Impact of premature ejaculation: the psychological, quality of life, and sexual relationship consequences

No Evidence for Long-Term Causal Associations Between Symptoms of Premature Ejaculation and Symptoms of Anxiety, Depression, and Sexual Distress in a Large, Population-Based Longitudinal Sample

Premature ejaculation (PE) is one of the most common male sexual complaints, but its etiology is unclear. Psychological problems, such as symptoms of anxiety and depression, have traditionally been seen as causal or maintaining etiological components of PE, and previous cross-sectional studies have found weak positive associations between them. The aim of the present study was to test possible causal pathways over time between PE and symptoms of the psychological problems anxiety, depression, and sexual distress. A sample of 985 male Finnish twins and brothers of twins completed a questionnaire in 2006 and 2012. Significant bivariate correlations were found both within and across time between PE and the psychological problems. When fitting structural equation models to test hypothesized causal pathways, symptoms of anxiety and sexual distress at the first measurement time point did not predict future PE. Likewise, PE symptoms at the first measurement did not predict increments or decrements in anxiety, sexual distress, or depression later on. These null findings regarding hypothesized associations may partly be explained by the relatively long time between measurements, or that the measures possibly did not capture the aspects of anxiety that are related to PE.

A Structural Equation Modeling Analysis of the Relationships between Depression, Anxiety, and Sexual Problems over Time

Sexual dysfunctions are related to depressive and anxiety disorders, but the nature of these relationships remains unclear. This study examined the relationship among symptoms of these disorders over time by comparing (a) a model that included causal relationships, (b) a model that accounted for change over time with a shared underlying factor (or latent liability) among all the disorders, and (c) a model that conceptualized sexual dysfunctions as unrelated to depressive and anxiety disorders over time. Participants (n = 1,012) completed online self-report measures of sexual dysfunctions and depressive and anxiety disorders across six time points at either weekly or monthly intervals. Models 1 and 2 provided equal best fit for men and women based on data collected four weeks apart, but there were no evident causal relationships in Model 1. Subsequent analyses using data collected one week and six months apart found Model 2 provided robust fit for women, but these data were not examined for men due to inadequate sample sizes. The results are consistent with a shared latent liability of internalizing psychopathology driving the change in these disorders over time, which provides a clear direction for an empirically driven nosology and for future research into transdiagnostic treatments.

Initiators and Barriers to Discussion and Treatment of Premature Ejaculation Among Men and Their Partners in Asia Pacific - Results From a Web-based Survey

Introduction

Premature ejaculation (PE) is one of the most prevalent yet under-reported sexual disorders. Differing sociocultural norms across the Asia-Pacific region provide unique challenges in PE management.

Methods

This web-based study collected data from 5,038 men and women across 11 countries in the Asia-Pacific region. Respondents were recruited from an existing database.

Main Outcome Measures

The initiators and barriers for PE discussions and for seeking professional management following self-treatment, as well as their choices and expectations of healthcare professionals (HCPs).

Results

More than two-thirds of respondents have discussed PE with their partners, and men are more likely to initiate the discussion. Top drivers were for both partners to attain sexual satisfaction and greater fulfillment in the relationship. Emotional insecurity was the top barrier for men as they did not want to feel hurt or inadequate. Before consulting an HCP, more than two-thirds of men self-treated their PE for at least 20 months. The primary reason for stopping self-treatment and seeking medical management was a lack of improvement in sexual satisfaction. The ideal attributes that men seek in their HCP included trust and being knowledgeable about PE management.

Conclusion

Attitudes and barriers to PE and its treatment in the Asia-Pacific region are poorly understood. Many men are reluctant to seek professional advice and therefore resort to self-treatment for extended periods. HCPs can play a key role to empower PE sufferers and partners to understand the prevalence, medical relevance, treatability, and negative impacts of PE on sexual and overall relationships. Greater awareness of the diverse cultural and social norms, education of both partners and HCPs, and the involvement of HCPs through a patient-centric approach are all pivotal in managing PE optimally across the Asia-Pacific region.

Relationship between premature ejaculation and depression: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND

Premature ejaculation (PE) is the most prevalent male sexual dysfunction. Epidemiologic findings are inconsistent concerning the risk for depression associated with PE.

OBJECTIVE

The aim of this study was to investigate the potential association between between depression and risk of PE.

DATA SOURCES

We conducted a literature search of PubMed, Embase, and the Cochrane Library from these databases' inception through June 2014 for observational epidemiological studies examining the association between depression on risk of PE.

STUDY ELIGIBILITY CRITERIA

Studies were selected if they reported the risk estimates for PE associated with depression.

PARTICIPANTS

patients>18 years of age suffering from PE.

INTERVENTIONS

a history of depressive disorder.

STUDY APPRAISAL AND SYNTHESIS METHODS

These odds ratios (ORs) were pooled using a random or fixed effects model and were tested for heterogeneity. Subgroup analysis was employed to explore heterogeneity.

RESULTS

Eight trials involving 18,035 patients were included in the meta-analysis. Depression were statistically significantly associated with the risk of PE (OR = 1.63, 95% CI:1.42-1.87). There was no evidence of between-study heterogeneity (P = 0.623, I = 0.0%). The association was similar when stratified by mean age, geographical area, study design, sample size, publication year, and controlling key confounders.

