Abstract
BACKGROUND: Premature ejaculation (PE) is a common male sexual dysfunction with treatment limitations including side effects and partner dependency. AIM: To evaluate vacuum negative pressure hydropneumatic/pneumatic bubble massage (VNPHP/PBM) efficacy in primary PE (PPE) patients stratified by sexual frequency, focusing on subjective low-frequency (avoidance due to PE) vs objective low-frequency subgroups. METHODS: Retrospective analysis of 42 PPE patients: 22 low-frequency (LF; <4 intercourse/month) including 13 subjective (sub-LF) and 9 objective (ob-LF) vs 20 non-low-frequency (NLF; ≥4/month). OUTCOMES: Primary: intravaginal ejaculation latency time (IELT); secondary: Premature Ejaculation Diagnostic Tool (PEDT), Self-Rating Anxiety Scale (SAS) scores, and sexual frequency changes at 4 weeks. RESULTS: Both groups showed significant improvements in IELT, PEDT, and SAS scores (P < .05). Low-frequency group showed greater improvements than NLF in PEDT reduction (6.36 ± 2.38 vs 7.90 ± 2.02, P = .03), SAS reduction (30.95 ± 9.57 vs 38.45 ± 8.85, P = .01), and sexual frequency increase (0.50 [0.00, 4.00] vs 1.00 [1.00, 2.00], P = .02). Crucially, sub-LF patients exhibited dramatic sexual frequency normalization (6.00 [4.00, 7.50] vs 2.00 [1.00, 2.00], P < .001), while ob-LF unchanged (P = .56). No adverse events. CLINICAL IMPLICATIONS: Vacuum negative pressure hydropneumatic/pneumatic bubble massage is a partner-independent therapy that not only improves ejaculatory control but also restores sexual activity in patients avoiding intercourse due to PE-related anxiety. STRENGTHS AND LIMITATIONS: Strengths: First study analyzing subjective vs objective low-frequency PE, standardized protocols. Limitations: Retrospective design, self-reported IELT data, lack of a control group, and the non-blinded nature of the study. CONCLUSION: Vacuum negative pressure hydropneumatic/pneumatic bubble massage significantly improves PE symptoms with amplified benefits in low-frequency patients, particularly those with PE-driven sexual avoidance.