Review Article
The epidemiology of premature ejaculation Theodore Robert Saitz1, Ege Can Serefoglu2 1
Department of Urology, Oregon Health and Science University, Portland, Oregon, USA; 2Department of Urology, Bagcilar training & Research
Hospital, Istanbul, Turkey Contributions: (I) Conception and design: All authors; (II) Administrative support: EC Serefoglu; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Ege Can Serefoglu, MD, FECSM. Cinnah Caddesi No: 47, 06680, Cankaya - Ankara, Turkey. Email: [email protected].
Abstract: Vast advances have occurred over the past decade with regards to understanding the epidemiology, pathophysiology and management of premature ejaculation (PE); however, we still have much to learn about this common sexual problem. As a standardized evidence-based definition of PE has only recently been established, the reported prevalence rates of PE prior to this definition have been difficult to interpret. As a result, a large range of conflicting prevalence rates have been reported. In addition to the lack of a standardized definition and operational criteria, the method of recruitment for study participation and method of data collection have obviously contributed to the broad range of reported prevalence rates. The new criteria and classification of PE will allow for continued research into the diverse phenomenology, etiology and pathogenesis of the disease to be conducted. While the absolute pathophysiology and true prevalence of PE remains unclear, developing a better understanding of the true prevalence of the disease will allow for the completion of more accurate analysis and treatment of the disease. Keywords: Epidemiology; premature ejaculation (PE); prevalence Submitted Feb 13, 2016. Accepted for publication Mar 29, 2016. doi: 10.21037/tau.2016.05.11 View this article at: http://dx.doi.org/10.21037/tau.2016.05.11
Introduction Vast advances have occurred over the past decade with regards to understanding the epidemiology, pathophysiology and management of premature ejaculation (PE) (1); however, we still have much to learn about this common sexual problem. As a standardized evidence-based definition of PE has only recently been established (2), the reported prevalence rates of PE prior to this definition have been difficult to interoperate. As a result, a large range of conflicting prevalence rates have been reported (Table 1). In addition to the lack of a standardized definition and operational criteria, the method of recruitment for study participation and method of data collection have obviously contributed to the broad range of reported prevalence rates. Controversy regarding the specific criteria comprising the disease of PE has not only hindered the ability to determine true prevalence rates, but also to conduct evidence-based research on the treatment of the disease. Understanding the © Translational Andrology and Urology. All rights reserved.
clinical significance of a reported sexual dysfunctions also remains a challenge (41). In an attempt to remedy the disparity among reported prevalence rates, the International Society for Sexual Medicine (ISSM) developed an evidence-based definition and established set operational criteria (2). The American Psychiatric Association also recently revised their definition of PE, including a 1-minute cut off latency and the criterion of “ejaculation before desired” and “significant clinical distress” (42). Both of these definitions include three main parameters: ejaculatory latency time, distress and ejaculating before desired. A recent interesting statistical analysis took all three of these operational criteria into account and found that modifying each individual operational criterion could significantly alter the prevalence rates of PE (43). Thus, adherence to these criteria aims to allow for a better understanding of the prevalence of PE, according to each specific definition. tau.amegroups.com
Transl Androl Urol 2016;5(4):409-415
© Translational Andrology and Urology. All rights reserved.
tau.amegroups.com
Son et al. (15)
Amidu et al. (16)
Liang et al. (17)
2010
2010
2010
Table 1 (continued)
Traeen and Stigum (14)
2010
Brock et al. (13)
2009
Basile Fasolo et al. (9)
2005
Shindel et al. (12)
Laumann et al. (GSSAB) (8)
2005
2008
Nolazco et al. (7)
2004
Porst et al. (PEPA) (11)
Rowland et al. (6)
2004
2007
Fugl-Meyer and FuglMeyer (5)
2002
Stulhofer and Bajic (10)
Laumann et al. (NHSLS) (4)
1999
2006
Dunn et al. (3)
Authors
1998
Date
NA
Questionnaire
Questionnaire
Mailed questionnaire + internet
telephone interview
Questionnaire
Web-based survey Self-report
Interview
Clinician-based
Telephone-personal interview/mailed questionnaires
Interview
Mailed questionnaire
Interview
Interview
Mail
Method of data collection
Table 1 The prevalence rates of premature ejaculation
NA
NA
Internet panel (younger than 60)
Web interview + randomization
Web-based survey
Male partners of infertile couples under evaluation
Internet panel
Stratified sampling
Invitation to outpatient clinic
Random (systematic) sampling
Invitation to outpatient clinic
Internet panel
Population register
NA
General practice registers—random stratification
Method of recruitment
27
Distress
ISSM
NA
DSM IV
15.3
64.7
18.3
27
26
Control
NA
16
50
22.7
9.5
21.2
23.75 (4.26% frequently)
28.3
16.3
9
1,127
255
600
11,746+1,671
3,816
73
12,133
601
12,558
13,618
2,456
1,158
1,475
1,410
618
31 (lifetime) 31
617
Number of men
14 (past 3 mo)
Prevalence rate (%)
DSM III
Self-report premature ejaculation
Control over ejaculation, distress
Often ejaculating in less than 2 minutes
DSM IV
Reaching climax too quickly during the past 12 months
Ejaculating fast or prematurely
DSM IV
NA
Climaxing/ejaculating too rapidly during the past 12 months
Having difficulty with ejaculating prematurely
Operational criteria
410 Saitz and Serefoglu. Premature ejaculation epidemiology
Transl Androl Urol 2016;5(4):409-415
© Translational Andrology and Urology. All rights reserved.