LIMITATIONS

The severity of depression and PE could not be identified due to unavailable data of trials. No evidence of publication bias was observed.

CONCLUSIONS

These findings provide evidence that depression is associated with a significantly increased risk of PE. In addition, more prospective studies are necessary to evaluate the association and identify the ideal treatment.

SYSTEMATIC REVIEW REGISTRATION NUMBER

CRD42016041272.

The office management of ejaculatory disorders

Premature ejaculation (PE), delayed ejaculation (DE), anejaculation (AE) and retrograde ejaculation (RE) are four main ejaculatory disorders (EjDs) observed in clinical practice. Despite their high prevalence, EjDs remain underdiagnosed and undertreated. Primary care physicians should incorporate the discussion of sexual health topics into routine visits to facilitate EjD diagnosis and treatment. Because the causes of EjDs are multifactorial, the management of EjDs is etiology-specific and may require a holistic approach. Dapoxetine, a selective serotonin reuptake inhibitor, is the only drug approved for on-demand treatment of lifelong and acquired PE. In clinical practice, scheduled follow-up visits, risk factor treatment, appropriate dose escalation, adequate sexual attempts, patient education, and partner involvement are critical factors responsible for optimal overall management of PE and dapoxetine treatment outcomes.

Men with Sexual Problems and Their Partners: Findings from the International Survey of Relationships

Epidemiologic studies of sexual function problems in men have focused on the individual male and related sociodemographic characteristics, individual risk factors and lifestyle concomitants, or medical comorbidities. Insufficient attention has been given to the role of sexual and relationship satisfaction and, more particularly, to the perspective of the couple as causes or correlates of sexual problems in men or women. Previously, we reported results of the first large, multi-national study of sexual satisfaction and relationship happiness in 1,009 midlife and older couples in five countries (Brazil, Germany, Japan, Spain, U.S.). For the present study, we examined, within each problem, the association of four major sexual problems in men (loss of sexual desire, erectile problems, premature ejaculation, delayed/absent orgasm) and multiple problems, with male and female partners' assessments of physical intimacy, sexual satisfaction, and relationship happiness, as well as associations with well-known health and psychosocial correlates of sexual problems in men. Sexual problem rates of men in our survey were generally similar to rates observed in past surveys in the general population, and similar risk factors (age, relationship duration, overall health) were associated with lack of desire, anorgasmia, or erection difficulties in our sample. As in previous surveys, there were few correlates of premature ejaculation. As predicted, men with one or more sexual problems reported decreased relationship happiness as well as decreased sexual satisfaction compared to men without sexual problems. Moreover, female partners of men with sexual problems had reduced relationship happiness and sexual satisfaction, although these latter outcomes were less affected in the women than the men. The association of men's sexual problems with men's and women's satisfaction and relationship happiness were modest, as these couples in long-term, committed relationships were notable for their relatively high levels of physical affection and relationship happiness.

Interplay Between Premature Ejaculation and Erectile Dysfunction: A Systematic Review and Meta-Analysis

INTRODUCTION

The specific determinants and underlying factors linking erectile dysfunction (ED) and premature ejaculation (PE) have yet to be clearly identified.

AIM

The aim of this study was to review and meta-analyze all available data regarding the link between ED and PE.

METHODS

An extensive Medline Embase and Cochrane search was performed including the following words: "premature ejaculation" and "erectile dysfunction".

MAIN OUTCOME MEASURES

All observational trials comparing the risk of ED in relation to PE were included. Data extraction was performed independently by two of the authors (G.R, G.C.), and conflicts resolved by the third investigator (M.M.).

RESULTS

Out of 474 retrieved articles, 18 were included in the study for a total of 57,229 patients, of which 12,144 (21.2%) had PE. The presence of PE, however defined, was associated with a significant increase in ED risk (odds ratio: 3.68[2.61;5.18]; P < 0.0001). Meta-regression analysis showed that the risk of ED in PE subjects was higher in older individuals as well as in those with a lower level of education and in those who reported a stable relationship less frequently. In addition, subjects with PE and ED more often reported anxiety and depressive symptoms and a lower prevalence of organic associated morbidities, including diabetes mellitus, hypertension and dyslipidemia. All the latter associations were confirmed even after adjustment for age. Finally the risk of PE-related ED increased with the increased proportion of acquired ejaculatory problems (adj r = 0.414; P < 0.0001 after the adjustment for age).

CONCLUSIONS

In conclusion, the present data showed that ED and PE are not distinctly separate entities, but should be considered from a dimensional point of view. Understanding this dimensional perspective might help sexual health care professionals in providing the most appropriate therapeutic approach to realistically increase patient related outcomes in sexual medicine.

Emotional Intelligence and Sexual Functioning in a Sample of Swiss Men and Women

INTRODUCTION

Past research has emphasized the importance of psychologic factors in the multifactorial etiology of sexual problems.

AIM

The purpose of the study was to examine (i) how emotional intelligence (EI) associates with sexual functioning; and (ii) whether EI moderates the association between sexual functioning and sexual quality of life (SQoL).

