human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of the study is to investigate whether there is an effect of adult circumcision on ejaculation parameters and to research the relationship between intravaginal ejaculation latency time ( IELT ) and premature ejaculation diagnostic tool ( PEDT ) . Adults who underwent voluntary circumcision between September 2010 and November 2011 were enrolled in this prospect i ve study . The IELT before and 3 months following circumcision was recorded . Also , PEDT was filled out before and 3 months after circumcision . During statistical evaluation , the comparison of situations before and after circumcision was made using IELT averages and PEDT total scores . Furthermore , the correlation between changes in IELT and PEDT has also been evaluated . A total of 30 volunteers ( mean age 21.25±0.44 ) were enrolled in the study . The volunteers ’ mean and median IELT before were 104.36±66.21 and 88 ( 26–307 ) seconds , whereas mean and median IELT after circumcision were 123.56±54.44 and 107.5 ( 67–300 ) seconds , respectively . The increase after circumcision was statistically significant ( P=0.001 ) . The mean and median PEDT score were 4.26±2.91 and 3 ( 1–12 ) before , and 2.63±1.82 and 2 ( 0–7 ) after circumcision . Improvement was statistically significant ( P<0.0001 ) . No correlation could be found between ejaculation time and PEDT scores . Circumcision during adulthood does not adversely affect ejaculatory function ; it may slightly improve . However , it could not be interpreted as a justification for circumcision in men with premature ejaculation ( PE ) INTRODUCTION The Global Online Sexuality Survey ( GOSS ) is a worldwide epidemiologic study of sexuality and sexual disorders . In 2010 , the first report of GOSS came from the Middle East . AIM This report studies the prevalence rate of premature ejaculation ( PE ) in the U.S. as of 2011 - 2012 and evaluates risk factors for PE . METHODS GOSS was r and omly deployed to English-speaking male web surfers in the USA via paid advertising on Facebook ® , comprising 146 questions . MAIN OUTCOME MEASURES Prevalence of PE as per the International Society of Sexual Medicine 's ( ISSM ) definition . RESULTS With a mean age of 52.38 years ± 14.5 , 1,133 participants reported on sexual function . As per the ISSM definition of PE , the prevalence rate of PE in the USA as of 2011 was 6.3 % . This is in contrast to 49.6 % as per the Premature Ejaculation Diagnostic Tool ( PEDT ) , 77.6 % as per unfiltered subjective reports , and 14.4 % as per subjective reporting on more consistent basis . 56.3 % of the latter reported lifelong PE . 63.2 % could be classified as having natural variable PE . Erectile dysfunction is a possible predisposing factor for acquired PE , while genital size concerns may predispose to lifelong PE . Age , irregular coitus , circumcision , and the practice of masturbation did not pose a risk for PE , among other risk factors . Oral treatment for PE was more frequently used and reported to be more effective than local anesthetics , particularly in those with lifelong PE . CONCLUSION Applying the ISSM definition , prevalence of PE is far less than diagnosed by other methods , 6.3 % among Internet users in USA as of the year 2011 . PEDT measures both lifelong and acquired PE , in addition to 35 % men with premature-like ejaculatory dysfunction  , making it inaccurate for isolating lifelong and acquired PE cases INTRODUCTION Male circumcision is being promoted for HIV prevention in high-risk heterosexual population s. However , there is a concern that circumcision may impair sexual function . AIM To assess adult male circumcision 's effect on men 's sexual function and pleasure . METHODS Participants in a controlled trial of circumcision to reduce HIV incidence in Kisumu , Kenya were uncircumcised , HIV negative , sexually active men , aged 18 - 24 years , with a hemoglobin > or=9.0 mmol/L. Exclusion criteria included foreskin covering less than half the glans , a condition that might unduly increase surgical risks , or a medical indication for circumcision . Participants were r and omized 1:1 to either immediate circumcision or delayed circumcision after 2 years ( control group ) . Detailed evaluations occurred at 1 , 3 , 6 , 12 , 18 , and 24 months . MAIN OUTCOME MEASURES ( i ) Sexual function between circumcised and uncircumcised men ; and ( ii ) sexual satisfaction and pleasure over time following circumcision . RESULTS Between February 2002 and September 2005 , 2,784 participants were r and omized , including the 100 excluded from this analysis because they crossed over , were not circumcised within 30 days of r and omization , did not complete baseline interviews , or were outside the age range . For the circumcision and control groups , respectively , rates of any reported sexual dysfunction decreased from 23.6 % and 25.9 % at baseline to 6.2 % and 5.8 % at month 24 . Changes over time were not associated with circumcision status . Compared to before they were circumcised , 64.0 % of circumcised men reported their penis was " much more sensitive , " and 54.5 % rated their ease of reaching orgasm as " much more " at month 24 . CONCLUSIONS Adult male circumcision was not associated with sexual dysfunction . Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm . These data indicate that integration of male circumcision into programs to reduce HIV risk is unlikely to adversely effect male sexual function Many studies have shown that skin tissue extracted by circumcision can cause differences in sexual function , especially at the time of ejaculation . Sensitivity changes in penile skin and sexual satisfaction deriving from circumcision starting from premature ejaculation ( PE ) are discussed . Furthermore , most of these studies rely on question naires . Extracted free nerve endings ( FNE ) on the foreskin , which can detect temperature , mechanical stimuli ( touch , pressure , stretch ) or pain ( nociception ) , have not been research ed . Our aim is to determine FNEs in foreskin and the affects on sexual function , especially PE . This prospect i ve study was done on adults who voluntarily applied to be circumcised between September 2010 and October 2011 . The ejaculation latency times ( ELT ) before circumcision have been assessed , and a PE diagnostic tool ( PEDT ) form was filled out by the urologist according to the answers given by the volunteers . The proximal and distal ends of the foreskin were marked before circumcision , and the extracted foreskin was sent to the pathology department to determine FNEs . Twenty volunteers ( average age 21.25 ± 0.44 years ) were included in the study .  The average ELT was 103.55 ± 68.39 seconds , and the average PE score was 4.35 ± 3.13 . Proximal , middle , and distal tip nerve densities were compared . Proximal and distal ( P = .003 ) and proximal and middle ( P = .011 ) segments differed from each other , whereas middle and distal were similar ( P = .119 ) . There were not any correlations between PEDT scores and total nerve endings number ( r = .018 , P = .942 ) . Also there were not any correlations between mean ELT and PEDT scores ( r = .054 , P = .822 ) . The tissue extracted by circumcision has intensive FNEs , yet FNE intensity has no relation to PE The aim of the present study was to determine the relevance of serum nitric oxide levels and the efficacy of selective serotonin reuptake inhibitors ( SSRI ) treatment on  premature ejaculation . Sixty married men ( aged 20–50 ) with lifelong premature ejaculation and forty healthy men ( aged 24–48 ) as control group were included in this study . The patients were evaluated by  intravaginal ejaculation latency time ( IELT ) for premature ejaculation ( PE ) . IELT<1 min is accepted PE . Patients with diabetes mellitus , chronic disorders or erectile dysfunction and heavy smokers were excluded . All patients were evaluated with history , physical examination , International Index of Erectile Dysfunction‐5 ( IIEF‐5 ) score and IELT by stopwatch  method . Nitric oxide levels were measured by Griess reaction , and all sample s were frozen at −80 ° C . Patients were r and omly categorised 4 group to receive fluoxetine 20 mg day−1 ( Group 1 ) , paroxetine 20 mg day−1 ( Group 2 ) , sertraline 50 mg day−1 ( Group 3 ) and healthy control ( Group 4 ) for 4 weeks . Baseline and post‐treatment findings were compared between the four groups . At the end of 4 weeks , in fluoxetine , paroxetine , sertraline  groups mean IELT values showed a statistically significant improvement from the baseline values ( P < 0.001 , P < 0.001 , P = 0.03 ; respectively ) . Baseline and 1st month follow‐up mean IIEF scores were 24.5 and 23.05 , 24.70 and 23.60 ( P < 0.05 ) in group 1 and group 3 respectively ; also 23.09 and 23.32 ( P > 0.05 ) in group 2 . Baseline serum NO levels were 31.8 , 30.44 , 30.8 and 42.84 in fluoxetine , paroxetine , sertraline and healthy control groups respectively . NO levels were statistically lower in patients with PE . After treatment of fluoxetine , paroxetine and sertraline , NO levels were increased baseline ( 35.8 , 36.4 , 38.08 ) ( P < 0.05 ) . Our findings indicated that PE is associated with decreased serum NO levels . After the SSRI treatment increased , NO may retard ejaculation presumably by central peripheral mechanism . Further studies are needed to confirm this suggestion and the role of NO in pathophysiology and treatment for premature ejaculation INTRODUCTION Intravaginal ejaculation  latency time ( IELT ) , defined as the time between the start of vaginal intromission and the start of