title":"Neural mechanism underlying acupuncture analgesia","volume":"85","author":"Zhao","year":"2008","journal-title":"Prog. Neurobiol."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.eujim.2016.06.022","article-title":"The effects of acupuncture on serotonin metabolism","volume":"8","author":"Lee","year":"2016","journal-title":"Eur. J. Integr. Med."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1007\/s11655-017-2789-x","article-title":"Nitric oxide signaling molecules in acupoints: Toward mechanisms of acupuncture","volume":"23","author":"Ma","year":"2017","journal-title":"Chin. J. Integr. Med."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/cns.13207","article-title":"B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin","volume":"26","year":"2020","journal-title":"CNS Neurosci. Ther."},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Abatangelo, G., Vindigni, V., Avruscio, G., Pandis, L., and Brun, P. (2020). Hyaluronic acid: Redefining its role. Cells, 9.","DOI":"10.3390\/cells9071743"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s13205-016-0379-9","article-title":"Biotechnological production of hyaluronic acid: A mini review","volume":"6","author":"Sze","year":"2016","journal-title":"3 Biotech"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/andr.13083","article-title":"Clinical use of hyaluronic acid in andrology: A review","volume":"10","author":"Zucchi","year":"2022","journal-title":"Andrology"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"2814","DOI":"10.21037\/tau-20-1026","article-title":"Glans penis augmentation using hyaluronic acid for the treatment of premature ejaculation: A narrative review","volume":"9","author":"Kosseifi","year":"2021","journal-title":"Transl. Androl. Urol."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1038\/ijir.2008.26","article-title":"Long-term effects of glans penis augmentation using injectable hyaluronic acid gel for premature ejaculation","volume":"20","author":"Kwak","year":"2008","journal-title":"Int. J. Impot. Res."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1038\/sj.ijir.3901226","article-title":"Effects of glans penis augmentation using hyaluronic acid gel for premature ejaculation","volume":"16","author":"Kim","year":"2004","journal-title":"Int. J. Impot. Res."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1111\/j.1439-0272.2011.01244.x","article-title":"Treatment of premature ejaculation by glans penis augmentation using hyaluronic acid gel: A pilot study","volume":"44","author":"Abdallah","year":"2012","journal-title":"Andrologia"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"e14084","DOI":"10.1111\/and.14084","article-title":"Hyaluronic acid injection in the glans penis for the treatment of refractory premature ejaculation: A prospective, controlled study","volume":"53","author":"Shebl","year":"2021","journal-title":"Andrologia"},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1080\/17437199.2020.1846580","article-title":"Music therapy for stress reduction: A systematic review and meta-analysis","volume":"16","author":"Pinho","year":"2022","journal-title":"Health Psychol. Rev."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jad.2015.04.011","article-title":"Music therapy as an adjunct to standard treatment for obsessive compulsive disorder and co-morbid anxiety and depression: A randomized clinical trial","volume":"184","author":"Mehryar","year":"2015","journal-title":"J. Affect. Disord."},{"key":"ref_126","first-page":"531","article-title":"Effects of the music therapy on the serotonin and tubulin in brain tissue of chronic unpredictable mild stress rats","volume":"12","author":"Wu","year":"2014","journal-title":"Chin. J. Behav. Med. Brain Sci."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/9\/1607\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:45:58Z","timestamp":1760129158000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/9\/1607"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,6]]},"references-count":126,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["medicina59091607"],"URL":"https:\/\/doi.org\/10.3390\/medicina59091607","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,6]]}}}