METHODS

A total of 211 participants completed questionnaires relating to EI, sexual functioning, and SQoL. A set of standardized and validated questionnaires were used, including the International Index of Erectile Function, the Premature Ejaculation Diagnostic Tool, the Female Sexual Function Index, the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), and the Sexual Quality of Life Questionnaire (SQoL).

MAIN OUTCOME MEASURES

Correlation, partial correlation, and moderation analyses were used to investigate the associations and moderations.

RESULTS

When taking into account age and relationship duration, EI was significantly negatively correlated with female sexual desire only (rs  = -0.39, P < 0.01). No associations between EI and male sexual functioning on any domain could be detected. A moderation effect of EI in the association between sexual satisfaction and SQoL was observed in women, but not in men. Sexual functioning correlated positively with SQoL in both sexes.

CONCLUSIONS

Our findings show for the first time an association between female desire levels and normal variations in EI. Findings also tentatively suggest a relative gender difference in the factors contributing to sexual problems and SQoL, although results need to be confirmed in larger samples.

Psychosocial profile of male patients presenting with sexual dysfunction in a psychiatric outpatient department in Mumbai, India

INTRODUCTION

Sexual dysfunction can occur due to biological problems, relationship problems, lack of proper sexual knowledge or a combination of these. India is often known as the land of Kamasutra. But as far as sexuality research is concerned, there is a paucity of relevant data from India. In view of this, we conducted a study to assess the psychosocial profile of males presenting with sexual dysfunction to psychiatry out-patient department of a tertiary medical hospital.

MATERIALS AND METHODS

Hundred consecutive male patients presenting with sexual dysfunction were screened using Arizona Sexual Experiences Scale for clinical sexual dysfunction and after obtaining their informed consent were included in this study. They were assessed using a semi-structured proforma, Diagnostic and Statistical Manual of Mental Disorders, 4(th) Edition, Text Revision criteria, Mini-International Neuropsychiatric Interview, and Dyadic Adjustment Scale.

RESULTS

Majority of our respondents were in the 18-30 years age group and were married. The main source of sex knowledge for 69% of them was peer group. Age of onset of masturbation was 11-13 years for 43% of them. Premature ejaculation was the most common sexual dysfunction seen in the respondents. Marital discord was seen in significantly lesser number of respondents (32.35%) as also major depressive disorder that was seen in only 16%.

DISCUSSION

Premature ejaculation was the most common sexual dysfunction in our sample. Despite the sexual dysfunction, marital discord and depression were seen less commonly in our respondents.

An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second international society for sexual medicine ad hoc committee for the definition of premature ejaculation

Introduction

The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE.

Aim

The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE.

Methods

In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence-based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted.

Results

The committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time (IELT) as compared with men with lifelong PE. A self-estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut-off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 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 intimacy.

Conclusion

The ISSM unified definition of lifelong and acquired PE represents the first evidence-based definition for these conditions. This definition will enable researchers to design methodologically rigorous studies to improve our understanding of acquired PE. Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, Becher EF, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An evidence-based unified definition of lifelong and acquired premature ejaculation: Report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. Sex Med 2014;2:41–59.

An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE)

INTRODUCTION

In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts.

AIM

The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts.

METHOD

A comprehensive literature review was performed.

RESULTS

This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients.

CONCLUSION

Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60-90.

Erectile dysfunction is a strong predictor of poor quality of life in men with Type 2 diabetes mellitus

AIMS

To identify predictors of poor quality of life among men with diabetes from a comprehensive set of sexual, clinical, socio-economic and lifestyle variables.

METHODS

This was a cross-sectional observational-study of 253 men with Type 2 diabetes, randomly selected from a clinic in Colombo, Sri Lanka. Erectile dysfunction was assessed using the five-item International Index of Erectile Function and quality of life was assessed using the Sri Lankan version of the 36-item short form health survey questionnaire and the disease-specific Psychological Impact of Erectile Dysfunction scale. The presence of premature ejaculation, reduced libido, socio-demographic and lifestyle data was obtained using an interviewer-administered questionnaire. Significant predictors of quality of life were identified by stepwise multivariate linear regression models for short form-36 subscales, summary scales and two scales of Psychological Impact of Erectile Dysfunction.

RESULTS

Significant predictors on the physical summary scale of the 36-item short form were erectile dysfunction (β = 7.93, 95% CI 3.70-12.17, P < 0.001) and reduced libido (β = 5.20, 95% CI 0.82-9.59, P < 0.05). Predictors on the mental health summary scale of the 36-item short form were erectile dysfunction (β = 5.82, 95% CI 2.26-9.37, P < 0.01), BMI > 27.5 kg/m(2) (β = 9.12, 95% CI 1.38-17.44, P < 0.05), ischaemic heart disease (β = 6.39, 95% CI 0.74-12.04, P < 0.05) and insulin therapy (β = 5.28, 95% CI 0.34-10.22, P < 0.05). Significant predictors in the sexual experience scale of the Psychological Impact of Erectile Dysfunction were erectile dysfunction (β = 6.57, 95% CI 4.63-8.51, P < 0.001), reduced libido (β =4.33, 95% CI 2.34-6.32, P < 0.001) and postural hypotension (β = 3.99, 95% CI 0.13-7.85, P < 0.05). Predictors on the emotional life scale of the Psychological Impact of Erectile Dysfunction were erectile dysfunction (β = 2.96, 95% CI 1.37-4.58, P < 0.001), reduced libido 2.75 (β = 2.75, 95% CI 1.12-4.40, P < 0.01), younger age (β = 1.05, 95% CI 0.35-1.75, P < 0.01) and postural hypotension (β = 3.39, 95% CI 0.35-6.45, P < 0.05).

