Delayed Ejaculation and Associated Complaints: Relationship to Ejaculation Times and Serum Testosterone Levels

Abstract

Background Although delayed ejaculation (DE) is typically characterized as a persistently longer than anticipated or desired time to ejaculation (or orgasm) during sexual activity, a timing-based definition of DE and its association with serum testosterone has not been established in a large cohort. Aim To examine in an observational study estimated intravaginal ejaculatory latency time (IELT) and masturbatory ejaculation latency time (MELT) in men self-reporting DE, assess the association of IELT and MELT with serum testosterone levels, and determine whether correlation with demographic and sexual parameters exist. Methods Men who resided in the United States, Canada, and Mexico were enrolled from 2011 to 2013. Self-estimated IELT and MELT were captured using an Ejaculatory Function Screening Questionnaire in a sample of 988 men screened for possible inclusion in a randomized clinical trial assessing testosterone replacement therapy for ejaculatory dysfunction (EjD) and who self-reported the presence or absence of DE and symptoms of hypogonadism. Additional comorbid EjDs (ie, anejaculation, perceived decrease in ejaculate volume, and decreased force of ejaculation) were recorded. Men with premature ejaculation were excluded from this analysis. IELT and MELT were compared between men self-reporting DE and men without DE. The associations of IELT and MELT with serum testosterone were measured. Outcomes IELT, MELT, and total testosterone levels. Results Sixty-two percent of screened men self-reported DE with or without comorbid EjDs; 38% did not report DE but did report at least one of the other EjDs. Estimated median IELTs were 20.0 minutes for DE vs 15 minutes for no DE (P < .001). Estimated median MELTs were 15.0 minutes for DE vs 8.0 minutes for no DE (P < .001). Ejaculation time was not associated with serum testosterone levels. Younger men and those with less severe erectile dysfunction had longer IELTs and MELTs. Clinical Implications Estimated ejaculation times during vaginal intercourse and/or masturbation were not associated with serum testosterone levels in this study; thus, routine androgen evaluation is not indicated in these men. Strengths and Limitations This large systematic analysis attempted to objectively assess the ejaculation latency in men with self-reported DE. Limitations were that ejaculation time estimates were self-reported and were queried only once; the questionnaire did not distinguish between failure to achieve orgasm and ejaculation; and assessment of DE was limited to heterosexual vaginal intercourse and masturbation. Conclusion IELT and MELT were longer in men with DE, and there was no association of ejaculation times with serum testosterone levels in this study population.

Controversial aspects of testosterone in the regulation of sexual function in late‐onset hypogonadism

“…Although a cross-sectional study on a large series of subjects consulting for sexual dysfunction essentially supports this notion, 43 other studies were contradictory. 44,45 A recent study suggests that men with lifelong premature ejaculation (PE) have suffered from a higher androgenization during fetal life because they show an increased anogenital distance, a surrogate marker of in utero androgen priming. 46 Considering these contradictory findings, results from intervention studies with TRT would be very important in shedding light on this topic.…”

“…As a result, high T potentially favors orgasm and ejaculation, whereas low T levels may be associated with a delayed ejaculation. Although a cross‐sectional study on a large series of subjects consulting for sexual dysfunction essentially supports this notion, 43 other studies were contradictory 44,45 . A recent study suggests that men with lifelong premature ejaculation (PE) have suffered from a higher androgenization during fetal life because they show an increased anogenital distance, a surrogate marker of in utero androgen priming 46 …”

Editorial comment: Is testosterone replacement an effective treatment of secondary premature ejaculation?

“…A second objective was to examine hormonal and demographic predictors of ejaculation time in the DE vs non-DE cohorts. This study proved that men with DE complain really had an increased IELT but failed to find that men reporting DE had lower T concentrations than men not reporting DE (15).…”

Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

“…Disorders affecting levels of testosterone (T), prolactin, and thyroid hormone have also been associated with DE/AE. T appears to play a facilitatory role in the control of the ejaculatory reflex [ 76 ], but estimated ejaculation times during vaginal intercourse and/or masturbation were not associated with serum T levels in a recent study [ 77 ]. Once again, there is weak evidence of an association between hyperprolactinemia and DE [ 78 ].…”