Advances and Missteps in Diagnosing Premature Ejaculation: Analysis and Future Directions

Althof, Stanley E.; McMahon, Chris G.; Rowland, David L.

doi:10.1016/j.jsxm.2021.10.010

Cited by 11 publications

(5 citation statements)

References 52 publications

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“…In particular, ELT has been traditionally considered a diagnostic criterion for PE 1–8 with an established limit (1-3 minutes) for diagnosis. However, we believe that a differentiating time limit should not be established, for 2 reasons: the weakness shown in some studies 43–45 and the potential for men to be misdiagnosed (men without PE but with a short ELT would be included, and men with PE but a normal ELT would be excluded). Moreover, our results show that PE seems to be significantly related to difficulties in prolonging or modulating the arousal phase.…”

Section: Discussionmentioning

confidence: 99%

Progressive arousal: a new concept and definition for premature ejaculation

Bustos

Carreño

Gutiérrez³

et al. 2023

Sexual Medicine

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Background Premature ejaculation (PE) is a nosologic entity with issues in its conceptualization and definition. Aim To understand if the altered sexual response in men with PE is in the orgasm phase, as currently assumed, or the arousal phase with difficulties in modulating, regulating, or decreasing sexual arousal. Methods Men were recruited who looked for help for PE and met the diagnostic criteria according to clinical standards. The participants completed a sociodemographic survey and the Premature Ejaculation Diagnostic Tool. They also performed a masturbation exercise with a maximum of 5 stops, with the intention of prolonging the arousal phase. The time of the exercise was measured from the beginning of genital masturbation to ejaculation. Outcomes We calculated the total time of the exercise, the median time at each start, and the number of dropouts. We performed a pairwise comparison analysis between starts and made a survival curve representing the percentage of men who remained in the exercise. Results A total of 481 men with PE participated (mean ± SD; age, 29.25 ± 8.72 years). We found that the expected median survival time until ejaculation was 317.00 seconds (95% CI, 288.34-345.65). However, the average time during stimulation decreased as the exercise progressed, and statistically significant differences were observed in their pairwise comparison (P < .001). Also, the chances of ejaculation increased as the exercise progressed, with 62.16% of the participants ejaculating before the end of the exercise. The results indicated increasing sexual arousal, where stops in stimulation were progressively less effective at maintaining ejaculation times at starts. Clinical Implications We showed that the arousal phase is altered in PE, not the orgasm phase, and this could finally have implications in the diagnosis and/or treatment of this condition. Strengths and Limitations The analysis of the times at starts and stops in a masturbation exercise in men with PE, had been barely addressed before. In the future, it would be important to verify the effect of stops during sexual intercourse and to incorporate a control group of men without PE. Conclusions We propose a new conceptualization and definition for PE: progressive arousal disorder is the inability to modulate, regulate, or decrease arousal during any sexual activity, even with brief stops during sexual stimulation, causing unwanted ejaculation.

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Section: Discussionmentioning

confidence: 99%

Progressive arousal: a new concept and definition for premature ejaculation

Bustos

Carreño

Gutiérrez³

et al. 2023

Sexual Medicine

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“…This condition may lead to secondary psychological, sexual or interpersonal relationship problems [2]. The secondary (acquired) PE is defined when the patient had successful coital relationships in the past, yet began experiencing PE [22].…”

Section: Discussionmentioning

confidence: 99%

“…The primary (lifelong) type is characterized by experiencing PE from the first sexual act encountered during puberty or adolescence [2]. The secondary (acquired) PE is defined when the patient had successful coital relationships in the past, yet began experiencing PE [22].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Serum Prolactin and Testosterone in Premature Ejaculation Patients

Eid,

Elwan,

Hazzaa

et al. 2023

JAMMR

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Background Premature ejaculation is a frequently encountered sexual dysfunction in men. It significantly impairs quality of life of the affected male and his partner. This study investigated the role of hormonal factors (prolactin and testosterone) in patients with premature ejaculation. Objectives: evaluating the contribution of prolactin and testosterone in the pathogenesis of premature ejaculation. Methods: A group of 26 patients suffering from premature ejaculation;15 of them presented with primary type, and 11 of them complained of secondary type. Another group of 10 subjects served as a control group. All the individuals were subjected to clinical evaluation, and venous blood samples for laboratory investigation of serum prolactin and total testosterone. Results: Comparing the serum prolactin levels between all groups showed no significant statistical differences (p:>0.05). While the levels of total serum testosterone were significantly lower in the primary premature ejaculation patients than in the control group and were more lower in the secondary premature ejaculation patients than both the control and primary type patients (p:<0.05). Conclusion: It is recommended to routinely investigate testosterone serum levels in secondary premature ejaculation patients, especially that is thought to be a high-risk factor in secondary type.

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“…To face this challenge, increasing research efforts have been devoted to understanding the etiology of PE 8 . However, our understanding of the exact pathogenetic mechanisms behind PE is still insufficient 9 .…”

Section: Introductionmentioning

confidence: 99%

Altered reward processing in patients with lifelong premature ejaculation

Li,

Wang

et al. 2023

Sci Rep

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Given that sexual behavior is usually pleasurable and highly rewarding, it is surprising that there is as yet no known research to empirically assess how premature ejaculation (PE) patients respond to the rewarding aspect of sexual behavior. This study was designed to address this issue by evaluating how these men respond to the anticipation and hedonic experience of sexual rewards in comparison to non-sexual rewards. Thirty lifelong PE patients and thirty healthy controls (HCs) performed the incentive delay task manipulating both erotic and monetary rewards. Compared to HCs, lifelong PE patients exhibited significantly faster RTs to erotic cues than to monetary cues during reward anticipation. Meanwhile, hedonic experience ratings after obtaining the actual reward showed that erotic rewards were rated as more pleasant than monetary rewards only by lifelong PE patients, which was driven by a decreased sensitivity to experienced monetary rewards in lifelong PE patients compared to HCs. These findings indicate the existence of dysfunctional reward processing in lifelong PE patients, which is characterized by increased incentive motivation elicited by sexual cues and reduced hedonic impact of nonsexual rewards. This study may offer an insightful clue regarding how PE is related to the abnormal regulation of the rewarding aspect of sexual behavior.

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Advances and Missteps in Diagnosing Premature Ejaculation: Analysis and Future Directions

Cited by 11 publications

References 52 publications

Progressive arousal: a new concept and definition for premature ejaculation

Progressive arousal: a new concept and definition for premature ejaculation

Evaluation of Serum Prolactin and Testosterone in Premature Ejaculation Patients

Altered reward processing in patients with lifelong premature ejaculation

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