The authors state that`premature ejaculation (PE) like psychogenic erectile dysfunction is a performance anxiety related problem'. This may well be so. Certainly the levels of anxiety measured on the Hamilton anxiety ratings have been shown to be higher in patients with primary PE compared to secondary PE. 1 However, this anxiety in primary PE may be secondary to the patients having a chronic sexual problem. Other workers feel primary PE may be controlled by biogenic factors, 2 which may well have their basis in dysfunctional 5HT receptors in the central and peripheral nervous systems. 3,4 Although PDE5 receptors have been found in the cerebellum of rats 5 and PDE7 receptors in the caudate nucleus of humans, 6 we ®nd it implausible on a theoretical level that sildena®l has a direct effect on latency times. It is tautological to state, as they say, that`ejaculation latency time is dependent on erection time' Ð intravaginal latency time is terminated by ejaculation, so that these times (in men without erectile dysfunction) are almost always the same.We are also concerned that the EDITS 7 was used to measure sexual satisfaction. The EDITS was constructed and validated for use in erectile dysfunction Ð it is therefore inappropriate to use it for assessment of sexual satisfaction associated with PE.The most plausible reason for the prolonged intravaginal latency time in patients on sildena®l, we feel, is that this drug enables patients to respond to small amounts of sexual desire soon after an initial episode of intercourse. It is well known that a second or third coitus within a short space of time results in prolonged ejaculatory latency time. 8 We feel this explanation should have been put forward as the most plausible cause of the prolonged ejaculatory latency time for patients on sildena®l.
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