Male Sexual Dysfunction Autonomic Nervous System Dysfunction in Lifelong Premature Ejaculation: Analysis of Heart Rate Variability Orhan Unal Zorba, Yuksel Cicek, Hakkı Uzun, Mehmet C ¸ etinkaya, Kadir € Onem, and Mehmet Murat Rifaio  glu OBJECTIVE To identify autonomic nervous dysfunction in patients with lifelong premature ejaculation. METHODS The study participants were 25 men with lifelong premature ejaculation and 25 healthy controls. The parameters of 24-hour heart rate variability that are influenced by the autonomic nervous system were compared between the men with lifelong premature ejaculation and the healthy controls. RESULTS The laboratory results of all patients were within normal limits, and no significant differences were found between the patients and the controls in age, body weight, and body mass index. A low-frequency signal that is influenced by the sympathetic system was increased in the patients (P ¼ .026). Furthermore, a high-frequency signal that is influenced by the parasympathetic system was decreased in the patients (P ¼ .011). Finally, the low frequency-to-high frequency ratio, an indicator of the balance between the two components of the autonomic nervous system, was increased in the patients (P ¼ .002). CONCLUSION To our knowledge, no study has investigated the influence of the autonomic nervous system on 24-hour heart rate variability in premature ejaculation. In the present study, sympathetic activity was increased in men with lifelong premature ejaculation; this overactivity might lead to lifelong premature ejaculation. Additional studies are required to reveal the possible alter- ation of the autonomic nervous system in premature ejaculation. UROLOGY 80: 1283e1286, 2012. Ó 2012 Elsevier Inc. P remature ejaculation (PE) is one of the most commonly reported male sexual disorders. 1,2 Although the physiology of ejaculation has been clearly identified, the exact pathogenesis of PE remains to be clarified. Genetic etiologies, psychological causes, hormonal pathologies, penile sensory changes, and chronic prostatitis have all been considered responsible; however, no definitive evidence has been presented thus far linking PE and the aforementioned conditions. 3 There are two phases in normal ejaculation: emission and ejection. Emission is the result of a sympathetic spinal cord reflex initiated by the genital or cerebral erotic stimuli, or both, and entails the sequential contraction of the accessory sexual organs. Ejection also involves a sympathetic spinal cord reflex with compatible action of the somatic nervous system. 4 Despite the significant role played by the sympathetic nervous system (SNS) in ejaculation, few studies have tested autonomic measures across men with and without PE. 5,6 Heart rate variability (HRV) is being used widely to assess sympathetic and parasympathetic activity. 7,8 It is a vali- dated noninvasive analysis that provides numeric data about global autonomic functions. We conducted a study to evaluate the status of the autonomic nervous system (ANS) using 24-hour HRV recordings in men with lifelong PE and healthy age-matched controls to reveal an association between ANS dysfunction and lifelong PE. MATERIAL AND METHODS The study participants comprised 50 men, 25 of whom were lifelong PE patients and 25 of whom were controls. PE was defined as in the World Health Organization 2nd International Consultation on Sexual Health. 9 PE patients were in a stable, heterosexual relationship with the same, nonpregnant, sexually active partner for at least 6 months, had experienced PE since their first sexual encounters, and were seeking medical treat- ment for this condition. The controls were chosen from among former ureteral stone patients with no new stone in the urinary tract. These individuals were also in a stable, heterosexual relationship with the same, nonpregnant, sexually active partner for at least 6 months. The exclusion criteria were (1) acquired PE; (2) any condi- tion that could disrupt HRV, such as diabetes, cardiac Financial Disclosure: The authors declare that they have no relevant financial interests. From the Departments of Urology and Cardiology, School of Medicine, Rize University, Rize; the Department of Urology, School of Medicine, Mu gla University, Mu gla; the Department of Urology, School of Medicine, Ondokuz Mayıs University, Samsun; and the Department of Urology, School of Medicine, Mustafa Kemal University, Hatay, Turkey Reprint requests: Orhan Unal Zorba, M.D., Rize Universitesi, Tip Fakultesi, 53000 Rize, Turkey. E-mail: zorbaunal@gmail.com Submitted: July 18, 2012, accepted (with revisions): August 17, 2012 ª 2012 Elsevier Inc. 0090-4295/12/$36.00 1283 All Rights Reserved http://dx.doi.org/10.1016/j.urology.2012.08.029