ORIGINAL RESEARCH—EJACULATION DISORDERS: A Multinational Population Survey of Intravaginal Ejaculation Latency Time
ABSTRACT
Introduction. Intravaginal ejaculation latency time (IELT), defined as the time between the start of vaginal intromission and the start of intravaginal ejaculation, is increasingly used in clinical trials to assess the amount of selective serotonin reuptake inhibitor‐induced ejaculation delay in men with premature ejaculation. Prospectively, stopwatch assessment of IELTs has superior accuracy compared with retrospective questionnaire and spontaneous reported latency. However, the IELT distribution in the general male population has not been previously assessed.
Aim. To determine the stopwatch assessed‐IELT distribution in large random male cohorts of different countries.
Methods. A total of 500 couples were recruited from five countries: the Netherlands, United Kingdom, Spain, Turkey, and the United States. Enrolled men were aged 18 years or older, had a stable heterosexual relationship for at least 6 months, with regular sexual intercourse. The surveyed population were not included or excluded by their ejaculatory status and comorbidities. This survey was performed on a “normal” general population. Sexual events and stopwatch‐timed IELTs during a 4‐week period were recorded, as well as circumcision status and condom use.
Main Outcome Measures. The IELT, circumcision status, and condom use.
Results. The distribution of the IELT in all the five countries was positively skewed, with a median IELT of 5.4 minutes (range, 0.55–44.1 minutes). The median IELT decreased significantly with age, from 6.5 minutes in the 18–30 years group, to 4.3 minutes in the group older than 51 years (P < 0.0001). The median IELT varied between countries, with the median value for Turkey being the lowest, i.e., 3.7 minutes (0.9–30.4 minutes), which was significantly different from each of the other countries. Comparison of circumcised (N = 98) and not‐circumcised (N = 261) men in countries excluding Turkey resulted in median IELT values of 6.7 minutes (0.7–44.1 minutes) in circumcised compared with 6.0 minutes (0.5–37.4 minutes) in not‐circumcised men (not significant). The median IELT value was not affected by condom use.
Conclusion. The IELT distribution is positively skewed. The overall median value was 5.4 minutes but with differences between countries. For all five countries, median IELT values were independent of condom usage. In countries excluding Turkey, the median IELT values were independent of circumcision status.
Number of times cited: 71
- M. Kadihasanoglu, M. Kilciler, G. Kilciler, U. Yucetas, E. Erkan, E. Karabay, M. G. Toktas and M. Kendirci, Relation between blood vitamin B12 levels with premature ejaculation: case–control study, Andrologia, 49, 5, (2016).
- William L. Marshall, Kathryn S. K. Hall and Chin‐pang Woo, Sexual Functioning in the Treatment of Sex Offenders, The Wiley Handbook on the Theories, Assessment and Treatment of Sexual Offending, (1369-1384), (2016).
- Xiansheng Zhang, Dongdong Tang, Chuan Xu, Pan Gao, Zongyao Hao, Jun Zhou and Chaozhao Liang, The Relationship between Self‐Estimated Intravaginal Ejaculatory Latency Time and International Prostate Symptom Score in Middle‐Aged Men Complaining of Ejaculating Prematurely in China, The Journal of Sexual Medicine, 12, 3, (705-712), (2015).
- David L. Rowland and Tiffany N. Kolba, Understanding the Effects of Establishing Various Cutoff Criteria in the Definition of Men with Premature Ejaculation, The Journal of Sexual Medicine, 12, 5, (1175-1183), (2015).
- B.‐P. Jiann and Y.‐J. Huang, Assessing satisfaction in men with premature ejaculation after dapoxetine treatment in real‐world practice, International Journal of Clinical Practice, 69, 11, (1326-1333), (2015).
- Amir H. Pakpour, Mir Saeed Yekaninejad, Mohammad Reza Nikoobakht, Andrea Burri and Bengt Fridlund, Psychometric Properties of the Iranian Version of the Premature Ejaculation Diagnostic Tool, Sexual Medicine, 2, 1, (31-40), (2014).
