1
|
Wang C, Chen X, Liu Z, Zhang Y. The Association Between Atypical Masturbation and Male Sexual Dysfunction: A Study Based on Men in Heterosexual Relationships. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02929-y. [PMID: 38918329 DOI: 10.1007/s10508-024-02929-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 05/25/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024]
Abstract
We aimed to establish the prevalence of atypical masturbation in the general population and explore the association between atypical masturbation and male sexual dysfunction in heterosexual males. Atypical masturbation refers to stimulation significantly distinct from that encountered during partnered sexual activity. We posted questionnaires that contained the abridged International Index of Erectile Function (IIEF-6) and the premature ejaculation diagnostic tool on social media in China. We collected 2743 valid questionnaires from December 9, 2020, to April 18, 2021. We found that the prevalence of atypical masturbation in the general population was 10.97%. Men with atypical masturbation had lower IIEF-6 scores and higher rates of erectile dysfunction (ED) than men with typical masturbation. The prevalence of premature ejaculation and estimated intravaginal ejaculatory latency time were not significantly different among men with different patterns of masturbation. Our study demonstrated that atypical masturbation is associated with ED, and a clinician dealing with sexual issues should inquire more fully about masturbation patterns than has been done to date.
Collapse
Affiliation(s)
- Chunlin Wang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Xiaohong Chen
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Zhuojie Liu
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Yan Zhang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China.
| |
Collapse
|
2
|
Cervilla O, Álvarez-Muelas A, Sierra JC. Relationship between Solitary Masturbation and Sexual Satisfaction: A Systematic Review. Healthcare (Basel) 2024; 12:235. [PMID: 38255122 PMCID: PMC10815145 DOI: 10.3390/healthcare12020235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Masturbation is a healthy sexual behavior associated with different sexual functioning dimensions, which highlights sexual satisfaction as an important manifestation of sexual wellbeing. This review aims to systematically examine studies that have associated masturbation with sexual satisfaction, both in individuals with and without a partner. Following the PRISMA statement, searches were made in the APA PsycInfo, Medline, Scopus, and Web of Science databases. The search yielded 851 records, and twenty-two articles that examined the relation between solitary masturbation and sexual satisfaction were selected. In men, a negative relation between masturbation and sexual satisfaction was observed in 71.4% of the studies, 21.4% found no such relation, and 7.2% observed a positive association. In women, 40% reported no relation, 33.3% a negative relation, and 26.7% a positive one. The negative association between solitary masturbation and sexual satisfaction is consistent with the previously proposed compensatory role of masturbation, especially for men. In women, compared to men, the complementary role of masturbation in relation to sexual relationships is observed to a greater extent and is associated more closely with sexual health. The importance of including different parameters beyond the masturbation frequency in future studies to explore its relation with sexual satisfaction is emphasized. This systematic review is registered in PROSPERO (CRD42023416688).
Collapse
Affiliation(s)
| | | | - Juan Carlos Sierra
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, 18011 Granada, Spain; (O.C.); (A.Á.-M.)
| |
Collapse
|
3
|
Rowland DL, Hevesi K. Response to the Commentary on: Do pornography use and masturbation play a role in erectile dysfunction and relationship satisfaction in men? Int J Impot Res 2023; 35:585-587. [PMID: 36473956 DOI: 10.1038/s41443-022-00648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA.