CONCLUSION

Erectile dysfunction was a strong predictor of poor generic and disease-specific quality of life among other sexual and clinical variables in men with diabetes.

An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation

INTRODUCTION

The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE.

AIM

The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE.

METHODS

In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence-based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted.

RESULTS

The committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time (IELT) as compared with men with lifelong PE. A self-estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut-off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 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 intimacy.

CONCLUSION

The ISSM unified definition of lifelong and acquired PE represents the first evidence-based definition for these conditions. This definition will enable researchers to design methodologically rigorous studies to improve our understanding of acquired PE.

An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE)

INTRODUCTION

In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts.

AIM

The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts.

METHOD

A comprehensive literature review was performed.

RESULTS

This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients.

CONCLUSION

Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years.

Female partner's perception of premature ejaculation and its impact on relationship breakups, relationship quality, and sexual satisfaction

INTRODUCTION

Women's perceptions of the men's ejaculatory behavior, as well as the impact premature ejaculation (PE) has on the couple's functioning, are important factors that need to be considered.

AIM

This survey investigated women's perception and importance of ejaculatory function, as well as the specific aspects of PE that cause distress. In addition, the survey further identified the factors with a greater impact on intimacy, relationship, and sexual behavior.

METHODS

The 1,463 females belonging to a web panel from three different countries (Mexico, Italy, and South Korea), aged 20-50 years, participated in the survey. A combination of validated and self-constructed questionnaires to assess women's perception of PE, relationship satisfaction and quality, and sexual functioning and satisfaction were used.

MAIN OUTCOME MEASURES

Descriptive statistics in form of proportions and percentages, correlation, and regression analyses.

RESULTS

A significant correlation between the importance of ejaculatory control and felt distress could be observed (rho = 0.55, P < 0.001). Women reporting less sexual problems considered ejaculatory control more important and reported more PE-related distress (rho = 0.23 and 0.11, respectively; P < 0.001 for both). The male's lack of attention and focus on performance was the most frequently reported reasons for sexual distress (47.6%) followed by "the short time between penetration and ejaculation" (39.9%), and "the lack of ejaculatory control" (24.1%). Almost a quarter of women reported that the man's ejaculatory problem had previously led to relationship breakups (22.8%). Women considering duration to be important were more likely to report breakups.

CONCLUSIONS

The study highlights the detrimental effects of PE on relationship and sexual satisfaction in the female partner and how it can lead to the termination of the relationship. Most notably, this is the first study to report that an important source of female distress are not only parameters related to performance such as control or duration but rather inappropriate attention focus and the negligence of other forms of sexual activities.

Prevalence and impact of premature ejaculation in outpatients complaining of ejaculating prematurely: using the instruments of intravaginal ejaculatory latency time and patient-reported outcome measures

This study was designed to assess the impact of premature ejaculation (PE) on a large population of men and their female partners using the instruments of intravaginal ejaculatory latency time (IELT) and patient-reported outcome (PRO) measures. A non-interventional, observational and cross-sectional field survey enrolled 2704 men with self-reported PE and their female partners from January 2010 to January 2012. PE was diagnosed by the International Society for Sexual Medicine (ISSM) criterion. IELT and sexual dysfunction were measured using a stopwatch and PRO measures, respectively. The incidence of PE in this study was 19.27%. PE negatively impacted on subjects and their partners, including reduced ejaculatory control and sexual satisfaction, and increased personal distress and interpersonal difficulty (P<0.001 for all). The severity of PE was considered worse by subjects than by their female partners (P<0.001). Reduced ejaculatory control and sexual satisfaction were considered the central themes of PE. Furthermore, a correlation was observed among the outcomes of IELT and PRO measures for subjects and their partners (absolute correlation coefficient ranged from 0.33 to 0.67). This in-depth qualitative study provides valuable insight into the PE status in Chinese men. Further research is needed to confirm and extend these results.

Comparison of alpha blockers in treatment of premature ejaculation: a pilot clinical trial

Background:

Premature ejaculation (PE) is the most common sexual disorder in men and studies reported prevalence up to 30% (1, 2). PE is not a life-threatening medical condition but it influences the quality of life (QoL).

Objectives:

The aim of this study was to compare the efficiency, and safety of alpha blocker drugs in the treatment of patients with premature ejaculation (PE). Additionally we investigated the quality of life (QoL) in patients with PE who were treated with alpha blocker drugs.