- Daniel H. Shin and Aaron Spitz, The Evaluation and Treatment of Delayed Ejaculation, Sexual Medicine Reviews, 2, 3-4, (121-133), (2014).
- C. G. McMahon, Management of ejaculatory dysfunction, Internal Medicine Journal, 44, 2, (124-131), (2014).
- Ege Can Serefoglu, Chris G. McMahon, Marcel D. Waldinger, Stanley E. Althof, Alan Shindel, Ganesh Adaikan, Edgardo F. Becher, John Dean, Francois Giuliano, Wayne J.G. Hellstrom, Annamaria Giraldi, Sidney Glina, Luca Incrocci, Emmanuele Jannini, Marita McCabe, Sharon Parish, David Rowland, R. Taylor Segraves, Ira Sharlip and Luiz Otavio Torres, An Evidence‐Based Unified Definition of Lifelong and Acquired Premature Ejaculation: Report of the Second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation, The Journal of Sexual Medicine, 11, 6, (1423-1441), (2014).
- Ege Can Serefoglu, Chris G. McMahon, Marcel D. Waldinger, Stanley E. Althof, Alan Shindel, Ganesh Adaikan, Edgardo F. Becher, John Dean, Francois Giuliano, Wayne J.G. Hellstrom, Annamaria Giraldi, Sidney Glina, Luca Incrocci, Emmanuele Jannini, Marita McCabe, Sharon Parish, David Rowland, R. Taylor Segraves, Ira Sharlip and Luiz Otavio Torres, An Evidence‐Based Unified Definition of Lifelong and Acquired Premature Ejaculation: Report of the Second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation, Sexual Medicine, 2, 2, (41-59), (2014).
- Jennifer A. Bossio, Caroline F. Pukall and Stephen Steele, A Review of the Current State of the Male Circumcision Literature, The Journal of Sexual Medicine, 11, 12, (2847-2864), (2014).
- Brian J. Morris and John N. Krieger, Does Male Circumcision Affect Sexual Function, Sensitivity, or Satisfaction?—A Systematic Review, The Journal of Sexual Medicine, 10, 11, (2644-2657), (2013).
- Guy A. Bronselaer, Justine M. Schober, Heino F.L. Meyer‐Bahlburg, Guy T'Sjoen, Robert Vlietinck and Piet B. Hoebeke, Male circumcision decreases penile sensitivity as measured in a large cohort, BJU International, 111, 5, (820-827), (2013).
- Chris G. McMahon, Emmanuele Jannini, Marcel Waldinger and David Rowland, Standard Operating Procedures in the Disorders of Orgasm and Ejaculation, The Journal of Sexual Medicine, 10, 1, (204-229), (2012).
- A. L. Pastore, G. Palleschi, A. Leto, L. Pacini, F. Iori, C. Leonardo and A. Carbone, A prospective randomized study to compare pelvic floor rehabilitation and dapoxetine for treatment of lifelong premature ejaculation, International Journal of Andrology, 35, 4, (528-533), (2012).
- C. G. McMahon, G. Lee, J. K. Park and P. G. Adaikan, Premature Ejaculation and Erectile Dysfunction Prevalence and Attitudes in the Asia‐Pacific Region, The Journal of Sexual Medicine, 9, 2, (454-465), (2011).
- Pierre Clément, Miguel Laurin, Sandrine Compagnie, Patricia Facchinetti, Jacques Bernabé, Laurent Alexandre and François Giuliano, Effect of Dapoxetine on Ejaculatory Performance and Related Brain Neuronal Activity in Rapid Ejaculator Rats, The Journal of Sexual Medicine, 9, 10, (2562-2573), (2012).
- Patrick Jern, Lars Westberg, Ada Johansson, Annika Gunst, Elias Eriksson, Kenneth Sandnabba and Pekka Santtila, A Study of Possible Associations Between Single Nucleotide Polymorphisms in the Serotonin Receptor 1A, 1B, and 2C Genes and Self‐Reported Ejaculation Latency Time, The Journal of Sexual Medicine, 9, 3, (866-872), (2012).
- Simon Podner, REPLY, BJU International, 110, 5, (E161-E161), (2012).
