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Re: The Global Online Sexuality Survey (GOSS): The United States of America in 2011 Chapter III-Premature Ejaculation among English-Speaking Male Internet Users
Abstract
The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders. In 2010, the first report of GOSS came from the Middle East.
This report studies the prevalence rate of premature ejaculation (PE) in the U.S. as of 2011–2012 and evaluates risk factors for PE.
GOSS was randomly deployed to English-speaking male web surfers in the USA via paid advertising on Facebook®, comprising 146 questions.
Prevalence of PE as per the International Society of Sexual Medicine's (ISSM) definition.
With a mean age of 52.38 years ± 14.5, 1,133 participants reported on sexual function. As per the ISSM definition of PE, the prevalence rate of PE in the USA as of 2011 was 6.3%. This is in contrast to 49.6% as per the Premature Ejaculation Diagnostic Tool (PEDT), 77.6% as per unfiltered subjective reports, and 14.4% as per subjective reporting on more consistent basis. 56.3% of the latter reported lifelong PE. 63.2% could be classified as having natural variable PE. Erectile dysfunction is a possible predisposing factor for acquired PE, while genital size concerns may predispose to lifelong PE. Age, irregular coitus, circumcision, and the practice of masturbation did not pose a risk for PE, among other risk factors. Oral treatment for PE was more frequently used and reported to be more effective than local anesthetics, particularly in those with lifelong PE.
Applying the ISSM definition, prevalence of PE is far less than diagnosed by other methods, 6.3% among Internet users in USA as of the year 2011. PEDT measures both lifelong and acquired PE, in addition to 35% men with premature-like ejaculatory dysfunction, making it inaccurate for isolating lifelong and acquired PE cases. Shaeer O. The Global Online Sexuality Survey (GOSS): The United States of America in 2011 chapter III—Premature ejaculation among English-speaking male Internet users. J Sex Med **;**:**–**.
... The median (IQR) IELT-a in the whole sample was 5 (3-13.5) min, while the median (IQR) ILET-p was 15 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) min. The median (IQR) AIPE score for the whole sample was 27 (23-29). ...
... Within the PE Group, 609/1171 participants reported their IELT-a, and the median (IQR) was 3 (2-10) min. In all, 559/1171 participants described the IELT that they presumed to be normal, and the median (IQR) IELT-p was 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) min. According to the AIPE severity classification, the differences in IELT-a and IELT-p between the severity groups were highly significant, with the duration of both IELT-a and ILET-p being higher in the AIPE-No-PE and Mild-PE groups (P < 0.001 for both; Table 3). ...
... This result was higher than the self-reported prevalence in Argentina 28.3% [8], Turkey 20% [9], and South Korea 19.5% [10], using direct interview. On the other hand, this result was much less than the self-reported results in the USA (77.6% [11]) and Middle East (82.6% [12]) using online surveys. ...
Objective: To determine the prevalence of premature ejaculation (PE) in Qatar as a representative of the Middle East region and the population perception of normal ejaculation.
Subjects and methods: This study was a cross-sectional, observational, non-interventional, epidemiological study, conducted from February 2012 to February 2013. Randomly selected married males were asked to answer two questionnaires in a direct interview. The first questionnaire assessed the PE complaint, the time between ejaculation and intromission (actual intravaginal ejaculatory latency time [IELT-a]), and the perceived normal average time between intromission and ejaculation (IELT-p). The second questionnaire used was the Arabic Index of Premature Ejaculation (AIPE).
Results: A total of 3042 subjects were included. The mean (SD) age was 37.09 (9.1) years. The prevalence of PE in Qatar using the self-report and AIPE score was 38.5% and 36.2%, respectively. The median (interquartile range) IELT-a and IELT-p were 5 (3–13.5) and 15 (5–15) min. In the AIPE-confirmed PE group, and according to the AIPE severity classification, the differences in IELT-a and IELT-p between the severity groups were highly significant, with the duration of both IELT-a and ILET-p being higher in AIPE-No-PE and mild-PE groups (P < 0.001 for both). A negative correlation was found between AIPE score and age in the PE group.
Conclusion: The prevalence of PE in Qatar is high. PE prevalence was found to increase with age. The IELT and perception of normal IELT were both correlated with the severity of PE.
... PE is the most common sexual dysfunction in men, its prevalence appears to vary across several reports. Nevertheless, referring to the two most widely used diagnostic criteria of PE, International Society of Sexual Medicine (ISSM) and the PE diagnostic tool (PEDT) score ≥ 9 or 11, the prevalence of PE is approximately~6-40% worldwide [5][6][7][8][9][10][11][12][13][14][15][16]. Ejaculation is a physiological process controlled by the autonomic nervous system and consists of two main phases (emission and expulsion) that occur in sequence [17]. ...
... Ignoring the statistical relationship between age with LUTS/PE, the data showed PE is more common in older age [11,31,37] with the peak prevalence in age ranged between 60 and 69 years old (Table 5) [35]. Proquest ab((LUTS OR "lower urinary tract symptoms" OR BPH OR "benign prostatic hyperplasia")) AND ab("premature ejaculation") 14 25/02/2020 14:15:08 ClinicalKey (BPH OR LUTS OR "lower urinary tract symptoms" OR "benign prostate hyperplasia") AND "premature ejaculation" 20 25/02/2020 14:36:24 ScienceDirect ...
... Title, abstract, keywords: (BPH OR LUTS OR "lower urinary tract symptoms" OR "benign prostate hyperplasia") AND "premature ejaculation" 14 25/02/2020 14:06:10 ...
Lower urinary tract symptoms (LUTS) refer to a group of symptoms related to bladder, prostate, and urethra. LUTS are common in men and the severity increases with age. LUTS are frequently associated with sexual dysfunction, such as premature ejaculation (PE), standing as the most common sexual dysfunction in men. Both LUTS and PE cause distress and dissatisfaction for the patient and his partner. This systematic review aims to determine the relationship between LUTS and PE in men. Two reviewers independently conduct a literature search in five online databases (PubMed, Scopus, Proquest, ClinicalKey, and ScienceDirect). In addition, reviewers also reviewed the reference list of chosen articles to identify additional relevant studies. Twelve articles were included in this systematic review that consists of one cohort study and 11 cross-sectional studies. The total scores of each identified study ranged from “poor” to “good.” The prevalence of PE in LUTS ranged from 12 to 77%. Most of the studies showed a significant relationship between LUTS and PE. PE is more common in older age with the peak prevalence in age of 60–69 years old. There is a possible association between PE and LUTS. Further research using cohort or case-control study design on this topic is needed.
... Premature ejaculation (PE) is a common male sexual dysfunction that may adversely affect 20% to 30% of the male population. [1,2] The prevalence of PE did not vary significantly in young and middle-aged men, indicating that no particular age group has consistently been shown to be at greater risk for PE. [3,4] Traditionally, PE can be classified as lifelong or acquired PE. ...
... We defined the study eligibilities by selecting the patient population, intervention/exposure, comparator, outcome, and study design (PICOS). [14] The PICOS evidence base used consisted of the following combinations: (1) participants: patients >18 years of age suffering from PE. (2) Interventions: a history of depressive disorder. (3) Comparisons: compared with the general population. ...
... (5) Study design: any type of observational, cohort or cross-sectional study, and case series. Exclusion criteria were the following: (1) articles not in English; (2) incomplete data availability; (3) review or meta-analysis articles; (4) duplicated or updated data; (5) comments, editorials, letters, and congress reports; animal studies and case reports. In the case of multiple publications based on the same study sample, the most recent publication was included in the analysis. ...
Background:
Premature ejaculation (PE) is the most prevalent male sexual dysfunction. Epidemiologic findings are inconsistent concerning the risk for depression associated with PE.
Objective:
The aim of this study was to investigate the potential association between between depression and risk of PE.
Data sources:
We conducted a literature search of PubMed, Embase, and the Cochrane Library from these databases' inception through June 2014 for observational epidemiological studies examining the association between depression on risk of PE.
Study eligibility criteria:
Studies were selected if they reported the risk estimates for PE associated with depression.
Participants:
patients>18 years of age suffering from PE.
Interventions:
a history of depressive disorder.
Study appraisal and synthesis methods:
These odds ratios (ORs) were pooled using a random or fixed effects model and were tested for heterogeneity. Subgroup analysis was employed to explore heterogeneity.
Results:
Eight trials involving 18,035 patients were included in the meta-analysis. Depression were statistically significantly associated with the risk of PE (OR = 1.63, 95% CI:1.42-1.87). There was no evidence of between-study heterogeneity (P = 0.623, I = 0.0%). The association was similar when stratified by mean age, geographical area, study design, sample size, publication year, and controlling key confounders.
Limitations:
The severity of depression and PE could not be identified due to unavailable data of trials. No evidence of publication bias was observed.
Conclusions:
These findings provide evidence that depression is associated with a significantly increased risk of PE. In addition, more prospective studies are necessary to evaluate the association and identify the ideal treatment.
Systematic review registration number:
CRD42016041272.
... We included all trials enrolling and comparing the risk of ED in subjects with or without PE, without any arbitrary restriction ( [17][18][19]21,22,[25][26][27][28][29][30][31][32][33][34][35][36][37][38]; see also Figure 1 and Tables 1 and 2). Studies not specifically reporting the prevalence of ED or ED risk in subjects with or without PE were excluded from the analysis (see also Figure 1). ...
... Out of 474 retrieved articles, 18 were included in the study (Figure 1) [20][21][22]24,25,[30][31][32][33][34][35][36][37][38][39][41][42][43][44];. In particular, of those, 15 reported data on the prevalence of ED in patients with or without PE or the risk of ED in PE subjects [20][21][22][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]43]. ...
... Out of 474 retrieved articles, 18 were included in the study (Figure 1) [20][21][22]24,25,[30][31][32][33][34][35][36][37][38][39][41][42][43][44];. In particular, of those, 15 reported data on the prevalence of ED in patients with or without PE or the risk of ED in PE subjects [20][21][22][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]43]. In addition, three [25,39,42] and two [41,44] studies reported also IIEF-5 score in patients with or without PE or IELT in subjects with or without ED, respectively. ...
... We included all trials enrolling and comparing the risk of ED in subjects with or without PE, without any arbitrary restriction ( [17][18][19]21,22,[25][26][27][28][29][30][31][32][33][34][35][36][37][38]; see also Figure 1 and Tables 1 and 2). Studies not specifically reporting the prevalence of ED or ED risk in subjects with or without PE were excluded from the analysis (see also Figure 1). ...
... Out of 474 retrieved articles, 18 were included in the study (Figure 1) [20][21][22]24,25,[30][31][32][33][34][35][36][37][38][39][41][42][43][44];. In particular, of those, 15 reported data on the prevalence of ED in patients with or without PE or the risk of ED in PE subjects [20][21][22][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]43]. ...
... Out of 474 retrieved articles, 18 were included in the study (Figure 1) [20][21][22]24,25,[30][31][32][33][34][35][36][37][38][39][41][42][43][44];. In particular, of those, 15 reported data on the prevalence of ED in patients with or without PE or the risk of ED in PE subjects [20][21][22][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]43]. In addition, three [25,39,42] and two [41,44] studies reported also IIEF-5 score in patients with or without PE or IELT in subjects with or without ED, respectively. ...
Introduction:
The specific determinants and underlying factors linking erectile dysfunction (ED) and premature ejaculation (PE) have yet to be clearly identified.
Aim:
The aim of this study was to review and meta-analyze all available data regarding the link between ED and PE.
Methods:
An extensive Medline Embase and Cochrane search was performed including the following words: "premature ejaculation" and "erectile dysfunction".
Main outcome measures:
All observational trials comparing the risk of ED in relation to PE were included. Data extraction was performed independently by two of the authors (G.R, G.C.), and conflicts resolved by the third investigator (M.M.).
