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Przydacz M, Chlosta M, Rajwa P, Chlosta P. Population-level prevalence, effect on quality of life, and treatment behavior for erectile dysfunction and premature ejaculation in Poland. Sci Rep 2023; 13:13168. [PMID: 37580405 PMCID: PMC10425435 DOI: 10.1038/s41598-023-39968-9] [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: 04/11/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023] Open
Abstract
The prevalence of erectile dysfunction (ED) and premature ejaculation (PE) has been investigated in many population-based studies in different regions of the world. However, reliable data are lacking for Eastern Europe. Therefore, the aim of this study was to analyze the prevalence, effect on quality of life, and treatment-related behaviors for ED and PE in a population-representative sample of Polish men. We used an Internet interview format and rigorously adapted, widely accepted instruments for ED and PE evaluation. The study included 3001 men, representative for age and place of residence and adequate proportions of respondents from urban and rural areas. The prevalence of ED was 30.1-61.1%, and the prevalence of PE was 19.3-38.1%; there were no differences between urban and rural areas. Whereas the prevalence of ED increased with age, the prevalence of PE did not increase. More than 50% of respondents with ED and more than 60% of respondents with PE had concerns about their quality of life. However, less than one fourth of participants with ED and PE were seeking treatment, most of whom received treatment. The results of our nationwide analysis, reflecting the entire Polish population of men, are consistent with other epidemiologic studies of ED and PE and may support educational campaigns and health improvement programs in Poland.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jagiellonian University Medical College, ul. Macieja Jakubowskiego 2, 30-688, Krakow, Poland.
| | - Marcin Chlosta
- Department of Urology, Jagiellonian University Medical College, ul. Macieja Jakubowskiego 2, 30-688, Krakow, Poland
| | - Pawel Rajwa
- Department of Urology, Medical University of Silesia, Zabrze, Poland
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University Medical College, ul. Macieja Jakubowskiego 2, 30-688, Krakow, Poland
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Erdogan A, Demirbas M, Oner S, Aydos MM, Sambel M, Yilmaz C. Comparison of the levels of the serotonin metabolite, 5-hydroxyindole acetic acid, in cerebrospinal fluid from patients with and without premature ejaculation. Rev Int Androl 2019; 17:41-45. [PMID: 31029436 DOI: 10.1016/j.androl.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/03/2018] [Accepted: 01/09/2018] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Premature ejaculation (PE) is a significant problem as it can cause a loss of sexual self-confidence and a significant deterioration in quality of life. The frequency of PE varies between 9% and 27%. In the current study, we aimed to compare the levels of the serotonin metabolite 5HIAA (5 hydroxyindole acetic acid) in the cerebrospinal fluid (CSF) of patients with and without PE according to IELT (intravaginal ejaculation latency time) in order to investigate the relationship of PE with CSF 5HIAA levels. MATERIALS AND METHODS A total of 60 male patients were included in the study who were planning to undergo surgery under spinal anesthesia, 30 in the patient (PE) group (all of the included patients had an IELT of <1min) and 30 in the control group (patients had an IELT of >1min). Levels of CSF 5HIAA were measured. RESULTS There was a significant negative correlation between IELT and the 5HIAA variables in all patients (r=-0.322, p=0.012). Although the average 5HIAA levels (nmol/L) were higher in the patient group (86.80±28.33) than in the control group (76.44±35.91), this difference was not significant (p=0.22). DISCUSSION Results of the current study bring new and different perspectives to the explanation of PE pathophysiology. There is a need for more specific and genetic studies to determine the best treatment for this common disorder.