- Gregory J. Boyle, CLINICAL ELICITATION OF THE PENILO‐CAVERNOSUS REFLEX IN CIRCUMCISED MEN, BJU International, 110, 5, (E160-E160), (2012).
- Marcel D. Waldinger, Marcus M.H.M. Meinardi, Aeilko H. Zwinderman and Dave H. Schweitzer, Postorgasmic Illness Syndrome (POIS) in 45 Dutch Caucasian Males: Clinical Characteristics and Evidence for an Immunogenic Pathogenesis (Part 1), The Journal of Sexual Medicine, 8, 4, (1164-1170), (2011).
- G. Corona, E. A. Jannini, F. Lotti, V. Boddi, G. De Vita, G. Forti, A. Lenzi, E. Mannucci and M. Maggi, Premature and delayed ejaculation: two ends of a single continuum influenced by hormonal milieu, International Journal of Andrology, 34, 1, (41-48), (2011).
- I. Vakalopoulos, G. Dimitriadis, C. Varnava, Y. Herodotou, G. Gkotsos and D. Radopoulos, Prevalence of ejaculatory disorders in urban men – results of a random‐sample survey, Andrologia, 43, 5, (327-333), (2011).
- Chris G. McMahon, Stanley E. Althof, Joel M. Kaufman, Jacques Buvat, Stephen B. Levine, Joseph W. Aquilina, Fisseha Tesfaye, Margaret Rothman, David A. Rivas and Hartmut Porst, Efficacy and Safety of Dapoxetine for the Treatment of Premature Ejaculation: Integrated Analysis of Results from Five Phase 3 Trials, The Journal of Sexual Medicine, 8, 2, (524-539), (2010).
- Ege C. Serefoglu, Onder Yaman, Selahittin Cayan, Ramazan Asci, Irfan Orhan, Mustafa F. Usta, Oguz Ekmekcioglu, Muammer Kendirci, Bulent Semerci and Ates Kadioglu, Prevalence of the Complaint of Ejaculating Prematurely and the Four Premature Ejaculation Syndromes: Results from the Turkish Society of Andrology Sexual Health Survey, The Journal of Sexual Medicine, 8, 2, (540-548), (2010).
- Wei Shuong Tang and Ee Ming Khoo, Prevalence and Correlates of Premature Ejaculation in a Primary Care Setting: A Preliminary Cross‐Sectional Study, The Journal of Sexual Medicine, 8, 7, (2071-2078), (2011).
- Ibrahim A. Abdel‐Hamid and El‐Sayed Saleh, Primary Lifelong Delayed Ejaculation: Characteristics and Response to Bupropion, The Journal of Sexual Medicine, 8, 6, (1772-1779), (2010).
- Hwancheol Son, Sang Hoon Song, Jun‐Young Lee and Jae‐Seung Paick, Relationship between Premature Ejaculation and Depression in Korean Males, The Journal of Sexual Medicine, 8, 7, (2062-2070), (2011).
- Roy J. Levin, Can the Controversy About the Putative Role of the Human Female Orgasm in Sperm Transport be Settled with Our Current Physiological Knowledge of Coitus?, The Journal of Sexual Medicine, 8, 6, (1566-1578), (2011).
- Hwancheol Son, Sang Hoon Song, Soo Woong Kim and Jae‐Seung Paick, Self‐Reported Premature Ejaculation Prevalence and Characteristics in Korean Young Males: Community‐Based Data From an Internet Survey, Journal of Andrology, 31, 6, (540-546), (2013).
- Hubert I.M. Claes, Irwin Goldstein, Stanley E. Althof, Michael M. Berner, Joseph C. Cappelleri, Andrew G. Bushmakin, Tara Symonds and Gabriel Schnetzler, Understanding the Effects of Sildenafil Treatment on Erection Maintenance and Erection Hardness, The Journal of Sexual Medicine, 7, 6, (2184-2191), (2010).