intravaginal ejaculation , is increasingly used in clinical trials to assess the amount of selective serotonin reuptake inhibitor-induced ejaculation delay in men with premature ejaculation . Prospect ively , stopwatch assessment of IELTs has superior accuracy compared with retrospective question naire and spontaneous reported latency . However , the IELT distribution in the general male population has not been previously assessed . AIM To determine the stopwatch assessed-IELT distribution in large r and om male cohorts of different countries . METHODS A total of 500 couples were recruited from five countries : the Netherl and s , United Kingdom , Spain , Turkey , and the United States . Enrolled men were aged 18 years or older , had a stable heterosexual relationship for at least 6 months , with regular sexual intercourse . The surveyed population were not included or excluded by their ejaculatory status and comorbidities . This survey was performed on a " normal " general population .  Sexual events and stopwatch-timed IELTs during a 4-week period were recorded , as well as circumcision status and condom use . MAIN OUTCOME MEASURES The IELT , circumcision status , and condom use . RESULTS The distribution of the IELT in all the five countries was positively skewed , with a median IELT of 5.4 minutes ( range , 0.55 - 44.1 minutes ) . The median IELT decreased significantly with age , from 6.5 minutes in the 18 - 30 years group , to 4.3 minutes in the group older than 51 years ( P<0.0001 ) . The median IELT varied between countries , with the median value for Turkey being the lowest , i.e. , 3.7 minutes ( 0.9 - 30.4 minutes ) , which was significantly different from each of the other countries . Comparison of circumcised ( N=98 ) and not-circumcised ( N=261 ) men in countries excluding Turkey result ed in median IELT values of 6.7 minutes ( 0.7 - 44.1 minutes ) in circumcised compared with 6.0 minutes ( 0.5 - 37.4 minutes ) in not-circumcised men ( not significant ) . The median IELT value was not affected by condom use . CONCLUSION The IELT distribution is positively skewed . The overall median value was 5.4 minutes but with differences between countries . For all five countries , median IELT values were independent of condom usage . In countries excluding Turkey , the median IELT values were independent of circumcision status 
    Output:
    
agent
Based on these findings , circumcision does not have effect on PE
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of the study is to investigate whether there is an effect of adult circumcision on ejaculation parameters and to research the relationship between intravaginal ejaculation latency time ( IELT ) and premature ejaculation diagnostic tool ( PEDT ) . Adults who underwent voluntary circumcision between September 2010 and November 2011 were enrolled in this prospect i ve study . The IELT before and 3 months following circumcision was recorded . Also , PEDT was filled out before and 3 months after circumcision . During statistical evaluation , the comparison of situations before and after circumcision was made using IELT averages and PEDT total scores . Furthermore , the correlation between changes in IELT and PEDT has also been evaluated . A total of 30 volunteers ( mean age 21.25±0.44 ) were enrolled in the study . The volunteers ’ mean and median IELT before were 104.36±66.21 and 88 ( 26–307 ) seconds , whereas mean and median IELT after circumcision were 123.56±54.44 and 107.5 ( 67–300 ) seconds , respectively . The increase after circumcision was statistically significant ( P=0.001 ) . The mean and median PEDT score were 4.26±2.91 and 3 ( 1–12 ) before , and 2.63±1.82 and 2 ( 0–7 ) after circumcision . Improvement was statistically significant ( P<0.0001 ) . No correlation could be found between ejaculation time and PEDT scores . Circumcision during adulthood does not adversely affect ejaculatory function ; it may slightly improve . However , it could not be interpreted as a justification for circumcision in men with premature ejaculation ( PE ) INTRODUCTION The Global Online Sexuality Survey ( GOSS ) is a worldwide epidemiologic study of sexuality and sexual disorders . In 2010 , the first report of GOSS came from the Middle East . AIM This report studies the prevalence rate of premature ejaculation ( PE ) in the U.S. as of 2011 - 2012 and evaluates risk factors for PE . METHODS GOSS was r and omly deployed to English-speaking male web surfers in the USA via paid advertising on Facebook ® , comprising 146 questions . MAIN OUTCOME MEASURES Prevalence of PE as per the International Society of Sexual Medicine 's ( ISSM ) definition . RESULTS With a mean age of 52.38 years ± 14.5 , 1,133 participants reported on sexual function . As per the ISSM definition of PE , the prevalence rate of PE in the USA as of 2011 was 6.3 % . This is in contrast to 49.6 % as per the Premature Ejaculation Diagnostic Tool ( PEDT ) , 77.6 % as per unfiltered subjective reports , and 14.4 % as per subjective reporting on more consistent basis . 