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Affiliation(s)
- Abdullah Erdogan
- Bursa Yuksek Ihtisas Education and Training Hospital, Urology Department, Turkey.
| | - Murat Demirbas
- Bursa Yuksek Ihtisas Education and Training Hospital, Urology Department, Turkey
| | - Sedat Oner
- Bursa Yuksek Ihtisas Education and Training Hospital, Urology Department, Turkey
| | - Mustafa Murat Aydos
- Bursa Yuksek Ihtisas Education and Training Hospital, Urology Department, Turkey
| | - Murat Sambel
- Bursa Yuksek Ihtisas Education and Training Hospital, Urology Department, Turkey
| | - Canan Yilmaz
- Bursa Yuksek Ihtisas Education and Training Hospital, Anesthesiology Department, Turkey
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Abstract
Premature ejaculation (PE) is a common complaint of male sexual dysfunction affecting men and their partners and consequently causing significant personal and interpersonal distress. Increased sensitivity of the glans penis and abnormalities of the afferent-efferent reflex pathway within the ejaculatory process are involved in the occurrence of PE. Drugs that either selectively reduce penile sensitization or modify the afferent-efferent reflex are well established therapeutic options for PE. Fortacin™ is the first topical treatment to be officially approved for the treatment of primary PE in adult men, and is mentioned as an experimental aerosol (as TEMPE) in the current European Association of Urology guidelines. It was approved for use in the European Union and launched in the United Kingdom in November 2016. Fortacin™ is a eutectic-like mixture of lidocaine 150 mg/mL and prilocaine 50 mg/mL that meets the requirements of an ideal treatment for PE because it is fast acting (within 5 minutes), has durable effects, can be easily used "on-demand", and shows minimal side-effects. The metered-dose spray delivery system allows the desensitizing agents to be deposited in a dose-controlled, concentrated film onto the glans penis consequently reducing its sensitivity. This is translated into a delaying of the ejaculatory latency time without adversely affecting the sensation of ejaculation and orgasmic pleasure. The efficacy and safety of Fortacin™ have been proven by means of increased ejaculatory latency, control, and sexual satisfaction in large scale studies demonstrating the significant benefits for both patients and their partners.
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Affiliation(s)
- Hartmut Porst
- Private Institute for Urology, Andrology and Sexual Medicine,
Hamburg - Germany
| | - Andrea Burri
- Private Institute for Urology, Andrology and Sexual Medicine,
Hamburg - Germany
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Abstract
Vast advances have occurred over the past decade with regards to understanding the epidemiology, pathophysiology and management of premature ejaculation (PE); however, we still have much to learn about this common sexual problem. As a standardized evidence-based definition of PE has only recently been established, the reported prevalence rates of PE prior to this definition have been difficult to interpret. As a result, a large range of conflicting prevalence rates have been reported. In addition to the lack of a standardized definition and operational criteria, the method of recruitment for study participation and method of data collection have obviously contributed to the broad range of reported prevalence rates. The new criteria and classification of PE will allow for continued research into the diverse phenomenology, etiology and pathogenesis of the disease to be conducted. While the absolute pathophysiology and true prevalence of PE remains unclear, developing a better understanding of the true prevalence of the disease will allow for the completion of more accurate analysis and treatment of the disease.
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Affiliation(s)
| | - Ege Can Serefoglu
- Department of Urology, Bagcilar training & Research Hospital, Istanbul, Turkey
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Lee G, McMahon CG, McCabe M, Jiang H, Lee SW, Lim P, Jiann BP. Initiators and Barriers to Discussion and Treatment of Premature Ejaculation Among Men and Their Partners in Asia Pacific - Results From a Web-based Survey. Sex Med 2016; 4:e233-e241. [PMID: 27528556 PMCID: PMC5121536 DOI: 10.1016/j.esxm.2016.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 06/27/2016] [Accepted: 07/04/2016] [Indexed: 01/23/2023] Open
Abstract
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.
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Affiliation(s)
- George Lee
- Monash University, Kuala Lumpur, Malaysia.