- Alvaro Morales, Javaad Zargooshi, Patrick Jern, Andrew McCullough, Wayne Hellstrom, Rany Shamloul, Anthony J. Bella, Edgardo F. Becher, Eusebio Rubio‐Aurioles, Michael A. Perelman, Neil Palmer and Margaret Rothman, Comments on “Considerations for an Evidence‐Based Definition of Premature Ejaculation in the DSM‐V”, The Journal of Sexual Medicine, 7, 2pt1, (679-689), (2010).
- Michael L. Eisenberg, Alan W. Shindel, James F. Smith, Benjamin N. Breyer and Larry I. Lipshultz, Socioeconomic, Anthropomorphic, and Demographic Predictors of Adult Sexual Activity in the United States: Data from the National Survey of Family Growth, The Journal of Sexual Medicine, 7, 1pt1, (50-58), (2009).
- Ege Can Serefoglu, Haci Ibrahim Cimen, Ali Fuat Atmaca and M. Derya Balbay, The Distribution of Patients Who Seek Treatment for the Complaint of Ejaculating Prematurely According to the Four Premature Ejaculation Syndromes, The Journal of Sexual Medicine, 7, 2pt1, (810-815), (2009).
- Culley Carson and Michael Wyllie, Improved Ejaculatory Latency, Control and Sexual Satisfaction When PSD502 is Applied Topically in Men with Premature Ejaculation: Results of a Phase III, Double‐Blind, Placebo‐Controlled Study, The Journal of Sexual Medicine, 7, 9, (3179-3189), (2010).
- Chris G. McMahon, Treatment of Premature Ejaculation, Evidence‐Based Urology, (120-133), (2010).
- W. Wallace Dinsmore and Michael G. Wyllie, PSD502 improves ejaculatory latency, control and sexual satisfaction when applied topically 5 min before intercourse in men with premature ejaculation: results of a phase III, multicentre, double‐blind, placebo‐controlled study, BJU International, 103, 7, (940-949), (2009).
- Chris G. McMahon, ORIGINAL RESEARCH—EJACULATORY DISORDERS: Screening for Erectile Dysfunction in Men with Lifelong Premature Ejaculation—Is the Sexual Health Inventory for Men (SHIM) Reliable?, The Journal of Sexual Medicine, 6, 2, (567-573), (2009).
- Javaad Zargooshi, ORIGINAL RESEARCH—EJACULATORY DISORDERS. Premature Ejaculation: Bother and Intravaginal Ejaculatory Latency Time in Iran, The Journal of Sexual Medicine, 6, 12, (3478-3489), (2009).
- Marcel D. Waldinger, Joe McIntosh and Dave H. Schweitzer, A Five‐nation Survey to Assess the Distribution of the Intravaginal Ejaculatory Latency Time among the General Male Population, The Journal of Sexual Medicine, 6, 10, (2888-2895), (2009).
- Paddy K.C. Janssen, Steven C. Bakker, Janos Réthelyi, Aeilko H. Zwinderman, Daan J. Touw, Berend Olivier and Marcel D. Waldinger, ORIGINAL RESEARCH–EJACULATORY DISORDERS: Serotonin Transporter Promoter Region (5‐HTTLPR) Polymorphism is Associated with the Intravaginal Ejaculation Latency Time in Dutch Men with Lifelong Premature Ejaculation, The Journal of Sexual Medicine, 6, 1, (276-284), (2008).
- Gerald B. Brock, Francois Bénard, Richard Casey, Stacy L. Elliott, Jerzy B. Gajewski and Jay C. Lee, Canadian Male Sexual Health Council Survey to Assess Prevalence and Treatment of Premature Ejaculation in Canada, The Journal of Sexual Medicine, 6, 8, (2115-2123), (2009).
- Ion G. Motofei, A dual physiological character for sexual function: the role of serotonergic receptors, BJU International, 101, 5, (531-534), (2007).
- Chris G. McMahon, Stanley E. Althof, Marcel D. Waldinger, Hartmut Porst, John Dean, Ira D. Sharlip, P.G. Adaikan, Edgardo Becher, Gregory A. Broderick, Jacques Buvat, Khalid Dabees, Annamaria Giraldi, François Giuliano, Wayne J.G. Hellstrom, Luca Incrocci, Ellen Laan, Eric Meuleman, Michael A. Perelman, Raymond C. Rosen, David L. Rowland and Robert Segraves, REPORT: An Evidence‐Based Definition of Lifelong Premature Ejaculation: Report of the International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation, The Journal of Sexual Medicine, 5, 7, (1590-1606), (2008).
