Hyaluronic Acid Gel Injections in the Glans Penis: A Potential Treatment for Premature Ejaculation
Premature ejaculation (PE) affects up to 30% of men, causing ejaculation within 1 minute of vaginal penetration or in less than 3 minutes (as a change from one’s previous normal). It often leads to emotional distress and dissatisfaction for both partners. Various treatments are available, including therapy, medications, and surgery. One alternative treatment option that has been presented recently is hyaluronic acid (HA) gel injections in the glans penis.
HA is a substance naturally found in the body, commonly used in medical treatments like joint injections and cosmetic surgery. While the exact way it works for PE isn’t fully understood, it’s believed that HA injections may help prolong ejaculation by increasing pressure in the penis during intercourse.
Recent studies have reported that HA injections can improve the time it takes to ejaculate (known as intravaginal ejaculation latency time or IELT). A new systematic review examined the effectiveness and safety of HA gel injections for treating PE. It aimed to answer several questions: Does the treatment increase ejaculation time? Does it improve patient satisfaction and PE-related symptoms? How does it affect glans penis size? Are there side effects?
The authors of this study followed strict guidelines (PRISMA) to evaluate how effective HA injections are for treating PE. They searched several major databases for various types of studies, including clinical trials, case reports, and randomized controlled trials (RCTs), but excluding animal studies, non-English articles, and unpublished work. Two reviewers checked the studies to ensure they were relevant for their research, and a third helped resolve any disagreements.
The main outcomes they focused on were how long it takes for men to ejaculate after penetration (IELT measured in seconds), changes in penis size, and any side effects. They also looked at different ways HA gel was applied and the doses used. The data was carefully analyzed using specialized software to compare the results before and after treatment. Any inconsistencies in the studies were addressed through additional analyses.
Out of 245 articles, 213 remained after removing duplicates. Then, after excluding studies that didn’t meet inclusion criteria, 13 were included in the final review: 4 randomized controlled trials, 8 prospective observational studies, and 1 retrospective study.
The studies mainly focused on using HA gel applied to the glans penis, with varying methods and dosages ranging from 1 to 4 mL. Techniques for HA application differed, with some studies using multiple-puncture methods and others using a fan technique. The total number of patients treated with HA was 706.
Of the RCTs, two compared HA with a placebo, one compared it with dapoxetine (a drug used for premature ejaculation), and another with polylactic acid. The studies provided varying results on the effectiveness of HA in treating premature ejaculation. Several reported patient and partner satisfaction, while side effects included mild pain, ecchymosis (bruising), and discomfort at the injection site.
However, in the end, the analysis showed HA injections significantly improve IELT and increase glans circumference when used for cosmetic reasons. One study reported a 2.6-fold IELT improvement after 1 month of HA injections, with effects lasting up to 9 months. HA injections also outperformed dapoxetine, an oral PE treatment, in both IELT improvement and fewer side effects.
HA injections are not approved by the Food and Drug Administration for the treatment of PE and ongoing research is needed to refine the techniques, determine ideal dosage, and show long-term benefits. Some of the side effects noted in studies thus far include pain, bullae (blisters), nodule formation, and bruising at the injection sites. Therefore, larger and more rigorous studies are essential to better understand HA’s potential as a PE treatment.
If you are an individual suffering from PE, help contribute to research that can support change by enrolling in the SMSNA Climax Registry today: https://menshealthstudies.com/research/ejaculatory-and-orgasmic-dysfunction-registry/
For more information on this topic, please read these publications from the ISSM Journals: The Journal of Sexual Medicine, Sexual Medicine Reviews, and Sexual Medicine Open Access:
Hyaluronic acid and urology: a systematic review and meta-analysis
References:
Culha, M. G., Baran, C., & Erkoc, M. (2024). Clinical efficacy and safety of hyaluronic acid gel injection in the glans penis for treatment of premature ejaculation: Systematic review and meta-analysis. The Journal of Sexual Medicine, 21(10), 878–888. https://doi.org/10.1093/jsxmed/qdae090
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