| | | | - Marita McCabe
- Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia
| | - Hui Jiang
- Peking University Third Hospital, Beijing, China
| | - Sung Won Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rasch Analysis of the Premature Ejaculation Diagnostic Tool (PEDT) and the International Index of Erectile Function (IIEF) in an Iranian Sample of Prostate Cancer Patients. PLoS One 2016; 11:e0157460. [PMID: 27336626 PMCID: PMC4918965 DOI: 10.1371/journal.pone.0157460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/31/2016] [Indexed: 01/23/2023] Open
Abstract
Background Male sexual dysfunction is an increasing problem across a variety of general and clinical populations, such as cancer populations; especially among prostate cancer patients who tend to receive treatments that often result in erectile dysfunction (ED) and/or premature ejaculation (PE). Therefore, in order to diagnose ED and PE in these populations, adequate and efficient instruments such as the International Index of Erectile Function 5-item version (IIEF-5) and the Premature Ejaculation Diagnostic Tool (PEDT) are needed. However, since this is an important topic additional evidence of psychometric properties of the IIEF-5 and the PEDT in such samples are required. Thus the aim of the present study was to use Rasch models to investigate the construct validity, local dependency, score order, and differential item functioning (DIF) of both questionnaires in a sample of prostate cancer patients. Methods Prostate cancer patients (n = 1058, mean±SD age = 64.07±6.84 years) who visited urology clinics were invited to fill out the IIEF-5 and the PEDT. Construct validity was examined using infit and outfit mean square (MnSq) and local dependency using correlations between each two residual Rasch scores. Score order was investigated using step and average measures of difficulty and DIF using DIF contrast. Results All IIEF-5 and PEDT items had acceptable infit and outfit MnSq. Step measures revealed that all but two items had disordered categories in terms of scores 1 to 3. Only one local dependency was found, and no items displayed DIF across age, educational level, and help seeking. Conclusions The results showed that both the IIEF-5 and the PEDT had sound psychometric properties in the Rasch analyses, although some score disordering could be detected in both instruments. The results of no DIF items in both instruments suggest using them to compare ED and PE across age and educational level is adequate.
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Angst J, Hengartner MP, Rössler W, Ajdacic-Gross V, Leeners B. A Swiss Longitudinal Study of the Prevalence of, and Overlap Between, Sexual Problems in Men and Women Aged 20 to 50 Years Old. JOURNAL OF SEX RESEARCH 2015; 52:949-959. [PMID: 26132602 DOI: 10.1080/00224499.2014.1002556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this study was to obtain data on the development and course of sexual problems and their interrelationships by investigating a representative sample of men and women over a period of 30 years. A representative sample of 299 women selected from the complete electoral register and 292 men selected from screening lists for military service in Zurich, Switzerland, answered questions about their sexuality as part of a series of seven interviews between ages 20 (1979) and 50 (2008). Of the initial sample of 591 participants, 43% (57% of them male) were lost to follow-up. Interviews were conducted using the Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology (SPIKE), a semistructured interview. Sexual problems were identified on the basis of the study participants' self-appraisal. One-year prevalence rates, lifetime risks, and overlap of functional, emotional, and sexual desire problems in men and women were evaluated. The findings confirmed higher lifetime risks in women than in men for any sexual problem (females 67.0%; males 46.0%) and for functional (39.3%; 22.1%), emotional (35.7%; 15.9%), and sexual desire problems (51.6%; 33.3%). While in general men's sexual problems increased with age, no such association was observed in women. The overlap of all three problems (functional, emotional, and sexual desire) was reported by 16.9% of women but only 5.0% of men. Although there are commonalities, the type but also the development and, in particular, the overlap of sexual problems in women and men are markedly different.
