Stesura Seveso Archivio Italiano di Urologia e Andrologia 2025; 97(1):13445 1 ORIGINAL PAPER INTRODUCTION Premature ejaculation (PE) is a common sexual dysfunction that significantly impacts individuals' sexual experiences and overall well-being (1-3). PE is traditionally catego- rized into lifelong and acquired forms, with definitions often revisited by the scientific community. According to the current definition by the International Society for Sexual Medicine (ISSM), acquired and lifelong PE are male sexual dysfunctions characterized by: (i) an intravaginal ejaculato- ry latency time (IELT) that always or nearly always is about one minute of vaginal penetration from the first sexual experience (lifelong PE), or a clinically significant and bothersome reduction in latency time, often to about three minutes or less (acquired PE); (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intima- cy (4). The true prevalence of PE remains ambiguous, evi- denced by a wide range of different multinational studies (5-8). Numerous studies have evaluated satisfaction with sexual life, considering both patients and their partners, in cases of sexual dysfunctions such as PE or erectile dysfunc- tion (ED), as well as in the general population, underscor- ing the adverse effects of PE on relationships and sexual satisfaction (9-11). The primary aim of this study is to assess the ejaculatory latency time with a focus on the prevalence of PE in a large cohort of young patients, to Background: Premature ejaculation is a sexu- al dysfunction that can impact both men and women. This study aimed to shed light on this condition within a cohort as extensive as possible. Materials and methods: We conducted an online open survey, distributed via social media, proposing a questionnaire regard- ing various aspects including the duration of ejaculatory latency, perceptions of premature or delayed ejaculation, as well as lifestyle and psychological aspects of sexuality. The question- naire comprised 77 questions for male participants and 16 for female participants, with responses structured on a Likert scale ranging from 1 to 5. Results: A total of 1300 men and 1197 women participated in the survey, completing the entire questionnaire.The median age (IQR) of male participants was 27 (23-32) years, while that of female participants was 22 (19-35) years. Men reported a medi- an (IQR) ejaculatory latency time of 17 (8-20) minutes during sexual intercourse, compared to 20 (15-20) minutes reported by women. Only 7.5% (98) of men and 5% (60) of women reported an ejaculatory latency time of less than 3 minutes in their last five sexual encounters (p = 0.0001). Twelve percent (160) of men believed they consistently experienced premature ejacula- tion, whereas only 3% (41) of women reported this sensation (p = 0.0001). Regarding satisfaction with ejaculatory latency time, 7% of men (85) expressed dissatisfaction, whereas only 2% of women (28) reported the same (p = 0.0001). Conversely, only 12% of men (160) considered themselves completely satisfied, compared to 30% of women (358) (p = 0.0001). Conclusions: These analyses highlight a dissonance between male and female perceptions of premature ejaculation, not only in terms of actual intercourse duration but also in terms of psy- chological perception and sexual well-being. This should suggest a need to increase awareness among the population regarding the contrast between idealized sexual experiences and reality. Discrepancy between male and female perceptions of ejaculation latency and sexual satisfaction: Results from an online open survey Andrea Cocci 1, Marta Pezzoli 1,2, Arturo Lo Giudice 3, Gaia Polloni 4, Giorgio Ivan Russo 3, Leonardo Gajo 1, 2, Daniel Giunti 5, Michele Di Dio 6, Borja Garcia Gòmez 7, Manuel Alonso Isa 8, Agustin Fraile Poblador 9, Javier Romero Otero 10, Andrea Minervini 1, Mattia Lo Re 1, 2 1 Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy; 2 Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; 3 Urology Section, Department of Surgery, University of Catania, Catania, Italy; 4 Centre of Psychology, Como, Italy; 5 Centro Integrato di Sessuologia Il Ponte, Florence, Italy; 6 Department of Surgery, Division of Urology, SS Annunziata Hospital, Cosenza, Italy; 7 Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain; 