56.3 % of the latter reported lifelong PE . 63.2 % could be classified as having natural variable PE . Erectile dysfunction is a possible predisposing factor for acquired PE , while genital size concerns may predispose to lifelong PE . Age , irregular coitus , circumcision , and the practice of masturbation did not pose a risk for PE , among other risk factors . Oral treatment for PE was more frequently used and reported to be more effective than local anesthetics , particularly in those with lifelong PE . CONCLUSION Applying the ISSM definition , prevalence of PE is far less than diagnosed by other methods , 6.3 % among Internet users in USA as of the year 2011 . PEDT measures both lifelong and acquired PE , in addition to 35 % men with premature-like ejaculatory dysfunction  , making it inaccurate for isolating lifelong and acquired PE cases INTRODUCTION Male circumcision is being promoted for HIV prevention in high-risk heterosexual population s. However , there is a concern that circumcision may impair sexual function . AIM To assess adult male circumcision 's effect on men 's sexual function and pleasure . METHODS Participants in a controlled trial of circumcision to reduce HIV incidence in Kisumu , Kenya were uncircumcised , HIV negative , sexually active men , aged 18 - 24 years , with a hemoglobin > or=9.0 mmol/L. Exclusion criteria included foreskin covering less than half the glans , a condition that might unduly increase surgical risks , or a medical indication for circumcision . Participants were r and omized 1:1 to either immediate circumcision or delayed circumcision after 2 years ( control group ) . Detailed evaluations occurred at 1 , 3 , 6 , 12 , 18 , and 24 months . MAIN OUTCOME MEASURES ( i ) Sexual function between circumcised and uncircumcised men ; and ( ii ) sexual satisfaction and pleasure over time following circumcision . RESULTS Between February 2002 and September 2005 , 2,784 participants were r and omized , including the 100 excluded from this analysis because they crossed over , were not circumcised within 30 days of r and omization , did not complete baseline interviews , or were outside the age range . For the circumcision and control groups , respectively , rates of any reported sexual dysfunction decreased from 23.6 % and 25.9 % at baseline to 6.2 % and 5.8 % at month 24 . Changes over time were not associated with circumcision status . Compared to before they were circumcised , 64.0 % of circumcised men reported their penis was " much more sensitive , " and 54.5 % rated their ease of reaching orgasm as " much more " at month 24 . CONCLUSIONS Adult male circumcision was not associated with sexual dysfunction . Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm . These data indicate that integration of male circumcision into programs to reduce HIV risk is unlikely to adversely effect male sexual function Many studies have shown that skin tissue extracted by circumcision can cause differences in sexual function , especially at the time of ejaculation . Sensitivity changes in penile skin and sexual satisfaction deriving from circumcision starting from premature ejaculation ( PE ) are discussed . Furthermore , most of these studies rely on question naires . Extracted free nerve endings ( FNE ) on the foreskin , which can detect temperature , mechanical stimuli ( touch , pressure , stretch ) or pain ( nociception ) , have not been research ed . Our aim is to determine FNEs in foreskin and the affects on sexual function , especially PE . This prospect i ve study was done on adults who voluntarily applied to be circumcised between September 2010 and October 2011 . The ejaculation latency times ( ELT ) before circumcision have been assessed , and a PE diagnostic tool ( PEDT ) form was filled out by the urologist according to the answers given by the volunteers . The proximal and distal ends of the foreskin were marked before circumcision , and the extracted foreskin was sent to the pathology department to determine FNEs . Twenty volunteers ( average age 21.25 ± 0.44 years ) were included in the study .  