| | - Krisztina Hevesi
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| |
Collapse
|
4
|
Rowland DL, Castleman JM, Bacys KR, Csonka B, Hevesi K. Do pornography use and masturbation play a role in erectile dysfunction and relationship satisfaction in men? Int J Impot Res 2023; 35:548-557. [PMID: 35840678 DOI: 10.1038/s41443-022-00596-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022]
Abstract
Both masturbation frequency and pornography use during masturbation have been hypothesized to interfere with sexual response during partnered sex as well as overall relationship satisfaction. However, results from prior studies have been inconsistent and frequently based on case studies, clinical reports, and simple binary analyses. The current study investigated the relationships among masturbation frequency, pornography use, and erectile functioning and dysfunction in 3586 men (mean age = 40.8 yrs, SE = 0.22) within a multivariate context that assessed sexual dysfunctions using standardized instruments and that included other covariates known to affect erectile functioning. Results indicated that frequency of pornography use was unrelated to either erectile functioning or erectile dysfunction (ED) severity in samples that included ED men with and without various sexual comorbidities or in a subset of men 30 years or younger (p = 0.28-0.79). Masturbation frequency was also only weakly and inconsistently related to erectile functioning or ED severity in the multivariate analyses (p = 0.11-0.39). In contrast, variables long known to affect erectile response emerged as the most consistent and salient predictors of erectile functioning and/or ED severity, including age (p < 0.001), having anxiety/depression (p < 0.001 except for a subset of men ≤ 30 years), having a chronic medical condition known to affect erectile functioning (p < 0.001 except for a subset of men ≤ 30 years), low sexual interest (p < 0.001), and low relationship satisfaction (p ≤ 0.04). Regarding sexual and relationship satisfaction, poorer erectile functioning (p < 0.001), lower sexual interest (p < 0.001), anxiety/depression (p < 0.001), and higher frequency of masturbation (p < 0.001) were associated with lower sexual and lower overall relationship satisfaction. In contrast, frequency of pornography use did not predict either sexual or relationship satisfaction (p ≥ 0.748). Findings of this study reiterate the relevance of long-known risk factors for understanding diminished erectile functioning while concomitantly indicating that masturbation frequency and pornography use show weak or no association with erectile functioning, ED severity, and relationship satisfaction. At the same time, although verification is needed, we do not dismiss the idea that heavy reliance on pornography use coupled with a high frequency of masturbation may represent a risk factor for diminished sexual performance during partnered sex and/or relationship satisfaction in subsets of particularly vulnerable men (e.g., younger, less experienced).
Collapse
Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA.
| | | | - Katelyn R Bacys
- Department of Mathematics and Statistics, Valparaiso University, Valparaiso, IN, USA
| | - Balazs Csonka
- Department of Psychology, University of Debrecen, Debrecen, Hungary
| | - Krisztina Hevesi
- Institute of Psychology, ELTE Eotvos Lorand University, Budapest, Hungary
| |
Collapse
|
5
|
Rowland DL, Padilla S, Kӧvi Z, Hevesi K. Self-reported reasons for having difficulty reaching orgasm in men with diverse etiologies. Sex Med 2023; 11:qfad030. [PMID: 37408873 PMCID: PMC10318491 DOI: 10.1093/sexmed/qfad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 07/07/2023] Open
Abstract
Background Difficulty reaching orgasm/ejaculation during partnered sex, a primary characteristic of delayed or absent ejaculation, affects about 5% to 10% of men, but the reasons underlying this problem are poorly understood. Aim The study sought to gain insight into possible etiologies of delayed ejaculation by assessing men's self-perceptions as to why they experience difficulty reaching orgasm. Methods We drew 351 men reporting moderately severe to severe difficulty reaching orgasm during partnered sex from a sample of over 3000 respondents obtained through an online survey. As part of the 55-item survey, participants responded to 2 questions asking about their self-perceived reasons for having difficulty reaching orgasm and selected from a list of 14 options derived from the research literature, a series of men's focus groups, and expert opinion. The first question allowed respondents to select all the reasons that they felt contributed to the problem, the second to select only the most important reason. In addition, both men with and without comorbid erectile dysfunction were investigated and compared. Outcomes Hierarchical ordering of men's self-pereceived reasons for having difficulty reaching orgasm, including typal reasons established through principal component analysis. Results The major reasons for difficulty were related to anxiety/distress and lack of adequate stimulation, with relationship and other factors endorsed with lower frequency. Further exploration using principal components analysis identified 5 typal reasons, in descending order of frequency: anxiety/distress (41%), inadequate stimulation (23%), low arousal (18%), medical issues (9%), and partner issues (8%). Few differences emerged between men with and without comorbid ED other than ones related to erectile problems, such as higher level of endorsement of medical issues. Typal reasons showed correlations, albeit mostly weak, with a number of covariates, including sexual relationship satisfaction, frequency of partnered sex, and frequency of masturbation. Clinical Implications Until supplemental medical treatments for delayed ejaculation are developed and approved, a number of men's purported reasons for difficult or absent ejaculation/orgasm-anxiety/distress, inadequate stimulation, low arousal, relationship issues-fall into areas that can be addressed in couples counseling by a trained sex therapist. Strengths and Limitations This study is unique in scope and robust in sample size. Drawbacks include those associated with online surveys, including possible bias in sample selection, limitation to Western-based samples, and the lack of differentiation between men with lifelong and acquired difficulty. Conclusion Men who have difficulty reaching ejaculation/orgasm identify putative reasons for their problem, ranging from anxiety/stress, inadequate stimulation, and low arousal to partner issues and medical reasons.
