Impact of erectile function and age in men with lower urinary tract symptoms on ejaculatory dysfunction and premature ejaculation

Abstract

Lower urinary tract symptoms (LUTSs) and ED are clearly correlated, but to date no correlation with ejaculatory dysfunction (EjD) has been identified. Therefore, this study evaluated the impact of erectile function in men with LUTS on EjD and premature ejaculation (PE). Erectile function, PE and EjD of 239 men (mean age, 53.0±10.65 years), International Prostate Symptom Score (IPSS), International Index of Erection Function (IIEF), intravaginal ejaculatory latency time (IELT) and the seven-item Male Sexual Health questionnaire (MSHQ)-EjD were used to compare with the degree of LUTS. Ages were divided into five groups (o40, 40 --49, 50 --59, 60--69 and 470 years). The IPSS categorized patients into three symptom groups: mild, 1 --7; moderate, 8 --19; and severe, 419. ED was classified into five categories based on IIEF-EF scores: severe (0 --6), moderate (7 --12), mild-to-moderate (13--18), mild (19 --24) and normal (25 --30). The correlations among age, IIEF-EF, IELT and the MSHQ-EjD domain were studied through regression and cross-tabulation analyses. The results revealed that aging significantly affected each item of the MSHQ-EjD (Po0.05). The IIEF-EF domain was also correlated with each question on the MSHQ-EjD (Po0.05). PE (IELT o1 min) increased in incidence as patients got older but was not linked to IIEF-EF (P40.05). These results indicate that EjD is closely related to age and erectile function, and that PE is closely related to age, although PE is not related to erectile function. INTRODUCTIONRepresentative symptoms that may develop with aging include lower urinary tract symptoms (LUTSs) and ED. These two symptoms are not simply the result of aging, and they have a common pathophysiology. Thus, by treating one disease, a synergistic effect of treating the other disease may occur simultaneously. 1,2 A multinational questionnaire survey involving 12 815 men older than 50 years revealed that the two diseases are associated, and for those with ED, age and LUTS were more potent risk factors than diabetes, hypertension or hyperlipidemia. 3 Ejaculation is the process of sperm transport from the epididymis to the urethral meatus, resulting in the expulsion of semen. Ejaculation occurs in two phases: seminal emission and ejaculation proper, and they are mediated by sympathetic and parasympathetic inputs, respectively. When sexual stimulation is extremely intense, the autonomic impulses responsible for the emission phase exit the spinal cord at the T10 --L2 level via sympathetic chains, course into the pelvis as hypogastric outflow and onto the genital structures involved in ejaculation. Parasympathetic and somatic inputs from S2 to S4 then cause ejaculation proper, and antegrade ejaculation occurs. 4,5 If the ejaculation reflex takes place too quickly, it may induce premature ejaculation (PE). In contrast, if it is late, delayed ejaculation may occur. Abnormalities in the sympathetic nerves or deterioration in male hormone levels because of aging may reduce semen volume or ejaculation force and decrease the fre...

Associations Between Premature Ejaculation, Lower Urinary Tract Symptoms, and Erectile Dysfunction in Middle-Aged Korean Policemen

“…Additionally, a significant increase in the PE ratio was observed as the severity of ED increased. However, in a Korean study of 250 men who visited a urology clinic with LUTS, no differences were detected in intravaginal ejaculatory latency time in men with varying ED severity [23]. This study had a relatively small sample size.…”

Erectile Dysfunction Among Male Hypertensives in a Tertiary Health Facility in South-West Nigeria

“…Those aged ≥ 65 years and 46-64 were 3 times each more likely to have erectile dysfunction than those 45 years and below. Several studies have reported strong association between age and ED ( Johannes et al, 2000 ; Wagle et al, 2012 ; Hwa et al, 2012) . This could be as a result of the association between aging and many chronic disorders which are organic causes of ED such as hypertension, diabetes and dyslipidemia.…”

Tadalafil Once Daily Improves Ejaculatory Function, Erectile Function, and Sexual Satisfaction in Men with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia and Erectile Dysfunction: Results from a Randomized, Placebo- and Tamsulosin-Controlled, 12-Week Double-Blind Study

“…The mechanism by which tadalafil and other PDE5 inhibitors may improve ejaculation remains unclear but is likely multifactorial. Although erection is not a prerequisite for ejaculation to occur from a physiological perspective , EjD has been closely associated with ED . Restoration of erectile function has been correlated with increased overall sexual satisfaction and intercourse satisfaction, thus the improvements in the IIEF‐OS and IIEF‐IS domains with tadalafil treatment in men with ED and LUTS/BPH were likely associated at least in part with improvements in erectile function.…”