Results:
Out of 474 retrieved articles, 18 were included in the study for a total of 57,229 patients, of which 12,144 (21.2%) had PE. The presence of PE, however defined, was associated with a significant increase in ED risk (odds ratio: 3.68[2.61;5.18]; P < 0.0001). Meta-regression analysis showed that the risk of ED in PE subjects was higher in older individuals as well as in those with a lower level of education and in those who reported a stable relationship less frequently. In addition, subjects with PE and ED more often reported anxiety and depressive symptoms and a lower prevalence of organic associated morbidities, including diabetes mellitus, hypertension and dyslipidemia. All the latter associations were confirmed even after adjustment for age. Finally the risk of PE-related ED increased with the increased proportion of acquired ejaculatory problems (adj r = 0.414; P < 0.0001 after the adjustment for age).
Conclusions:
In conclusion, the present data showed that ED and PE are not distinctly separate entities, but should be considered from a dimensional point of view. Understanding this dimensional perspective might help sexual health care professionals in providing the most appropriate therapeutic approach to realistically increase patient related outcomes in sexual medicine.
... Male sexual dysfunction is a sensitive topic, and face-to-face information collection may lead to bias; therefore, an anonymous internet survey is a convenient and effective means of collecting data. [8][9][10][11] According to previous reports, within the category of male sexual dysfunction, premature ejaculation is relatively common, with a prevalence of 5%-35%. [12][13][14][15][16][17][18][19][20][21][22][23][24] However, these data regarding the prevalence of PE are doubtful. ...
... Especially for private matters such as sexual dysfunctions, an anonymous online questionnaire survey has great advantages. 8,9 In many web survey studies, the IIEF-5 has been used as the crucial means of diagnosing ED. 46,47 However, several studies have found that the specificity of the IIEF-5 among the PE population is concerning. [34][35][36] What are the reasons leading the decreasing specificity of the IIEF-5 in the context of PE? ...
Background
The reliability of the International Index of Erectile Function (IIEF-5) in diagnosing erectile dysfunction (ED) is significantly decreased for the population with premature ejaculation (PE).
Aim
We aimed to illustrate a better way of diagnosing ED among the general population through a web survey study.
Methods
We collected online surveys from 2,746 men between the ages of 18 and 65. Two methods were used to determine the prevalence of ED, and these 2 methods were compared. Additionally, we divided our sample into 2 equally sized groups by median age and repeated the analyses for each group. In Method Ⅰ (M Ⅰ), men with an IIEF-5 score ≤ 21 were diagnosed with ED. In Method Ⅱ (M Ⅱ), PE was defined as a PEDT score ≥ 9, and no-PE was defined as a PEDT score ≤ 8. We used an IIEF-6 score cutoff of ≤ 24 among the PE population and a cutoff of ≤ 25 among the no-PE population to diagnose ED.
Main outcome measures
We examined the results from the IIEF-5, PEDT, and IIEF-6.
Results
Of the 2,746 men, 1,540 were in a stable heterosexual relationship, and the prevalence of ED among these men was determined. The prevalence of ED, as measured by Method Ⅰ, was significantly higher than that measured by Method Ⅱ. The kappa coefficients between the 2 methods were 0.595, 0.704, and 0.430 for the overall, no-PE, and PE populations, respectively. The internal consistency of the IIEF-5 for the PE population increased if Question 5 (intercourse satisfaction) was removed. Similar trends were observed for the groups, and there were no substantial differences.
Clinical implications
Our research suggests that before using the erectile function assessment scale to evaluate erectile function, ejaculatory function should be assessed with the PEDT.
Strengths and limitations
This was the first study to highlight the importance of evaluating ejaculatory function using the PEDT before diagnosing ED via an internet survey. There may have been recruitment bias because our study was an internet survey.
Conclusion
Establishing the prevalence of ED by using a combination of the IIEF-6 and PEDT was more reliable than using the IIEF-5 alone. Further validation of the modified procedure, especially regarding the effects of age on the results, in future studies is required.
Wang C, Zhang H, Liu Z, et al. A Modified Procedure to Diagnose Erectile Dysfunction Using the International Index of Erectile Function (IIEF-6) Combined With the Premature Ejaculation Diagnosis Tool (PEDT) via an Internet Survey. Sex Med 2021;XX:XXXXXX.
... Some authors observed an increase in the prevalence of PE with higher age, 42,43,37 while others did not find any statistically significant associations between age and PE. 29,44,45 A possible reason for these discrepancies is the heterogeneity in the age composition of the samples included in the studies − some with participants of very similar age (for example, Karakaban et al, 46 who studied men aged between 24 and 30 years) and others with wide age range (from 18 to 80 years old). 29,43 Another possible explanation may be related to the inclusion or not of PE-associated comorbidities, among which erectile dysfunction (ED) and prostatitis, which are also linked to age; in these studies, after controlling for confounding variables, age no longer has a statistically significant association with PE and the association with comorbidities remains. ...
... 29,44,45 A possible reason for these discrepancies is the heterogeneity in the age composition of the samples included in the studies − some with participants of very similar age (for example, Karakaban et al, 46 who studied men aged between 24 and 30 years) and others with wide age range (from 18 to 80 years old). 29,43 Another possible explanation may be related to the inclusion or not of PE-associated comorbidities, among which erectile dysfunction (ED) and prostatitis, which are also linked to age; in these studies, after controlling for confounding variables, age no longer has a statistically significant association with PE and the association with comorbidities remains. 44,45 Furthermore, the social representations associated with "normal" time to ejaculate and expectations of sexual performance among men of different ages and cultural contexts may explain the different prevalence rates of PE observed between studies and age groups. ...
Background
Premature ejaculation (PE) prevalence can vary according to different definitions, assessment methods and populational demographics and culture.
Aims
To investigate the differences between men classified as having “probable PE” (PEDT≥11), “possible PE” (PEDT = 9 or 10) or “no PE” (PEDT≤8) according to the Premature Ejaculation Diagnostic Tool (PEDT) criteria in regard to sociodemographic characteristics, and sexual and relational behavior. To assess the agreement of prevalence of PE according to 3 assessment methods: (i) the ejaculation latency time (ELT) according to the participant's memory; (ii) PEDT and (iii) a direct question about the self-perception of ejaculation as being normal, too early (premature) or retarded.
Methods
In this web-based cross-sectional study, men aged ≥ 18 years living in the metropolitan region of São Paulo, Brazil, responded anonymously to an online survey. We used multinomial regression to estimate the association between PE according PEDT criteria and other features and the kappa coefficient to estimate agreement between the assessment methods.
Outcomes
Association between PEDT-PE, sociodemographic characteristics and sexual and relational behaviors; agreement between PEDT, ELT and self-perception of PE.
Results
Obesity, trying to hold back ejaculation, short or nonexistent foreplay and age <30 years were associated with PEDT ≥11. Men who considered that latency was shorter for oral, anal and vaginal sex than for masturbation were more likely to have probable PE according to PEDT. Possible PE (PEDT scores 9/10) was associated with trying to hold back ejaculation and considering time for ejaculation shorter for vaginal sex. There was fair agreement between assessments (kappa 0.39; CI:0.28 –0.42; P < .001).
Conclusion
PE prevalence varies according to instruments and cut-offs used, with fair agreement between them. This finding shows that the methods evaluate different aspects of the EP syndrome and they must be combined to allow the discrimination between the different types of PE and treatments. Clinical approaches should consider the sexual behavior and relationship of the patient and their distress.
... In our survey, we used a selfestimated IELT. Stopwatch-based IELT varies considerably in the general male population and does not capture a man's subjective experience with his IELT [12]. Men with a very short IELT may not suffer from their condition, while others with a much longer IELT can be unhappy with their performance [12]. ...
... Stopwatch-based IELT varies considerably in the general male population and does not capture a man's subjective experience with his IELT [12]. Men with a very short IELT may not suffer from their condition, while others with a much longer IELT can be unhappy with their performance [12]. We didn´t distinguish between men in stable partnerships vs. men without a regular partner as long as men were sexually active since we wanted a 'real life' representation of the study population. ...
Background: This study estimated combined prevalence of Lifelong and Acquired PE in German adult men and assessed potential risk factors and coping methods for PE. Methods: In October 2012 this online survey of a representative sample of the German male population aged 18-64 years (n=2,459) used an active pre-existing and independent online panal. Results: Prevalence of PE as a ‘sexual dysfunction’ according to the modified ISSM definition of was 3.3% (n=81), whereas the prevalence of PE as a ‘sexual complaint’ (i.e., men who estimated their time to ejaculation was occasionally very short, suffered to some extent from PE and had a lack of ejaculation control) was 14.5% (n=356). Men attributed PE predominantly to particularly high sexual arousal (75%) or a long time since the last sexual intercourse (53%), but less than one third of all men with PE (30%) considered PE a ‘disease’. Potential selfreported risk factors showed significant differences (P<0.05) for overweight (21% vs 30%), depression (9% vs 14%) and erectile dysfunction (3% vs 15%) between men without and with PE. Conclusions: All men perceived PE as a ‘sexual difficulty’ and suffered from a very short time to ejaculation and/or the inability to control that time.
... Premature ejaculation (PE) is the most common male sexual dysfunction. 1,2 Approximately 20%-30% of men complained of PE, and 76.9% of males with typical erectile function reported various degrees of PE. [3][4][5] Psychological issues and neurogenic conditions have been suggested as etiological factors of PE. 6 Anxiety or conditioning toward rapid ejaculation was attributed to psychological causes, and either hyposensitivity of 5-hydroxytryptamine 2C (5-HT 2c ) receptors or hypersensitivity of the 5-HT 1a receptors was associated with the neurogenic etiology. 6,7 Selective serotonin reuptake inhibitors (SSRIs) are capable of increasing the activity of serotonergic cells in the nucleus paragigantocellularis, thereby inhibiting the expulsion phase of ejaculation by modulating bulbospongiosus muscle activity and impairing the emission phase by blocking the rise in seminal vesicular pressure. ...
... Dose escalation was determined based on the 2-day tolerability results after the final dosing in the previous dose group. ) were collected at pre-dose (0 h) and 1,2,3,4,5,6,8,12,24,36,48,72,96, and 120 h after dosing. At each time point, 6 mL of blood was obtained in heparin tubes and separated by 3,000 rpm centrifugation for 10 min at 4°C. ...
Objective
DA-8031 is a selective serotonin reuptake inhibitor under development for the treatment of premature ejaculation. This is the first-in-human study aimed at evaluating the pharmacokinetics and tolerability of DA-8031 and its metabolites (M1, M2, M4, and M5) in the plasma and urine after administration of a single oral dose in healthy male subjects.
Methods
A dose block-randomized, double-blind, placebo-controlled, single ascending dose study was conducted. Subjects received either placebo or a single dose of DA-8031 at 5, 10, 20, 40, 60, 80, or 120 mg. DA-8031 and its four metabolites were analyzed in the plasma and urine for pharmacokinetic evaluation. The effect of genetic polymorphisms of cytochrome-P450 (CYP) enzymes on the pharmacokinetics of DA-8031 was evaluated.
Results
After a single dose, plasma DA-8031 reached the maximum concentration at a median of 2–3 h and was eliminated with terminal elimination half-life of 17.9–28.7 h. The mean renal clearance was 3.7–5.6 L/h. Dose-proportional pharmacokinetics was observed over the dose range of 20–80 mg. Among the metabolites, M4 had the greatest plasma concentration, followed by M5 and M1. Subjects with CYP2D6 intermediate metabolizer had significantly greater dose-normalized Cmax and AUC0–t of DA-8031 as well as smaller metabolic ratios than those subjects with CYP2D6 extensive metabolizer. The most common adverse events were nausea, dizziness, and headache, and no serious adverse events were reported.
Conclusion
In conclusion, the systemic exposure of DA-8031 was increased proportionally to the dose within 20–80 mg. Genetic polymorphisms of CYP2D6 had an effect on the systemic exposure of DA-8031. DA-8031 was well tolerated after single doses of 80 mg or less.