Collapse
Affiliation(s)
- David L Rowland
- Corresponding author: Department of Psychology, Valparaiso University, Valparaiso IN 46383, United States.
| | - Sarah Padilla
- Department of Psychology, Valparaiso University, Valparaiso IN 46383, United States
| | - Zsuzsanna Kӧvi
- Institute of Psychology, Károli Gáspár University of the Reformed Church, Budapest 1037, Hungary
| | - Krisztina Hevesi
- Institute of Psychology, Eötvös Loránd University, Budapest 1053, Hungary
| |
Collapse
|
6
|
Hevesi K, Tamas S, Rowland DL. Why Men Masturbate: Reasons and Correlates in Men with and without Sexual Dysfunction. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:783-797. [PMID: 37125683 DOI: 10.1080/0092623x.2023.2204088] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Men purportedly masturbate for a variety of reasons, but systematic investigation of men's reasons has been lacking. We analyzed reasons why men masturbate (n = 2967, mean age = 37.7, SD = 12.9), whether men with and without sexual problems differ in their reasons, and whether those reasons vary with the frequency of masturbation and partnered sex. Results indicated that deriving pleasure, decreasing sexual tension, and reducing anxiety/stress were among the top motives, whereas partner issues were cited less frequently. Men with sexual dysfunctions showed only minor differences from men without sexual dysfunctions, the former more often citing anxiety/stress reduction as a motive. In addition, samples tapping participants from two world regions showed only minor differences in their patterns of responding. Motives for masturbation were also related to both the frequency of masturbation and the frequency of partnered sex. Overall, these findings indicate that men, like women, masturbate primarily for the positive reinforcing effects of pleasure, but in contrast with women, men are also more likely to use masturbation for the negatively reinforcing effects of reducing anxiety/distress. Unsatisfying sex with the partner and/or relationship issues were cited as a reason for masturbation in only a minority of men.
Collapse
Affiliation(s)
- Krisztina Hevesi
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Stella Tamas
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA
| |
Collapse
|
7
|
Rowland DL, Attinger DR, Morrow AL, Motofei I, Hevesi K. Characteristics of men who report symptoms of delayed ejaculation: providing support for empirically derived diagnostic criteria. J Sex Med 2023; 20:426-438. [PMID: 36781403 DOI: 10.1093/jsxmed/qdad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/15/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Little is known regarding the demographic, sexual, and relationship characteristics of men with symptoms of delayed ejaculation (DE). AIM To identify differences between men with and without DE symptomology to validate face-valid diagnostic criteria and to identify various functional correlates of DE. METHODS A total of 2679 men meeting inclusion criteria were partitioned into groups with and without DE symptomology on the basis of their self-reported "difficulty reaching ejaculation/orgasm during partnered sex." Men were then compared on a broad array of demographic and relationship variables, as well as sexual response variables assessed during partnered sex and masturbation. OUTCOMES Outcomes included the identified differences between men with and without DE symptomology. RESULTS Men with DE-whether having comorbid erectile dysfunction or not-differed from men without DE on 5 face-valid variables related to previously proposed diagnostic criteria for DE, including ones related to ejaculation latency (P < .001); self-efficacy related to reaching ejaculation, as assessed by the percentage of episodes reaching ejaculation during partnered sex (P < .001); and negative consequences of the impairment, including "bother/distress" and (lack of) "orgasmic pleasure/sexual satisfaction" (P < .001). All such differences were associated with medium to large effect sizes. In addition, men showed differences on a number of functional correlates of DE, including anxiety, relationship satisfaction, frequency of partnered sex and masturbation, and level of symptomology during partnered sex vs masturbation (P < .001). CLINICAL IMPLICATIONS Face-valid criteria for the diagnosis of DE were statistically verified, and functional correlates of DE relevant to guiding and focusing treatment were identified. STRENGTHS AND LIMITATIONS In this first comprehensive analysis of its kind, we have demonstrated widespread differences on sexual and relationship variables relevant to the diagnosis of DE and to its functional correlates between men with and without DE symptomology during partnered sex. Limitations include participant recruitment through social media, which likely biased the sample; the use of estimated rather than clocked ejaculation latencies; and the fact that differences between men with acquired and lifelong DE were not investigated. CONCLUSION This well-powered multinational study provides strong empirical support for several face-valid measures for the diagnosis of DE, with a number of explanatory and control covariates that may help shed light on the lived experiences of men with DE and suggest focus areas for treatment. Whether or not the DE men had comorbid erectile dysfunction had little impact on the differences with men having normal ejaculatory functioning.
