Premature and delayed ejaculation : prevalence, heredity and diagnostic considerations
Jern, Patrick (2009-11-27)
Jern, Patrick
Åbo Akademi - Åbo Akademi University
27.11.2009
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Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi-fe2016112529976
https://urn.fi/URN:NBN:fi-fe2016112529976
Tiivistelmä
Premature ejaculation is commonly regarded as the most common sexual dysfunction in men. Studies have reported prevalence rates of around 30% in the general population, but prevalence rates fluctuate widely between studies because of discrepancies with regards to definitions and diagnostic criteria. When defined by an intra-vaginal ejaculation latency time of less than one minute, frequency of occurrence is dramatically reduced, and it is estimated that around one and a half per cent of the population exhibit ejaculation latency times of one minute or less. Delayed, or retarded, ejaculation is a lot less common, and is estimated to occur in around one percent of the general population, or even less. The etiology of both premature and delayed ejaculation is still uncertain. Recent research has proposed that premature ejaculation is (strongly) affected by neurobiological mechanisms, and that it is treatable with selective serotonin reuptake inhibitors (i.e. antidepressant pharmacotherapy). Delayed ejaculation is hypothesized to occur as a side effect of (both medicinal and recreational) drugs, as well as secondary to physical trauma, or as a complication of surgery. Psychological factors influencing the etiology of delayed ejaculation have also been proposed. However, not all aspects of the etiology of delayed ejaculation have been charted either.
The aim of the present study was to investigate certain aspects of ejaculatory disorders and their etiology in a large, population-based sample of Finnish twins and their siblings. These aspects include prevalence of premature and delayed ejaculation, as well as analyses of potential etiological factors (e.g. genetic, environmental, and contextual effects that may have an impact on ejaculatory functioning). Effects of age and relationship length on ejaculatory dysfunction were also assessed. Data were collected through a survey, and ejaculatory function was measured empirically with ten variables focusing on different aspects of ejaculatory function and control (e.g. frequency of anteportal ejaculation, ejaculation latency time, whether the participant had taken any measures to prevent premature ejaculation, and subjectively perceived control of ejaculatory function). These variables were subsequently subjected to factor analyses, based on which composite variables measuring premature and delayed ejaculation were formed. Questions regarding premature ejaculation during the first intercourse were also asked of the participants. Finally, they were asked to respond to questions regarding variations in and frequency of sexual activities.
The data collection was completed in two separate phases. In the first phase, 5000 male twins aged 33-43 years were contacted, of which 1,313 replied to the questionnaire (27%). In the second phase, a total of 11,914 men were contacted. Of these, 2,660 twins (33.7%) aged 18-33 years, and 1,263 (31.5%) of their at least 18-year-old siblings responded to the survey, yielding a total response rate of 30.8% when both data sets were combined.
Premature, as well as delayed, ejaculation had very similar prevalence rates in the sample under study compared to what has previously been reported elsewhere. This was true regardless of definition: for example, if premature ejaculation was defined by an ejaculation latency time of no more than one minute, prevalence rates of less than two per cent were found, replicating findings from, for example, the Netherlands, the US, and Spain. A significant genetic effect explaining around 30% of the total phenotypic variance in premature ejaculation was also detected. Self report of premature ejaculation was found to be relatively stable from the first intercourse to later in life. For the most part, genetic effects mediated this stability. In contrast, unique (or non-shared) environmental effects on premature ejaculation had a very weak correlation between the first intercourse and when measured later in life, indicating that there are unique factors contributing to premature ejaculation during the first intercourse. These could be contextual factors, such as the partner being unknown, or intoxication. Even though only weak effects of age were found in the present study, severe premature ejaculation was more than ten times more common during the first intercourse, compared to later in life, which could be the result of the impact sexual naïvete may have on ejaculation latency time. No genetic effects were detected for delayed ejaculation. Temporal stability was found here as well in the sense that premature ejaculation problems during the first intercourse were negatively related to later delayed ejaculation. Effects of age and relationship length were generally positive, so that problems related to premature ejaculation increased slightly with increasing age and relationship length. Ejaculation latency time was also significantly positively associated with frequency of sexual activities and variations in the ways of achieving ejaculation, with oral and anal sex having the strongest associations. On the whole, variables measuring different aspects of ejaculatory dysfunction had quite weak associations with sexual distress. Altogether, these variables accounted for 16.5% of the variation in sexual distress, implying that more than four fifths of the total variance in sexual distress is accounted for by something other than premature or delayed ejaculation. Variables measuring subjective experience of PE had the strongest associations with sexual distress.
Results were discussed in relation to the ongoing debate on diagnostic criteria for premature ejaculation. It was suggested that effects of sexual experience on premature ejaculation should be investigated, and perhaps, considered when diagnosing premature ejaculation. Ejaculation latency time-improving effects of varied and frequent sexual activity should also be subjects of further study, especially to establish direction of causality: it may also be the case that men with naturally longer ejaculation latency time are more sexually adventurous, and engage more frequently in sexual behavior. Molecular genetic studies should be conducted to identify the genes that are behind the perceived genetic effects on premature ejaculation. These studies could, then, be a first step in a process of developing genetically tailored drugs to further improve pharmacotherapy of premature ejaculation. Also, properly conducted and well-designed longitudinal studies of ejaculatory function are needed to investigate further how ejaculatory performance behaves over time.
