Use of a stopwatch to measure ejaculatory latency may not be accurate among Indian patients

Characteristics of men who report symptoms of delayed ejaculation: providing support for empirically derived diagnostic criteria

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.

Description of and Relationships among Potential Variables Supported for the Diagnosis of Delayed Ejaculation

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.

Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?

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.

Are the Criteria for the Diagnosis of Premature Ejaculation Applicable to Gay Men or Sexual Activities Other than Penile-Vaginal Intercourse?

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.

Distribution and relation of arousal to ejaculatory latency time, erection to ejaculation latency time, and intravaginal ejaculation latency time in Indian men: A pilot study

Introduction

Arousal to ejaculation latency time interval (AETI) and erection to ejaculation latency time interval (EETI) are new tools used to measure ejaculatory latency time (ET). Unlike intravaginal ejaculation latency time (IELT), they are applicable for sexual activities other than penovaginal intercourse and do not require penetration. We assessed the distribution and relation between AETI, EETI, and IELT in Indian men.

Methods

Voluntary participation was sought to recruit subjects reporting premature ejaculation (PE) and normal ejaculation. Those able to record the ETs correctly were then asked to record their ETs for two subsequent sexual events.

Results

A total of 26 subjects (13 - normal and 13 - PE) were able to complete the study. The mean age of the participants was 29.85 ± 4.8 years, with no difference seen between the two groups. The mean AETI, EETI, and IELT were 817 ± 592.016 s, 726 ± 566.346 s, and 582 ± 450.859 s, respectively, in normal subjects. PE subjects had significantly lesser mean ETs, AETI 80.62 ± 24.74 s, EETI 53.46 ± 25.441 s, and IELT 21 ± 14.785 s. Regression analysis found that 131.67 s of AETI and 99.58 s of EETI were equivalent to 60 s of IELT.

Conclusions

AETI and EETI have positively skewed distribution similar to IELT. Premature ejaculators had less difference between AETI and EETI, suggesting that sexual cycle gets completed immediately following arousal in these subjects causing PE.

Defining ejaculatory latencies in heterosexual males using novel tools in all types of sexual encounters in multinational population sample

Research into ejaculatory dysfunction in sexual activities other than penovaginal intercourse is limited due to the absence of well-defined tools to measure ejaculatory latencies in these sexual activities. Our pilot study using Arousal to Ejaculation Time Interval (AETI) and Erection to Ejaculation Time Interval (EETI) as tools to measure ejaculatory latencies in different types of sexual encounters in medical professionals had yielded promising results. Hence, we conducted a similar study using AETI and EETI as tools, measured using stopwatch in healthy, sexually active heterosexual male population in a multinational sample from January 2018 to December 2020. Though mean AETI and EETI differed in different sexual activities, on analysing them across all sexual activities, mean AETI and EETI in normal ejaculators, premature ejaculators and delayed ejaculators were 10.3 ± 5.81 min and 6.8 ± 4.13 min, 4.31 ± 2.98 min and 3.35 ± 3.06 min and 20.9 ± 16.1 min and 16.3 ± 10.6 min respectively. Both AETI and EETI were significantly different from normal to premature as well as normal to delayed ejaculators (p-value < 0.05). It could be concluded that these novel tools can help to measure ejaculatory latencies in sexual activities in heterosexual males.

Redefining a sexual medicine paradigm: subclinical premature ejaculation as a new taxonomic entity

Premature ejaculation (PE) and poor ejaculatory control are multidimensional sexual symptoms estimated to affect almost one-third of men, severely impairing the overall quality of life of patients and their partners. However, patients who do not completely fulfil the definition criteria for PE rarely receive a diagnosis or adequate treatment, with the risk of subsequent progression from initial, subclinical symptoms to clinically overt PE, frequently with other sexual comorbidities. Thus, the current definitions of PE warrant review, in order to consider and propose a new taxonomy encompassing other unaddressed, crucial clinical aspects of PE. These newly proposed criteria include the recommendation for a primary screening for erectile dysfunction (ED), as PE and ED can be comorbid in up to 50% of patients but have never before been considered as a unified clinical entity. In order to facilitate clinical practice and improve clinical management of men with PE and comorbid conditions, we propose and define the new taxonomic clinical entities of subclinical PE (SPE) and loss of control of erection and ejaculation (LCEE). Application of these diagnoses to men who meet the criteria for SPE and/or LCEE, but not the overt conditions, could improve access to treatment for these patients and reduce progression to the more serious clinical disorder.

New Tools to Measure Ejaculatory Latency-Arousal to Ejaculation Time Interval and Erection to Ejaculation Time Interval: A Pilot Study

OBJECTIVE

The present study aimed to evaluate the proposed novel tools, namely, arousal to ejaculation time interval (AETI) and erection to ejaculation time interval (EETI), and to measure ejaculatory latency during different types of sexual encounters in a pilot study.

MATERIALS AND METHODS

The study period was from September 2016 to December 2016. After obtaining informed consent and institutional review board approval, the medical practitioners without any comorbidity and who volunteered to participate were asked to report their self-assessed AETI and EETI during a sexual activity. They were also asked to opine as to whether they consider themselves as normal ejaculators, delayed ejaculators, or premature ejaculators. Statistical data including mean, standard deviation, and P value were obtained.

RESULTS

The sample size was 60 with a mean age of 48.9 ± 10.8 years. A total of 48 participants reported themselves as normal. Their mean AETIs were 624.8 ± 83.6 seconds, 700 ± 79.1 seconds, and 420 ± 57.7 seconds, and their mean EETIs were 355 ± 82.6 seconds, 442.5 ± 46.6 seconds, and 240 ± 38.6 seconds during heterosexual vaginal intercourse, masturbation, and oral sex, respectively. Twelve participants reported premature ejaculation, and their mean AETIs were 122 ± 11.6 seconds, 73.33 ± 11.2 seconds, and 74 ± 12.3 seconds, and their mean EETIs were 106.7 ± 21.6 seconds, 70 ± 13.7 seconds, and 60 ± 11.8 seconds during heterosexual vaginal intercourse, masturbation, and oral sex, respectively. None of the participants reported themselves as delayed ejaculators. The differences between the means were statistically significant (P ≤.0001).

CONCLUSION

AETI and EETI can be used to measure ejaculatory latency in different types of sexual encounters.