Collapse
Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN 46383, United States
| | - Drew R Attinger
- Department of Psychology, Valparaiso University, Valparaiso, IN 46383, United States
| | - Abigail L Morrow
- Department of Psychology, Valparaiso University, Valparaiso, IN 46383, United States
| | - Ion Motofei
- Department of Psychiatry, Carol Davila University, 020021 Bucharest, Romania
| | - Krisztina Hevesi
- Institute of Psychology, ELTE Eötvös Loránd University, H-1053 Budapest, Hungary
| |
Collapse
|
8
|
Description of and Relationships among Potential Variables Supported for the Diagnosis of Delayed Ejaculation. SEXES 2023. [DOI: 10.3390/sexes4010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The lack of empirically based diagnostic criteria for delayed ejaculation (DE) not only undermines confidence in the reported prevalence rates for this sexual dysfunction, but it has also resulted in a lack of validated patient reported outcomes (PROs) for assessing this condition. The current study was designed to describe and evaluate six face-valid variables previously shown to discriminate between men with and without DE for their utility as diagnostic measures for DE. A sample of 1285 men (mean age = 37.8, SD = 12.7) free of erectile problems and premature ejaculation completed an online sexual health survey that included potential questions intended for use in the diagnosis of DE. Questionnaire items included ones reflective of previously proposed diagnostic constructs related to DE: ejaculation timing/latency, ejaculation efficacy/control, and negative effects of DE. Results indicated that five of the six proposed items showed moderate intercorrelations, suggesting that each constituted a distinct (i.e., non-redundant) though relevant criterion related to the diagnosis of DE. Based on the level of interrelatedness, the better items representing each construct were included in commonality analysis to assess their unique contributions to the diagnosis of DE. Perceived lack of ejaculatory efficacy/control contributed the largest portion of the variance to the diagnosis of DE (58%), with bother/distress (an index of the negative effects of DE) contributing the second largest portion (25%), and ejaculation timing/latency contributing only a small portion of the variance (6%) to the diagnosis of DE. The relevance of these findings to developing a patient report outcome (PRO) for diagnosing DE that considers both empirically supported questions/items and an appropriate balance of items regarding the three constructs was discussed.
Collapse
|
9
|
Niu C, Ventus D, Jern P, Santtila P. Premature ejaculation among Chinese urban men: prevalence and correlates. Sex Med 2023; 11:qfac015. [PMID: 37007854 PMCID: PMC10065173 DOI: 10.1093/sexmed/qfac015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/13/2022] [Accepted: 11/23/2022] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background
Premature ejaculation (PE) is a common male sexual dysfunction worldwide. It leads to substantial distress in men and their partners, constitutes a serious threat to the quality and stability of romantic relationships, and results in a decreased quality of life in a large part of the population.
Aim
We investigated the prevalence of PE and correlated factors in an urban sample of Chinese men.
Methods
In total, 1976 Chinese men aged 18 to 50 years responded to an online questionnaire regarding background information, present and previous sexual experience, frequency of different types of sex, as well as erectile and ejaculatory function.
Outcomes
Participants’ age, assigned sex at birth, sexual identity, relationship status, present and previous sexual experience, frequency of sexual activities, International Index of Erectile Function–5, and Checklist for Early Ejaculation Symptoms were used in the analyses.