The average ELT was 103.55 ± 68.39 seconds , and the average PE score was 4.35 ± 3.13 . Proximal , middle , and distal tip nerve densities were compared . Proximal and distal ( P = .003 ) and proximal and middle ( P = .011 ) segments differed from each other , whereas middle and distal were similar ( P = .119 ) . There were not any correlations between PEDT scores and total nerve endings number ( r = .018 , P = .942 ) . Also there were not any correlations between mean ELT and PEDT scores ( r = .054 , P = .822 ) . The tissue extracted by circumcision has intensive FNEs , yet FNE intensity has no relation to PE The aim of the present study was to determine the relevance of serum nitric oxide levels and the efficacy of selective serotonin reuptake inhibitors ( SSRI ) treatment on  premature ejaculation . Sixty married men ( aged 20–50 ) with lifelong premature ejaculation and forty healthy men ( aged 24–48 ) as control group were included in this study . The patients were evaluated by  intravaginal ejaculation latency time ( IELT ) for premature ejaculation ( PE ) . IELT<1 min is accepted PE . Patients with diabetes mellitus , chronic disorders or erectile dysfunction and heavy smokers were excluded . All patients were evaluated with history , physical examination , International Index of Erectile Dysfunction‐5 ( IIEF‐5 ) score and IELT by stopwatch  method . Nitric oxide levels were measured by Griess reaction , and all sample s were frozen at −80 ° C . Patients were r and omly categorised 4 group to receive fluoxetine 20 mg day−1 ( Group 1 ) , paroxetine 20 mg day−1 ( Group 2 ) , sertraline 50 mg day−1 ( Group 3 ) and healthy control ( Group 4 ) for 4 weeks . Baseline and post‐treatment findings were compared between the four groups . At the end of 4 weeks , in fluoxetine , paroxetine , sertraline  groups mean IELT values showed a statistically significant improvement from the baseline values ( P < 0.001 , P < 0.001 , P = 0.03 ; respectively ) . Baseline and 1st month follow‐up mean IIEF scores were 24.5 and 23.05 , 24.70 and 23.60 ( P < 0.05 ) in group 1 and group 3 respectively ; also 23.09 and 23.32 ( P > 0.05 ) in group 2 . Baseline serum NO levels were 31.8 , 30.44 , 30.8 and 42.84 in fluoxetine , paroxetine , sertraline and healthy control groups respectively . NO levels were statistically lower in patients with PE . After treatment of fluoxetine , paroxetine and sertraline , NO levels were increased baseline ( 35.8 , 36.4 , 38.08 ) ( P < 0.05 ) . Our findings indicated that PE is associated with decreased serum NO levels . After the SSRI treatment increased , NO may retard ejaculation presumably by central peripheral mechanism . Further studies are needed to confirm this suggestion and the role of NO in pathophysiology and treatment for premature ejaculation INTRODUCTION Intravaginal ejaculation  latency time ( IELT ) , defined as the time between the start of vaginal intromission and the start of intravaginal ejaculation , is increasingly used in clinical trials to assess the amount of selective serotonin reuptake inhibitor-induced ejaculation delay in men with premature ejaculation . Prospect ively , stopwatch assessment of IELTs has superior accuracy compared with retrospective question naire and spontaneous reported latency . However , the IELT distribution in the general male population has not been previously assessed . AIM To determine the stopwatch assessed-IELT distribution in large r and om male cohorts of different countries . METHODS A total of 500 couples were recruited from five countries : the Netherl and s , United Kingdom , Spain , Turkey , and the United States . Enrolled men were aged 18 years or older , had a stable heterosexual relationship for at least 6 months , with regular sexual intercourse . The surveyed population were not included or excluded by their ejaculatory status and comorbidities . This survey was performed on a " normal " general population .  Sexual events and stopwatch-timed IELTs during a 4-week period were recorded , as well as circumcision status and condom use . MAIN OUTCOME MEASURES The IELT , circumcision status , and condom use . RESULTS The distribution of the IELT in all the five countries was positively skewed , with a median IELT of 5.4 minutes ( range , 0.55 - 44.1 minutes ) . The median IELT decreased significantly with age , from 6.5 minutes in the 18 - 30 years group , to 4.3 minutes in the group older than 51 years ( P<0.0001 ) . The median IELT varied between countries , with the median value for Turkey being the lowest , i.e. , 3.7 minutes ( 0.9 - 30.4 minutes ) , which was significantly different from each of the other countries . Comparison of circumcised ( N=98 ) and not-circumcised ( N=261 ) men in countries excluding Turkey result ed in median IELT values of 6.7 minutes ( 0.7 - 44.1 minutes ) in circumcised compared with 6.0 minutes ( 0.5 - 37.4 minutes ) in not-circumcised men ( not significant ) . The median IELT value was not affected by condom use . CONCLUSION The IELT distribution is positively skewed . The overall median value was 5.4 minutes but with differences between countries . For all five countries , median IELT values were independent of condom usage . In countries excluding Turkey , the median IELT values were independent of circumcision status 
    Output:
    