... Based on the absence of distress, such men would not meet the current criteria for PE [12,23]. Peer-reviewed studies on the prevalence of PE published prior to March 2013 are summarized in Table 2 [26,27,29,30,[33][34][35][37][38][39][40][41][43][44][45][46][48][49][50][51][52][53][54][55][56][57][58][59]. Most of these studies utilized the DSM, Fourth Edition, Text Revision (IV-TR) definition and characterized PE as the "most common male sexual dysfunction," with a prevalence rate of 20-30% [20][21][22]. ...
... In two online surveys, one of Arabic-speaking men in the Middle East, the second of US men, 82.6% and 78% of participants, respectively, reported some degree of PE [43,49]. This high rate of PE is best accounted for by the inclusion of men with VPE or SPE. ...
... Based on the absence of distress, such men would not meet the current criteria for PE [12,23]. Peer-reviewed studies on the prevalence of PE published prior to March 2013 are summarized in Table 2 [26,27,29,30,[33][34][35][37][38][39][40][41][43][44][45][46][48][49][50][51][52][53][54][55][56][57][58][59]. Most of these studies utilized the DSM, Fourth Edition, Text Revision (IV-TR) definition and characterized PE as the "most common male sexual dysfunction," with a prevalence rate of 20-30% [20][21][22]. ...
... In two online surveys, one of Arabic-speaking men in the Middle East, the second of US men, 82.6% and 78% of participants, respectively, reported some degree of PE [43,49]. This high rate of PE is best accounted for by the inclusion of men with VPE or SPE. ...
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.
... Based on the absence of distress, such men would not meet the current criteria for PE [12,23]. Peer-reviewed studies on the prevalence of PE published prior to March 2013 are summarized in Table 2 [26,27,29,30,[33][34][35][37][38][39][40][41][43][44][45][46][48][49][50][51][52][53][54][55][56][57][58][59]. Most of these studies utilized the DSM, Fourth Edition, Text Revision (IV-TR) definition and characterized PE as the "most common male sexual dysfunction," with a prevalence rate of 20-30% [20][21][22]. ...
... In two online surveys, one of Arabic-speaking men in the Middle East, the second of US men, 82.6% and 78% of participants, respectively, reported some degree of PE [43,49]. This high rate of PE is best accounted for by the inclusion of men with VPE or SPE. ...
Introduction
In 2014, the International Society for Sexual Medicine (ISSM) convened a panel of experts to develop an evidence-based process of care for the diagnosis and management of testosterone deficiency (TD) in adult men. The panel considered the definition, epidemiology, etiology, physiologic effects, diagnosis, assessment and treatment of TD. It also considered the treatment of TD in special populations and commented on contemporary controversies about testosterone replacement therapy, cardiovascular risk and prostate cancer.
Aim
The aim was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of diagnosis and management of TD for clinicians without expertise in endocrinology, such as physicians in family medicine and general urology practice.
Method
A comprehensive literature review was performed, followed by a structured, 3-day panel meeting and 6-month panel consultation process using electronic communication. The final guideline was compiled from reports by individual panel members on areas reflecting their special expertise, and then agreed by all through an iterative process.
Results
This article contains the report of the ISSM TD Process of Care Committee. It offers a definition of TD and recommendations for assessment and treatment in different populations. Finally, best practice treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with TD.
Conclusion
Development of a process of care is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to new insights into the pathophysiology of TD, as well as new, efficacious and safe treatments. We recommend that this process of care be reevaluated and updated by the ISSM in 4 years.
... Based on the absence of distress, such men would not meet the current criteria for PE [12,23]. Peer-reviewed studies on the prevalence of PE published prior to March 2013 are summarized in Table 2 [26,27,29,30,[33][34][35][37][38][39][40][41][43][44][45][46][48][49][50][51][52][53][54][55][56][57][58][59]. Most of these studies utilized the DSM, Fourth Edition, Text Revision (IV-TR) definition and characterized PE as the "most common male sexual dysfunction," with a prevalence rate of 20-30% [20][21][22]. ...
... In two online surveys, one of Arabic-speaking men in the Middle East, the second of US men, 82.6% and 78% of participants, respectively, reported some degree of PE [43,49]. This high rate of PE is best accounted for by the inclusion of men with VPE or SPE. ...
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.
... Based on the absence of distress, such men would not meet the current criteria for PE [12,23]. Peer-reviewed studies on the prevalence of PE published prior to March 2013 are summarized in Table 2 [26,27,29,30,[33][34][35][37][38][39][40][41][43][44][45][46][48][49][50][51][52][53][54][55][56][57][58][59]. Most of these studies utilized the DSM, Fourth Edition, Text Revision (IV-TR) definition and characterized PE as the "most common male sexual dysfunction," with a prevalence rate of 20-30% [20][21][22]. ...
... In two online surveys, one of Arabic-speaking men in the Middle East, the second of US men, 82.6% and 78% of participants, respectively, reported some degree of PE [43,49]. This high rate of PE is best accounted for by the inclusion of men with VPE or SPE. ...
IntroductionThe 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.AimThe 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.ResultsThe 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 **;**:**–**.
... Based on the absence of distress, such men would not meet the current criteria for PE [12,23]. Peer-reviewed studies on the prevalence of PE published prior to March 2013 are summarized in Table 2 [26,27,29,30,[33][34][35][37][38][39][40][41][43][44][45][46][48][49][50][51][52][53][54][55][56][57][58][59]. Most of these studies utilized the DSM, Fourth Edition, Text Revision (IV-TR) definition and characterized PE as the "most common male sexual dysfunction," with a prevalence rate of 20-30% [20][21][22]. ...
... In two online surveys, one of Arabic-speaking men in the Middle East, the second of US men, 82.6% and 78% of participants, respectively, reported some degree of PE [43,49]. This high rate of PE is best accounted for by the inclusion of men with VPE or SPE. ...
IntroductionThe 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.AimThe 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.ResultsThe 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. J Sex Med **;**:**–**.
... Although some studies found a statistically significant relationship between the circumcision of adult men and PE (Son et al., 2010;Tang & Khoo, 2011), the majority did not determine such relationship (Collins et al., 2002;Morris & Krieger, 2013;Shaeer, 2013;Tian et al., 2013). Bronselaer et al. (Bronselaer et al., 2013) investigated the somatosensorial effects of circumcision and concluded that males who were circumcised after the age of 10 were more likely to get less tactile sexual arousal from glans penis and reported more penile discomfort and pain at the penile shaft. ...
We aimed to investigate the relationship between premature ejaculation and the age when men had been circumcised before adulthood. A total of 2,768 sexually active male patients aged between 18 and 65 years were included in this study. A multicentre study was conducted prospectively with the participation of 20 centres. A survey consisting of 12 questions prepared by the researchers, as well as the validated Turkish versions of the five‐item Premature Ejaculation Diagnostic Tool, was administered to all participants. The study included 1,603 participants who met the inclusion criteria. There was no significant difference in the Premature Ejaculation Diagnostic Tool and self‐reported ejaculation time between the participants who had been circumcised at different ages during childhood. Remembering circumcision experience with fear or anxiety did not increase the risk of sexual dysfunction compared to the participants who described their experience with happiness or with no particular emotion. There was no significant difference in Premature Ejaculation Diagnostic Tool scores or the self‐reported ejaculation time of the participants circumcised at different ages. The age of childhood circumcision, having a fearful or anxious circumcision experience, does not affect the risk of premature ejaculation in adult life.
... Premature ejaculation (PE) is one of the most common male sexual dysfunction diseases, which may have adversely affected 20% to 30% of the male population. [1][2] Premature ejaculation has a serious negative impact on the sexual life satisfaction of patients and their sexual partners. [3] The prevalence of PE did not vary significantly in young and middle-ages men, indicating that no particular age group has consistently been shown to be at greater risk for PE. ...
Background:
Premature ejaculation (PE) is the one of the most prevalent male sexual dysfunction, there has not been specific medicine or therapy for the disease. As an effective treatment for premature ejaculation is a behavioral therapy and is widely used worldwide. The purpose of this study is to evaluate the efficacy and safety of behavioral therapy in patients who suffer from PE.
Method:
We will search all randomized controlled trials (RCTs) from the following electronic databases, by September 30, 2018, such as PubMed, EMBASE, the Cochrane Library, Web of Science database, China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI), China Science and Technology Journal database (VIP), and Wanfang Database. We will also collect clinical trial registries, dissertations, grey literature, reference lists of studies, systematic reviews, and conference abstracts. The primary outcomes include the Intravaginal Ejaculatory Latency Time (IELT). Besides, Premature Ejaculation Diagnostic Tool (PEDT), Arabic index of Premature Ejaculation (AIPE), Index of Premature Ejaculation (IPE) will be the secondary outcomes. Two people will review these articles, extract the data information, and assess the quality of studies separately. RevMan (version 5.3) and EndNote X7 will be used for meta-analysis.
Results:
This study will generate a comprehensive review of current evidence of behavioral therapy for premature ejaculation.
Conclusion:
The study will provide updated evidence to evaluate the efficacy and safety of behavioral therapy for premature ejaculation.
Ethics and dissemination:
It is not necessary for this systematic review to acquire an ethical approval. This review will be reported in a peer-reviewed journal.
Prospero registration number:
PROSPERO CRD42018111339.
... This non-partnered practice can be a root cause of DE at times. In a recent US epidemiology study by the Global Online Sexuality Survey, 76.1% of men admitted to masturbation [87]. Other studies indicate 92% of all men masturbate [20,88]. ...
Ejaculation is a complex event that involves the autonomic, somatic, and central nervous systems working together with physiologic coordination of muscular contractions. With such a complex array of intricate processes, many things can go awry.
Delayed ejaculation (DE) is overall a very poorly understood ejaculatory disorder with low quality data in terms of incidence, pathology, diagnosis, and treatment. In this chapter, we summarize the proper assessment of DE patients and highlight not only the medical conditions contributing to the disorder but also the psychologic ailments. Treatment is outlined based on pathology and an algorithm will be presented for treatment of ejaculatory disorders. With appropriate treatment many of those afflicted will be able to find relief. Nonetheless, ongoing DE research is still needed.
... The prevalence of PE is as high as 20% to 30%, but few affected individuals seek medical help [2,3]. According to a previous study, approximately 25% to 40% of adult men may develop PE at certain stages in their lives [4]. ...
Premature ejaculation (PE) is a common male sexual dysfunction that can have significant effects on a couple’s relationship.
Behavioral therapy and psychotherapy are both safe and effective methods of treating PE. Ancient Chinese fangzhongshu (sexual
skills and methods), which reflects a summary of expert experiences in sexology, contains many therapies for sexual dysfunction
that are similar to those used in behavioral therapy or psychotherapy. A brief introduction dealing with the latest definitions of
PE and treatment strategies drawn from behavioral therapy and psychotherapy is provided. Typical therapies for PE from ancient
Chinese fangzhongshu are listed and briefly analyzed in order to define their domain of applicability and instructions for use.
Ancient Chinese fangzhongshu contains many effective and safe therapies for PE. It should be incorporated into modern medical
practice after critical analysis, and its scientific aspects should be promoted as a way of improving reproductive health, both to
benefit individuals affected by PE and to promote traditional Chinese culture. Based on an analysis of the condition of the
individual patient, one or multiple therapies guided by fangzhongshu can be expected to have an effect on the patient. Ancient
Chinese fangzhongshu is of great value and should to be popularized and applied as a remedy for PE.
... Nine cohort studies had a risk of attrition bias due to insufficient completion of follow-up [28,[31][32][33][34][35][36][37][38], and ten observational studies did not adjust for age [28,29,[37][38][39][40][41][42][43][44]. A risk of recall bias was present in four retrospective cohort studies [28,[36][37][38] (Table 1). ...
Introduction:
The debate on non-medical male circumcision has gaining momentum during the past few years. The objective of this systematic review was to determine if circumcision, medical indication or age at circumcision had an impact on perceived sexual function in males.