Results
Forty-four (2.3%) participants had scores that were indicative or strongly indicative of PE, which was highly correlated with erectile problems. Men with more sexual experience (ie, more sexual partners and longer duration of being sexually active) had fewer ejaculatory problems. More frequent masturbation was associated with ejaculatory problems when controlling for age and education. More frequent partnered sex (ie, penile-vaginal sex) was associated with fewer ejaculatory problems. Ejaculation latency times for different types of sexual activities were positively correlated.
Clinical Translation
The results indicated that ejaculatory problems have complex relationships with sexual experience that clinicians should be aware of.
Strengths and Limitations
This study was the first to investigate PE with the Checklist for Early Ejaculation Symptoms as the measurement tool and the associations between PE and sexual experience, frequency of sexual activities, and sexual function in a large Chinese sample. However, self-reported ejaculation latency times may suffer from problems with validity.
Conclusion
Men’s sexual experience (ie, more sexual partners and longer duration of being sexually active) has an effect on their sexual function, which in turn affects their sexual activity.
Collapse
Affiliation(s)
- Caoyuan Niu
- East China Normal University School of Psychology and Cognitive Science, , Shanghai 200062, People’s Republic of China
- Faculty of Arts and Sciences, NYU Shanghai , Shanghai 200122, People’s Republic of China
| | - Daniel Ventus
- Åbo Akademi University Experience Lab, Faculty of Education and Welfare Studies, , Turku FI-20500 , Finland
| | - Patrick Jern
- Faculty of Arts, Psychology and Theology, Åbo Akademi University , Turku FI-20500 , Finland
| | - Pekka Santtila
- East China Normal University School of Psychology and Cognitive Science, , Shanghai 200062, People’s Republic of China
- Faculty of Arts and Sciences, NYU Shanghai , Shanghai 200122, People’s Republic of China
| |
Collapse
|
10
|
Rowland DL, McNabney SM, Hevesi K. Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation? Sex Med 2022; 10:100548. [PMID: 35952615 PMCID: PMC9537260 DOI: 10.1016/j.esxm.2022.100548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction The role of bother/distress in the diagnosis of premature ejaculation (PE) has received minimal investigation compared with the 2 other diagnostic criteria, ejaculatory control and ejaculatory latency (EL). Aim This study assessed (i) the added variance explained by bother/distress to the diagnostic accuracy of PE and (ii) determined its overall contribution to a PE diagnosis. Methods The 3 diagnostic criteria for PE were assessed in 2,589 men (mean age = 38.2 years, SD = 13.5) in order to determine the contribution of each factor to a dysfunctional diagnosis. A series of regression and discriminant analyses were used to assess the value of bother/distress in explaining ejaculatory control and in predicting accuracy of PE group status. Commonality analysis was used to determine the relative contribution of each of these factors to the diagnosis of PE. Main Outcome Measure The major outcome was the quantified contribution of “bother/distress” to a PE diagnosis. Results Bother/distress accounted for about 3–4% of the variation in ejaculatory control and added only minimally to the prediction accuracy of PE group status (no, probable, definite PE). Commonality analysis indicated that bother/distress comprised about 3.6% of the unique explained variation in the PE diagnosis, compared with ejaculatory control and EL which contributed 54.5% and 26.7%, respectively. Common variance among factors contributed the remaining 15.5% to the PE diagnosis. Clinical Translation Bother/distress contributes least to the determination of a PE diagnosis. Its contribution is largely redundant with the unique and combined contributions of ejaculatory control and EL. Strengths and Limitations Using a well-powered and multivariate analysis, this study parsed out the relative contributions of the 3 diagnostic criteria to a PE diagnosis. The study is limited by its use of estimated EL, a single item assessment of bother/distress, and the lack of differentiation of PE subtypes, lifelong and acquired. Conclusion Bother/distress contributes minimally to the PE diagnosis, yet its assessment may be key to understanding the experiences of the patient/couple and to developing an effective treatment strategy. Rowland DL, McNabney SM, Hevesi K. Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?. Sex Med 2022;10:100548.
