Lifelong premature ejaculation: from authority-based to evidence-based medicine



In response to my article on evidence-based research of lifelong premature ejaculation [1], Denniston and Hill expressed their concern that circumcision was not mentioned as an important factor in the development of premature ejaculation [2]. With their reference to the studies of O’Hara and O’Hara [3] and Gemmell and Boyle [4], readers may erroneously have the impression that circumcision is considered as a scientifically accepted risk factor for developing premature ejaculation. My current reply mainly considers the notion that both references are methodologically insufficient. For example, O’Hara and O’Hara [3] reported about women who had experienced intercourse with both circumcised and intact partners. These women stated that more of their circumcised than intact partners had premature ejaculation. However, notably in this study, premature ejaculation was defined as having an orgasm within 2–3 min in more than half the attempts. Apart from this arbitrary definition of premature ejaculation, the analysis was based on an open-label retrospective design with a questionnaire, assessing subjective judgements of these women. In other words, the actual ejaculation time of the men reported was not prospectively recorded with an objective timer.

Indeed, the presence or absence of a prepuce may be influential on how intercourse or other forms of sexual contact is conducted and experienced by both partners. However, no information about the exact role of circumcision on the development of ejaculatory disorders has been provided by evidence-based studies.

A scientific and realistic way to obtain basic information on this issue is to conduct population-based studies among different cultures, using stopwatch analysis of the intravaginal ejaculation latency time (IELT) [5]. Only comparison of the IELT distribution in both circumcised and intact men (with no genital diseases) and within and between cultures or countries will provide answers on the role of circumcision as a risk factor for developing either lifelong premature or delayed ejaculation.