8 Department of Urology, Hospital Universitario HM Puerta del Sur, Instituto Investigación Sanitaria HM Hospitales and ROC Clinic, Madrid, Spain; 9 Department of Urology, Hospital Universitario HM Rivas, Instituto Investigación Sanitaria HM Hospitales and ROC Clinic, Madrid, Spain; 10 Department of Urology, Hospital Universitario HM Sanchinarro, Instituto Investigación Sanitaria HM Hospitales and ROC Clinic, Madrid, Spain. DOI: 10.4081/aiua.2025.13445 Summary KEY WORDS: Premature ejaculation; Delayed ejaculation; Sexual satisfaction. Submitted 1 December 2024; Accepted 13 December 2024 Archivio Italiano di Urologia e Andrologia 2025; 97(1):13445 A. Cocci, M. Pezzoli, A. Lo Giudice, et al. 2 understand how it affects satisfaction with sexual inter- course for both males and their partners. Secondary objec- tives include evaluating factors that may influence PE and examining behaviors adopted by the population in real- life experiences to enhance their quality of sexual life. MATERIALS AND METHODS Study population Participants were recruited via nonpaid posts of a survey link on Instagram, Facebook and Telegram, correlated to the webpage “Sessuologia” of Daniel Giunti (https://www. instagram.com/sessuologia/?hl=it). No advertising campaigns or giveaway incentives were utilized for patient recruit- ment, and all responses were kept completely anonymous. Inclusion criteria included being 18 years of age or older, proficiency in the Italian language, and providing informed consent before accessing the survey, with the explicit option to terminate participation at any time by closing the webpage. Data from participants who did not complete the survey were omitted from the analysis. Additionally, meas- ures were implemented to prevent individuals from partic- ipating in the survey more than once. A completed check- list following the CHERRIES criteria (12) is provided as Supplementary material 1. Questionnaire Institutional Review Board (IRB) approval was not required from our center for this kind of survey, but an informed consent was provided before the start of the questionnaire with information on the topics of the survey, the anonymi- ty of the responses and the possibility to terminate partici- pation at any time by closing the webpage. The survey encompassed a variety of questions, and two models were developed (refer to Supplement Material 2): one targeting the male population, comprising 77 questions that were more complex and detailed regarding aspects of masturba- tion (age of onset, frequency, ejaculation latency), lifestyle (consumption of alcohol, drugs, and their influence on ejaculation time), and psychological aspects of sexuality; the other tailored to the female population, consisting of 16 questions, primarily addressing the frequency and duration of sexual intercourse and its impact on sexual life satisfac- tion. Ejaculatory latency time was documented as the aver- age duration across the last five penetrative and masturba- tory episodes. PE patients were identified as individuals with an IELT of less than three minutes and who exhibited distress related to this condition, as evidenced in the psy- chological questions. Statistical analysis Descriptive statistics were utilized to examine the respons- es from the questionnaire. The sample was one of conven- ience, without the conduct of a power analysis. The esti- mations of IELTs did not follow a normal distribution; therefore, summarized data are presented as medians and interquartile ranges. Response frequencies were compared between male and female groups using the Chi-square test. A multivariate logistic regression was employed to analyze the association between the condition of PE and factors such as abnormal sexual habits or trauma, lifestyle, and psychic dysfunction. Statistical analyses were performed using STATA (StataCorp. 2023. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC). RESULTS Demographic characteristics A total of 2,497 respondents were included in this study, with 1,300 men and 1,197 women. The male sample com- prised individuals who identified as heterosexual straight Table 1. Demographic characteristics. Male, n = 1300 Female, n = 1197 Age, Median (IQR) 27 (23-32) 22 (19-35) Ethnia Caucasic 1091 83.9% 1010 83.4% Ispanic 39 3.1% 24 2.0% Asian 3 0.2% 5 0.4% Other/unspecificed 167 12.8% 158 13.2% BMI, median (IQR) 24 (21-27) Na Smoker, n (%) 537 Na Antidepressive user, n (%) 38 2,9 Na Recreational drugs use Never, n (%) 1015 78% Na Sometimes, n (%) 228 17.5% Na Regularly, n (%) 57 4.4% Na Alcohol assumption Never, n (%) 145 11.1% Na Sometimes, n (%) 953 73.3% Na Regularly, n (%) 202 15.5% Na Sexual orientation Heterosexual, n (%) 1148 88.3% Na Homosexual, n (%) 65 5% Na Bisexual, n (%) 74 5.7% Na Other, n (%) 13 1% Na Stable relation, n (%) Yes 1083 83.8% 1002 83.1% No 217 16.2% 195 16.9% Sexual intercourse frequency, n (%) < 1 month 177 13.6% 51 4.3% 1-2 month 294 22.6% 238 19.9% 1-2 Weekly 566 43.5% 695 58.1% 4-5 Weekly 153 11.8% 178 14.9% Daily 19 1.5% 35 2.9% Foreplay, n (%) Never 20 1.5% 23 1.9% Less than half the time 28 2.2% 43 3.6% Half the time 59 4.5% 77 6.4% More than half the time 185 14.2% 129 10.8% Everytime 1008 77.5% 925 77.3% Foreplay Time, n (%) None 12 0.9% 11 0.9% < 5 minutes 169 13.0% 183 15.3% 5-15 minutes 805 61.9% 692 57.8% 15-30 minutes 276 21.2% 267 22.3% 30-60 minutes 31 2.4% 38 3.2% > 60 minutes 0 0.0% 0 0.0% Time until ejaculation minutes, median (IQR) 17 (8-20) 20 (15-20) n: number; IQR, interquartile range. Archivio Italiano di Urologia e Andrologia 2025; 97(1):13445 3 Perceptions of ejaculation latency and sexual satisfaction (n = 1,148, 88.3%), homosexual gay (n = 65, 5.0%), bisex- ual (n = 74, 5.7%), and other or unspecified orientations (n = 13, 1.0%). We included female participants who had sexual intercourses with male subjects, independently from their sexual orientation. The median age (IQR) for the two groups was 27 (23-32) for men and 22 (19-35) for women. The participation of principally young subjects was probably due to the use of social media. At the time of the survey, 83.3% (n = 1083) of men and 83.7% (n = 1002) of women reported being in a stable relationship. The most frequent rate of sexual intercourse reported was 1-2 times per week by 43.5% (n = 566) of men and 58.1% (n = 695) of women. Median (IQR) ejaculatory latency time (ELT) declared by men during sexual intercourse was 17 (8-20) minutes versus 20 (15-20) minutes by women. Additional demographic and sexual life-related character- istics are reported in Table 1. Regarding the perception of suffering from delayed ejac- ulation, 44.5% (n = 578) of men and 52.3% (n = 626) of women declared that they had never experienced it (Table 2). Conversely, 8.3% (n = 108) of men believed they always suffered from delayed ejaculation, while only 2.1% (n = 25) of women reported that they partners never suffered if it (p < 0.01). In terms of perceived suffering from PE, 36.3% (n = 472) of men reported never experiencing it, in contrast to 60.9% (n = 730) of women who reported that they part- ners never suffered if it (p < 0.01). While 12.3% (n = 160) of men believed they always suffered from PE, only 3.4% (n = 41) of women reported this feeling (p < 0.01) (Figure 1). However, only 7.5% (n = 98) of men and 5% (n = 60) of women declared an ejaculatory latency time of under 3 minutes in their last five sexual encounters (p < 0.01). Regarding satisfaction with ejaculatory latency time, 6.5% (n = 85) of men considered themselves unsatisfied, com- pared to 2.3% (n = 28) of women (p < 0.01). Moreover, only 12.3% (n = 160) of men reported being fully satisfied, versus 29.9% (n = 358) of women (p < 0.01) (Figure 2). In terms of overall sexual satisfaction, only 25.9% (n = 337) of men considered themselves fully satisfied, compared with 43.5% (n = 521) of women (p < 0.01) (Figure 3). Figure 1. Feeling premature ejaculation. Figure 2. Satisfaction with ejaculatory latency time. Figure 3. Overall sexual satisfaction. Table 2. Male and Female response comparison by M F P value Feeling delayed ejacuation p = 0.0001 Never 578 44.5% 626 52.3% Rarely 387 29.8% 339 28.3% Sometime 126 9.7% 124 10.4% Often 101 7.8% 83 6.9% Everytime 108 8.3% 25 2.1% Feeling premature ejacuation p = 0.0001 Never 472 36.3% 730 61.0% Rarely 307 23.6% 246 20.6% Sometime 181 13.9% 107 8.9% Often 180 13.8% 73 6.1% Everytime 160 12.3% 41 3.4% Time satisfaction p = 0.0001 Unsatisfied 85 6.5% 28 2.3% Quite unsatisfied 227 17.5% 107 8.9% Unmoved 272 20.9% 170 14.2% Quite satisfied 556 42.8% 534 44.6% Satisfied 160 12.3% 358 29.9% Importance