Materials and Methods:

This study was a pilot clinical trial. Prospectively documented 108 patients with PE were treated and were followed-up in urology outpatient clinic. All patients were divided into 5 groups according to used alpha blocker agents which were determined by simple randomization. Silodosin 4mg (Group 1, n = 21), tamsulosin hydrochloride 0.4mg (Group 2, n = 23), alfuzosin 10mg (Group 3, n = 22), terazosin 5mg (Group 4, n = 21), doksazosin mesylate 4mg (Group5, n = 21), were used for treatment. The demographic parameters of patients, pre and post treatment intravaginal ejaculation latency time (IELT), PE Profile (PEP), and QoL index were recorded and evaluated. Effectiveness of treatment was evaluated by measuring IELT. Additionally, side effects of drugs were recorded. P < 0.05 was considered statistically significant.

Results:

All alpha blocker drugs were statistically effective for preventing PE. Notably, silodosin seemed to be more effective for preventing PE than other alpha blockers (P < 0.05). However all alpha blockers provided development in QoL scores, silodosin was a little better than other drugs in statistical analyses. Furthermore statistical increase in IELT and decrease in PEP were provided more in Group 1 than other groups (P < 0.05).

Conclusions:

Silodosin seems to be able to even more prevent PE. Silodosin may provide development in QoL than other alpha blocker agents. Additionally, lower systemic adverse events and more effectivity are the prominent features of silodosin in PE.This study was a pilot clinical trial. Prospectively documented 108 patients with PE were treated and were followed-up in urology outpatient clinic. All patients were divided into 5 groups according to used alpha blocker agents which were determined by simple randomization. Silodosin 4mg (Group 1, n = 21), tamsulosin hydrochloride 0.4mg (Group 2, n = 23), alfuzosin 10mg (Group 3, n = 22), terazosin 5mg (Group 4, n = 21), doksazosin mesylate 4mg (Group5, n = 21), were used for treatment. The demographic parameters of patients, pre and post treatment intravaginal ejaculation latency time (IELT), PE Profile (PEP), and QoL index were recorded and evaluated. Effectiveness of treatment was evaluated by measuring IELT. Additionally, side effects of drugs were recorded. P < 0.05 was considered statistically significant.

Self-Reported Prevalence of and Attitudes toward Premature Ejaculation in a Community-Based Study of Married Couples

PURPOSE

We evaluated the self-reported prevalence of and attitudes toward premature ejaculation (PE) in a community-based study of married couples.

MATERIALS AND METHODS

A community-based cross-sectional study of PE was conducted among married couples in Gwangju, Korea. Self-reported data were collected through the use of questionnaires, which included demographic questions, the Premature Ejaculation Diagnostic Tool (PEDT), the intravaginal ejaculation latency time (IELT), patient-reported outcome (PRO), and the Female Sexual Function Index (FSFI).

RESULTS

Of the 290 couples who completed the survey, the prevalence of PEDT-diagnosed PE including probable PE was 23.7% of men. By IELT measure, the prevalence of PE was 21.7% as reported by the men and 23.9% as reported by their partners, respectively. PRO responses indicated that control over ejaculation and severity of PE were not reported significantly differently by the men and their partners. Satisfaction with sexual intercourse was poorer for the men's partners than for the men. Personal distress and interpersonal difficulty were higher for the men than for their partners. The partners of men in the PE group had significantly lower FSFI scores than did the partners of men in the non-PE group.

CONCLUSIONS

The reporting of the prevalence of PE did not differ significantly between the men in this study and their partners. However, PE in men tended to impact their partners' sexual function.

A meta-analysis of the effects of the 5-hydroxytryptamine transporter gene-linked promoter region polymorphism on susceptibility to lifelong premature ejaculation

Objective

Premature ejaculation (PE) has been reported as the most common male sexual dysfunction with global prevalence rates estimated at approximately 30%. The neurobiogenesis of ejaculation is very complex and involves the serotoninergic (5-hydroxytryptamine, 5-HT) system. Recently, genetic polymorphisms located on SLC6A4 gene codifying for 5-HT transporter (5-HTT), the major regulator of serotonic neurotransmission, have been linked with the pathogenesis and risk of PE. Apparently studies of this type of polymorphism in PE have show conflicting results.

Methods

A meta-analysis was performed that are available in relation with 5-HTT gene-linked promoter region (5-HTTLPR) polymorphism and the risk of lifelong PE (LPE) in men to clarify this relationship. We searched Pubmed and Embase (last search updated on Aug 2012) using ‘premature ejaculation’, ‘polymorphism or variant’, ‘genotype’, ‘ejaculatory function’, and ‘rapid ejaculation’ as keywords and reference lists of studies corresponded to the inclusion criteria for meta-analysis. These studies involved the total number of 481 LPE men and 466 health control men subjects. Odds ratio (OR) and 95% confidence intervals (CIs) were used to evaluate this relationship.

Results

In the overall analysis, significant associations between LPE risk and 5-HTTLPR polymorphism were found (L-allele vs. S-allele OR = 0.86, 95% CI = 0.79–0.95, P = 0.002; LL vs. SS: OR = 0.80, 95% CI = 0.68–0.95, P = 0.009; LS vs. SS: OR = 0.85, 95% CI = 0.76–0.97, P = 0.012 and LL+LS vs. SS: OR = 0.88, 95% CI = 0.81–0.95, P = 0.002). Moreover, in subgroup analysis based on ethnicity, similar significant associations were detected. The Egger’s test did not reveal presence of a publication bias.