Collapse
Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA.
| | - Sean M McNabney
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA; Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Krisztina Hevesi
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| |
Collapse
|
11
|
The Tenuous Role of Distress in the Diagnosis of Premature Ejaculation: A Narrative Review. Sex Med 2022; 10:100546. [PMID: 35905650 PMCID: PMC9537272 DOI: 10.1016/j.esxm.2022.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Unlike the other 2 criteria for diagnosing premature ejaculation (PE), namely lack of ejaculatory control and short ejaculation latency (EL), the role of bother/distress has received only minimal consideration and investigation. AIM The specific aim was to determine both why distress is included in the PE diagnosis and whether such inclusion is advantageous to achieving better diagnostic outcomes. To this end, the review explored the historical and theoretical underpinnings of the inclusion of "bother/ distress" in the diagnosis of PE, with reference to the larger role that distress has played in the diagnosis of mental disorders, in an attempt to understand the utility (or lack thereof) of this construct in making a PE diagnosis. METHODS We reviewed the role of bother/distress across current professional definitions for PE and then expanded this discussion to include the role of distress in other sexual dysfunctions. We then included a brief historical perspective regarding the role that distress has played in the diagnosis of PE. This discussion is followed by a deeper look at 2 nosological systems, namely DSM and ICD, to allow perspective on the inclusion of the bother/distress construct in the diagnosis of mental and behavioral disorders, including the assumptions/arguments put forward to include or exclude bother/distress as an important criterion underlying various professional assumptions. OUTCOME Determination of the value and/or need of including bother/distress as a necessary criterion for the diagnosis of PE. RESULTS Based on the research literature, bother/distress does not appear to be as critical for a PE diagnosis as either the lack of ejaculatory control or short EL. It is the weakest of the differences among men with and without PE, and recent evidence suggests that its inclusion is generally redundant with the severity of the 2 other criteria for PE, ejaculatory control and EL. CLINICAL TRANSLATION Bother/distress appears to serve little purpose in the diagnosis of PE yet its assessment may be important for the treatment strategy and for assessing treatment effectiveness. STRENGTHS AND LIMITATIONS This review did not provide a critical analysis of the literature regarding the role of bother/distress in PE, but rather focused on its potential value in understanding and diagnosing PE. CONCLUSION Although bother/distress appears to add little to the improvement of accuracy for a PE diagnosis, understanding and assessing the man's or couple's experience of distress has important implications for the treatment strategy and focus, as well as for assessing treatment success. Rowland DL, Cooper SE. The Tenuous Role of Distress in the Diagnosis of Premature Ejaculation: A Narrative Review. Sex Med 2022;XX:XXXXXX.
Collapse
|
12
|
Pozza D, Pozza M, Mosca A, Pozza C. Cyber pornography use and masturbation outburst. Considerations on 150 italian patients complaining erectile dysfunction and trying to solve it. Arch Ital Urol Androl 2022; 94:228-231. [PMID: 35775352 DOI: 10.4081/aiua.2022.2.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/29/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We aimed to verify the rate of masturbation (Mst) in a group of 150 Italian patients complaining Erectile Dysfunction (ED). MATERIALS AND METHODS Our diagnostic protocol for penile and sexual problems included the collection of the patient's history, general and local clinical examination, and metabolic and hormonal analyses. Selected patients were also submitted to nocturnal penile tumescence test (Rigiscan), Duplex ultrasound of the penis, Magnetic Resonance Imaging, neurological tests and cardiological examination. A group of 150 Italian males (aged between 20 and 86 years) who complained ED and who presented to our Andrological Center to research the possibility of correcting their ED and being able to recover adequate sexual erectile activity were included in this study. In this group of patients suffering from ED we decided to evaluate the practice of Mst by asking specific questions: 1. Do you sometimes practice Mst? 2. How often in a week? 3. Is Mst hidden or known by the partner? 4. What do you use as a masturbatory sexual stimulus? The frequency of Mst was assessed according to a Likert scale as follow: a: No Mst; b:1-2/week; c: 2-3/week; d: > 3/week; e: daily or more. We also asked if it was possible to have penetrative marital intercourse on the same day as Mst (1-10 hours). We also asked what they used as a triggering sexual stimulus: press magazines, TV movies, the WEB. RESULTS Only 5/150 patients did not report Mst while 27/145 pts (aged 20-30 years) reported it more than 3 times a week; 44/145 (aged 31-50 years) 1-3 times a week and 27/145 (51-86 years) 1-2 times a week. Almost all patients used WebPorn as a stimulus for Mst. A group of patients over the age of 50 said they were quite satisfied with the physical results of Mst even though they would prefer to have sex as part of a couple relationship. CONCLUSIONS The outburst of Mst in this web-dominated era could affect the sexual activity of individual males and couples.