- Chris G. McMahon, Stanley Althof, Marcel D. Waldinger, Hartmut Porst, John Dean, Ira Sharlip, P.G. Adaikan, Edgardo Becher, Gregory A. Broderick, Jacques Buvat, Khalid Dabees, Annamaria Giraldi, François Giuliano, Wayne J.G. Hellstrom, Luca Incrocci, Ellen Laan, Eric Meuleman, Michael A. Perelman, Raymond Rosen, David Rowland and Robert Segraves, An evidence‐based definition of lifelong premature ejaculation: report of the International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation, BJU International, 102, 3, (338-350), (2008).
- Marcel D. Waldinger and Dave H. Schweitzer, Premature Ejaculation and Pharmaceutical Company‐Based Medicine: The Dapoxetine Case, The Journal of Sexual Medicine, 5, 4, (966-997), (2008).
- Eric W. Corty, ORIGINAL RESEARCH—EJACULATORY DISORDERS: Perceived Ejaculatory Latency and Pleasure in Different Outlets, The Journal of Sexual Medicine, 5, 11, (2694-2702), (2008).
- Yoram Vardi, Chris G. McMahon, Marcel D. Waldinger, Eusebio Rubio‐Aurioles and David Rabinowitz, Controversies in Sexual Medicine: Are Premature Ejaculation Symptoms Curable?, The Journal of Sexual Medicine, 5, 7, (1546-1551), (2008).
- Giovanni Corona, Emmanuele A. Jannini, Edoardo Mannucci, Alessandra D. Fisher, Francesco Lotti, Luisa Petrone, Giancarlo Balercia, Elisa Bandini, Valerio Chiarini, Gianni Forti and Mario Maggi, Different Testosterone Levels Are Associated with Ejaculatory Dysfunction, The Journal of Sexual Medicine, 5, 8, (1991-1998), (2008).
- Chris G. McMahon, Clinical Trial Methodology in Premature Ejaculation Observational, Interventional, and Treatment Preference Studies—Part II—Study Design, Outcome Measures, Data Analysis, and Reporting, The Journal of Sexual Medicine, 5, 8, (1817-1833), (2008).
- Chris G. McMahon, Clinical Trial Methodology in Premature Ejaculation Observational, Interventional, and Treatment Preference Studies—Part I—Defining and Selecting the Study Population, The Journal of Sexual Medicine, 5, 8, (1805-1816), (2008).
- Eric W. Corty and Jenay M. Guardiani, Canadian and American Sex Therapists' Perceptions of Normal and Abnormal Ejaculatory Latencies: How Long Should Intercourse Last?, The Journal of Sexual Medicine, 5, 5, (1251-1256), (2008).
- Marcel D. Waldinger and Dave H. Schweitzer, The Use of Old and Recent DSM Definitions of Premature Ejaculation in Observational Studies: A Contribution to the Present Debate for a New Classification of PE in the DSM‐V, The Journal of Sexual Medicine, 5, 5, (1079-1087), (2008).
- Kia Fatt Quek, Atiya Abdul Sallam, Chai Heng Ng and Chong Beng Chua, Prevalence of Sexual Problems and Its Association with Social, Psychological and Physical Factors among Men in a Malaysian Population: A Cross‐Sectional Study, The Journal of Sexual Medicine, 5, 1, (70-76), (2007).
- Marcel D. Waldinger, Aeilko H. Zwinderman, Berend Olivier and Dave H. Schweitzer, Geometric Mean IELT and Premature Ejaculation: Appropriate Statistics to Avoid Overestimation of Treatment Efficacy, The Journal of Sexual Medicine, 5, 2, (492-499), (2007).
- Marcel D. Waldinger, Aeilko H. Zwinderman, Berend Olivier and Dave H. Schweitzer, The Majority of Men with Lifelong Premature Ejaculation Prefer Daily Drug Treatment: An Observation Study in a Consecutive Group of Dutch Men, The Journal of Sexual Medicine, 4, 4i, (1028-1037), (2007).
