Diagnosis, etiology, and psychobehavioral treatment of premature ejaculation

G5 Doctoral dissertation (article)


Internal Authors/Editors


Publication Details

List of Authors: Daniel Ventus
Publisher: Åbo akademi university
Place: Åbo
Publication year: 2019
ISBN: 978-952-12-3861-1
eISBN: 978-952-12-3862-8


Abstract

Premature ejaculation (PE) is characterized by a pattern of involuntary
ejaculation prior to, upon, or shortly after penetration leading to personal or
interpersonal distress. Some definitions add a time limit of about 1 minute
following penetration. Around 25% of the male population report ejaculating
before they wish to do so, while about 4% are estimated to meet current
diagnostic criteria. PE has been associated with anxiety, depression, low self-
esteem, sexual distress, interpersonal difficulties and a decreased quality of
life. Little is known of what causes PE. Many possible etiological factors have
been explored, however, none have as of yet been replicated and confirmed in
large scale studies. The first-line treatment for PE today is pharmacological,
namely using selective serotonin-reuptake inhibitors, sometimes combined
with sexological therapy.


Study I aimed at clarifying the temporal stability of PE symptoms. Two
longitudinal samples were used: a population-based sample followed six years,
and a sample of patients previously diagnosed with PE, who were untreated at
the time of the study, followed three years. In the population-based sample, less
than half of those who reported ejaculation latency times (ELT) of less than 1
minute at the first data collection also reported it six years later. In this sample,
47% reported having experienced a change in ELT between the two
measurement points. In the clinical sample, only 5 out of 16 men reported ELTs
of less than 1 minute at both time points. In the clinical sample, 63% reported
having experienced a change in ELT between the two measurement points.

Study II aimed at clarifying the direction of causality between PE symptoms on
the one hand, and anxiety, depression, and sexual distress on the other. In a
longitudinal, population-based sample followed six years, bivariate analyses
revealed that PE and sexual distress were mutually positively correlated acorss
time. Also across time, PE was positively correlated with future anxiety, and
depression was positively correlated with future PE. Correlation coefficients
were small to moderate. However, when fitting structural equation models to
the data, no associations were found across time between PE and the other
variables.

Study III explored associations between PE and the lifestyle factors alcohol
use, physical exercise, and body-mass index. Cross-sectional population-based
and clinical samples were used. The most consistent finding was a negative
association between PE and physical exercise. While the effect size was small,
the negative association was robust, since it was observed when comparing the
clinical sample to both the whole population-based sample and to an age-
matched subsample, as well as within samples and in multivariate analyses of
all study variables.

Study IV aimed at developing more effective psychobehavioral treatment
protocols for PE. Fifty PE patients were randomized into three groups: 1) a
treatment regime consisting of vibrator-assisted start-stop exercises 2)
vibrator-assisted start-stop exercises, and additional psychoeducation and
exercises aimed to improve the patient’s awareness and utilization of
physiological cues related to sexual arousal, or 3) waiting-list control group.
Both treatment groups improved with large effect sizes after treatment
compared to the control group. The treatment groups did not differ on the PE
outcome measure at any time. However, the second group also improved on
most secondary outcome measures, including anxiety and sexual distress,
indicating a favorable outcome for the group receiving additional intervention.

In conclusion, PE symptoms might not be quite as stable over time as
previously thought. I suggest that the current cutoff for ELT for PE diagnosis at
1 minute is unnecessarily strict. Increasing the temporal criterion to
approximately 2–4 minutes would reduce false negatives, while the criteria for
distress and control reduce the risk of false positives. Furthermore, results
from the present studies showed no indication that anxiety and depression
would be major etiological factors in PE. Hence, these should probably not be
targeted in most cases in attempts to improve PE. On the other hand, increased
physical exercise may be a promising intervention for PE in some men, and
should be further investigated in future studies. Vibrator-assisted start-stop
exercises are supported by replicated evidence suggesting that they are viable
treatment options for PE.





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Last updated on 2019-09-12 at 02:58

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