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Authors Rowland DL and Neal CJ
Review Date November 2014
Citation Journal of Sexual Medicine 2014; 11(10): 2554–2561
Recent developments in the study of men’s sexual health have raised problems with the current definition of premature ejaculation (PE). This definition is essential for accurate diagnosis, and estimation of incidence and prevalence rates. Much of the debate surrounding this issue has focused on defining the period of time that constitutes ‘premature’; little is known about men’s perceptions of PE and the factors they attribute to it.
The authors aimed to examine (a) men’s perceived reasons for ejaculating before they desired, (b) whether they endorsed multiple reasons within the same broad category or whether reasons crossed categories, and (c) whether reasons differed across younger and older men.
Participants: Potential participants were men aged at least 18 years recruited through forums on reddit.com and from the research home page on facebook.com. Participants relevant to this paper were those who indicated that they ejaculated before they wanted to on half or more of the occasions they had had sexual intercourse.
Procedure: Participants completed an anonymous 24-item online survey on men’s sexual health. Items assessed men’s ejaculatory patterns and included two questions listing 10 optional self-reported reasons for their quick ejaculation; one item allowed respondents to endorse multiple reasons while the other forced participants to pick the most prominent reason.
Data analysis: The sub-sample was divided into two groups; those who indicated ejaculation in less than 1-2 minutes and distress about this (Probably PE), and those who indicated ejaculating before they wanted to but not under 2 minutes (Just Dissatisfied). Data was first eyeballed graphically and then groups (Probably PE vs Just Dissatisfied; younger vs older) were compared using z-tests. Concordance among reasons was examined with cross-tabulations.
Participants: The study sub-sample included 376 men (30% of the total sample; Probably PE: N=83, Just Dissatisfied: N=293) and did not differ from the remainder of men who had little or no issue with ejaculating before desired on any of the demographic variables. Of note, 18.3% of men in the Probably PE group reported a diagnosed chronic medical condition compared to 10.2% in Just Dissatisfied and 13.3% in the remainder of men who reported little or no ejaculation timing issues. Participants were relatively young (mean age: 26 years) and well educated.
Reasons for ejaculating before desired: Each group tended to select similar reasons when given the opportunity to endorse multiple options. Most reasons pertained to issues of self-efficacy such as penile hypersensitivity, general stress, and performance-specific anxiety. The least endorsed were ‘partner-related issues’, ‘concerns about losing an erection’, and ‘medical/medications’. A similar pattern emerged when asked to select the most salient reason with 71% identifying a specific self-efficacy issue (control or aroused too quickly).
Concordance among reasons: Of those men who responded with ‘lack of control’, 96.8% also selected ‘becoming aroused too quickly’. Of those who selected either ‘lack of control’ or ‘aroused too quickly’, 60.8% also selected ‘penile hypersensitivity.’ No other significant (i.e. >10%) correlations were found.
Effect of age on self-reported reasons: A minor difference was noted with younger men (35 years or younger) more likely to endorse reasons related to self-efficacy than older men (above 35 years). No other differences were observed.
Men overwhelmingly attributed their quick ejaculation to causes that reflected self-efficacy. The large majority of men who indicated that they ejaculated before desired but not before 1-2 minutes (i.e. the Just Dissatisfied group) suggests that the diagnostic cut-off for ejaculatory latency as 1 or 2 minutes may not reflect men’s lived experiences. The perceived causes for ejaculating quickly were similar across the Probably PE and Just Dissatisfied groups suggesting that (at least conceptually) these groups are only divided by the arbitrary cut-off of 1 or 2 minutes. The authors state that this finding supports the importance of clinical judgement when making a diagnosis of PE; health care providers may want to give greater weight to issues of lack of control and psychological distress when considering a patient for treatment (compared to the time cut-off only). Overall, these findings suggest that current definitions of PE need to be updated to include ‘lack of self-efficacy’ (e.g. issues with controlling or delaying ejaculation).
Points to Note
- Recent research has raised problems with the current definition of PE. This is the first study to assess men’s perceptions of causes for their PE in order to develop a more accurate definition that reflects men’s experiences.
- Men reported issues of self-efficacy (control or aroused too quickly) as being most related to ejaculating before they desired.
- Only one minor difference was noted between younger and older participants: younger men were more likely to endorse reasons relating to self-efficacy than older men.
- Use of Reddit and Facebook to recruit participants may have contributed to the relatively young age of participants. This may partially explain the low percentage of attribution to partner issues, medications, and fear of erectile loss – conditions likely to increase with age.
- Detailed demographic information was not included making it difficult to assess the generalisability of these findings to the general population and to minority groups such as men who have sex with men and men from low socioeconomic backgrounds.