The effects of diaphragmatic breathing exercises on individuals with premature ejaculation: a randomized controlled trial

Abstract

Background: There are no standardized, evidence-based rehabilitation protocols for premature ejaculation (PE) which hinders effective management, the development of validated patient-reported outcomes, regulatory oversight, and the potential benefits of targeted interventions.

Aim: To investigate the effect of diaphragmatic breathing exercises (DBE) on PE.

Methods: Sixty-two participants with PE were randomly assigned to Group I (n = 31) or Group II (n = 31). Both groups received behavioral therapy (BT) and pelvic floor muscle training (PFMT) twice daily, three days a week, for eight weeks. Additionally, Group I recieved DBE twice daily, every day, for eight weeks. Intravaginal ejaculation latency time (IELT) was calculated with a stopwatch, at the end of the 8th week (post-treatment), and at 1-year follow-up. Pelvic floor muscle (PFM) strength and endurance were evaluated with ultrasound, and changes in the in the autonomic nerves system (ANS) parameters (including the root mean square of successive differences [RMSSD], proportion of NN50 [PNN50], low-frequency [LF] power, and high-frequency [HF] power) were evaluated with an Elite HRV device at pre-treatment and post-treatment by a blinded assessor.

Outcomes: Primary outcome measurements were IELT, PFM strength and endurance, and changes in ANS paramaters.

Results: The study was completed by 29 participants (mean age = 31.4 ± 6.5 years) in Group I and 30 (mean age = 31.3 ± 7.6 years) in Group II. At post-treatment, all outcome measures showed significant improvements in both groups (P <.001 for all). Compared to Gropu II, Group I showed significantly greater improvements in IELT(P=0.12), RMSDD (P<.001), PNN50 (P=.003), LF Power (P<.001), HF Power (P=.003), strength(P<.001), and endurance (P<.001). The median IELT increase from baseline to post-treatment was 283 seconds (range: 84-870; 900%) in Group I and 204 seconds (range: 44- 581; 690%) in Group II. While IELT declined significantly from post-treatment to 1-year follow-up in Group II, no statistically significant change was found in Group I.

Clinical implications: The effect of DBE on the ANS may help regulate the ejaculatory reflex.

Strengths and limitations: This is the first study to apply breathing exercises with BT and PFMT in men with PE. Limitations include the lack of exercise adherence records beyond 8 weeks and the estimation-based IELT measurement at baseline.

Conclusion: Adding DBE, to BT and PFMT, yields better results in IELT (at 8 weeks and 1 year) and inreases PFM strength and endurance of PFM (at 8 weeks) in men with PE.

Keywords: Behavioral therapy; diaphragmatic breathing exercises; intravaginal ejaculation latency time; pelvic floor muscle training; premature ejaculation.