of foreplay for lasting p = 0.0001 None 55 4.2% 33 2.8% Little 281 21.6% 215 18.0% Much 649 49.9% 540 45.1% Very much 315 24.2% 409 34.2% Satisfaction overall p = 0.0001 Unsatisfied 68 5.2% 16 1.3% Quite unsatisfied 102 7.8% 56 4.7% Unmoved 185 14.2% 90 7.5% Quite satisfied 608 46.8% 514 42.9% Satisfied 337 25.9% 521 43.5% M = Male; F = Female; Comparison between two groups were performed by chi-square test. Archivio Italiano di Urologia e Andrologia 2025; 97(1):13445 A. Cocci, M. Pezzoli, A. Lo Giudice, et al. 4 Finally, most men often or always use expedients to delay ejaculation, most used the "stop and start" technique, and the change of intercourse position (Table 4) (Figure 4). Factors associated with premature ejaculation In Table 3 we reported the result of the multivariate logis- tic regression analysis. In the analysis, the odds ratio in predicting PE during sexual intercourse for "age", "substance abuse" and "porn use frequency” was 1.00 (p = 0.46) 0.76 (p = 0.24) and 0.88 (p = 0.66), respectively. The odds ratio in predicting PE for "masturbation frequen- cy", "penetrating frequency" and "erection quality" was 0.76 (p = 0.02), 0.75 (p < 0.01) and 0.73 (p < 0.01). The odds ratio in predicting PE during sexual intercourse for "premature ejaculation during masturbation" was 6.74 (p < 0.001). The odds ratio for "alcohol abuse" is 1.60 (p = 0.019), sug- gesting that alcohol use has a positive effect, increasing the risk of PE. The odds ratio for "sex desire" is 1.02 (p = 0.903), indi- cating that sexual desire does not significantly affect PE. DISCUSSION Here, we presented our work in which we subjected the largest population cohort presented in a study from a sin- gle center to the best of our knowledge, to a questionnaire regarding the sexual life of both men and women. In this study, the IELT reported by male patients was a median (IQR) of 17 (8-20) minutes. This finding is cor- roborated by female partners, who reported a median IELT of 20 (15-20) minutes, indicating an increased dura- tion of intercourse compared to that reported in the liter- ature. For instance, Nguyen et al. (13) recently observed a perceived IELT of 6.09 (± 6.59) minutes (median 3 min- utes, range 0.5-45 minutes), which was 2.01 (± 1.21) minutes for the PE-affected group and 11.69 (± 6.83) min- utes for the control group, in a population with a mean age of 30.9 (±6.84) years, similar to our study's population (median 27 (23-32) years). Conversely, Giuliano et al. (14), in a multicentric study, reported a median IELT in the group of Italian subjects not affected by PE of 15.0 (1.5-45.0) minutes, more in line with our data, although our series did not differentiate between patients affected by PE and those who were not. Moreover, Patrick et al. (15), in a study of a large population sample (1,587 patients), noted a median IELT of 1.8 (range, 0-41) min- utes for PE subjects and 7.3 (range, 0-53) minutes for Table 3. Multiple logistic regression of factors associated with premature ejaculation. OR 95% CI P Age 1.01 0.98-1.03 0.457 Substance abuse 0.76 0.48-1-03 0.239 Porn use frequency 0.88 0.51-1.53 0.659 Masturbation frequency 0.76 0.61-0.95 0.017 Penetration frequency 0.75 0.63-0.90 0.002 Erection quality 0.73 0.62-0.87 < 0.001 Premature ejaculation during masturbation 6.74 4.42-10.30 < 0.001 Alcohol abuse 1.60 1.08-2.38 0.019 Sex desire 1.02 0.73-1.43 0.903 Figure 4. Graphical representation of most used expedients for retarding ejaculation. Archivio Italiano di Urologia e Andrologia 2025; 97(1):13445 5 Perceptions of ejaculation latency and sexual satisfaction non-PE subjects, with a mean age of 35.4 (± 10.7) years. Our results, therefore, offer an update on the average IELT among the population, particularly in younger individu- als. Regarding the prevalence of PE, we observed a global prevalence of 7.5% in our study population, which aligns with the results of two large observational studies includ- ed in the ISSM evidence-based definition of PE, where the prevalence of lifelong and acquired PE was 6.2% and 8.0%, respectively (2, 3). The implementation of multivariate logistic regression analysis enabled the assessment of predictive factors for PE. Factors such as masturbation frequency, penetration frequency, and quality of erections were identified as