- Alan Riley, The diagnosis of premature ejaculation, International Journal of Clinical Practice, 61, 1, (12-13), (2007).
- Ridwan Shabsigh and David Rowland, The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision as an Appropriate Diagnostic for Premature Ejaculation, The Journal of Sexual Medicine, 4, 5, (1468-1478), (2007).
- Brian J. Morris, Why circumcision is a biomedical imperative for the 21st century, BioEssays, 29, 11, (1147-1158), (2007).
- Paolo Maria Michetti, Roberta Rossi, Daniele Bonanno, Carlo De Dominicis, Francesco Iori and Chiara Simonelli, Dysregulation of Emotions and Premature Ejaculation (PE): Alexithymia in 100 Outpatients, The Journal of Sexual Medicine, 4, 5, (1462-1467), (2007).
- Patrick Jern, Pekka Santtila, Katarina Witting, Katarina Alanko, Nicole Harlaar, Ada Johansson, Bettina Von Der Pahlen, Markus Varjonen, Nina Vikström, Monica Ålgars and Kenneth Sandnabba, Premature and Delayed Ejaculation: Genetic and Environmental Effects in a Population‐Based Sample of Finnish Twins, The Journal of Sexual Medicine, 4, 6, (1739-1749), (2007).
- Amie Frewen, Ronald M. Rapee, Pip Bowden and Katerina Lagios, Regional Differences in Men Attending a Sexual Health Clinic in Sydney for Premature Ejaculation, The Journal of Sexual Medicine, 4, 6, (1733-1738), (2007).
- Trynke R. De Jong, Jan G. Veening, Berend Olivier and Marcel D. Waldinger, Oxytocin Involvement in SSRI‐Induced Delayed Ejaculation: A Review of Animal Studies, The Journal of Sexual Medicine, 4, 1, (14-28), (2007).
- Morris L. Sorrells, James L. Snyder, Mark D. Reiss, Christopher Eden, Marilyn F. Milos, Norma Wilcox and Robert S. Van Howe, Fine‐touch pressure thresholds in the adult penis, BJU International, 99, 4, (864-869), (2007).
- Stanley Althof, The Psychology of Premature Ejaculation: Therapies and Consequences, The Journal of Sexual Medicine, 3, (324-331), (2006).
- Craig F. Donatucci, Etiology of Ejaculation and Pathophysiology of Premature Ejaculation, The Journal of Sexual Medicine, 3, (303-308), (2006).
- Marcel D. Waldinger and Dave H. Schweitzer, Changing Paradigms from a Historical DSM‐III and DSM‐IV View Toward an Evidence‐Based Definition of Premature Ejaculation. Part II—Proposals for DSM‐V and ICD‐11, The Journal of Sexual Medicine, 3, 4, (693-705), (2006).
- CHRIS G. McMAHON, CHELSEA N. McMAHON, LIANG JOO LEOW and CHRISTOPHER G WINESTOCK, Efficacy of type‐5 phosphodiesterase inhibitors in the drug treatment of premature ejaculation: a systematic review, BJU International, 98, 2, (259-272), (2006).
- Michael A. Perelman, ORIGINAL RESEARCH—PSYCHOLOGY: A New Combination Treatment for Premature Ejaculation: A Sex Therapist’s Perspective, The Journal of Sexual Medicine, 3, 6, (1004-1012), (2006).
- Marcel D. Waldinger, Relevance of an evidence‐based ejaculation time cutoff point for neurobiological research of premature ejaculation, Journal of Comparative Neurology, 493, 1, (46-50), (2005).
- Tommy Pattij, Trynke R. De Jong, Andre Uitterdijk, Marcel D. Waldinger, Jan G. Veening, Alexander R. Cools, Piet Hein Van Der Graaf and Berend Olivier, Individual differences in male rat ejaculatory behaviour: searching for models to study ejaculation disorders, European Journal of Neuroscience, 22, 3, (724-734), (2005).