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Affiliation(s)
- Jules Angst
- a Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital , University of Zurich
| | - Michael P Hengartner
- a Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital , University of Zurich
- b Department of Applied Psychology , Zurich University of Applied Sciences
| | - Wulf Rössler
- a Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital , University of Zurich
- c Institute of Psychiatry, Laboratory of Neuroscience (LIM 27) , University of Sao Paulo
| | - Vladeta Ajdacic-Gross
- a Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital , University of Zurich
| | - Brigitte Leeners
- d Division of Reproductive Endocrinology , University Hospital Zurich
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Pakpour AH, Yekaninejad MS, Nikoobakht MR, Burri A, Fridlund B. Psychometric properties of the Iranian version of the premature ejaculation diagnostic tool. Sex Med 2014; 2:31-40. [PMID: 25356299 PMCID: PMC4184614 DOI: 10.1002/sm2.21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Introduction Premature ejaculation (PE) is one of the most prevalent male sexual problems. The Premature Ejaculation Diagnostic Tool (PEDT) is a suitable patient-reported outcome measure for the assessment of PE. Aim To examine the psychometric proporties of a translated and culturally adapted version of the PEDT in a sample of Iranian men suffering from PE. Methods Two independent samples were compared, one including patients with PE based on the DSM-IV-TR criteria (n = 269) and the other including healthy men without PE (n = 289). A backward–forward translation procedure was used to translate the PEDT into Persian. Both samples were asked to fill in the PEDT twice—at baseline and 4 weeks later. Main Outcome Measures Internal consistency, test–retest reliability, convergent validity, factor structure, measurement invariance across sexual health status (i.e., between men with and without PE). Results Mean ages of men without and with PE were 34.9 and 35.3 years, respectively. Cronbach's alpha coefficient for the total PEDT score was 0.89. All items and the total score were remarkably consistent between the two measurement points. All five PEDT items correlated at r = 0.40 or greater with their own scale, indicating good convergent validity. There was a high and significant correlation (r = −0.82, P < 0.001) between the PEDT score and IELT. Healthy men reported lower scores (fewer complaints) on the PEDT compared with the PE group. A single-factor model was found to be best-fitting in the exploratory factor analysis; this was confirmed by confirmatory factor analysis. The PEDT was invariant across sexual health status and perceived similarly by men with and without PE. Conclusion The results provide evidence for good reliability and validity of the Iranian version of the PEDT. The questionnaire therefore represents a suitable tool for screening PE in Iranian men. Pakpour AH, Yekaninejad MS, Nikoobakht MR, Burri A, and Fridlund B. Psychometric properties of the Iranian version of the Premature Ejaculation Diagnostic Tool. Sex Med 2014;2:31–40.
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Affiliation(s)
- Amir H Pakpour
- Qazvin Research Center for Social Determinants of Health, Qazvin University of Medical Sciences Qazvin, Iran ; Department of Public Health, Qazvin University of Medical Sciences Qazvin, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences Tehran, Iran
| | | | - Andrea Burri
- Institute of Psychology, University of Zurich Zurich, Switzerland
| | - Bengt Fridlund
- School of Health Sciences, Jönköping University Jönköping, Sweden
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Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, Becher EF, Dean J, Giuliano F, Hellstrom WJ, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, 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. [PMID: 25356301 PMCID: PMC4184676 DOI: 10.1002/sm2.27] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Ege Can Serefoglu
- Department of Urology, Bagcilar Training & Research Hospital Istanbul, Turkey
| | - Chris G McMahon
- Australian Center for Sexual Health Sydney, New South Wales, Australia
| | - Marcel D Waldinger
- Department of Pharmacology, Utrecht Institute of Pharmaceutical Sciences, University of Utrecht Utrecht, The Netherlands
| | - Stanley E Althof
- Department of Psychiatry, Case Western Reserve University School of Medicine West Palm Beach, FL, USA
| | - Alan Shindel
- Department of Urology, University of California at Davis Davis, CA, USA
| | - Ganesh Adaikan
- Department of Obstetrics and Gynecology, National University of Singapore Singapore
| | - Edgardo F Becher
- Division of Urology, University of Buenos Aires Buenos Aires, Argentina
| | - John Dean
- St. Peter's Sexual Medicine Centre, The London Clinic London, UK
| | - Francois Giuliano
- Neuro-Uro-Andrology Unit, Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital Paris, France
| | - Wayne Jg Hellstrom
- Department of Urology, Tulane University Health Sciences Center New Orleans, LA, USA
| | - Annamaria Giraldi
- Department of Sexological Research, Psychiatric Center Copenhagen, Rigshospitalet Copenhagen, Denmark
| | - Sidney Glina
- Department of Urology, Instituto H. Ellis Sao Paulo, Brazil
| | - Luca Incrocci
- Erasmus MC-Daniel den Hoed Cancer Center Rotterdam, The Netherlands
| | - Emmanuele Jannini
- Endocrinology and Medical Sexology, Department of Experimental Medicine, University of L'Aquila L'Aquila, Italy
| | - Marita McCabe
- School of Psychology, Deakin University Melbourne, Victoria, Australia
| | - Sharon Parish
- Montefiore Medical Center, Department of Medicine, Albert Einstein College of Medicine New York, NY, USA
| | - David Rowland
- Graduate School, Valparaiso University Valparaiso, IN, USA
| | - R Taylor Segraves
- Department of Psychiatry, Case Western Reserve University School of Medicine Cleveland, OH, USA
| | - Ira Sharlip
- Department of Urology, University of California San Francisco, CA, USA
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Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJ, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, 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. [PMID: 25356302 PMCID: PMC4184677 DOI: 10.1002/sm2.28] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
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.