Methods:
Systematic searches were performed in MEDLINE and Embase. The included studies compared long-term sexual function in circumcised and non-circumcised males, before and after circumcision, or compared different ages at circumcision. The quality of the studies was assessed according to the level of evidence (Grade A-D).
Results:
Database and hand searches yielded 3,677 records. Inclusion criteria were fulfilled in 38 studies including two randomised trials. Overall, the only identified differences in sexual function in circumcised males were decreased premature ejaculation and increased penile sensitivity (Grade A-B). Following non-medical circumcision, no inferior sexual function was reported (A-B). Following medical circumcision, most outcomes were comparable (B); however, problems in obtaining an orgasm were increased (C) and erectile dysfunction was reported with inconsistency (D). A younger age at circumcision seemed to cause less sexual dysfunction than circumcision later in life.
Conclusions:
The hypothesis of inferior male sexual function following circumcision could not be supported by the findings of this systematic review. However, further studies on medical circumcision and age at circumcision are required.
... As Boyle (2012) commented, "Is it not more likely that it is precisely the lack of neurological control over the timing of ejaculation resulting from the severed neuronal circuitry after circumcision that is a major causal factor in PE?" [132] Indeed, Bollinger and Van Howe [143] found that young circumcised men were 2.56 times more likely than genitally intact men, to suffer from premature ejaculation-see also [144]. At least 10 studies have been published comparing PE prevalence in genitally intact versus circumcised men [117] [139] [144]- [151]. A metaanalysis based on all 10 studies (Van Howe [152]-Personal communication, 5 July, 2014) found a strong trend that circumcised men were more likely to suffer from premature ejaculation (OR = 1.15; 0.93 to 1.41). ...
Non-therapeutic infant male circumcision is a permanent surgical alteration to the penis that may cause significant physical, sexual and psychological harm. Physical harms include unintended adverse effects of the surgery itself (e.g., complications such as bleeding, infection, excessive removal of foreskin leaving insufficient shaft skin to accommodate erections, etc.), as well as the inherent loss of healthy, functional tissue. Sexual harms that necessarily follow from circumcision include the loss of all sensation in the foreskin itself, and the loss of all sexual functions that involve the physical manipulation of the foreskin. Additional sexual harms that may follow cir-cumcision include reduced sexual sensation in the remaining penile structures, difficulty with masturbation, increased chafing in both the circumcised man and his sexual partner, as well as reduced overall psychosexual/psychological tension relief and subjective satisfaction. Psychological harms include short-term trauma as well as the potential for long-term emotional disturbances , including sadness, frustration, distress, and anger—akin to post-traumatic stress disorder (PTSD). In this paper, the extent and severity of these various harms are considered and it is argued that they are more serious and more widespread than is commonly believed.
... We read with great interest the recently published manuscript on premature ejaculation (PE), based on the global online sexual survey (GOSS) [1]. Similar in scope to other papers published from the observational Internet-based, cross-sectional GOSS data [2][3][4], this study focuses on determining the prevalence of erectile dysfunction and PE among English-speaking "Internet users." ...
... It is considered as normal healthy sexual development starts during adolescence, and maturation of sex hormones predisposes to the activity which every one indulges in some part in life. (Shaeer 2013, Heitham K. Ajlouni et al., 2010. It is also proposed that age at the first conscious solitary ejaculation be used as an index of maturation of male puberty and and through this many people learn about their bodies and sexual pleasures (Laron et al., 1980). ...
Background: The information on mean age at first nocturnal ejaculation and first masturbation
among male individuals are sparse in India. In the era of computers, improved education level, social
networks, and entertainment and level, it is necessary to know the onset of nocturnal ejaculation and
sexual activity among males at frequent intervals.
Objective: to find the age at first nocturnal ejaculation and first masturbation (Orgasmic experience)
among collegiate young adult men.
Methodology: A community based descriptive cross sectional survey was undertaken in the selected
16 colleges on different education courses during October 2013 to February 2014 by using the pilot
tested, self administered anonymous questionnaire. The detailed information was collected on
nocturnal ejaculation and masturbation related variables. Analysis was done using SPSS software
package.
Results: The number of young adults participated in this study was 686 and the response rate to all the
questions was 90%. Eighty percent of the subjects were aged less than 23 years. Nearly 20 percent of
the participants did not share information on nocturnal ejaculation and masturbation practices. The
mean age at experiencing first nocturnal ejaculation was 15.3 + 1.5 years (95% CI 15.13 – 15.45) and
first orgasmic experience (Masturbation) was 15.4+ 1.6 years (95% CI 15.21 - 15.55). There was
statistical significant difference between students of difference courses on age at first nocturnal
ejaculation and first masturbation (p<0.003).
Conclusion: The mean age at the onset of sexual maturity among males is 15 years. The difference
between onset of nocturnal ejaculation and first solitary masturbation was narrow and a periodical
study on these factors is needed in future in India.
Purpose:
The specific underlying mechanisms supporting the association between erectile dysfunction (ED) and premature ejaculation (PE) are still not completely clarified. To summarize and discuss all available data supporting the relationship between PE and ED.
Methods:
A comprehensive narrative review was performed. In addition, to better clarify the specific factors underlining ED and PE, a meta-analytic approach of the selected evidence was also performed. In particular, the meta-analytic method was selected in order to minimize possible sources of bias derived from a personal interpretation of the data.
Results:
Current data confirm the close association between ED and PE and the bidirectional nature of their relationship. In particular, PE was associated with a fourfold increased risk of ED independently of the definition used. In addition, the risk increased in older patients and in those with lower education, and it was associated with higher anxiety and depressive symptoms. Conversely, ED-related PE was characterized by lower associations with organic parameters such as diabetes mellitus, arterial hypertension, dyslipidemia and with smoking habit. Finally, when ED was defined according to the International Index of Erectile Function questionnaire, the presence of a stable relationship increased the risk.
Conclusions:
ED and PE should be considered in a dimensional prospective way considering the possibility that both clinical entities can overlap and influence each. Correctly recognizing the underlying factors and sexual complaint can help the clinician in deciding the more appropriate diagnostic and therapeutic work-up.
To date, many analogies of sildenafil, tadarafil, and vadenafil, which are phosphodiesterase-5 (PDE5) inhibitor have been reported. On the other hand, a novel type of PDE5 inhibitor, thioquinapiperifil has not yet been evaluated. Therefore, in this study, liquid chromatography quadrupole time of flight mass spectrometry (LC-Q-TOF-MS) was conducted to determine the in vitro and in vivo metabolites of thioquinapiperifil. Metabolites in urine and feces samples of rats injected with thioquinapiperifil and in human liver microsomal extract were characterized to examine its possible metabolic pathways. Metabolized samples were extracted and precipitated using acetonitrile and subsequently injected into the LC-Q-TOF-MS system. Peaks of interest were analyzed via tandem-mass spectrometry to identify the metabolite structure. A total of 11, 5, and 7 metabolites were detected in human liver microsomal extract, rat urine, and rat feces, respectively. The mass error values of all TOF mass results were within 5 ppm, indicating high accuracy. These newly identified metabolites may be useful for evaluating the toxicology of thioquinapiperifil and this knowledge may be applied to related forensic cases.
Background
Premature ejaculation (PE) is one of the most described psychosocial stress and sexual complaints worldwide. Previous investigations have focused predominantly on the prospective identification of cases that meet researchers’ specific criteria. The genuine demand from patients with regard to information on PE and related issues may thus be neglected.
Objective
This study aims to examine the online search trend and user demand related to PE on a national and regional scale using the dominant major search engine in mainland China.
Methods
The Baidu Index was queried using the PE-related terms for the period of January 2011 to December 2020. The search volume for each term was recorded to analyze the search trend and demographic distributions. For user interest, the demand and trend data were collected and analyzed.
Results
Of the 36 available PE search keywords, 4 PE searching topics were identified. The Baidu Search Index for each PE topic varied from 46.30% (86,840,487/187,558,154) to 6.40% (12,009,307/187,558,154). The annual percent change (APC) for the complaint topic was 48.80% (P<.001) for 2011 to 2014 and –16.82% (P<.001) for 2014 to 2020. The APC for the inquiry topic was 16.21% (P=.41) for 2011 to 2014 and –11.00% (P<.001) for 2014 to 2020. For the prognosis topic, the annual APC was 11.18% (P<.001) for 2011 to 2017 and –19.86% (P<.001) for 2017 to 2020. For the treatment topic, the annual APC was 14.04% (P<.001) for 2011 to 2016 and –38.83% (P<.001) for 2016 to 2020. The age distribution of those searching for topics related to PE showed that the population aged 20 to 40 years comprised nearly 70% of the total search inquiries (second was 17.95% in the age group younger than 19 years). People from East China made over 50% of the total search queries.
Conclusions
The fluctuating online popularity of PE searches reflects the real-time population demands. It may help medical professionals better understand population interest, population concerns, regional variations, and gender differences on a nationwide scale and make disease-specific health care policies. The internet search data could be more reliable when the insufficient and lagging registry data are completed.
Introduction
There are many Western reports on factors influencing coital frequency among men. However, no articles could be found about the factors influencing sexual activity among Chinese men.
Aim
The aim of this study was to identify the factors that influence the coital frequency of Chinese men.
Main Outcome Measures
The main outcome measures included self-reported monthly coital frequency, age, occupation, education level, andrology-related scales and dietary habits.
Methods
Data for 1,407 men aged 18–79 years were collected in the Health Management Center of the Third Xiangya Hospital of Central South University from January 2019 to May 2019. The respondents completed the questionnaires independently or with the help of an interviewer (who read or explained the questionnaires to them) to analyse the factors that influence coital frequency.
Results
In the previous 6 months, the sample had a mean monthly coital frequency (±SD) of 4.34 ± 3.18. Univariate logistic regression results indicated that the number of children (P = 0.004), IIEF-5 scores (P <0.001), EHSs (P <0.001) and frequency of milk consumption (P = 0.001) were associated with more frequent sexual activity. These statistical associations did not change after further adjustment for age, occupation, and reproductive history. We observed that the frequency of sexual activity showed an increasing trend with a greater number of children, higher IIEF-5 scores, higher EHSs and greater frequency of milk consumption (test for trend, P<0.05). Both univariate and multivariate analysis results indicated that the frequency of sexual activity decreased with increasing age (test for trend, P<0.001).
Conclusion
The coital frequency of Chinese men is associated with erectile function, anthropometric parameters, age, occupation, and dietary habits. Xiang Y, Peng J, Yang J, et al. What Influences Coital Frequency Among Chinese Men?: A Cross-Sectional Study. Sex Med 2021;9:100363.
Introduction
Because the prevalence of premature ejaculation (PE) may change with time, few studies have been conducted over a 10-year time interval.
Aim
A 10-year time interval survey to determine whether there was a change in the prevalence of self-identified PE and PE defined on the basis of an estimated intravaginal ejaculation latency time of <3 minutes in adult Korean men, even after adjusting for various sociocultural factors.
Methods
We sent an e-mail to the panels registered in the same Internet survey agency in 2006, asking them to participate in a questionnaire-based survey of the same study design. 1,401 participants were enrolled in the 2016 study that included 800 subjects in their 20s–50s. The PE prevalence adjusted for age was evaluated because the proportion of participants per age was different between the 2 surveys. The age-adjusted prevalence of self-identified PE and PE with an estimated intravaginal ejaculation latency time of 3 minutes, which meets the diagnostic criteria for PE set by the International Society for Sexual Medicine (PE), was evaluated.
Main Outcome Measures
Changes in the overall prevalence of self-identified PE and PE in over a decade were evaluated.
Results
The overall age-adjusted prevalence of self-identified PE increased from 19.0% in 2006 to 21.6% in 2016; however, the result was not statistically significant (P = .244). The overall age-adjusted prevalence of PE increased from 1.8–4.0% in 2006 and 2016, respectively (P = .012). The risk factors of self-identified PE were few intercourses per month, masturbation, and self-identified erectile dysfunction. In addition, the risk factors of PE were aging, high body mass index, few intercourses per month, and masturbation.