Conclusions

Our investigations demonstrate that 5-HTTLPR (L>S) polymorphism might protect men against LPE risk. Further studies based on larger sample size and gene-environment interactions should be conducted the role of 5-HTTLPR polymorphism and LPE risk.

Functional and psychological characteristics of belgian men with premature ejaculation and their partners

Physiological, behavioral, cognitive, and emotional factors are generally acknowledged to play a role in premature ejaculation (PE). However, the nature and the extent of their etiological impact remain largely imprecise. The present study examined functional and psychometric dynamics at work in a PE population. A total of 461 men with PE and 80 partners completed an online questionnaire. The main outcome measures were self-reported ejaculatory latency time, the feeling of control upon ejaculation, sexual satisfaction, distress related to PE, trait anxiety (STAI-B), sexual cognitions (Sexual Irrationality Questionnaire [SIQ]), social anxiety (Liebowitz's Social Anxiety Scale [LSAS] and Social Interaction Self-Statement Test [SISST]), and personality traits (Temperament and Character Inventory-Revised [TCI-R]). In our sample, the median latency time to ejaculation was between 1 and 2 min. Sexual satisfaction and distress correlated more strongly with the feeling of control than with the self-reported latency time. Men experienced more distress and dissatisfaction related to PE than did their partners, while overestimating their partners' distress and dissatisfaction. PE participants' scores differed significantly, albeit slightly, from STAI-B, SIQ, LSAS, and SISST norms. The differences were negligible on TCI-R. Some differences became stronger when subtypes were considered. Participants combining generalized and lifelong PE with self-reported latency times of <30 s reported lower sexual satisfaction and control, higher distress, higher social anxiety, and harm avoidance (TCI-R/HA) scores. By contrast, the situational subtype of PE was found to be characterized by a higher level of satisfaction, a greater feeling of control, less distress, and higher trait anxiety scores. However, the trends remained statistically discrete.

Prevalence and risk factors for female sexual dysfunction among Egyptian women

PURPOSE

To assess sexual function among married women and determine associated risk factors for sexual dysfunction.

PARTICIPANTS AND METHOD

Cross-sectional hospital-based study involving 509 non-pregnant married females 20-59 years old who were enrolled into the study after approval of the ethics committee. The study population was recruited among women attending gynecology outpatient clinic or their relatives visiting inpatients of obstetrics and gynecology department at Suez Canal University Hospital. Female and male partner-related data were collected using an interview questionnaire. Sexual dysfunction was assessed using female sexual function index (FSFI).

RESULTS

Mean female age was 39.5 years. About half of the participants were premenopausal (48.7 %). Most of the females were circumcised (71.7 %). Desire and Orgasm domains were the most affected with 52.8 % of the participants having sexual dysfunction. Total FSFI score of ≤26.55 was the cutoff value for diagnosis of FSD and female age, postmenopausal status, duration of marriage, circumcision, partner's age, and the presence of male sexual dysfunction were found to be significant associated factors with FSD.

CONCLUSION

FSD is highly prevalent in Egypt and orgasm and desire scores were the most affected domains. Several personal (female age, postmenopausal status, duration of marriage and circumcision) and male partner (age, and the presence of sexual dysfunction) factors were significantly associated.

Premature ejaculation results in female sexual distress: standardization and validation of a new diagnostic tool for sexual distress

PURPOSE

We measured premature ejaculation related female sexual distress using a new diagnostic tool, the Female Sexual Distress Scale-Revised-Premature Ejaculation questionnaire.

MATERIALS AND METHODS

In this large-scale, Internet based population study we evaluated 2,109 women in a stable relationship during the last 6 months. The 1,361 women in the premature ejaculation group had no female sexual disorder but the partner had premature ejaculation alone. The 748 controls had no female sexual disorder and a partner without premature ejaculation. We determined questionnaire content and discriminant validity, internal consistency and test-retest reliability. Multivariate logistic regression with propensity score reweighting was done to determine the clinical impact of demographics on the perception of sexual distress.

RESULTS

The questionnaire was well understood. Internal consistency was greater than 0.90 and 0.84 in the premature ejaculation and control groups, respectively. Test-retest reliability was 0.82 (95% CI 0.72-0.87) and 0.85 (95% CI 0.79-0.92) in the premature ejaculation and control groups, respectively. The questionnaire had a high AUC of 0.90 (95% CI 0.89-0.91). The new cutoff score of 12 or greater had 79.1% sensitivity (95% CI 73.8-82.5), 99.5% specificity (95% CI 98.0-100.0), 99.3% positive predictive value (95% CI 98.7-100.0) and 67.9% negative predictive value (95% CI 64.2-73.2). Median questionnaire scores were significantly higher in the premature ejaculation group than in controls (20, 95% CI 19-21 vs 6, 95% CI 6-7, p <0.0001). Logistic regression adjusted and unadjusted by propensity score indicated that women in the premature ejaculation group had a 7.12 (95% CI 5.98-10.14, p <0.0001) to 9.83 (95% CI 7.94-12.15) greater probability of sexual distress than controls.

CONCLUSIONS

The Female Sexual Distress Scale-Revised-Premature Ejaculation questionnaire fulfills psychometric requirements for measuring sexual distress related to partner sexual dysfunction.