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Affiliation(s)
- Stanley E Althof
- Department of Psychiatry, Case Western Reserve University School of Medicine West Palm Beach, FL, USA
| | | | - Marcel D Waldinger
- Division of Pharmacology, Department of Pharmaceutical Sciences, Utrecht University Utrecht, The Netherlands
| | - Ege Can Serefoglu
- Department of Urology, Bagcilar Training & Research Hospital Istanbul, Merkez Mah, Turkey
| | - Alan W Shindel
- Department of Urology, University of California at Davis CA, USA
| | - P Ganesan Adaikan
- Department of Obstetrics and Gynecology, National University of Singapore Singapore, Singapore
| | - Edgardo Becher
- Division of Urology, University of Buenos Aires Buenos Aires, Argentina
| | - John Dean
- St. Peter's Sexual Medicine, The London Clinic London, UK
| | - Francois Giuliano
- Neuro-Uro-Andrology, Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital Garches, France
| | - Wayne Jg Hellstrom
- Department of Urology, Tulane University Health Sciences Center New Orleans, LA, USA
| | - Annamaria Giraldi
- Department of Sexological Research, Psychiatric Center Copenhagen, Rigshospitalet Copenhagen, Denmark
| | - Sidney Glina
- Department of Urology, Instituto H. Ellis Sao Paulo, Brazil
| | - Luca Incrocci
- Erasmus MC-Daniel den Hoed Cancer Center Rotterdam, The Netherlands
| | - Emmanuele Jannini
- School of Sexology, Department of Clinical, Applied and Biotechnological Sciences, University of L'Aquila L'Aquila, Italy
| | - Marita McCabe
- School of Psychology, Deakin University Burwood, Vic., Australia
| | - Sharon Parish
- Albert Einstein College of Medicine, Department of Medicine, Montefiore Medical Center Bronx, NY, USA
| | - David Rowland
- Graduate School, Valparaiso University Valparaiso, IN, USA
| | - R Taylor Segraves
- Department of Psychiatry, Case Western Reserve University School of Medicine Cleveland, OH, USA
| | - Ira Sharlip
- Department of Urology, University of California San Francisco, CA, USA
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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, 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. J Sex Med 2014; 11:1423-41. [PMID: 24848805 DOI: 10.1111/jsm.12524] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
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.
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Affiliation(s)
- Ege Can Serefoglu
- Department of Urology, Bagcilar Training & Research Hospital, Istanbul, Turkey
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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, Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med 2014; 11:1392-422. [PMID: 24848686 DOI: 10.1111/jsm.12504] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Stanley E Althof
- Department of Psychiatry, Case Western Reserve University School of Medicine, West Palm Beach, FL, USA
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Bailey GC, Trost LW. Current Diagnosis and Management of Premature Ejaculation. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-014-0014-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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New insights on premature ejaculation: a review of definition, classification, prevalence and treatment. Asian J Androl 2012; 14:822-9. [PMID: 23064688 DOI: 10.1038/aja.2012.108] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
There are ongoing debates about the definition, classification and prevalence of premature ejaculation (PE). The first evidence-based definition of PE was limited to heterosexual men with lifelong PE who engage in vaginal intercourse. Unfortunately, many patients with the complaint of PE do not meet these criteria. However, these men can be diagnosed as one of the PE subtypes, namely acquired PE, natural variable PE or premature-like ejaculatory dysfunction. Nevertheless, the validity of these subtypes has not yet been supported by evidence. The absence of a universally accepted PE definition and lack of standards for data acquisition have resulted in prevalence studies that have reported conflicting rates. The very high prevalence of 20%-30% is probably due to the vague terminology used in the definitions at the time when such surveys were conducted. Although many men may complain of PE when questioned for a population-based prevalence study, only a few of them will actively seek treatment for their complaint, even though most of these patients would define symptoms congruent with PE. The complaints of acquired PE patients may be more severe, whereas complaints of patients experiencing premature-like ejaculatory dysfunction seem to be least severe among men with various forms of PE. Although numerous treatment modalities have been proposed for management of PE, only antidepressants and topical anaesthetic creams have currently been proven to be effective. However, as none of the treatment modalities have been approved by the regulatory agencies, further studies must be carried to develop a beneficial treatment strategy for PE.