Clinical Implication
The prevalence of PE has increased over 10 years. However, this increase may be due to sociocultural changes and should be more concerned with these factors.
Strength & Limitations
This study was the first to conduct a 10-year interval Web-based survey on the prevalence and risk factors of PE. However, this was not a cohort study with the same participants.
Conclusion
The overall age-adjusted prevalence of PE increased significantly over a decade, and sociocultural factors such as lifestyle were associated with the difference of PE prevalence for 10 years. However, more research is needed to determine how these sociocultural changes affect PE prevalence.
Song WH, Yoo S, Oh S, et al. Ten-Year Interval Changes in the Prevalence of Self-Identified Premature Ejaculation and Premature Ejaculation Based on an Estimated Intravaginal Ejaculation Latency Time of <3 Minutes in the General Population: The Korean Internet Sexuality Survey (KISS) 2016. J Sex Med 2019;16:512–521.
Premature Ejaculation Management
1. Somayyeh Nasiripour, Maryam Farasatinasab *, 3. Sepideh Khodaverdi
Pharm D, Assistant Professor of Clinical Pharmacy, Endocrine Research Center, Institute of Endocrinology and Metabolism, Firoozgar Hospital Iran University of Medical Sciences, Tehran, Iran
Abstract:
Male sexual disorder includes hypoactive sexual desire disorder, male erectile disorder, premature ejaculation and male orgasmic disorder. Premature ejaculation is the most common problem. Premature ejaculation could have an effect on the various aspects of the quality of life including emotional happiness, interpersonal relationship, and social behavior. One of the important aspects of premature ejaculation is definition of this problem and explanation to the individuals. Currently, various treatments are available for premature ejaculation consistent with psychological/behavioral management and pharmacotherapy. Serotonin Specific Reuptake Inhibitors (SSRIs) especially dapoxitin, are first-line pharmacotherapy; however tramadol might be used for unresponsive premature ejaculation. New therapeutic approaches are being researched including modafinil, botulinum toxin, acupuncture and circumcision.
Keywords: Male sexual dysfunctions, Premature ejaculation, Premature ejaculation treatment
How to cite:
Nasiripour 1, Farasatinasab M, Khodaverdi 3. Premature Ejaculation Management. RJMS. 2017; 23 (152) :65-76
We attempted to evaluate whether circumcision has an effect on premature ejaculation. We searched three databases: PubMed, EMBASE and Google scholar on 1 May 2016 for eligible studies that referred to male sexual function after circumcision. No language restrictions were imposed. The Cochrane Collaboration's RevMan 5.2 software was employed for data analysis, and the fixed or the random-effect model was selected depending on the heterogeneity. Twelve studies were included in the meta-analysis, containing a total of 10019 circumcised and 11570 uncircumcised men. All studies were divided into five subgroups by types of study design to evaluate the effect of circumcision on premature ejaculation (PE). Intravaginal ejaculation latency time (IELT), difficulty of orgasm, erectile dysfunction (ED) and pain during intercourse were also assessed because PE was usually discussed along with these subjects. There were no significant differences in PE (odds ratio [OR], 0.90; 95% confidence interval (CI), 0.72-1.13; p = .37) and orgasm (OR, 1.04; 95% CI, 0.89-1.21; p = .65) between circumcised and uncircumcised group. However, IELT (OR, 0.72; 95% CI, 0.60-0.83; p < .00001), ED (OR, 0.42;95% CI, 0.22-0.78; p = .40) and pain during intercourse (OR, 0.36; 95% CI, 0.17-0.76; p = .007) favoured circumcised group. Based on these findings, circumcision does not have effect on PE.
Ejaculation is a highly integrated process that involves both the sympathetic and parasympathetic neural pathways. Numerous studies reveal that ejaculatory dysfunction is a common disorder and the source of significant bother for many of those affected. Ejaculatory dysfunction comprises several different, more specific abnormalities including: premature ejaculation, inhibited ejaculation (consisting of delayed and absent ejaculation), and painful ejaculation. The evaluation of affected patients should include a comprehensive medical history, physical examination, and laboratory testing. Numerous therapeutic options are available to treat ejaculatory disorders, with many of these leading to marked improvement in patients’ symptoms and associated bother.
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.
The rise of sexual medicine and interdisciplinary approaches to the study of etiology and treatment have transformed our understanding of sexual dysfunctions from psychodynamic disturbances to mind-body-relationship disorders whose treatment requires attention to physiology in addition to cognitive, affective, and relational factors. The organization of this chapter splits treatments into somatic, psychosocial, and combined. The chapter is organized according to the DSM-5 sexual dysfunctions in the alphabetical order in which they appear in that text: Delayed Ejaculation, Erectile Disorder, Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder, Genito-Pelvic Pain/Penetration Disorder, Male Hypoactive Sexual Desire Disorder, Premature (Early) Ejaculation, and Substance/Medication-Induced Sexual Dysfunction. On the other hand, the research reviewed here is necessarily based on the DSM-IV categories, as some of the new diagnostic categories have yet to be empirically investigated.
Premature ejaculation (PE) is an important male sexual disorder that can significantly impact the well-being of patients and their partners. Only recently an evidence-based definition has been established. Its diagnosis requires the combination of three components: (a) ejaculation which always or nearly always occurs before or within about 1 min of vaginal penetration, (b) the inability to delay ejaculation on all or nearly all vaginal penetrations, and (c) negative personal consequences such as distress, bother, frustration, and/or the avoidance of sexual intimacy. Prior to the establishment of this definition, some studies used the simple complaint of ejaculating more rapidly than desired as a diagnostic criterion, which has led to an overestimation of the prevalence of this disorder. PE is associated with anxiety (both generalized and intercourse associated) and can lead to a decrease in sexual frequency. In couples with fertility issues, PE cannot only represent a significant added stress to both partners and the relationship and, in severe cases, may potentially affect fertility. Shame and a lack of awareness about the condition are barriers to treatment seeking, which leaves many individuals undiagnosed and untreated. There are various therapeutic strategies available for patients with PE, which include behavioral therapy, topical, and oral medications. Behavioral therapy represented the mainstay for treatment until the description of the neurobiological aspects of PE and now represents an adjunct to other treatments. Currently, the FDA has only approved a single topical agent for the treatment of PE. Selective serotonin inhibitors are commonly used off-label for PE, and different regimens have been employed. Particularly in patients with fertility issue, caution is required because some studies suggest that it negatively impacts seminal parameters. Phosphodiesterase type 5 inhibitors have been used with some success in combination with other treatments. PE is a significant medical condition, and effective treatment has the potential to significantly improve the quality of life of patients and their partners.
Mismatch of partners in premature ejaculation (PE) regarding intra-vaginal ejaculation latency time (IELT) is usually neglected. Here we proposed the concept and evaluated the use of index of IELT (IIELT) as an objective diagnostic tool for PE. Data from 103 self-reporting PE patients and 59 normal controls were collected. The expected IELTs of both the male and female partners were provided by each participating couple in two questionnaires. IIELT=stopwatch IELT/(1/2 the male's expected IELT+1/2 the female's expected IELT). The stopwatch IELTs were 1.74±1.4 min (PE group) and 14.45±11.0 min (control group), P<0.05. The expected IELTs were 15.65±8.7 min (men) and 14.16±6.9 min (women) in the PE group, and 21.3±16.1 min (men) and 20.04±13.47 min (women) in the control group, P<0.05. The calculated IIELTs were 0.14±0.12 (PE group) and 0.83±0.60 (control group), P<0.05. The best cut-off point was 0.658, the Youden index was 0.652, sensitivity was 0.991, specificity was 0.661, positive predictive probability was 83.46% and negative predictive probability was 97.6%. We concluded that IIELT was an integrated measurement of the couples' sexual equilibrium and demonstrated that it provided a simple and objective screening indicator for diagnosing self-reported PE.International Journal of Impotence Research advance online publication, 11 February 2016; doi:10.1038/ijir.2016.7.
This study was conducted to investigate the prevalence of premature ejaculation (PE) in young Turkish men and to evaluate PE in a population having good physical and mental health. A total of 1230 healthy university graduates aged between 24 and 30 attending the police academy having no physical or mental problems were included in the study. To identify the presence of PE, the participants were asked to complete the premature ejaculation diagnostic tool (PEDT). The mean ages in the PE and non-PE group were 27.3 and 26.7 respectively. There was no statistically significant difference between the two groups concerning age, body mass index (BMI), smoking status and alcohol consumption (P > 0.05). The PE prevalence was found to be 9.2%. The mean PEDT score was calculated as 6.3. Of the participants, 92 scored 11 and higher (9.2%), 66 scored 9 and 10 (6.6%), and the remaining 842 obtained a score equal to or lower than 8 (84.2%). The lower prevalence of PE in young Turkish men compared to the results of studies in the literature can be attributed to the physical and mental well-being of the participants. This study showed that the prevalence of PE in young men with good physical and mental health is lower than that found in the literature.
Over the past several years, many advances have been made in our understanding of the epidemiology, pathophysiology, and management of premature ejaculation. Newly developed definitions of premature ejaculation are now available, and our perception of the classification, prevalence, aetiological factors, and treatment options for premature ejaculation have evolved. Despite ongoing research, there remains much to be learned about all aspects of this common sexual disorder, in particular effective clinical diagnosis and treatment options.
To evaluate the efficacy and safety of combination therapy with selective serotonin reuptake inhibitors (SSRIs) and phosphodiesterase-5 (PDE-5) inhibitors for the treatment of PE.
A systematic search of EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews was undertaken to identify articles that referred to the use of a combination of SSRIs and PDE-5 inhibitors for the treatment of PE. A meta-analysis of these clinical studies was performed. The post-treatment intravaginal ejaculatory latency time (IELT) and adverse events were used in this meta-analysis.
Six publications involving 971 patients were included in the meta-analysis. In the analysis, we found significantly improved IELT in the combination use group compared with the use of SSRIs (mean differences (MD) 1.01, 95% confidence interval(CI) 0.61-1.41, p < 0.01) or PDE-5 inhibitors alone (MD 1.11, 95% CI 0.79-1.43, p < 0.01) for PE whether or not these patients suffered from ED. Combined treatment was more efficacious than PDE-5 inhibitors use alone on sexual satisfaction. Although the occurrence of drug-related adverse events (AEs) in the combination use group was higher than that in the use of SSRIs or PDE5 inhibitors alone group (37.5% vs. 25.63%, p < 0.01), the most common AEs were mild and tolerable.
The combined use of SSRIs and PDE-5 inhibitors provided additive favorable effects in men with PE compared with SSRIs or PDE-5 inhibitors monotherapy and was generally well tolerated.
Copyright © 2015 Elsevier Inc. All rights reserved.
Ejaculation consists of two synchronized phases: a) emission, the contraction of the vas deferens, prostate and seminal vesicles and bladder neck expelling the seminal fluid to the urethra; it is mediated by sympathetic nerves, and b) expulsion, seminal fluid outward propulsion by the rhythmic contraction of perineal muscles. Ejaculation results from a complex spinal reflex having its essential components within the lumbosacral cord. The main afferent signals derive from mechanical stimulation of the glans penis and are conveyed by sacral sensory roots. The ejaculatory reflex is under strong modulatory influence from the brain through both facilitatory and inhibitory descending signals. Several central neurotransmitters including serotonin and dopamine modulate the ejaculatory reflex. The intravaginal ejaculatory latency time (IELT), measured or estimated, provides clinically useful assessment of the ejaculatory reflex. The new DSM-5 definition of premature ejaculation (PE) includes a specified time to ejaculation criterion (IELT of about one minute or shorter). Four subtypes of PE, showing different prevalence rates, have been proposed. PE etiology is multifactorial with interacting psychological and biological factors contributing to the disorder. A number of genetic polymorphisms related to serotonin and dopamine neurotransmission may predispose the bearers to developing PE. High prevalence rates of PE have been found in patients with chronic prostatitis, hyperthyroidism, and premature ejaculation.
Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Rural y Generalista (SEMERGEN). All rights reserved.
Morris and Krieger (2013) have argued that male circumcision does not impact adversely on sexual sensation, satisfaction, and/or function. In the present paper, it is argued that such a view is untenable. By selectively citing Morris' own non-peer-reviewed letters and opinion pieces purporting to show flaws in studies reporting evidence of negative effects of circumcision, and by failing adequately to account for replies to these letters by the authors of the original research (and others), Morris and Krieger give an incomplete and misleading account of the available literature. Consequently, Morris and Krieger reach an implausible conclusion that is inconsistent with what is known about the anatomy and functions of the penile foreskin, and the likely effects of its surgical removal.
Morris and Krieger (2013) have argued that male circumcision does not impact adversely on sexual sensation, satisfaction, and/or function. In the present paper, it is argued that such a view is untenable. By selectively citing Morris' own non-peer-reviewed letters and opinion pieces purporting to show flaws in studies reporting evidence of negative effects of circumcision, and by failing adequately to account for replies to these letters by the authors of the original research (and others), Morris and Krieger give an incomplete and misleading account of the available literature. Consequently, Morris and Krieger reach an implausible conclusion that is inconsistent with what is known about the anatomy and functions of the penile foreskin, and the likely effects of its surgical removal.
Purpose: The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study on sexuality and sexual disorders, investigating the cultural characteristics and uniqueness and comparing sexuality across the cultures and races as well as across the time where the survey is intended to be relaunched every 5 years. The initial launch of GOSS was in the Middle East in the year 2010. In 2011, GOSS was launched in the USA, with enhancements and expansion over the previous launch in the Middle East. The current report investigates the preference for and performance of various sexual practices among heterosexual male individuals in the USA. Patients and methods: GOSS was randomly deployed to English-speaking male web surfers in the USA through paid advertising on Facebook, comprising 146 questions. Results: The three most preferred sexual positions were the missionary position, the female on top, and the rear vaginal entry positions, with no statistically significant differences in-between. However, with respect to performance, the missionary position was the most commonly performed coinciding with the preference for it, whereas all other positions showed discrepancy between preference and performance, being performed less than preferred, with statistically significant differences. Anal intercourse was the least preferred and practiced, although practiced by 20.6%. Preference for and performance of the oral stimulation techniques is also described. Conclusion: Preference of the female partner can theoretically be an important factor in generating the discrepancy between preference for and performance of certain sexual position. Such information could enhance the understanding of the female partner for her male partner’s preferences. The data herein may be informative for female partners with respect to the preferences of male individuals in the coital positions. Anal insertive intercourse was performed by 52.6% of respondents, pointing to a possible target for sexually transmitted diseases prevention efforts.
IntroductionPremature ejaculation (PE) is the most common male sexual dysfunction. Its prevalence in Type 1 diabetes is unknown. AimThe aim of this study was to assess the prevalence of PE in Type 1 diabetes and the influence of glycemic control on ejaculatory function. Methods
One hundred Type 1 diabetic male patients (age<40 years) and 51 age-matched nondiabetic control subjects were evaluated for PE. A subgroup of 30 diabetic patients (20 with PE and 10 without) were also evaluated for blood glucose variability. Main Outcome MeasuresThe presence of PE was assessed with the premature ejaculation diagnostic tool (PEDT) and the self-estimated intravaginal ejaculatory latency time (IELT). Glucose variability was evaluated by continuous glucose monitoring for a 7-day period with a DexCom G4 CGM system: the mean amplitude of glycemic excursions (MAGEs), low (LBGI) and high (HBGI) blood glucose indices, and the standard deviation of blood glucose (BGSD) were calculated. ResultsPE prevalence did not differ significantly between the two groups: pathological values of the PEDT score (>8) and IELT score (<1 minute) were recorded in 24 out of 100 diabetic patients (24%) and in 12 out of 51 controls (23.5%). There were significant associations between hemoglobin A1c and the PEDT score (r=0.27; P=0.006) and IELT (r=-0.3; P=0.01). In the subgroup assessed for glucose variability, the PEDT score was associated with LBGI (r=0.43; P=0.01), but not with BGSD (r=0.1, P=0.6), MAGE (r=-0.1; P=0.4), or HBGI (r=0.1; P=0.6). Conclusions
Our results show a similar prevalence of PE in young male patients with Type 1 diabetes and in the age-matched control population; in diabetic patients with PE, a higher glycemic variability in the hypoglycemic domain is significantly associated with the PEDT score. Bellastella G, Maiorino MI, Olita L, Della Volpe E, Giugliano D, and Esposito K. Premature ejaculation is associated with glycemic control in Type 1 diabetes. J Sex Med 2015;12:93-99.
Introduction:
Recent developments in the study of men's sexual response have raised significant issues related to the definition and diagnosis of premature ejaculation (PE).
Aim:
We wanted to understand men's perceived reasons for "ejaculating before they wanted," whether they selected attributions from the same broad category when allowed to endorse multiple reasons, and whether younger and older cohorts differed in their attributions.
Methods:
A subsample of 376 men who indicated that they "ejaculated before they wanted" was drawn from a larger pool of 1,249 men participating in an online survey on men's sexual health. This subsample responded to a number of items regarding their ejaculatory patterns, including two questions listing 10 possible self-reported attributions/reasons for their quick ejaculation--one item allowed respondents to endorse multiple reasons, the other limited the response to the most important reason.
Main outcome measures:
The primary outcome measure was men's attributions for ejaculating before desired, with choices from 10 possible pretested reasons. In addition, concordance across attributions was determined, that is, if a man responded to one category, was he also likely to select another category?
Results:
Men who met the ejaculatory latency criterion for PE were generally no different from those who did not. Overall, when required to select the most important attribution, most men identified a specific issue with "lack of self-efficacy" (lack of control or aroused too quickly). Few respondents identified erection loss, partner issues, or medical/medication concerns as the reason--and these patterns were independent of age. Concordance was high across self-efficacy attributions but low across other attributions.
Conclusions:
Most men who complain of ejaculating before desired attribute this response to problems with self-efficacy. Only a small percent of men identified other possible reasons for their quick ejaculation. Such findings have implications for both the diagnostic process and definitional language for PE.
A recent WHO analysis has revealed the need for a new world standard population (see attached table). This has become particularly pertinent given the rapid and continued declines in age-specific mortality rates among the oldest old, and the increasing availability of epidemiological data for higher age groups. There is clearly no conceptual justification for choosing one standard over another, hence the choice is arbitrary. However, choosing a standard population with higher proportions in the younger age groups tends to weight events at these ages disproportionately. Similarly, choosing an older standard does the opposite. Hence, rather than selecting a standard to match the current age-structure of some population(s), the WHO adopted a standard based on the average age-structure of those populations to be compared (the world) over the likely period of time that a new standard will be used (some 25-30 years), using the latest UN assessment for 1998 (UN Population Division, 1998). From these estimates, an average world population age-structure was constructed for the period 2000-2025. The use of an average world population, as well as a time series of observations, removes the effects of historical events such as wars and famine on population age composition. The terminal age group in the new WHO standard population has been extended out to 100 years and over, rather than the 85 and over as is the current practice. The WHO World Standard population has fewer children and notably more adults aged 70 and above than the world standard. It is also notably younger than the European standard.
It is important to note, however, that the age standardized death rates based on the new standard are not comparable to previous estimates that are based on some earlier standard(s). However, to facilitate comparative analyses, WHO will disseminate trend analyses of the “complete” historical mortality data using on the new WHO World Standard Population in future editions of the World Health Statistics Annual.
To study sexual activity, the prevalence of sexual dysfunction and related help-seeking behaviors among mature adults in the United States of America, a telephone survey was conducted in 2001-2002. A total of 1491 individuals (742 men/749 women) aged 40-80 years completed the survey. Overall, 79.4% of men and 69.3% of women had engaged in sexual intercourse during the 12 months preceding the interview. Early ejaculation (26.2%) and erectile difficulties (22.5%) were the most common male sexual problems. A lack of sexual interest (33.2%) and lubrication difficulties (21.5%) were the most common female sexual problems. Less than 25% of men and women with a sexual problem had sought help for their sexual problem(s) from a health professional. Many men and women in the United States report continued sexual interest and activity into middle age and beyond. Although a number of sexual problems are highly prevalent, few people seek medical help.
An abridged five-item version of the 15-item International Index of Erectile Function (IIEF) was developed (IIEF-5) to diagnose the presence and severity of erectile dysfunction (ED). The five items selected were based on ability to identify the presence or absence of ED and on adherence to the National Institute of Health's definition of ED. These items focused on erectile function and intercourse satisfaction. For 1152 men (1036 with ED, 116 controls) analyzed, a receiver operating characteristic curve indicated that the IIEF-5 is an excellent diagnostic test. Based on equal misclassification rates of ED and no ED, a cutoff score of 21 (range of scores, 5-25) discriminated best (sensitivity=0.98, specificity=0. 88). ED was classified into five severity levels, ranging from none (22-25) through severe (5-7). Substantial agreement existed between the predicted and 'true' ED classes (weighted kappa=0.82). These data suggest that the IIEF-5 possesses favorable properties for detecting the presence and severity of ED.
Relatively little is known about the usual frequency of sexual activity and how older individuals cope with sexual problems. The objective was to study sexual activity, prevalence of sexual problems and related help-seeking behaviors among middle-aged and older men and women in Brazil.
Population survey, by Fundação Oswaldo Cruz.
Interviews were held with 1,199 Brazilians aged 40-80 years (471 men and 728 women). The standardized questionnaire investigated demographics, general health, sexual behavior, attitudes and beliefs.
Overall, 92.6% of men and 58.3% of women had had sexual intercourse during the preceding year. More than half of the men and women had done so more than once a week. Early ejaculation (30.3%) was the commonest male sexual problem, followed by inability to reach orgasm (14.0%), erectile difficulties (13.1%) and lack of sexual interest (11.2%). For women, the commonest sexual problems were lubrication difficulties (23.4%) and lack of sexual interest (22.7%). Depression was a significant correlate of sexual problems, for men and women. More women than men had sought help for sexual problem(s) from a healthcare professional.
The findings highlight the importance of encouraging greater use of available healthcare services, including consultation with a medical doctor regarding sexual health. This should not only enable men and women to maintain satisfactory sexual function well into their later years, but may also result in overall improvement in the quality of healthcare.
To study the sexual activity and the prevalence of sexual dysfunctions and related help seeking behaviour, among people in Europe aged 40-80 years. A telephone survey was carried out in 2001-2002 in Sweden, the UK, Belgium, Germany, Austria, France, Spain and Italy, of 4,977 men and 5,023 women, using a structured, standardized questionnaire Eighty-three percent of men and 66% of women had sexual intercourse during the year preceding the interview. The sexual dysfunctions most frequently reported were early ejaculation (11%) and erectile dysfunction (8%) in men; and a lack of sexual interest (18%), an inability to reach orgasm (13%) and lubrication difficulties (11%) in women. Of the 23% of men and 32% of women who reported sexual dysfunction, 26% had consulted a physician, with considerable between-country differences. Sexual activity is widespread among adult middle-aged and elderly people, but many experience sexual dysfunctions and few seek medical care.
Diagnosis of premature ejaculation (PE) for clinical trial purposes has typically relied on intravaginal ejaculation latency time (IELT) for entry, but this parameter does not capture the multidimensional nature of PE. Therefore, the aim was to develop a brief, multidimensional, psychometrically validated instrument for diagnosing PE status.
