Diagnosis, etiology, and psychobehavioral treatment of premature ejaculation

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

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

Study II aimed at clarifying the direction of causality between PE symptoms onthe one hand, and anxiety, depression, and sexual distress on the other. In alongitudinal, population-based sample followed six years, bivariate analysesrevealed that PE and sexual distress were mutually positively correlated acorsstime. Also across time, PE was positively correlated with future anxiety, anddepression was positively correlated with future PE. Correlation coefficientswere small to moderate. However, when fitting structural equation models tothe data, no associations were found across time between PE and the othervariables.

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

Study IV aimed at developing more effective psychobehavioral treatmentprotocols for PE. Fifty PE patients were randomized into three groups: 1) atreatment regime consisting of vibrator-assisted start-stop exercises 2)vibrator-assisted start-stop exercises, and additional psychoeducation andexercises aimed to improve the patient’s awareness and utilization ofphysiological cues related to sexual arousal, or 3) waiting-list control group.Both treatment groups improved with large effect sizes after treatmentcompared to the control group. The treatment groups did not differ on the PEoutcome measure at any time. However, the second group also improved onmost 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 aspreviously thought. I suggest that the current cutoff for ELT for PE diagnosis at1 minute is unnecessarily strict. Increasing the temporal criterion toapproximately 2–4 minutes would reduce false negatives, while the criteria fordistress and control reduce the risk of false positives. Furthermore, resultsfrom the present studies showed no indication that anxiety and depressionwould be major etiological factors in PE. Hence, these should probably not betargeted in most cases in attempts to improve PE. On the other hand, increasedphysical exercise may be a promising intervention for PE in some men, andshould be further investigated in future studies. Vibrator-assisted start-stopexercises are supported by replicated evidence suggesting that they are viabletreatment options for PE.

Original languageUndefined/Unknown
Print ISBNs978-952-12-3861-1
Electronic ISBNs978-952-12-3862-8
Publication statusPublished - 2019
MoE publication typeG5 Doctoral dissertation (article)

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