Evaluating the Role of Subcoronal Botulinum Toxin Injection in the Management of Premature Ejaculation

Premature ejaculation (PE) is the most common male sexual dysfunction, which often causes significant psychological problems. Although botulinum toxin A (Botox) has shown promise for delaying ejaculation through chemodenervation, the optimal anatomical target remains uncertain. This study evaluated the efficacy and safety of Botox injection into the penile prepuce and subcoronal region as a novel approach for lifelong PE.

A prospective case series was conducted in 7 adult men (mean age 54.7 ± 6.5 years) diagnosed with lifelong PE (intravaginal ejaculatory latency time <1 minute, PEDT ⩾11). Participants received a single 100-unit Botox injection, administered subcutaneously into the prepuce and subcoronal region. The Premature Ejaculation Diagnostic Tool (PEDT) and Male Sexual Health Questionnaire (MSHQ) were completed before, 4 weeks, and 6 months after treatment to assess the efficacy.

Seven patients were included in the analysis. No significant changes were observed in PEDT scores at 4 weeks (18.00 ± 0.9; P = .7358) or at 6 months (17.71 ± 0.4; P = .762) compared with baseline. Similarly, MSHQ erection scores (5.00 ± 2.0 at 4 weeks; 4.85 ± 2.2 at 6 months), ejaculation scores (23.43 ± 3.8 at 4 weeks; 23.42 ± 3.1 at 6 months), and satisfaction scores (10.71 ± 4.07 at 4 weeks; 10.14 ± 3.5 at 6 months) did not differ significantly from baseline values (P > .05 for all comparisons). No adverse events or treatment-related side effects were reported throughout the study period.

Subcoronal Botox injection was safe and well-tolerated, but it did not show significant improvements in ejaculatory control or sexual function scores. The findings suggest that sensory-targeted Botox administration alone is insufficient to enhance the ejaculatory reflex.