The questionnaire development involved three stages: (1) Five focus groups and six individual interviews were conducted to develop the content; (2) psychometric validation using three different groups of men; and (3) generation of a scoring system. For psychometric validation/scoring system development, data was collected from (1) men with PE based on clinician diagnosis, using DSM-IV-TR, who also had IELTs < or =2 min (n=292); (2) men self-reporting PE (n=309); and (3) men self-reporting no-PE (n=701). Standard psychometric analyses were conducted to produce the final questionnaire. Sensitivity/specificity analysis was used to determine an appropriate scoring system.
The qualitative research identified 9 items to capture the essence of DSM-IV-TR PE classification. The psychometric validation resulted in a 5-item, unidimensional, measure, which captures the essence of DSM-IV-TR: control, frequency, minimal stimulation, distress, and interpersonal difficulty. Sensitivity/specificity analyses suggested a score of < or =8 indicated no-PE, 9 and 10 probable PE, and > or =11 PE.
The development and validation of this new PE diagnostic tool has resulted in a new, user-friendly, and brief self-report questionnaire for use in clinical trials to diagnose PE.
Introduction:
The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders, based on validated questionnaires and applying age adjustment to the World Standard Population (WSP) by the World Health Organization. In 2010, the first report of GOSS came from the Middle East, describing an erectile dysfunction (ED) prevalence rate of 47%.
Aim:
This report studies the prevalence rate of ED in the United States as of 2011-2012 and evaluates risk factors for ED.
Main outcome measures:
Prevalence of ED.
Methods:
GOSS was randomly deployed to English-speaking male web surfers in the United States via paid advertising on Facebook, comprising 146 questions including the abbreviated 5-item International Index of Erectile Function.
Results:
Two thousand twenty-two males participated; with a mean age was 52.38 years ± 14.5. Prevalence of ED was 37.7%, adjusted to 33.7% according to WSP, comparable across ethnic groups. The following risk factors were associated with higher risk for ED: diabetes mellitus, hypertension with and without antihypertensive treatment, coronary heart disease, obesity (defined by body mass index), difficult micturition, subjectively reported depression, interpersonal distress, subjectively reported impotence, in addition to novel factors such as subjectively reported premature ejaculation (PE) and concerns over genital size (not a smaller penis per se), low libido, and irregular coitus. Frequency of smoking and alcohol were not associated with higher prevalence of ED, although duration of smoking was.
Conclusion:
Adjusted to WSP, prevalence rate of ED in the United States of America is 33.7% in the year 2011, in contrast to the adjusted prevalence in the Middle East (47%). Most of the classical risk factors for ED play the same role in the United States and the World, including diabetes, hypertension, and aging. Concerns over genital size and PE are emerging risk factors for ED.
Introduction. Utility of phosphodiesterase inhibitors (PDEi's) for the treatment of erectile dysfunction (ED) has been the focus of experimental and clinical studies. However, public preferences, attitudes, and experiences with PDEi's are rarely addressed from a population/epidemiology viewpoint. The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders, first launched in the Middle East in 2010, followed by the United States in 2011.
Aim. To describe the utilization rates, trends, and attitudes toward PDEi's in the United States in the year 2011.
Methods. GOSS was randomly deployed to English-speaking male Web surfers in the United States via paid advertising on Facebook®, comprising 146 questions.
Main Outcome Measures. Utilization rates and preferences for PDEi's by brand.
Results. Six hundred three subjects participated; mean age 53.43 years ± 13.9. Twenty-three point seven percent used PDEi's on more consistent basis, 37.5% of those with ED vs. 15.6% of those without ED (recreational users). Unrealistic safety concerns including habituation were pronounced. Seventy-nine point six percent of utilization was on prescription basis. PDEi's were purchased through pharmacies (5.3% without prescription) and in 16.5% over the Internet (68% without prescription). Nine point six percent nonprescription users suffered coronary heart disease. Prescription use was inclined toward sildenafil, generally, and particularly in severe cases, and shifted toward tadalafil in moderate ED and for recreational use, followed by vardenafil. Nonprescription utilization trends were similar, except in recreational use where sildenafil came first.
Conclusion. In the United States unrealistic safety concerns over PDEi's utility exist and should be addressed. Preference for particular PDEi's over the others is primarily dictated by health-care providers, despite lack of guidelines that govern physician choice. Online and over-the-counter sales of PDEi's are common, and can expose a subset of users to health risks. Recreational use of PDEi's is common, and could be driven by undiagnosed premature ejaculation. Shaeer O. The Global Online Sexuality Survey (GOSS): The United States of America in 2011 chapter II: Phosphodiesterase inhibitors utilization among English speakers. J Sex Med **;**:**–**.
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.International Journal of Impotence Research advance online publication, 30 August 2012; doi:10.1038/ijir.2012.27.
Introduction
Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Specifically, we have witnessed substantial progress in understanding the physiology of ejaculation, clarifying the real prevalence of PE in population-based studies, reconceptualizing the definition and diagnostic criterion of the disorder, assessing the psychosocial impact on patients and partners, designing validated diagnostic and outcome measures, proposing new pharmacologic strategies and examining the efficacy, safety and satisfaction of these new and established therapies. Given the abundance of high level research it seemed like an opportune time for the International Society for Sexual Medicine (ISSM) to promulgate an evidenced-based, comprehensive and practical set of clinical guidelines for the diagnosis and treatment of PE.
Aim
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
Review of the literature.
Results
This article contains the report of the ISSM PE Guidelines Committee. It affirms the ISSM definition of PE and suggests that the prevalence is considerably lower than previously thought. Evidence-based data regarding biological and psychological etiology of PE are presented, as is population-based statistics on normal ejaculatory latency. 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. Therefore, it is strongly recommended that these guidelines be re-evaluated and updated by the ISSM every 4 years. Althof SE, Abdo CHN, 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 WJG, Incrocci L, Jannini EA, Park K, Parish S, Porst H, Rowland D, Segraves R, Sharlip I, Simonelli C, and Tan HM. International Society for Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation.
The exact prevalence of female sexual dysfunction (FSD) in the Middle East is exceptionally difficult to measure in light of its sensitive nature and the conservative tinge of the population.
The Global Online Sexuality Survey-Arabic-Females (GOSS-AR-F) is a community-based study of female sexuality in the Middle East through an online survey.
Prevalence of risk for female sexual dysfunction (rFSD) in the reproductive age group and its vulnerability to various risk factors.
GOSS-AR-F was offered via online advertising. The survey is comprised of the Female Sexual Function Index (FSFI) questionnaire among other questions.
Out of 2,920 participants, 344 participants completed all survey questions. Average total FSFI score was 23 ± 6.5, with 59.1% of participants suffering rFSD. Age adjusted prevalence of rFSD was 59.5%, standardized to World Health Organization World Standard Population. There was a statistically significant higher prevalence of rFSD among cases with subjectively reported depression and male partner-related shortcomings such as erectile dysfunction and premature ejaculation as reported by the female participant, in addition to dissatisfaction with partner's penile size, insufficient foreplay, and practice of masturbation. This was not the case with advancing age, diabetes mellitus, hypertension, smoking, ongoing pregnancy, mode of previous child delivery, infertility, menstrual irregularities, dysmenorrhea, interpersonal distress, subjectively reported hirsutism, and female genital cutting. Participants were found to require longer duration of coitus and better ejaculatory control but not necessarily a higher coital frequency.
Female sexual function in the reproductive age appears to be adversely affected by psychological factors and shortcomings in male sexual function more than anything. These findings point to the possibility that many cases of FSD can be managed with the focus on male partner's ailments and attitudes that are relatively easier to manage.
It is controversial whether or not the most frequent male sexual dysfunctions, premature ejaculation (PE) and erectile dysfunction (ED), share pathogenetic mechanisms and treatments.
Three scientists (C.McM., J.C., and A.A.), together with the Controversy's Editor (E.A.J.), with expertise in the area of medical treatment of PE, present different perspectives on the use of phosphodiesterase type 5 inhibitors (PDE5is) in PE. The psychological point of view is discussed by an expert in sexology (M.P.).
Outcome measures used are expert opinions supported by the critical review of the currently available literature.
This Controversy examines the role of nitric oxide (NO) as a neurotransmitter involved in the central and peripheral control of ejaculation, the adherence of methodology to the contemporary consensus of ideal PE drug trial design, the impact of methodology on treatment outcomes, and the role of PDE5i drugs (sildenafil, tadalafil, and vardenafil) in the treatment of PE.
While it is evident that PDE5is are the first choice in patients with comorbid ED and PE (where one may be secondary to the other), well-designed studies on the possible use of PDE5is in PE patients without ED are still limited. The issue will be less controversial when further evidence on the role of NO and PDE5 in the mechanism of ejaculation is available.
We aimed to determine the prevalence of early ejaculation disorders (EED) and to calculate the prevalence of lifelong premature ejaculation (PE) in Greek urban men. Associations with physiological and psychological conditions, treatment-seeking and treatment efficacy were defined. We surveyed 522 urban men aged 16-62 individually using an open, one-on-one questionnaire. A total of 305 (58.43%) participants reported EED. The prevalence of lifelong PE, according to the International Society for Sexual Medicine criteria, was calculated as 17.7%. Among sufferers of EED, unrelated stress was the most frequent comorbidity (42.6%) and, along with erectile dysfunction and lower urinary tract symptoms, occurred more frequently than in normal participants (P < 0.05). Half (50.3%) of the sufferers believed that their problem was psychological, while 69.5% never sought help. Most (69.2%) of those who did seek help sought it anonymously through the internet. Behavioural treatment was preferred to medical treatment. Few (13.8%) men were satisfied with their treatment. In conclusion, although the observed PE prevalence agrees with the previous findings, more patients suffer negative personal and relationship consequences and may also require treatment. Most men do not seek medical assistance, and from those who do, most are not satisfied with the results of treatment.
Sexuality is a sensitive issue that may be difficult to explore through surveys involving direct contact. Epidemiological studies in this domain are scarce. Online surveys may provide more anonymity and less direct contact encouraging participation. The Global Online Sexuality Survey (GOSS) reports on different aspects of male and female sexuality. The Global Online Sexuality Survey-Arabic-Males (GOSS-AR-M) is the Arabic version reporting on male sexuality.
To evaluate male ejaculatory function, penile size and contraceptive trends among Arabic speakers in the Middle East.
The survey was randomly offered online to web surfers in the Middle East.
Prevalence of premature ejaculation, ejaculatory latency, penile size and their correlation with erectile function.
A total of 82.6% reported various degrees of premature ejaculation, associated with a statically significant decline in erectile function, despite a median intravaginal ejaculatory latency time (IELT) of 5 minutes, 95% confidence interval (CI) of 8.4-9.8. Adjusted to the World Standard Population by the World Health Organization, the collective prevalence was 83.7%. Local anesthetics gave better results and tolerance in delaying ejaculation. Self-measured erect penile length from symphysis pubis to glans was 15.6 cm ± 4.1, 95% CI = 15.4-15.9, yet, 30% were dissatisfied with size, mainly in the flaccid state, with dissatisfaction being inversely proportional with erectile function. Intrauterine device was the method mostly used by couples, and condoms had a high dissatisfaction rate.
The prevalence of premature ejaculation appears to surpass that of erectile dysfunction, despite the possibility that it may be overreported considering the acceptable IELT of the population surveyed. Premature ejaculation and concerns over genital size may be considered as risk factors for ED. More male contraceptive measures should be introduced and popularized. Alleviating dissatisfaction with condom utility via health education should be a priority.
Introduction:
Epidemiologic studies exploring sexuality across different cultures and geographic regions are scanty, particularly from the Middle East. The Global Online Sexuality Survey (GOSS) is an Internet-based survey investigating male and female sexual function. GOSS-Arabic-Males is the Arabic version targeting males in the Middle East, exploring prevalence rate of and factors affecting erectile dysfunction and its therapeutic trends, as well as premature ejaculation, attitudes toward genital size, and contraception.
Aim:
To explore epidemiologic aspects of male sexuality through an online survey.
