Comorbidities Among Sexual Problems in Men: Results From an Internet Convenience Sample

Abstract

Introduction Men suffering from one sexual problem sometimes report having another sexual problem, but few studies have determined concordance rates among dysfunctions in non-clinical samples. Aim This study determined comorbidities among sexual dysfunctions based on an internet convenience sample of 4432 men from Hungary, the USA, and other world regions that visit social media fora. Method Participants completed an online 55-item questionnaire that included questions assessing erectile dysfunction (ED), premature ejaculation (PE), delayed ejaculation (DE), and lack of sexual interest (LSI). Main Outcome Measures Concordance rates and odds ratios among sexual dysfunctions. Results Approximately 8% of men suffered from two or more sexual problems; men with a severe sexual problem were significantly more likely to suffer from a second sexual problem; concordance between PE and erectile dysfunction ranged from 23–29%, with subtypes of lifelong vs acquired PE showing patterns similar to one another; and most men with delayed ejaculation reported minimal problems with LSI, although LSI was generally key to understanding all other dysfunctions. Conclusion The percentage of men with one sexual problem having a second sexual problem was substantial, ranging from 23–40%. These findings will help clinicians better understand the intertwined nature of sexual problems and assist them in developing management protocols that address concomitant inadequacies in sexual response. Rowland DL, Oosterhouse LB, Kneusel JA, et al. Comorbidities Among Sexual Problems in Men: Results From an Internet Convenience Sample. Sex Med 2021;9:100416 .

Do Pornography Use and Masturbation Frequency Play a Role in Delayed/Inhibited Ejaculation during Partnered Sex? A Comprehensive and Detailed Analysis

“…A covariate "sexual interest" was constructed from a question from the overall IIEF [48] (rate your sexual desire/interest) and supplemented with a second question on the "importance of sex". These questions tap into the same general construct, being strongly correlated both in this sample (r s = 0.71) as well as in other research [44,49], so they were combined to generate a composite variable "sexual interest" (SI). Finally, in a preliminary cleaning of data, several differences were noted regarding national origin (origin-of-data), so this measure was included as a control covariate in all analyses.…”

“…Thus far, support for a hypothetical role for pornography use on DE during partnered sex has been confined mainly to case studies, select clinical populations, and simple binary analyses. Furthermore, studies have relied on non-standardized assessments of sexual functioning, and they have not controlled for possible confounding variables such as masturbation frequency (a potential correlate of pornography use [35]) or concomitant erectile problems which may interfere with the ability to reach ejaculation [44]. Finally, DE itself has different etiologies, one form being lifelong, the other being acquired [7,[36][37][38], with prior research failing to distinguish between these DE subtypes.…”

“…Finally, DE itself has different etiologies, one form being lifelong, the other being acquired [7,[36][37][38], with prior research failing to distinguish between these DE subtypes. As such, much of the prior research investigating this topic has been underpowered, lacked reliable characterization of the sexual dysfunction [35], used highly selective and/or biased samples [43], omitted the assessment of potential confounding variables (e.g., masturbation frequency and concomitant ED) [44], and/or failed to assess the role of pornography use-including its effect size-within a larger multivariate context.…”

“…Thus, there is need to investigate the relationship between pornography use and DE within the general population rather than in clinical populations seeking treatment-a selfselected group representing a significant source of bias [44]. Furthermore, any investigation on the topic needs to be both comprehensive and multivariate: Comprehensive, in that it examines the data from different angles and parses out the relative effects of masturbation frequency from pornography use, while also controlling for confounding variables such as levels of erectile functioning and sexual interest; and multivariate, in that it examines the effects of masturbation frequency and pornography use relative to the effects of other variables on sexual response (e.g., DE etiology, relationship satisfaction).…”

“…In fact, when men with ED were removed from the analysis, the level of explained variance in DE symptomology dropped by nearly 70% in the overall sample. The relationship between erectile functioning and DE symptomology was not surprising, as a significant percent of men suffering from DE also report ED [44,55,56]. Within this subgroup, men's inability to get or sustain an erection undoubtedly interferes with their capacity to reach ejaculation-a point that underscores the importance of the clinician's differentiation of DE caused by erectile insufficiency vs. DE caused by insufficient psycho-sexual arousal and/or other etiological factors [39,44].…”