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The prevalence of premature ejaculation and its clinical characteristics in Korean men according to different definitions. Int J Impot Res 2012; 25:12-7. [PMID: 22931761 DOI: 10.1038/ijir.2012.27] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Shindel AW, Vittinghoff E, Breyer BN. Erectile dysfunction and premature ejaculation in men who have sex with men. J Sex Med 2012; 9:576-84. [PMID: 22214402 PMCID: PMC3271132 DOI: 10.1111/j.1743-6109.2011.02585.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Quantitative research into sexual function and dysfunction in men who have sex with men (MSM) has been sparse due in large part to a lack of validated, quantitative instruments for the assessment of sexuality in this population. AIM To assess prevalence and associations of erectile problems and premature ejaculation in MSM. METHODS MSM were invited to complete an online survey of sexual function. Ethnodemographic, sexuality, and health-related factors were assessed. MAIN OUTCOME MEASURE Participants completed a version of the International Index of Erectile Function modified for use in MSM (IIEF-MSM) and the Premature Ejaculation Diagnostic Tool (PEDT). Total score on the erectile function (EF) domain of the IIEF-EF (IIEF-MSM-EF) was used to stratify erectile dysfunction (ED) severity (25-30 = no ED, 16-24 mild or mild moderate ED, 11-15 moderate ED, and ≤10 severe ED). PEDT scores were used to stratify risk of premature ejaculation (PE, diagnosed as PEDT score ≥9). RESULTS Nearly 80% of the study cohort of 2,640 men resided in North America. The prevalence of ED was higher in older men whereas the prevalence of PE was relatively constant across age groups. Multivariate logistic regression revealed that increasing age, HIV seropositivity, prior use of erectogenic therapy, lower urinary tract symptoms (LUTS), and lack of a stable sexual partner were associated with greater odds of ED. A separate multivariate analysis revealed that younger age, LUTS, and lower number of lifetime sexual partners were associated with greater odds of PE. CONCLUSIONS Risk factors for sexual problems in MSM are similar to what has been observed in quantitative studies of non-MSM males. Urinary symptoms are associated with poorer sexual function in MSM.
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Affiliation(s)
- Alan W Shindel
- Department of Urology, University of California, Davis, Sacramento, CA 95817, USA.
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Abstract
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.
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Affiliation(s)
- David L Rowland
- The Graduate School and Office of Continuing Education, Valparaiso University, Valparaiso, IN, USA.