The prevalence of premature ejaculation and its clinical characteristics in Korean men according to different definitions

This study compared the prevalence of premature ejaculation (PE) diagnosed by the PE diagnostic tool (PEDT) score, self-reporting and stopwatch-recorded intravaginal ejaculation latency time (IELT). It examined the characteristics of males diagnosed with PE by each criterion. A questionnaire survey enrolled 2081 subjects from March to October, 2010. Stopwatch-recorded IELT was measured in 1035 of the 2081 subjects. We aimed to determine whether PE has an influence on the frequency and satisfaction of sexual intercourse, the degree of libido/erectile function and the satisfaction. These factors were evaluated according to different definitions of PE to assess whether the definition used yielded differences in the data. The prevalence of PE, based on a PEDT score of ≥11, self-reporting and stopwatch-recorded IELT of ≤1 min was 11.3%, 19.5% and 3%, respectively. The prevalence of PE diagnoses based on PEDT score and self-reporting increased with age, but stopwatch-recorded IELT-based diagnoses did not. Males experiencing PE showed lower levels of libido, erectile function and frequency and satisfaction of sexual intercourse compared with non-PE males. PE males felt that they did not satisfy their partners in terms of the partners' sexual satisfaction and frequency of orgasm, in comparison with non-PE males. PE is a highly prevalent sexual dysfunction in males. Regardless of whether the PE diagnosis was made on the basis of self-reporting, PEDT score or stopwatch-recorded IELT, subjective symptoms were similar among PE males.

What does premature ejaculation mean to the man, the woman, and the couple?

INTRODUCTION

The relational impact of male and female sexual dysfunction, and specifically premature ejaculation (PE), is an important consideration. Published findings are consistent in identifying the negative psychosocial impact of PE on the man. However, the effect of PE on the female partner, especially in relation to her sexual functioning, has been less well studied.

AIM

Provide an overview of the impact of PE on the man, the woman, and the couple.

METHODS

Review of relevant literature.

RESULTS

Female partners of men with PE report significantly greater sexual problems, with reduced satisfaction, increased distress and interpersonal difficulty, and more orgasmic problems than partners of non-PE men. Both men with PE and their partners feel control over ejaculation is the central issue in PE. For both, the lack of control leads to dissatisfaction, a feeling that something is missing from the relationship, and an impaired sense of intimacy. If left untreated, the situation can lead to increased irritability, interpersonal difficulties, and deepening of an emotional divide.

CONCLUSIONS

When treating a man with PE, the partner's participation should be encouraged to enable the physician to fully understand the extent of the problem, and consider other relevant factors, from her perspective. Identifying the best approach for the couple requires consultation with each person individually and together. In clinical practice, treatments for PE are likely to include a combination of pharmacological, psychological, sexological, and/or behavioral approaches for both the man and his partner. It is important that physicians regard PE as the couple's problem and endeavor to include the partner in its management where possible.

Measuring sexual function in community surveys: development of a conceptual framework

Among the many psychometric measures of sexual (dys)function, none is entirely suited to use in community surveys. Faced with the need to include a brief and non-intrusive measure of sexual function in a general population survey, a new measure was developed. Findings from qualitative research with men and women in the community designed to inform the conceptual framework for this measure are presented. Thirty-two semi-structured interviews with individuals recruited from a general practice, an HIV/AIDS charity, and a sexual problems clinic were conducted. From their accounts, 31 potential criteria of a functional sex life were identified. Using evidence from qualitative data and the existing literature, and applying a set of decision rules, the list was reduced to 13 (eight for those not in a relationship), and a further eight criteria were added to enable individuals to self-rate their level of function and indicate the severity of difficulties. These criteria constitute a conceptual framework that is grounded in participant perceptions; is relevant to all, regardless of sexual experience or orientation; provides opportunity to state the degree of associated distress; and incorporates relational, psychological, and physiological aspects. It provides the conceptual basis for a concise and acceptable measure of sexual function.

Premature ejaculation and erectile dysfunction prevalence and attitudes in the Asia-Pacific region

INTRODUCTION

Premature ejaculation (PE) is a common male sexual dysfunction. The prevalence of PE in the Asia-Pacific region has not been comprehensively studied.

AIM

The aim of this study is to evaluate PE prevalence in nine Asia-Pacific countries and the impact of PE on sufferers.

METHODS

A random sample of heterosexual males aged 18-65 years in a stable sexual relationship currently or in the past 2 years completed a 48-question survey by computer-assisted interviewing, online, or in-person; the survey and recruitment methodologies varied by location. The survey included demographic questions, the five-question Premature Ejaculation Diagnostic Tool (PEDT), the five-question Sexual Health Inventory for Men (SHIM), and the 10-question Index of Premature Ejaculation (IPE). Separately, men self-reported having PE (lifelong or acquired) or erectile dysfunction (ED).

MAIN OUTCOME MEASURES

The PEDT was used to diagnose PE or probable PE; the SHIM was used to diagnose ED; and the IPE was used to assess respondent's attitudes toward PE.