tau.amegroups.com
Vakalopoulos et al. (19)
Hirshfeld et al. (20)
Christensen et al. (21)
Serefoglu et al. (22)
Son et al. (23)
Tang and Khoo (24)
Mialon et al. (25)
Shaeer and Shaeer (26)
Shindel et al. (27)
McMahon et al. (28)
Lotti et al. (29)
Zhang et al. (30)
2011
2010
2011
2011
2011
2011
2012
2012
2012
2012
2012
2013
Table 1 (continued)
Park et al. (18)
Authors
2010
Date
Table 1 (continued)
Interview
Interview
Computer assisted interviewing, online, or inperson self-completed
Web-based survey
Web-based survey
Mailed questionnaire
Interview
Questionnaire
Interview
Interview + questionnaire
Web-based survey
One-on-one survey
Mailed questionnaire
Method of data collection
Random stratified sample of married men aged 30–60
Men seeking medical care for infertility
NA
Online advertisement targeted to MSM + distribution of invitation to organizations catering to MSM
Online advertisement in Arabic countries
Convenience sampling (18–25 years old)
Primary care setting
Internet panel
Stratified sampling
Population register (random)
Online advertisement in the United States and Canada
Population based cohort
Stratified sampling
Method of recruitment
Self-reported premature ejaculation
4.7
15.6
13
Self-reported (always/nearlyalways) PEDT ≥9
16
8–12
83.7
11.4
40.6
10.5
20.0
7
PEDT ≥11
PEDT ≥9
Ejaculate before the person wishes to ejaculate at least sometimes
Control over ejaculation; distress
PEDT ≥9
Estimated IELT ≤5 min, inability to control ejaculation, distress
Complaining about ejaculating prematurely
NA
34
17.7
ISSM lifelong PE Climaxing/ejaculating too rapidly during the past 12 months
58.43
27.5
Prevalence rate (%)
EED
Suffering from PE
Operational criteria
728
244
4,997
1,769
804
2,507
207
334
2,593
5,552
7,001
522
2,037
Number of men
Translational Andrology and Urology, Vol 5, No 4 August 2016 411
Transl Androl Urol 2016;5(4):409-415
© Translational Andrology and Urology. All rights reserved.
tau.amegroups.com
Gao et al. (35)
Shaeer (36)
Mo et al. (37)
Akre et al. (38)
2013
2013
2014
2014
O’Sullivan et al. (40)
Vansintejan et al. (34)
2013
2014
Hwang et al. (33)
2013
Song et al. (39)
Gao et al. (32)
2013
2014
Lee et al. (31)
Authors
2013
Date
Table 1 (continued)
Web-based survey
Web-based survey
Mailed questionnaire
NA
Web-based survey
Interview
Web-based survey
Survey of married couples
Interview
Interview
Method of data collection
Adolescents aged 16–21
population-based sample of males aged 20–59 years
–
Chronic prostatitis patients
English-speaking male web surfers in the USA via paid advertising on Facebook®
Healthy volunteers
Men seeking medical care for infertility
Online and flyer advertisements to Belgian men who have sex with men (only HIV+ men in this study)
Married heterosexual couples in Korea
Random stratified sample of monogamous heterosexual men in China
Stratified random sampling
Method of recruitment
3
IELT
The epidemiology of premature ejaculation Theodore Robert Saitz1, Ege Can Serefoglu2 1
Department of Urology, Oregon Health and Science University, Portland, Oregon, USA; 2Department of Urology, Bagcilar training & Research
Hospital, Istanbul, Turkey Contributions: (I) Conception and design: All authors; (II) Administrative support: EC Serefoglu; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Ege Can Serefoglu, MD, FECSM. Cinnah Caddesi No: 47, 06680, Cankaya - Ankara, Turkey. Email: [email protected].
