ORIGINAL RESEARCH—EJACULATORY DISORDERS: Trends in Research on Premature Ejaculation Over the Past 25 Years

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

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

Distribution and factors associated with four premature ejaculation syndromes in outpatients complaining of ejaculating prematurely

INTRODUCTION

Because available definitions of premature ejaculation (PE) were unable to encompass the various forms of PE, Waldinger et al. proposed a new classification that distinguished four PE syndromes. However, few studies have examined the prevalence rates of these four PE syndromes.

AIMS

The study aims to analyze the prevalence of and factors associated with four PE syndromes in outpatients who complained of ejaculating prematurely.

METHODS

Between December 2009 and December 2011, outpatients who complained of PE completed a detailed verbal questionnaire regarding their demographic data and medical and sexual history. Each patient was classified as having one of four PE subtypes: lifelong PE (LPE), acquired PE (APE), natural variable PE (NVPE), or premature-like ejaculatory dysfunction (PLED).

MAIN OUTCOME MEASURES

Based on the new classification scheme, PE was classified into four subtypes. The anxiety/depression status of patients was assessed by the Zung self-rating anxiety/depression scales, and erectile function was assessed by the International Index of Erectile Function-5 instrument.

RESULTS

This study included 1,988 male outpatients who complained of PE, with mean ages and body mass index (BMI) scores of 35.52 ± 10.38 years and 25.34 ± 4.51 kg/m(2), respectively. Prevalence rates of PE syndromes were 35.66% for LPE, 28.07% for APE, 12.73% for NVPE, and 23.54% for PLED. Patients with APE had the highest mean ages and BMI scores, and they more frequently reported several comorbidities, including sexual desire disorder, hypertension, diabetes mellitus, chronic prostatitis, and erectile dysfunction. The PLED group had a lower mean frequency of sexual intercourse than other groups and higher rates of anxiety and depression.

CONCLUSION

The prevalence of LPE was higher than that of other PE subtypes in an outpatient setting. Several comorbidities were more common in patients with APE and PLED. In particular, a lower frequency of intercourse and higher frequencies of anxiety and depression were found in patients with PLED.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

SUMMARY AND CONCLUSIONS

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

Identifying constructs and criteria for the diagnosis of premature ejaculation: implication for making errors of classification

OBJECTIVES

To review the many definitions of premature ejaculation (PE), determine the essential elements that best define PE, and examine and discuss the consequences of errors of inclusion and exclusion in the diagnosis of PE.

METHODS

We reviewed recent evidenced-based studies that delineate the variables that best define PE, and the relationships between these factors. We then assessed the consequences of errors of measurement, inclusion and exclusion for setting the thresholds for the three variables.

RESULTS

PE can best be defined by a multidimensional set of criteria composed of three essential elements: (i) intravaginal ejaculatory latency time (IELT); (ii) a lack of perceived self-efficacy or control about the timing of ejaculation; and (iii) distress and interpersonal difficulty related to the ejaculatory dysfunction. After delineating the variables, thresholds for each variable need to be determined. Carefully constructed thresholds attempt to minimize errors of inclusion and exclusion. However, even the best criteria cannot eliminate all error. The two types of errors in classification are, to some extent, inversely related: the more restrictive the criteria, the more likely that there will be errors of exclusion, whereas the more lenient the criteria the more likely there will be errors of inclusion.

CONCLUSION

Research and treatment protocols might use different threshold values for classification, as their goals might be different. For a PE research protocol, we suggest erring on the side of a more narrow definition as it would: (i) provide a more conservative, and we think, realistic prevalence of the disorder; (ii) help to establish PE as a bona fide sexual dysfunction rather than a 'life-style' issue for men seeking to enhance their sexual life; (iii) ensure greater confidence in the efficacy of existing and new treatment approaches; and (iv) strengthen the likelihood of acceptance by the regulatory authorities. Conversely, standard treatment protocols for PE might use more lenient criteria if the treatment has minimal adverse events and the degree of distress of the sufferer is high.

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

INTRODUCTION

Premature ejaculation (PE) has been associated with a range of negative psychological effects, including anxiety, depression, and distress in men and their female partners.

AIM

To review evidence of the psychosocial concomitants of premature ejaculation in recent observational studies, and to consider the psychosocial and quality of life outcomes associated with PE, including effects on the partner relationship.

MAIN OUTCOME MEASURE

Psychosocial and quality of life consequences related to premature ejaculation.

METHODS

A literature search was performed to retrieve publications relating to management or treatment of PE or male sexual dysfunction. Publications were included if they reported the impact of PE on the man, his partner or relationship, or the impact of male sexual dysfunction and included PE in the analysis.

RESULTS

Eleven observational studies were selected. All these studies found evidence for an association between PE and adverse psychosocial and quality of life consequences, including detrimental effects on the partner relationship. Comparative analyses were restricted by major differences across the studies.

CONCLUSIONS

PE significantly negatively impacts men and their partners and may prevent single men forming new partner relationships. Men are reluctant to seek treatment from their physicians, although they may be more encouraged to do so through their partner's support and the availability of effective treatments. There is a need for validated diagnostic screening criteria and validated, reliable, brief patient-reported outcome measures that can be used to assess men with PE and their partners. These factors would allow further studies with more complete and accurate assessment of the impact of PE.

Inhibition of Seminal emission is the main cause of anejaculation induced by a new highly selective alpha1A-blocker in normal volunteers

INTRODUCTION

Recent studies have highlighted the influence of alpha1-adrenoceptor antagonists on ejaculatory function.

AIM

We evaluated the effect of a new, highly selective alpha1A-blocker, silodosin, on ejaculatory function of normal volunteers.

METHODS

The study included 15 healthy male urologists who voluntarily participated in the study. They took 4 mg of silodosin or a placebo twice daily for 3 days in a randomized, double-blind crossover design.

MAIN OUTCOME MEASURES

We investigated the ejaculatory volume, sperm count in urine after ejaculation, and fructose concentration in seminal plasma before and after administration of the agents.

RESULTS

All volunteers on silodosin had a complete lack of ejaculation. Three days after completion of silodosin, the mean ejaculatory volume recovered to the baseline level. There was no sperm in urine after ejaculation under silodosin administration in any volunteer.

CONCLUSIONS

All volunteers on silodosin had anejaculation and did not show post-ejaculate sperm in their urine. The mechanism of ejaculatory dysfunction caused by silodosin is a loss of seminal emission.