hav- ing a negative impact on PE. The association between pen- etration frequency and PE is well-documented in the liter- ature. This was highlighted in a study by Verze et al. (16), which found that Italian men with PE experienced a sig- nificant reduction in sexual intercourse attempts. A com- parable decline in sexual frequency was observed among men with PE versus non-PE men in a study based on the Korean general population (17). Consistently, the current study found an inverse correlation, indicating that a high- er frequency of sexual intercourse was associated with a reduced probability of experiencing PE (Table 3). The correlation between ED and PE is equally evident, with a higher incidence of PE noted in patients with ED (18-20), a finding that is consistent with observations from the current research (Table 3). Concerning sexual desire, our results were contrasting. While the study was based on the Korean general popu- lation (17), low libido was more frequent in men with PE compared to men without, we did not find those associ- ation. Our questionnaire incorporated five questions related to potential PE prevention techniques (Male Questionnaire, Questions 58-62, Supplementary Material 2). Behavioral therapy is recognized as a critical component in the man- agement of PE (21-24). As indicated in Table 4, the "start and stop" method, along with "changing position," emerged as the most frequently utilized technique in our sample, reported as sometimes or often by 40% and 30% for the former, and 38% and 23% for the latter, respectively. Given that "changing position" could be considered anoth- er variant of the "start and stop" method, a considerable segment of the population employs these techniques. This suggests that a majority of the population, even those not diagnosed with PE, use behavioral strategies to extend the duration of sexual encounters, which in turn indicates a high prevalence of subjective PE. On one hand, this finding may explain the higher IELT observed in our cohort compared to that documented in the litera- ture; on the other hand, it could imply a degree of dis- comfort with the duration of intercourse, despite exceed- ing the 3-minute threshold defined by the ISSM. Concerning the latter point, this study facilitates the assessment of both men's and their partners' satisfaction with sexual activity and their expectations. The link between PE and personal distress is well-established (25), with varying impacts on men and their partners. Patrick et al. (15) reported that partners' perceptions of PE are typically less problematic than those of the affected indi- viduals. This was also supported by Verze et al. (16), although a significantly higher proportion of partners of men with PE reported personal distress (44% vs. 3%) and interpersonal difficulties (25% vs. 2%) compared to part- ners of non-PE men. Graziottin & Althof (10), in a 2011 review, identified significantly greater sexual problems, decreased satisfaction, and heightened distress and inter- personal difficulties among partners of men with PE than those of non-PE men. In our dataset, as depicted in Table 2, there is a notable disparity in terms of satisfaction between men and women concerning the duration of intercourse and relat- ed sensations. Specifically, only 26% of men reported full satisfaction, compared to 44% of women. This discrepan- cy, alongside the fact that the study involved a younger population with fewer comorbidities that could impair sexual activity, should prompt reflection on the psycho- logical pressures faced by young men regarding sexual performance and may direct educational interventions toward a more accurate understanding of sexual realities and the adjustment of expectations to prevent a dysfunc- tional misperception of sexual life. This research offers a fresh outlook on the perception of ELTs among the young, male and female, population, and its influence on the behavioral and emotional facets of sexual life, and encompasses the largest mixed cohort yet assessed with this method, to the best of our knowledge. The substantial case series also enabled us to evaluate var- ious factors associated with PE, corroborating existing lit- erature (26, 27). Additionally, through the questionnaire focused on the psychological domain, this