Abstract: Vast advances have occurred over the past decade with regards to understanding the epidemiology, pathophysiology and management of premature ejaculation (PE); however, we still have much to learn about this common sexual problem. As a standardized evidence-based definition of PE has only recently been established, the reported prevalence rates of PE prior to this definition have been difficult to interpret. As a result, a large range of conflicting prevalence rates have been reported. In addition to the lack of a standardized definition and operational criteria, the method of recruitment for study participation and method of data collection have obviously contributed to the broad range of reported prevalence rates. The new criteria and classification of PE will allow for continued research into the diverse phenomenology, etiology and pathogenesis of the disease to be conducted. While the absolute pathophysiology and true prevalence of PE remains unclear, developing a better understanding of the true prevalence of the disease will allow for the completion of more accurate analysis and treatment of the disease. Keywords: Epidemiology; premature ejaculation (PE); prevalence Submitted Feb 13, 2016. Accepted for publication Mar 29, 2016. doi: 10.21037/tau.2016.05.11 View this article at: http://dx.doi.org/10.21037/tau.2016.05.11
Introduction Vast advances have occurred over the past decade with regards to understanding the epidemiology, pathophysiology and management of premature ejaculation (PE) (1); however, we still have much to learn about this common sexual problem. As a standardized evidence-based definition of PE has only recently been established (2), the reported prevalence rates of PE prior to this definition have been difficult to interoperate. As a result, a large range of conflicting prevalence rates have been reported (Table 1). In addition to the lack of a standardized definition and operational criteria, the method of recruitment for study participation and method of data collection have obviously contributed to the broad range of reported prevalence rates. Controversy regarding the specific criteria comprising the disease of PE has not only hindered the ability to determine true prevalence rates, but also to conduct evidence-based research on the treatment of the disease. Understanding the © Translational Andrology and Urology. All rights reserved.
clinical significance of a reported sexual dysfunctions also remains a challenge (41). In an attempt to remedy the disparity among reported prevalence rates, the International Society for Sexual Medicine (ISSM) developed an evidence-based definition and established set operational criteria (2). The American Psychiatric Association also recently revised their definition of PE, including a 1-minute cut off latency and the criterion of “ejaculation before desired” and “significant clinical distress” (42). Both of these definitions include three main parameters: ejaculatory latency time, distress and ejaculating before desired. A recent interesting statistical analysis took all three of these operational criteria into account and found that modifying each individual operational criterion could significantly alter the prevalence rates of PE (43). Thus, adherence to these criteria aims to allow for a better understanding of the prevalence of PE, according to each specific definition. tau.amegroups.com
Transl Androl Urol 2016;5(4):409-415
© Translational Andrology and Urology. All rights reserved.
tau.amegroups.com
Son et al. (15)
Amidu et al. (16)
Liang et al. (17)
2010
2010
2010
Table 1 (continued)
Traeen and Stigum (14)
2010
Brock et al. (13)
2009
Basile Fasolo et al. (9)
2005
Shindel et al. (12)
Laumann et al. (GSSAB) (8)
2005
2008
Nolazco et al. (7)
2004
Porst et al. (PEPA) (11)
Rowland et al. (6)
2004
2007
Fugl-Meyer and FuglMeyer (5)
2002
Stulhofer and Bajic (10)
Laumann et al. (NHSLS) (4)
1999
2006
Dunn et al. (3)
Authors
1998
Date
NA
Questionnaire
Questionnaire
Mailed questionnaire + internet
telephone interview
Questionnaire
Web-based survey Self-report
Interview
Clinician-based
Telephone-personal interview/mailed questionnaires
Interview
Mailed questionnaire
Interview
Interview
Method of data collection
Table 1 The prevalence rates of premature ejaculation
NA
NA
Internet panel (younger than 60)
Web interview + randomization
Web-based survey
Male partners of infertile couples under evaluation
Internet panel
Stratified sampling
Invitation to outpatient clinic
Random (systematic) sampling
Invitation to outpatient clinic
Internet panel
Population register
NA
General practice registers—random stratification
Method of recruitment
27
Distress
ISSM
NA
DSM IV
15.3
64.7
18.3
27
26
Control
NA
16
50
22.7
9.5
21.2
23.75 (4.26% frequently)
28.3
16.3
9
1,127
255
600
11,746+1,671
3,816
73
12,133
601
12,558
13,618
2,456
1,158
1,475
1,410
618
31 (lifetime) 31
617
Number of men
14 (past 3 mo)
Prevalence rate (%)
DSM III
Self-report premature ejaculation
Control over ejaculation, distress
Often ejaculating in less than 2 minutes
DSM IV
Reaching climax too quickly during the past 12 months
Ejaculating fast or prematurely
DSM IV
NA
Climaxing/ejaculating too rapidly during the past 12 months
Having difficulty with ejaculating prematurely
Operational criteria
410 Saitz and Serefoglu. Premature ejaculation epidemiology
Transl Androl Urol 2016;5(4):409-415
© Translational Andrology and Urology. All rights reserved.
