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Premature Ejaculation (PE) is considered the most common sexual dysfunction that affects approximately 15%-30% of men over the age of 18. (Laumann et al., 1999). According to the definition of PE made by the International Society of Sexual Medicine (ISSM) in 2014, lifelong PE (a) ejaculation is always or almost always within 1 min before vaginal penetration or after vaginal penetration, (b) inability to delay ejaculation and (c) this situation creates frustration, bother, mental distress and sexual avoidance problems in the individual (Serefoglu et al., 2014). Acquired PE (APE) is separated from lifelong PE with the onset of the PE complaint in individuals with previous normal ejaculation performance and the ejaculation within approximately 3 min (Serefoglu et al., 2014). Despite its high prevalence, controversies about the definition, classification and hence treatment of PE still continue (Saitz & Serefoglu, 2015). All organs that function in the body need oxygen and a proper blood flow to achieve function. Many studies have determined that hypoxia, ischaemia and oxidative stress caused by arterial obstructive diseases such as atherosclerosis are among the factors affecting male sexual dysfunction (Bolat et al., 2017; Thompson et al., 2005). While disorders in serotonin biosynthesis play a role in lifelong PE, many factors are observed in APE aetiology. (Culha, Tuken et al., 2020). Gao et al. (2013) stated that patients suffering from PE suffer from comorbidity such as chronic prostatitis, hypertension, diabetes mellitus, cardiovascular (CV) diseases and

Efficacy and safety of daily tadalafil and sertraline combination therapy in heterosexual patients presenting with erectile dysfunction and concomitant premature ejaculation OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of daily tadalafil 5 mg and sertraline 50 mg treatment in 3-month follow-up in patients presenting with erectile dysfunction (ED) complaints and accompanying premature ejaculation (PE) symptoms. MATERIAL and METHODS: This prospective, observational single-arm study was conducted between March and September 2021 among patients suffering from ED and concomitant Lifetime/acquired PE. The Turkish validity of the International Erectile Function-Erectile Function Index (IIEF-EF) was used for the diagnosis of ED in the patients. The patients filled the Premature Ejaculation Diagnostic Tool (PEDT) questionnaire for the diagnosis of PE. Additionally, the Premature Ejaculation Profile (PEP) score was filled. A detailed medical history was taken from all patients and a complete physical examination was performed. After a fourweek follow-up period, patients were given 5 mg tadalafil and sertraline 50 mg tablets daily. The IELT durations of the patients were recorded after 12 weeks of treatment. Premature ejaculation profile and IIEF-EF questionnaires administered to the patients at the beginning were filled again. In addition, the Global Impression of Change (GIC) questionnaire was applied in terms of treatment satisfaction. RESULTS: A total of 71 patients were included in the study. Sixty-three patients completed the study (88.73%). As a result of 3-month daily tadalafil 5 mg + sertraline 50 mg combination therapy, the geometric mean IELT, PEP index scores and subgroup scores of the patients improved and a statistically significant increase in the IIEF-EF scores (p<0.001). In addition, considering the GIC questionnaire, 81.69% (58/71) of the patients stated that they were satisfied with the treatment. CONCLUSION: In conclusion, daily administration of tadalafil and sertraline provides an effective and reliable objective and subjective improvement in the management of patients with ED and accompanying PE. Keywords: premature ejaculation, erectile dysfunction, sertraline, tadalafil, IELT

Premature ejaculation is a common male sexual disease in andrology practice. The goal of essay is to investigate the relation of anogenital distance that predicts prenatal testosterone exposure with premature ejaculation. Between January and May 2019, 150 men were participated in the study. The patients were evaluated with anamnesis and physical examination; age, smoking, alcohol consumption, intravaginal ejaculation latency time, body mass index, premature ejaculation diagnostic tool, distance from anal point to scrotum and distance from anal point to penis were recorded. According to premature ejaculation diagnostic tool score, the patients were classified as premature ejaculation group (score ≥11) and control group (score <11). The mean of the male age was 30.73 ± 4.40 years. The mean intravaginal ejaculation latency time score was 3.42 ± 2.71 min. Two groups were compared using the distance from anal point to scrotum distance from anal point to penis. In the premature ejaculation group, the distances were found lower (77.46 ± 2.31 and 54.78 ± 2.56 mm) than the control group (81.32 ± 3.11 and 58.16 ± 3.48 mm). There were statistical differences between two groups (p < .001). It was concluded that it is likely to have a negative relationship between anogenital distance and premature ejaculation diagnostic tool score.