study offers a preliminary view into the perceived differences in sexual life satisfaction between men and women. The interpretations of our findings must consider the study's limitations. Primarily, the employed questionnaire is not internationally validated, though it is akin to other instruments, such as the SCS-M (28) or the Female Sexual Distress Scale-Revised-Premature Ejaculation (FSDS-R-PE) devised by Limoncin et al. (29). Nonetheless, the use of a multi-item questionnaire enabled us to explore various aspects not assessable by any single questionnaire available in the literature to date. Secondly, it should be acknowl- edged that the study relies on voluntary participation in a questionnaire disseminated by a page addressing these types of issues. Consequently, it must be recognized that there is no explicit distinction between users who actively seek out the page, presumably for concerns pertaining to the sexual sphere, and those who encounter the page through sponsored content without perceiving themselves Table 4. Most used expedients for retarding ejaculation. Never Rarely Sometime Often Everytime Reducing foreplay 585 (45%) 312 (24%) 273 (21%) 104 (8%) 26 (2%) Masturbating before 403 (31%) 442 (34%) 364 (28%) 78 (6%) 13 (1%) Abuse of substances 1157 (90%) 76 (6%) 52 (4%) 13 (1%) 2 (0%) Stop and restart 132 (10%) 145 (11%) 524(40%) 392 (30%) 101 (8%) Changing position 210 (16%) 223 (17%) 498 (38%) 300 (23%) 69 (5%) Retarding condoms 1092 (84%) 117 (9%) 65 (5%) 12 (1%) 14 (1%) Archivio Italiano di Urologia e Andrologia 2025; 97(1):13445 A. Cocci, M. Pezzoli, A. Lo Giudice, et al. 6 to have such issues. Additionally, due to the specific clini- cal setting we employed, we did not differentiate whether the subjects had lifelong or acquired PE. Since the different clinical expressions of PE rarely require different treatment strategies, this bias does not significantly impact our results. An additional significant limitation is that the study partic- ipants were not evaluated by a professional, such as a sex- ologist or psychosexologist, which would have permitted a more precise objectification of the feelings described by the population. Regrettably, this limitation is intrinsic to the study design, which was structured as a survey. The inclu- sion of a predominantly young sample may introduce bias- es, especially concerning the prevalence of ED and its impact on PE (30). 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Do we have put a new cornerstone for the Correspondence Andrea Cocci, MD (Corresponding Author) cocci.andrea@gmail.com Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, 50100 Florence, Italy Marta Pezzoli marta.pezzoli@unifi.it Leonardo Gajo leonardo.gajo@unifi.it Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Urology, University of Florence, Careggi Hospital, 50100 Florence, Italy Arturo Lo Giudice arturologiudice@gmail.com Giorgio Ivan Russo giorgioivan.russo@unict.it Urology Section, Department of Surgery, University of Catania, Catania 95131, Italy Gaia Polloni info@gaiapolloni.com Centre of Psychology, Via Cadorna, 22100 Como, Italy Daniel Giunti danielgiunti@gmail.com Centro Integrato di Sessuologia Il Ponte, 50100 Florence, Italy. Michele Di Dio m.didio@aocs.it Department of Surgery, Division of Urology, SS Annunziata Hospital, Cosenza, Italy Borja Garcia Gòmez borjagarciagomez@gmail.com Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid 28041, Spain Manuel Alonso Isa manuel.alonso@rocclinic.com Department of Urology, Hospital Universitario HM Puerta del Sur, Instituto Investigación Sanitaria HM Hospitales and ROC Clinic, Madrid, Spain Agustin Fraile Poblador agustin.fraile@rocurologia.com Department of Urology, Hospital Universitario HM Rivas, Instituto Investigación Sanitaria HM Hospitales and ROC Clinic, Madrid, Spain Javier Romero Otero jromerootero@rocclinic.com Department of Urology, Hospital Universitario HM Sanchinarro, Instituto Investigación Sanitaria HM Hospitales and ROC Clinic, Madrid, Spain Andrea Minervini andrea.minervini@unifi.it Mattia Lo Re mattialore1994@gmail.com Unit of Oncologic Minimally Invasive Urology and Andrology, University of Florence, Careggi Hospital, 50100 Florence, Italy treatment of premature ejaculation? 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