tau.amegroups.com
Vakalopoulos et al. (19)
Hirshfeld et al. (20)
Christensen et al. (21)
Serefoglu et al. (22)
Son et al. (23)
Tang and Khoo (24)
Mialon et al. (25)
Shaeer and Shaeer (26)
Shindel et al. (27)
McMahon et al. (28)
Lotti et al. (29)
Zhang et al. (30)
2011
2010
2011
2011
2011
2011
2012
2012
2012
2012
2012
2013
Table 1 (continued)
Park et al. (18)
Authors
2010
Date
Table 1 (continued)
Interview
Interview
Computer assisted interviewing, online, or inperson self-completed
Web-based survey
Web-based survey
Mailed questionnaire
Interview
Questionnaire
Interview
Interview + questionnaire
Web-based survey
One-on-one survey
Mailed questionnaire
Method of data collection
Random stratified sample of married men aged 30–60
Men seeking medical care for infertility
NA
Online advertisement targeted to MSM + distribution of invitation to organizations catering to MSM
Online advertisement in Arabic countries
Convenience sampling (18–25 years old)
Primary care setting
Internet panel
Stratified sampling
Population register (random)
Online advertisement in the United States and Canada
Population based cohort
Stratified sampling
Method of recruitment
Self-reported premature ejaculation
4.7
15.6
13
Self-reported (always/nearlyalways) PEDT ≥9
16
8–12
83.7
11.4
40.6
10.5
20.0
7
PEDT ≥11
PEDT ≥9
Ejaculate before the person wishes to ejaculate at least sometimes
Control over ejaculation; distress
PEDT ≥9
Estimated IELT ≤5 min, inability to control ejaculation, distress
Complaining about ejaculating prematurely
NA
34
17.7
ISSM lifelong PE Climaxing/ejaculating too rapidly during the past 12 months
58.43
27.5
Prevalence rate (%)
EED
Suffering from PE
Operational criteria
728
244
4,997
1,769
804
2,507
207
334
2,593
5,552
7,001
522
2,037
Number of men
Translational Andrology and Urology, Vol 5, No 4 August 2016 411
Transl Androl Urol 2016;5(4):409-415
© Translational Andrology and Urology. All rights reserved.
tau.amegroups.com
Gao et al. (35)
Shaeer (36)
Mo et al. (37)
Akre et al. (38)
2013
2013
2014
2014
O’Sullivan et al. (40)
Vansintejan et al. (34)
2013
2014
Hwang et al. (33)
2013
Song et al. (39)
Gao et al. (32)
2013
2014
Lee et al. (31)
Authors
2013
Date
Table 1 (continued)
Web-based survey
Web-based survey
Mailed questionnaire
NA
Web-based survey
Interview
Web-based survey
Survey of married couples
Interview
Interview
Method of data collection
Adolescents aged 16–21
population-based sample of males aged 20–59 years
–
Chronic prostatitis patients
English-speaking male web surfers in the USA via paid advertising on Facebook®
Healthy volunteers
Men seeking medical care for infertility
Online and flyer advertisements to Belgian men who have sex with men (only HIV+ men in this study)
Married heterosexual couples in Korea
Random stratified sample of monogamous heterosexual men in China
Stratified random sampling
Method of recruitment
3
IELT
