Determining Prevalence of Premature Ejaculation

Men, for the most part, are becoming more comfortable discussing premature ejaculation (PE) with physicians. This acknowledgement demonstrates that many men feel PE is a treatable medical condition. Physicians, however, are limited by multiple definitions of the condition and vague criteria to diagnose it. Depending on the study that is used, prevalence can be anywhere from 25% to 60% of the population. Some researchers feel that PE is the most common male sexual dysfunction.

Without an understanding of “normal” ejaculation rates, researchers continue to be hindered in their search for a single definition. Factor in differences between male and female perceptions of “normal” are contributing to the uncertainty on the “right” definition. In addition, there are regional differences to consider: what is normal in Germany might not be considered normal in the U.S.

Current definitions put forth by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the International Classification of Diseases, Tenth Edition (ICD-10) comprise those most widely used. Key points that these definitions have in common include short ejaculatory latency, lack of control over ejaculation, personal distress and interpersonal difficulty and low sexual satisfaction. These criteria, however, are subjective and do not lend themselves readily to study or therapeutic intervention. Some men self-report PE to their physicians, despite the limitations with defining the conditions.

Two research studies that examined PE prevalence were examined in this article to determine if a global prevalence could be determined. One of the studies included Argentinean men who completed a sexual health survey while attending a prostate awareness campaign. This survey noted a 28.5% prevalence of PE. The second study compared was the Global Study of Sexual Attitudes and Behaviors (GSSAB) that looked at overall health, attitudes and beliefs of individuals in 29 countries. The GSSAB included both men and women and had more than 27,000 survey responses. The Argentinean study’s findings closely aligned itself with that of the GSSAB. Researchers divided survey responses into seven regions: Northern Europe, Southern Europe, Non-European West ( U.S.A., Canada, South Africa, Australia, and New Zealand), Latin America, Middle East, East Asia, Southeast Asia.

On a global level, the prevalence of PE was found to be approximately one-fourth of all men. There are notable regional differences, however. For example, men in the Middle East reported PE at 12.4%, while men in Southeast Asia noted PE at 30.5%. Researchers included information from men who reported PE either sometimes or frequently, therefore excluding those who may have only transient experiences with PE rather than chronic, ongoing difficulties. Some of the possible reasons why there are regional differences in the prevalence of PE include religious ideology, acceptance of sex, how widely accepted female sexuality is, and how accepted female positions in society may be. Researchers controlled for health conditions, such as erectile dysfunctions and vascular disease and found few correlations. They did, however, note that men with less education and lower overall health functioning were more likely to report PE.

Determining causes for PE is just as elusive as defining the condition. Four time periods or phases in history have recognized PE, however, each era has placed varying importance on psychological vs. physical causes. During the first phase (1887-1917), PE first made its appearance into medical texts. The second phase (1917-1950) described the condition, using rapid rather than premature ejaculation. Interesting to note is that during this time psychoanalytic theory dominated thinking of the disease at time, associating it with unresolved feelings of narcissism from infancy that resulted in exaggerated importance of the penis. The third phase (1950-1990) focused on behavioral strategies to control ejaculation responses. It wasn’t until 1990 (through the present) that the fourth phase began. This phase ushered in use of medication to treat PE, thereby recognizing that there could be both medical and psychological components to PE.

Men with higher risk factors for PE include those with little sexual experience, high levels of anxiety during sexual situations, and relationship problems. Men with physical conditions such as urinary tract infections and diabetes are also at increased risk of PE. Some medication and opiate usage (such as found in over-the counter cold medications) can exacerbate PE or influence its existence. Finally, 30% of men who self-report PE have some form of erectile dysfunction.

Source: Montorsi, Francesco, MD, “Prevalence of Premature Ejaculation: A Global and Regional Perspective.” The Journal of Sexual Medicine, 2005, Supplement 2, p. 96-102.

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