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Son H, Song SH, Lee JY, Paick JS. Relationship between premature ejaculation and depression in Korean males. J Sex Med 2011; 8:2062-70. [PMID: 21235722 DOI: 10.1111/j.1743-6109.2010.02173.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The psychological impacts of premature ejaculation (PE), which include guilt, anxiety, and distress, have been well established in Western countries. However, in Asia, although a substantial number of epidemiological studies have surveyed the prevalence of PE, researchers have not thoroughly investigated the relationship between PE and depression, or have defined PE properly. AIM We studied the association between PE and depression and other psychological disturbances, in a Korean cohort by applying an appropriate definition for PE and validated outcome measures of depression. METHODS. A total of 956 males (≥20 years) were initially approached via an Internet survey company. Participants were asked to complete a questionnaire requesting detailed medical and sexual histories, which included questions from the Erectile Function Domain score in the International Index of Erectile Function (IIEF-EF) and the Beck Depression Inventory (BDI). The prevalence of PE was evaluated using two different definitions-self-assessed PE and presumed PE. Presumed PE was defined as a short ejaculation time (an estimated intravaginal ejaculatory latency time ≤5 minutes), an inability to control ejaculation, and the presence of distress resulting from PE. MAIN OUTCOME MEASURES Ejaculation-related questionnaire, the IIEF-EF, and BDI. RESULTS A total of 334 men were evaluated. The prevalence of PE was 10.5% according to the Presumed PE definition, whereas by self-assessment, it was 25.4%. Self-assessed PE patients suffered from various psychological problems, such as depression, low self-esteem, bother, and low sexual satisfaction. Even after excluding erectile dysfunction (ED) subjects, a significant relationship was found between self-assessed PE and depression. Moreover, after further classification of the Self-assessed PE group, we found that subjects included in this group, but not in the Presumed PE group, suffered more from psychological burden than any other members of the cohort. CONCLUSION Korean men with subjective perceptions of PE are prone to various psychological problems, which include depression.
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Affiliation(s)
- Hwancheol Son
- Department of Urology, Seoul National University Boramae Hospital, Seoul, Korea
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Althof SE, Abdo CH, Dean J, Hackett G, McCabe M, McMahon CG, Rosen RC, Sadovsky R, Waldinger M, Becher E, Broderick GA, Buvat J, Goldstein I, El-Meliegy AI, Giuliano F, Hellstrom WJ, Incrocci L, Jannini EA, Park K, Parish S, Porst H, Rowland D, Segraves R, Sharlip I, Simonelli C, Tan HM. International Society for Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation. J Sex Med 2010; 7:2947-69. [DOI: 10.1111/j.1743-6109.2010.01975.x] [Citation(s) in RCA: 248] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Park HJ, Park JK, Park K, Lee SW, Kim SW, Yang DY, Moon DG, Min KS, Moon KH, Yang SK, Hyun JS, Park NC. Prevalence of premature ejaculation in young and middle-aged men in Korea: a multicenter internet-based survey from the Korean Andrological Society. Asian J Androl 2010; 12:880-9. [PMID: 20676115 DOI: 10.1038/aja.2010.9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In this study, we aimed to investigate the prevalence and perception of premature ejaculation (PE) in young and middle-aged Korean men. The study was conducted using an Internet-assisted questionnaire. A total of 2 037 Korean male adults, aged 20 years or older, were randomly sampled based on age and residency. The questionnaire developed by the PE Study Group of the Korean Andrological Society includes four categories (overall sexual function, symptoms, distress and treatment) with a total of 16 questions. For each question, symptoms were evaluated by a scale ranging from 0 to 10. Intravaginal ejaculation latency time was '5-10 min' in 38.6%, followed by 'longer than 10 min' in 29.9%, '2-5 min' in 23.6%, '1-2 min' in 5.4% and 'shorter than 1 min' in 2.5%. In our series, 27.5% of respondents reported having PE. Control over ejaculation within a recent 3-month period was 6.2 points on average. Respondent complaints of PE-related stress averaged 7.1 points and stress-related complaints from sexual partners averaged 7.1 points. The effect of PE on sexual life was 6.8 points. Of the respondents determined as having PE, 42.6% responded that they were inclined to receive treatment. Results from this study suggest that the prevalence of PE diagnosed by the respondent on his own was approximately 27.5% in young and middle-aged men in Korea. PE-related stress had a significant effect on the stress, sexual activity and quality of life of the respondent and his sexual partner.
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Affiliation(s)
- Hyun Jun Park
- Deparment of Urology, Pusan National University School of medicine, Busan 602739, Korea
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Morales A, Zargooshi J, Jern P, McCullough A, Hellstrom W, Shamloul R, Bella AJ, Becher EF, Rubio-Aurioles E, Perelman MA, Palmer N, Rothman M. Comments on “Considerations for an Evidence-Based Definition of Premature Ejaculation in the DSM-V”. J Sex Med 2010; 7:679-89. [DOI: 10.1111/j.1743-6109.2009.01682_1.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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