(042) Neuromodulation-Sphincter Control Training (SCT-Plus) Protocol for Primary Premature Ejaculation: A 7-Session Pilot Case Series

Introduction Premature ejaculation (PE) is the most frequent male sexual dysfunction. Current pharmacological therapies prolong intravaginal ejaculatory latency time (IELT) but do not improve voluntary control of the ejaculatory reflex. Neurophysiological evidence highlights the role of the emission phase-mediated by sympathetic activation (T12–L2) and reflex closure of the external urethral sphincter-in triggering the irreversible expulsion phase. We developed the Neuromodulation-Sphincter Control Training (SCT-Plus) protocol, targeting external urethral sphincter relaxation and spinal excitability to improve ejaculatory control. Objective To evaluate the feasibility, safety, and preliminary efficacy of the SCT-Plus protocol in men with lifelong premature ejaculation. Methods A prospective clinical case series was conducted including four sexually active men with lifelong PE (PEDT ≥11), stable partners, no pharmacological treatment for sexual dysfunction in the previous six months, and no erectile dysfunction or psychiatric disorders. All participants completed a seven-week intervention consisting of: (1) weekly posterior tibial nerve neuromodulation sessions (20 Hz, 200 μs, 30 minutes), (2) surface pelvic floor electromyographic biofeedback focused on awareness and voluntary relaxation of the external urethral sphincter during high arousal, and (3) home-based exercises using a realistic masturbation-assisting device to simulate intravaginal stimulation while practicing sphincter relaxation before the point of no return. IELT was measured using a stopwatch by patient or partner; PEDT and Patient Global Impression of Change (PGIC) were recorded pre- and post-treatment. No randomization, control group, pharmacological or topical agents were used. Ethical approval was not required, as this was a non-experimental observational case series conducted in routine clinical practice. All participants provided written informed consent for treatment and anonymized data use. Results All four patients completed the protocol without adverse effects. Mean baseline IELT was 124.9 seconds (range 42–182 s), increasing to 286.2 seconds at week 7. Two patients experienced more than a three-fold increase in IELT. Mean PEDT decreased from 18.75 to 10.25; two participants scored below the diagnostic threshold for PE (PEDT <11) after treatment. PGIC scores ranged from 2 to 3 (2 = “much improved”, 3 = “moderately improved”). No deterioration of erectile function or treatment withdrawal occurred. Conclusions The Neuromodulation-Sphincter Control Training (SCT-Plus) protocol appears feasible, safe, and clinically promising for lifelong PE. By specifically targeting external urethral sphincter relaxation and modulation of the emission phase, this approach may offer a novel non-pharmacological therapeutic strategy. Larger controlled studies are needed to confirm these findings. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Mysteryvibe, Myhixel,Cnex