RESULTS

Of the 4,997 men who completed the survey, the prevalences of PEDT-diagnosed PE, PEDT-diagnosed probable PE, and self-reported PE were 16%, 15%, and 13%, respectively. Less than half of men with PEDT-diagnosed PE (N = 816) or probable PE (N = 738) self-reported the condition (40% and 19%, respectively), and 6% of men with a PEDT diagnosis of no PE self-reported PE. In contrast, more respondents self-reported ED (8%) than had SHIM-diagnosed moderate or severe ED (5%). IPE responses indicated that 45%, 46%, and 23% of men with PEDT-diagnosed PE were somewhat or very dissatisfied with the length of intercourse before ejaculation, their control over ejaculation, and with sexual intercourse, respectively.

CONCLUSIONS

In this study, PE was more prevalent than ED in the Asia-Pacific countries surveyed, but only 40% of men with PEDT-diagnosed PE self-reported PE.

Predictors of sexual bother in a population of male North American medical students

INTRODUCTION

The prevalence and associations of sexual bother in male medical students has not been extensively studied.

AIMS

The aim of this study is to analyze predictors of sexual bother in a survey of male North American medical students.

METHODS

Students enrolled in allopathic and osteopathic medical schools in North America between February 2008 and July 2008 were invited to participate in an internet-based survey of sexuality and sexual function.

MAIN OUTCOME MEASURES

The principle outcome measure was a single-item question inquiring about global satisfaction with sexual function. The survey also consisted of a questionnaire that included ethnodemographic factors, student status, sexual history, and a validated scale for the assessment of depression. Respondents completed the International Index of Erectile Function, the premature ejaculation diagnostic tool, and the Self-Esteem and Relationship Quality survey (SEAR). Descriptive statistics, analysis of variance, and multivariable logistic regression were utilized to analyze responses.

RESULTS

There were 480 male subjects (mean age 26.3 years) with data sufficient for analysis. Forty-three (9%) reported sexual bother. Sexual bother was significantly more common in men with erectile dysfunction (ED), high risk of premature ejaculation (HRPE), depressive symptoms, and lower sexual frequency. However, after multivariate analysis including SEAR scores, ED, and HRPE were no longer independently predictive of sexual bother. Higher scores for all domains of the SEAR were associated with lower odds of sexual bother.

CONCLUSIONS

ED and HRPE are associated with sexual bother in this young and presumably healthy population. However, after controlling for relationship factors neither ED nor HRPE independently predicted sexual bother. It is plausible to hypothesize that sexual dysfunction from organic causes is rare in this population and is seldom encountered outside of relationship perturbations. Attention to relationship and psychological factors is likely of key importance in addressing sexual concerns in this population.

Psychological impact of premature ejaculation and barriers to its recognition and treatment

BACKGROUND

Premature ejaculation (PE) is the most common male sexual dysfunction, occurring in 20-30% of men. Unlike erectile dysfunction, which increases with age, rates of PE remain constant across the adult life span.

OBJECTIVE

To review the prevalence of PE, its psychological sequelae and barriers to effective treatment, treatment options, and the effects of treatment on the psychological burden of PE.

METHODS

PubMed and Embase databases were searched to identify primary papers related to PE published between 1980 and 2010. Key words included premature ejaculation, prevalence, quality of life, interpersonal relationships, psychotherapy, drug therapy, and treatment barriers.

RESULTS

Men with PE often suffer from significant psychological distress including anxiety, depression, lack of sexual confidence, poor self-esteem, impaired quality of life, sexual dissatisfaction, and interpersonal difficulties. Due to various reasons, however, most men do not seek treatment for PE. Many physicians are unaware of the distressful nature of PE and might be reluctant to ask patients about their sexual function. Nevertheless, increasing clinical research on pharmacologic treatment of PE, and the use of on-demand orally administered short-acting selective serotonin reuptake inhibitors or topically applied local anesthetics, appears promising. Although few rigorous studies assessing psychotherapeutic treatments have been conducted, many clinicians report the success of psychological treatments for PE.

SUMMARY AND CONCLUSIONS

Conclusions drawn from this review are limited due to inherent variations across studies, including criteria to define PE, study designs, outcome measures, populations, survey instruments, and study settings. While the psychological distress associated with PE suggests the appropriateness of at least minimal counseling for couples, limited data are available to support a combined psychotherapeutic and pharmacologic treatment approach. The paucity of well-designed psychotherapy or combination studies represents an important unmet need in the treatment of PE.

Services for erectile dysfunction in the UK - a 12-month review of referrals to a west Midlands NHS clinic

INTRODUCTION

Few studies have addressed the health economics of the provision of services for sexual dysfunction within the National Health Service.

AIM

To evaluate the referral patterns, workload and prescribing costs in secondary care resulting from government guidance on erectile dysfunction (ED).

METHOD

A review of 324 consecutive referral letters to the Good Hope Hospital Erectile Dysfunction Clinic was conducted to assess the purpose of referral. Prescribing data and costs were assessed over the same 2-year period.

RESULTS

Severe distress was the main reason for referral in 54% of referrals. Long term prescribing according to government guidance doubled the cost of care and created an unsustainable increase in clinic and pharmacy workload.

CONCLUSIONS

Existing regulations designed to control costs of ED therapy have created health inequalities, waste of resources and have increased the overall cost of care.