Collapse
Affiliation(s)
- Diego Pozza
- Studio di Andrologia e di Chirurgia Andrologica, Roma.
| | | | - Augusto Mosca
- UO Urologia e Andrologia, San Sebastiano Hospital, Frascati (RM).
| | - Carlotta Pozza
- Department Experimental Medicine, Sapienza University, Rome.
| |
Collapse
|
13
|
McNabney SM, Weseman CE, Hevesi K, Rowland DL. Are the Criteria for the Diagnosis of Premature Ejaculation Applicable to Gay Men or Sexual Activities Other than Penile-Vaginal Intercourse? Sex Med 2022; 10:100516. [PMID: 35477122 PMCID: PMC9177880 DOI: 10.1016/j.esxm.2022.100516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction The criteria for premature ejaculation (PE) have generally been limited to the diagnosis of heterosexual men engaging in penile-vaginal intercourse and therefore the applicability of PE diagnostic criteria to gay men and to activities beyond penile-vaginal intercourse has yet to be explored in depth. Aim To compare the prevalence of PE in gay and straight men and to assess whether PE-related diagnostic measures (ejaculatory control, ejaculation latency [EL], and bother/distress) can be applied with confidence to gay men or to men engaging in sexual activities other than penile-vaginal intercourse. Methods Gay and straight participants (n = 3878) were recruited to take an online survey assessing sexual orientation, sexual function/dysfunction (including specific PE-related measures), sexual relationship satisfaction, and various other sexual behaviors during partnered sex or masturbation. Outcomes Comparison of ejaculatory control, EL, and bother/distress across gay and straight men, as well as across different types of sexual activities. Results A slightly lower PE prevalence among gay men became undetectable when other predictors of prevalence were included in a multivariate analysis (aOR = 0.87 [95% CI: 0.60–1.22]). Gay men with PE reported longer typical ELs (zU = -3.35, P < .001) and lower distress (zU = 3.68, P < .001) relative to straight men, but longer ELs and lower distress were also associated with anal sex. Clinical Translation Clinicians can feel confident about using existing criteria for the diagnosis of PE in gay men but should be aware of potentially longer ELs and lower PE-related bother/distress—probably related to the practice of anal sex—compared with straight men. Strengths and Limitations Although well-powered and international in scope, this study was limited by biases inherent to online surveys, the lack of a sizable sample of bisexual men, and a lack of differentiation between men with acquired vs lifelong PE. Conclusions Irrespective of sexual orientation, gay and straight men with PE reported shorter ELs, lower satisfaction, and greater bother/distress than functional counterparts. While PE-related diagnostic criteria (ejaculatory control, EL, and bother/distress) are applicable to gay men, accommodation for longer ELs and lower bother/distress in gay men should be considered. McNabney SM, Weseman CE, Hevesi K, et al. Are the Criteria for the Diagnosis of Premature Ejaculation Applicable to Gay Men or Sexual Activities Other than Penile-Vaginal Intercourse?. Sex Med 2022;10:100516.
Collapse
Affiliation(s)
- Sean M McNabney
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA; Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Claire E Weseman
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA
| | - Kriszta Hevesi
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA.
