Diagnostic Criteria for Premature Ejaculation: Clarifying the Role of “Ejaculatory Control” and “Bother/Distress”

Abstract

“Ejaculatory control” and “bother/distress” are key criteria for diagnosing men with premature ejaculation (PE), yet compared with ejaculatory latency (EL), these constructs have received only minimal attention. In addition, they have not been characterized in men having different sexual orientations or subtypes of PE. This study aimed to characterize relationships among ejaculatory control, bother/distress, and EL; to assess differences across men having different sexual orientations, PE status, and PE subtypes (i.e., lifelong vs. acquired); and to determine the importance of ejaculatory control to men’s sexual partners. In total, 1071 men and sexual partners of men rated their ejaculatory control and bother/distress and estimated their EL; these measures were compared across sexual orientation, PE status, PE subtype, and male and female partners of men. Results revealed a monotonic though slightly curvilinear relationship between ejaculatory control and bother/distress. These PE criteria differed significantly between PE and non-PE men, to a lesser extent between gay and straight men, and not at all between men having lifelong vs. acquired PE. Female and male partners of men affirmed the importance of ejaculatory control during partnered sex, indicating lack of control as a potential reason for ending a relationship.

Are the Criteria for the Diagnosis of Premature Ejaculation Applicable to Gay Men or Sexual Activities Other than Penile-Vaginal Intercourse?

“…In this analysis, we examined men with varying levels of PE, ranging from normal ejaculatory function to probable and definite PE. These findings both affirm several prior assumptions regarding the relevance of the PE criteria to non-heterosexual men 8 , 16 , 37 and offer new insight into the relationships among sexual orientation, type of sexual activity, and PE diagnostic criteria.…”

“…In contrast, gay men with PE showed significantly longer average ELs and—to a lesser extent—lower PE-related bother/distress than straight men, a pattern hinted at by two previous reports. 7 , 8 Thus, even though gay and straight men showed similarity in their levels of ejaculatory control (as indicated by PEDT scores), gay men displayed less severe symptomology in terms of their ELs. The longer ELs in gay men with PE may well account for their generally lower PE-related bother/distress.…”

“…The constructs of bother/distress and sexual satisfaction figure heavily in the assessment of PE based on Patient Report Outcomes (PROs). 20 , 33 Given that a previous study of gay men with PE reported less PE-related bother/distress than straight men with PE, 8 we explored differences in both constructs across groups. Specifically, we asked “during sex with your partner, if you have difficulty with sex such as ejaculating before you want, does this bother, upset, or frustrate you, or make you feel guilty,” with response options 1 = almost never, 5 = almost always.…”

“…Except for two recent studies, 7 , 8 there has been a dearth of research comparing PE criteria across populations of men having different sexual orientations. The first of those studies—focusing on EL—found that gay and non-straight men (ie, gay and bisexual) reported slightly longer (though non-significant) ELs during partnered sex than straight men.…”

“…For gay men, in contrast, activities such as providing oral stimulation or receptive anal sex are not contingent upon a man's own ejaculatory threshold but that of his partner. 8 …”