Main outcome measures:
Prevalence rate of erectile dysfunction, its relationship to risk factors, and therapeutic trends.
Methods:
The online survey was randomly offered to Web surfers in the Middle East.
Results:
Eight hundred four subjects completed the survey. The overall prevalence of ED was 45.1%, strongly correlating with various risk factors studied, including age, diabetes, hypertension under treatment, depression, concerns over genital size, interpersonal distress, premature ejaculation, low libido, and subjective reports of penile deviation. Adjusted to the World Standard Population, the prevalence rate for ED was 47%. Phosphodiesterase (PDE) inhibitors gave a poor response among those with low libido and interpersonal distress, emphasizing the need for proper diagnosis and psychological counseling parallel to medical treatment. Furthermore, PDE inhibitors were stigmatized with unrealistic concerns that decreased their utility to a great extent.
Conclusion:
In the study population of Arab-speaking Internet users, prevalence of erectile dysfunction and effect of risk factors have proven similar to reports from different parts of the world, though not unanimously. Premature ejaculation, low desire, concerns over penile size, and penile curvature are factors to be considered in the evaluation of ED patients. PDE inhibitors are stigmatized with false beliefs that should be addressed through mass media and counseling if this population is to take full benefit from this therapeutic option.
Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Specifically, we have witnessed substantial progress in understanding the physiology of ejaculation, clarifying the real prevalence of PE in population-based studies, reconceptualizing the definition and diagnostic criterion of the disorder, assessing the psychosocial impact on patients and partners, designing validated diagnostic and outcome measures, proposing new pharmacologic strategies and examining the efficacy, safety and satisfaction of these new and established therapies. Given the abundance of high level research it seemed like an opportune time for the International Society for Sexual Medicine (ISSM) to promulgate an evidenced-based, comprehensive and practical set of clinical guidelines for the diagnosis and treatment of PE.
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. Review of the literature.
This article contains the report of the ISSM PE Guidelines Committee. It affirms the ISSM definition of PE and suggests that the prevalence is considerably lower than previously thought. Evidence-based data regarding biological and psychological etiology of PE are presented, as is population-based statistics on normal ejaculatory latency. 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.
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. Therefore, it is strongly recommended that these guidelines be re-evaluated and updated by the ISSM every 4 years.
Objective:
To develop a contemporary, evidence-based definition of premature ejaculation (PE).
Methods:
There are several definitions of PE; the most commonly quoted, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders - 4th Edition - Text Revision, and other definitions of PE, are all authority-based rather than evidence-based, and have no support from controlled clinical and/or epidemiological studies. Thus in August 2007, the International Society for Sexual Medicine (ISSM) appointed several international experts in PE to an Ad Hoc Committee for the Definition of PE. The committee met in Amsterdam in October 2007 to evaluate the strengths and weaknesses of current definitions of PE, to critically assess the evidence in support of the constructs of ejaculatory latency, ejaculatory control, sexual satisfaction and personal/interpersonal distress, and to propose a new evidence-based definition of PE.
Results:
The Committee unanimously agreed that the constructs which are necessary to define PE are rapidity of ejaculation, perceived self-efficacy, and control and negative personal consequences from PE. The Committee proposed that lifelong PE be defined as a male sexual dysfunction characterized by ejaculation which always or nearly always occurs before or within about one minute of vaginal penetration, and the inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy. This definition is limited to men with lifelong PE who engage in vaginal intercourse. The panel concluded that there are insufficient published objective data to propose an evidence-based definition of acquired PE.
Conclusion:
The ISSM definition of lifelong PE represents the first evidence-based definition of PE. This definition will hopefully lead to the development of new tools and patient-reported outcome measures for diagnosing and assessing the efficacy of treatment interventions, and encourage ongoing research into the true prevalence of this disorder, and the efficacy of new pharmacological and psychological treatments.
Premature ejaculation (PE) is suspected to be the most prevalent male sexual complaint, and the prevalence of PE is considerably high also in the younger generation. We investigated the PE prevalence based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed text revision; DSM-IV-TR) definition and the risk factors of PE in Korean young men via Internet survey. Subjects (n = 3980) aged from 20 to 59, who performed sexual intercourse more than once a month during the past 6 months were asked to participate in this study. Participants were asked to complete a questionnaire that consisted of questions on general, medical, and sexual history related to ejaculation. A total of 600 subjects were included in this study. PE prevalence was found to be 18.3%. Prevalences were not significantly different across age groups, after excluding subjects with erectile dysfunction (ED). Educational level, marital status and duration, average income, sexual orientation, smoking, alcohol consumption, and circumcision status showed no difference in the PE and non-PE groups. Partners perceived satisfaction rates were 45.0% in the PE group and 63.9% in the non-PE group. Significant differences were found between the PE and non-PE groups in terms of ED, obesity, and depression prevalence. However, multiple logistic regression analysis revealed that the significant risk factors of PE were age and the frequency of conversations with partners about sexual intercourse. This Internet-based study is limited because participants probably represent a selected population of Internet users with non-representative educational and socioeconomic profiles. This study is the first to report the prevalence of both self-reported PE and PE on the basis of the DSM-IV-TR definition in the Korean population. This study demonstrates that PE in Korea is as prevalent as it is in European countries and the United States.
The duration of the intravaginal ejaculation latency time (IELT) may give rise to subjective complaints of premature ejaculation (PE) and is usually determined by self-assessment or by stopwatch.
The aim of this study was to investigate the IELT distribution in the general male population and the accuracy of IELT assessment by using a blinded timer device instead of a stopwatch, thereby minimizing possible interference with the spontaneous and natural way of having intercourse.
The IELT was measured with a timer device during 4 weeks in a nonselected sample of 474 men from The Netherlands, Spain, United Kingdom, Turkey, and the United States. Questionnaires were administered before and after the 4-week IELT assessments.
IELT; erectile function dysfunction score of International Index of Erectile Dysfunction (IIEF).
The IELT had a positively skewed distribution, with a geometric mean of 5.7 minutes and a median of 6.0 minutes (range: 0.1-52.1 minutes). Men from Turkey had the shortest median IELT (4.4 minutes). Men from the United Kingdom had the longest IELT (10.0 minutes). Circumcision and condom use had no significant impact on the median IELT. Subjects who were discontent with their latency time had slightly lower median IELT values of 5.2 minutes than the median of the population.
The IELT distribution, measured with a blinded timer device, is very similar to the IELT distribution of our previous population survey which utilized a stopwatch. In the general male population, complaints of discontent with self-perceived latency had a slightly lower median IELT value than the median of the overall population.
The Global Study of Sexual Attitudes and Behaviours was a survey of 27 500 men and women in 29 countries. Here we report the sexual activity, the prevalence of sexual difficulties and related help-seeking behaviour among participants in Australia.
A telephone survey was conducted in Australia in 2001-2002, with interviews based on a standardised questionnaire. A total of 1500 individuals (750 men and 750 women) aged 40 to 80 years completed the survey. The questionnaire covered demographic information, overall health, and sexual behaviours, attitudes and beliefs.
Overall, 83% of men and 74% of women had engaged in sexual intercourse during the 12 months preceding the interview, and 38% of all men and 29% of all women engaged in sexual intercourse more than once a week. Early ejaculation (23%), erectile difficulties (21%) and a lack of sexual interest (18%) were the most common male sexual difficulties. The most frequently reported female sexual difficulties were: lack of sexual interest (33%), lubrication difficulties (26%) and an inability to reach orgasm (25%). Older age was a significant predictor of male erectile difficulties and of lubrication difficulties in women. Only a minority of men and women had sought help for their sexual difficulty(ies) from a health professional.
Many middle-aged and older adults in Australia report continued sexual interest and sexual activity. Several sexual difficulties are highly prevalent in this population, but those experiencing these difficulties rarely seek medical help. This may be because they do not perceive such difficulties as serious or sufficiently upsetting.
Accumulating evidence suggests that premature ejaculation is the most common sexual symptom. This review focuses on the epidemiology of premature ejaculation from geographical and medical perspectives.
In the past year many articles have been published using the data from the Global Study of Sexual Attitudes and Behaviors, a large survey that investigated various aspects of sex and relationships among 27 500 men and women aged 40-80 years. Despite some methodological bias, discussed herein, a prevalence of more than 21% seems a realistic figure for premature ejaculation.
Premature ejaculation is the most prevalent sexual dysfunction in every country.
Although there is considerable interest in the prevalence and impact of sexual problems worldwide, to date only male erectile dysfunction has been studied systematically in Asian countries.
To study the prevalence of sexual problems and associated help-seeking patterns, among mature adults in Korea and to compare the results with those obtained in other Southeast Asian and East Asian countries.
As part of the Global Study of Sexual Attitudes and Behaviors (GSSAB), a survey was conducted in Korea during 2001 and 2002. Sampling was based on an intercept methodology and 1,200 individuals (600 men and 600 women) aged 40-80 years completed the survey out of 3,691 eligible subjects (response rate of 32.5%).
General health, relationships, and sexual behaviors, attitudes, and beliefs.
Ninety-one percent of men and 71% of women had engaged in sexual intercourse during the 12 months preceding the interview. Early ejaculation (33%) and erectile difficulties (32%) were the sexual problems most frequently reported by Korean men; these conditions were more common in Korea than in other Asian regions. Increasing age, physical inactivity, smoking, and prostate disease were significant correlates of erectile difficulties. The sexual problems most frequently reported by women in Korea were lack of sexual pleasure (37%) and inability to reach orgasm (31%). Only 2% of men and women in Korea had talked to a medical doctor about their sexual problems.
Middle-aged and older adults in Korea regard sex as an important part of life and report continued sexual activity. Several sexual problems are highly prevalent in this population, but very few individuals seek medical help for these disorders. This is largely due to believing that the problem is not serious, not being bothered by the problem, difficulties regarding access to or affordability of medical care, and/or a lack of awareness of available treatments.
Premature ejaculation (PE) is a frequent male sexual complaint. Its occurrence does not automatically imply the existence of a male sexual disorder. The current DSM definition of PE has a low-positive predictive value with a high associated risk for false-positive diagnoses of PE. A new classification in four well-defined PE syndromes has recently been proposed for the pending DSM-V. According to this new classification there are different pathophysiologies, etiologies, and treatments of PE dependent on the underlying PE syndrome. Some types are particularly neurobiologically or medically determined and need drug treatment; other types, which are mainly psychologically determined, need psychotherapy or both. Moreover, according to the proposed new classification it is likely that only a small number of men with complaints of PE suffer from a neurobiologically determined PE disturbance.
The medical literature contains several definitions of premature ejaculation (PE). The most commonly quoted definition, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision, and other definitions of PE are all authority based rather than evidence based, and have no support from controlled clinical and/or epidemiological studies.
The aim of this article is to develop a contemporary, evidence-based definition of PE.
In August 2007, the International Society for Sexual Medicine (ISSM) appointed several international experts in PE to an Ad Hoc Committee for the Definition of Premature Ejaculation. The committee met in Amsterdam in October 2007 to evaluate the strengths and weaknesses of current definitions of PE, to critique the evidence in support of the constructs of ejaculatory latency, ejaculatory control, sexual satisfaction, and personal/interpersonal distress, and to propose a new evidence-based definition of PE.
The committee unanimously agreed that the constructs that are necessary to define PE are rapidity of ejaculation, perceived self-efficacy and control, and negative personal consequences from PE. The committee proposed that lifelong PE be defined as ". . . a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration, and the inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy." This definition is limited to men with lifelong PE who engage in vaginal intercourse. The panel concluded that there are insufficient published objective data to propose an evidence-based definition of acquired PE.
The ISSM definition of lifelong PE represents the first evidence-based definition of PE. This definition will hopefully lead to the development of new tools and Patient Reported Outcome measures for diagnosing and assessing the efficacy of treatment interventions and encourage ongoing research into the true prevalence of this disorder and the efficacy of new pharmacological and psychological treatments.