The Unfinished Business of Defining Premature Ejaculation: The Need for Targeted Research

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

doi:10.1016/j.sxmr.2021.11.003

Cited by 23 publications

(21 citation statements)

References 77 publications

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“…In particular, PE has been considered for a long time the most prevalent type of male sexual dysfunction occurring in around 30% of men aged 40–80 years [ 5 ]. However, it is important to recognize that there is a huge difference in the reported prevalence of PE worldwide ranging from 3% to more than 30% [ 2 , 6 ]. The latter represents the result of the use of different PE definitions [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, it is important to recognize that there is a huge difference in the reported prevalence of PE worldwide ranging from 3% to more than 30% [ 2 , 6 ]. The latter represents the result of the use of different PE definitions [ 6 ]. According to the International Society of Sexual Medicine (ISSM), three main aspects should be considered when defining PE: latency time (LT), inability to control and distress about the condition [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Conversely, the American Psychiatric Association, although it has recognized the LT of 1 min, it did not specifically recognize the difference between life-long and acquired PE [ 9 ], whereas the World Health Organization (ICD-11) did not clarify a latency criterion ( https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f361151087 ). Finally, emerging evidence supports the necessity of extending the LT from 1 to 2 min with a limited difference between acquired and life-long PE [ 6 , 10 ]. The method used to quantify LT constitutes another source of bias.…”

Section: Introductionmentioning

confidence: 99%

“…The method used to quantify LT constitutes another source of bias. A huge disparity in the prevalence of PE has been recognized when stopwatch intraejaculatory latency time (IELT) has been compared to self-reported PE [ 6 , 11 ]. To overcome all these problems, the concepts of variable PE and subjective PE have been proposed [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…To overcome all these problems, the concepts of variable PE and subjective PE have been proposed [ 12 ]. The real clinical significance of these new entities has not yet been universally recognized [ 6 ]. Besides LT, personal bother and distress represent other crucial points to adequately consider in subjects reporting PE.…”

Section: Introductionmentioning

confidence: 99%

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Erectile dysfunction and premature ejaculation: a continuum movens supporting couple sexual dysfunction

Corona

2022

J Endocrinol Invest

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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. Supplementary Information The online version contains supplementary material available at 10.1007/s40618-022-01793-8.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Erectile dysfunction and premature ejaculation: a continuum movens supporting couple sexual dysfunction

Corona

2022

J Endocrinol Invest

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The Tenuous Role of Distress in the Diagnosis of Premature Ejaculation: A Narrative Review

Rowland

Cooper

2022

Sexual Medicine

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Background Unlike the other 2 criteria for diagnosing premature ejaculation (PE), namely lack of ejaculatory control and short ejaculation latency (EL), the role of bother/distress has received only minimal consideration and investigation. Aim The specific aim was to determine both why distress is included in the PE diagnosis and whether such inclusion is advantageous to achieving better diagnostic outcomes. To this end, the review explored the historical and theoretical underpinnings of the inclusion of “bother/ distress” in the diagnosis of PE, with reference to the larger role that distress has played in the diagnosis of mental disorders, in an attempt to understand the utility (or lack thereof) of this construct in making a PE diagnosis. Methods We reviewed the role of bother/distress across current professional definitions for PE and then expanded this discussion to include the role of distress in other sexual dysfunctions. We then included a brief historical perspective regarding the role that distress has played in the diagnosis of PE. This discussion is followed by a deeper look at 2 nosological systems, namely DSM and ICD, to allow perspective on the inclusion of the bother/distress construct in the diagnosis of mental and behavioral disorders, including the assumptions/arguments put forward to include or exclude bother/distress as an important criterion underlying various professional assumptions. Outcome Determination of the value and/or need of including bother/distress as a necessary criterion for the diagnosis of PE. Results Based on the research literature, bother/distress does not appear to be as critical for a PE diagnosis as either the lack of ejaculatory control or short EL. It is the weakest of the differences among men with and without PE, and recent evidence suggests that its inclusion is generally redundant with the severity of the 2 other criteria for PE, ejaculatory control and EL. Clinical Translation Bother/distress appears to serve little purpose in the diagnosis of PE yet its assessment may be important for the treatment strategy and for assessing treatment effectiveness. Strengths and Limitations This review did not provide a critical analysis of the literature regarding the role of bother/distress in PE, but rather focused on its potential value in understanding and diagnosing PE. Conclusion Although bother/distress appears to add little to the improvement of accuracy for a PE diagnosis, understanding and assessing the man's or couple's experience of distress has important implications for the treatment strategy and focus, as well as for assessing treatment success.

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

2022

Self Cite

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Introduction The role of bother/distress in the diagnosis of premature ejaculation (PE) has received minimal investigation compared with the 2 other diagnostic criteria, ejaculatory control and ejaculatory latency (EL). Aim This study assessed (i) the added variance explained by bother/distress to the diagnostic accuracy of PE and (ii) determined its overall contribution to a PE diagnosis. Methods The 3 diagnostic criteria for PE were assessed in 2,589 men (mean age = 38.2 years, SD = 13.5) in order to determine the contribution of each factor to a dysfunctional diagnosis. A series of regression and discriminant analyses were used to assess the value of bother/distress in explaining ejaculatory control and in predicting accuracy of PE group status. Commonality analysis was used to determine the relative contribution of each of these factors to the diagnosis of PE. Main Outcome Measure The major outcome was the quantified contribution of “bother/distress” to a PE diagnosis. Results Bother/distress accounted for about 3–4% of the variation in ejaculatory control and added only minimally to the prediction accuracy of PE group status (no, probable, definite PE). Commonality analysis indicated that bother/distress comprised about 3.6% of the unique explained variation in the PE diagnosis, compared with ejaculatory control and EL which contributed 54.5% and 26.7%, respectively. Common variance among factors contributed the remaining 15.5% to the PE diagnosis. Clinical Translation Bother/distress contributes least to the determination of a PE diagnosis. Its contribution is largely redundant with the unique and combined contributions of ejaculatory control and EL. Strengths and Limitations Using a well-powered and multivariate analysis, this study parsed out the relative contributions of the 3 diagnostic criteria to a PE diagnosis. The study is limited by its use of estimated EL, a single item assessment of bother/distress, and the lack of differentiation of PE subtypes, lifelong and acquired. Conclusion Bother/distress contributes minimally to the PE diagnosis, yet its assessment may be key to understanding the experiences of the patient/couple and to developing an effective treatment strategy.

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The Unfinished Business of Defining Premature Ejaculation: The Need for Targeted Research

Cited by 23 publications

References 77 publications

Erectile dysfunction and premature ejaculation: a continuum movens supporting couple sexual dysfunction

Erectile dysfunction and premature ejaculation: a continuum movens supporting couple sexual dysfunction

The Tenuous Role of Distress in the Diagnosis of Premature Ejaculation: A Narrative Review

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

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