| |
Collapse
|
14
|
Rowland DL, Teague LG, Hevesi K. Premature Ejaculation Measures During Partnered Sex and Masturbation: What These Findings Tell Us About the Nature and Rigidity of Premature Ejaculation. JOURNAL OF SEX & MARITAL THERAPY 2022; 48:680-693. [PMID: 35253608 DOI: 10.1080/0092623x.2022.2042442] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Men with premature ejaculation (PE) during partnered sex (as defined by poor ejaculatory control) show significantly reduced PE symptomology during masturbation, but the reasons for this disparity are not clear. This study investigated the other two PE-related diagnostic criteria, namely ejaculatory latency (EL) and bother/distress, in order to explore possible explanations for this disparity between types of sexual activity. Specifically, 1,447 men with either normal or poor ejaculatory control were compared on EL parameters, bother/distress, and sexual satisfaction/pleasure during both partnered sex and masturbation. Results indicated that men with PE reported longer ELs during masturbation than partnered sex, in contrast with men without PE who reported shorter ELs during masturbation. Bother/distress was lower for both groups during masturbation, but bother/distress in men with PE during masturbation was comparable to that of men without PE during partnered sex. Minimal difference in these patterns was found across lifelong and acquired PE subtypes, whereas men with PE with comorbid erectile dysfunction appeared to represent a distinct group. These findings have implications for PE management or treatment as well as for the overall conceptualization of PE as a pathophysiological condition.
Collapse
Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA
| | - Lijana G Teague
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA
| | - Krisztina Hevesi
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| |
Collapse
|
15
|
Do Pornography Use and Masturbation Frequency Play a Role in Delayed/Inhibited Ejaculation during Partnered Sex? A Comprehensive and Detailed Analysis. SEXES 2022. [DOI: 10.3390/sexes3010010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The role of masturbation frequency and pornography use on sexual response during partnered sex has been controversial, the result of mixed and inconsistent findings. However, studies investigating this relationship have often suffered from methodological shortcomings. We investigated the role of masturbation frequency and pornography use on both the occurrence and severity of delayed/inhibited ejaculation (DE), an increasingly common sexual problem among men. We did so in a large (nonclinical) multinational sample of cisgender men (N = 2332; mean age = 40.3, SE = 0.31) within a multivariate context that relied on multiple (and, when possible, standardized) assessments of sexual dysfunctions while controlling for possible confounding variables. Results indicated a weak, inconsistent, and sometimes absent association between the frequency of pornography use and DE symptomology and/or severity. In contrast, both poorer erectile functioning and anxiety/depression represented consistent and strong predictors of DE and, to a lesser extent, DE severity. Other factors, including relationship satisfaction, sexual interest, and masturbation frequency, were significantly though moderately to weakly associated with DE. In conclusion, associations (or sometimes lack thereof) between masturbation frequency, pornography use, and delayed ejaculation are more clearly understood when analyzed in a multivariate context that controls for possible confounding effects.
Collapse
|
16
|
Rowland DL, Althof SE, McMahon CG. The Unfinished Business of Defining Premature Ejaculation: The Need for Targeted Research. Sex Med Rev 2022; 10:323-340. [PMID: 34996746 DOI: 10.1016/j.sxmr.2021.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Fifteen years have passed since the International Society of Sexual Medicine first established the 3-pronged criteria for premature ejaculation (PE): a short ejaculation latency, lack of ejaculatory control, and bother/distress. Although the process of establishing valid criteria for any condition or disorder is an ongoing one, a dearth of targeted research on these criteria has hindered professional societies from updating and revising them. OBJECTIVES To review and critique existing criteria used in the diagnosis of PE, to identify specific problems with them, and to recommend studies that will address shortcomings. METHODS Each of the PE criteria was evaluated and compared against standard procedures for establishing validated measures. Following each analysis, targeted research to address the gaps has been recommended. RESULTS Each PE criterion has shortcomings and each can be improved by using standard validation procedures, as noted by the targeted research outcomes. Professional societies can play an important role by encouraging broad participation in research that generates new and relevant data supporting, validating, or challenging the existing criteria. CONCLUSION The concepts underlying the diagnostic criteria for PE have both broad consensus and functional utility. Nevertheless, much of the research investigating PE has uncritically adopted these criteria without concomitantly recognizing their limitations. These limitations prevent determining accurate prevalence rates, interpreting research findings with confidence, and establishing efficacious treatment outcomes. Rowland DL, Althof SE, McMahon CG. The Unfinished Business of Defining Premature Ejaculation: The Need for Targeted Research. Sex Med Rev 2021;XX:XXX-XXX.
Collapse
Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA.
| | - Stanley E Althof
- Center for Marital and Sexual Health of South Florida, Greenacres, FL, USA and Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Chris G McMahon
- Australian Centre for Sexual Health, St Leonards, New South Wales, Australia
| |
Collapse
|