In summary, the present study generated the following key results: premature ejaculation is fairly common in Finnish men, if diagnosed by subjective perception and distress. If diagnosis is done by a one-minute ejaculation latency time, the prevalence is slightly less than two per cent; if by anteportal ejaculation, around one per cent. Ejaculatory dysfunctions have weak, but significant positive associations with age, indicating that problems related to premature ejaculation appeared to increase with increasing age. A significant genetic effect of around 30% could be measured for premature, but not delayed, ejaculation. Ejaculation latency time had some positive association with frequency of and variation in different sexual activities. Associations between experienced sexual distress and premature and delayed ejaculation are generally rather weak.
The aim of the present study was to investigate certain aspects of ejaculatory disorders and their etiology in a large, population-based sample of Finnish twins and their siblings. These aspects include prevalence of premature and delayed ejaculation, as well as analyses of potential etiological factors (e.g. genetic, environmental, and contextual effects that may have an impact on ejaculatory functioning). Effects of age and relationship length on ejaculatory dysfunction were also assessed. Data were collected through a survey, and ejaculatory function was measured empirically with ten variables focusing on different aspects of ejaculatory function and control (e.g. frequency of anteportal ejaculation, ejaculation latency time, whether the participant had taken any measures to prevent premature ejaculation, and subjectively perceived control of ejaculatory function). These variables were subsequently subjected to factor analyses, based on which composite variables measuring premature and delayed ejaculation were formed. Questions regarding premature ejaculation during the first intercourse were also asked of the participants. Finally, they were asked to respond to questions regarding variations in and frequency of sexual activities.
The data collection was completed in two separate phases. In the first phase, 5000 male twins aged 33-43 years were contacted, of which 1,313 replied to the questionnaire (27%). In the second phase, a total of 11,914 men were contacted. Of these, 2,660 twins (33.7%) aged 18-33 years, and 1,263 (31.5%) of their at least 18-year-old siblings responded to the survey, yielding a total response rate of 30.8% when both data sets were combined.
Premature, as well as delayed, ejaculation had very similar prevalence rates in the sample under study compared to what has previously been reported elsewhere. This was true regardless of definition: for example, if premature ejaculation was defined by an ejaculation latency time of no more than one minute, prevalence rates of less than two per cent were found, replicating findings from, for example, the Netherlands, the US, and Spain. A significant genetic effect explaining around 30% of the total phenotypic variance in premature ejaculation was also detected. Self report of premature ejaculation was found to be relatively stable from the first intercourse to later in life. For the most part, genetic effects mediated this stability. In contrast, unique (or non-shared) environmental effects on premature ejaculation had a very weak correlation between the first intercourse and when measured later in life, indicating that there are unique factors contributing to premature ejaculation during the first intercourse. These could be contextual factors, such as the partner being unknown, or intoxication. Even though only weak effects of age were found in the present study, severe premature ejaculation was more than ten times more common during the first intercourse, compared to later in life, which could be the result of the impact sexual naïvete may have on ejaculation latency time. No genetic effects were detected for delayed ejaculation. Temporal stability was found here as well in the sense that premature ejaculation problems during the first intercourse were negatively related to later delayed ejaculation. Effects of age and relationship length were generally positive, so that problems related to premature ejaculation increased slightly with increasing age and relationship length. Ejaculation latency time was also significantly positively associated with frequency of sexual activities and variations in the ways of achieving ejaculation, with oral and anal sex having the strongest associations. On the whole, variables measuring different aspects of ejaculatory dysfunction had quite weak associations with sexual distress. Altogether, these variables accounted for 16.5% of the variation in sexual distress, implying that more than four fifths of the total variance in sexual distress is accounted for by something other than premature or delayed ejaculation. Variables measuring subjective experience of PE had the strongest associations with sexual distress.
Results were discussed in relation to the ongoing debate on diagnostic criteria for premature ejaculation. It was suggested that effects of sexual experience on premature ejaculation should be investigated, and perhaps, considered when diagnosing premature ejaculation. Ejaculation latency time-improving effects of varied and frequent sexual activity should also be subjects of further study, especially to establish direction of causality: it may also be the case that men with naturally longer ejaculation latency time are more sexually adventurous, and engage more frequently in sexual behavior. Molecular genetic studies should be conducted to identify the genes that are behind the perceived genetic effects on premature ejaculation. These studies could, then, be a first step in a process of developing genetically tailored drugs to further improve pharmacotherapy of premature ejaculation. Also, properly conducted and well-designed longitudinal studies of ejaculatory function are needed to investigate further how ejaculatory performance behaves over time.
In summary, the present study generated the following key results: premature ejaculation is fairly common in Finnish men, if diagnosed by subjective perception and distress. If diagnosis is done by a one-minute ejaculation latency time, the prevalence is slightly less than two per cent; if by anteportal ejaculation, around one per cent. Ejaculatory dysfunctions have weak, but significant positive associations with age, indicating that problems related to premature ejaculation appeared to increase with increasing age. A significant genetic effect of around 30% could be measured for premature, but not delayed, ejaculation. Ejaculation latency time had some positive association with frequency of and variation in different sexual activities. Associations between experienced sexual distress and premature and delayed ejaculation are generally rather weak.
Kokoelmat
- 515 Psykologia [49]