Premature ejaculation 'doesn't just upset men'

"Women suffer during premature ejaculation too," the Mail Online reports after a new study has assessed the psychological impact of premature ejaculation on women and how this may influence their perception of their relationship.

The website reports on a survey that investigated a group of almost 1,500 women aged 20 to 50 years old on their perceptions of and attitudes towards premature ejaculation.

A series of online questionnaires given to the women found that around 40% considered "ejaculatory control" to be extremely or very important. The study also found a significant relationship between the importance of ejaculatory control and the women's "distress".

Lack of attention to women's other sexual needs, such as caressing or kissing, was the most frequently reported (47.6%) reason for sexual distress. This suggests that penetrative sex is not the be-all and end-all of mutually satisfactory sexual relationships.

But this study's findings may not be representative of how women in the UK feel about premature ejaculation – only women from Mexico, Italy and South Korea were surveyed.

There is also a potential conflict of interest in this study, as it was funded by a pharmaceutical company that manufactures three drugs for premature ejaculation.

Where did the story come from?

The study was carried out by researchers from the University of Zurich in Switzerland, Versailles-Saint Quentin en Yvelines University in France, and other institutions in Australia and Germany.

The funding of the study was not clear, but some of the researchers are reported to have had research and advisory ties to Menarini, an Italian pharmaceutical company, and the lead researcher is a board member of the company.

This therefore represents a conflict of interest, as Menarini manufactures the drugs ranolazine, dapoxetine and avanafil, which are all used for erectile dysfunction.

The online survey was carried out by a market research company called GfK Eurisko. It is not clear if the women were paid for their participation, which could be a further conflict of interest as they could have been more likely to report that their partner had premature ejaculation if they were being paid for their time.

The study was published in the peer-reviewed Journal of Sexual Medicine.

It was covered appropriately by the Mail Online, although the potential conflicts of interest were not outlined in the story.

What kind of research was this?

This was a cross-sectional study that involved surveying a group of women between April and June 2013 about their perceptions of ejaculation.

A cross-sectional study looks at the characteristics of a population at a given point in time. This type of study is useful for finding out how common a particular condition is in a population or recording information in a population. For example, this could be studying perceptions about premature ejaculation in a select population.

Because this study only looks at one point in time, it cannot establish whether there is a cause and effect relationship between factors as it does not show which of them came first.

The authors report that to date, most studies that have explored attitudes and behaviours about premature ejaculation have focused on men and few have focused on the satisfaction of women.

They say evidence has shown a strong association between premature ejaculation and sexual dissatisfaction in both partners, but that it is not known what exactly causes this distress.

For example, is it the lack of ejaculatory control or the consequential factor that the man is distressed and therefore less focused on the sexual needs of the woman? Or possibly a combination of both?

What did the research involve?

The researchers surveyed 1,463 women from three countries (Mexico, Italy and South Korea) that belonged to a web-based consumer group from a market research company.

The women were all aged between 20 and 50 years. The researchers say three countries were selected to capture cultural differences.

To be included in the survey, women had to meet the following criteria:

be sexually active
have engaged in sexual intercourse with a man
consider themselves heterosexual or bisexual
have had sexual relationships predominantly with men or with both men and women equally

The women also had to answer yes to one of the following questions:

Are you currently with a man who ejaculates earlier than you would like him to?
Are you currently with a man who has been given the clinical diagnosis of premature ejaculation?
Are you currently with a man whose time from penetration until ejaculation is on average less than two minutes most of the time?
Has your current partner ever reported the wish to have more control over his ejaculation?

Premature ejaculation was considered if the man had self-reported it or through subjective assessment by the woman. No objective data was available for the diagnosis of premature ejaculation.

Validated and self-constructed online questionnaires were used to assess the women's perception of premature ejaculation, relationship satisfaction and quality, and sexual functioning and satisfaction.

Some of the questionnaires used a Likert-type scale to rank their response – when asked about feeling distressed by premature ejaculation, the response was ranked from "extremely" to "not at all".

Statistical methods were then used to analyse the survey data. Analyses were carried out on the whole group of women as well as the individual groups of women, depending on how they reported which of the four questions they answered yes to.

What were the basic results?

The average age of the women was 34 years and the average relationship status was 86 months (about seven years).

The majority of women included in the study (63.1%) reported that their partner had expressed the desire to have more control over his ejaculation, with 53.7% reporting they were with a man who ejaculates earlier than they would like.

Fewer than 10% of women reported being with a partner who had a clinical diagnosis of premature ejaculation.

The study's main findings were:

Around 40% of women considered ejaculatory control to be extremely or very important.
There was a significant relationship found between the importance of ejaculatory control and women's distress.
Women reporting fewer sexual problems considered ejaculatory control more important and reported more premature ejaculatory-related distress.
The man's lack of attention to her other sexual needs, such as caressing or kissing, was the most frequently reported (47.6%) reason for women's sexual distress, followed by premature ejaculation (39.9%) and lack of ejaculatory control (24.1%).
Almost a quarter of women reported that the man's ejaculatory problem had previously led to relationship break-ups.
Women who considered duration to be important were more likely to report relationship break-ups.
About half of the women (49.8%) reported having a sexual problem such as low libido, with 41.4% reporting sexual dissatisfaction. Of the women with a self-reported sexual problem, 78.6% stated they experienced these problems while being with a man who ejaculated prematurely.
When asked what their ideal sexual intercourse duration would be (not including foreplay), the pooled average response was about 23 minutes, ranging from 1 to 200 minutes.

How did the researchers interpret the results?

In their conclusions, the researchers say the study highlights the detrimental effects of premature ejaculation on relationships and a woman's sexual satisfaction. The effect can sometimes lead to termination of the relationship.

They say this is the first study to report that important sources of female stress are not only factors relating to performance, such as control or duration of sexual intercourse, but rather inappropriate attention focus and the negligence of other forms of sexual activity.

Conclusion

This type of study has investigated the attitudes and perceptions of premature ejaculation, surveying a relatively small number of women from three countries. The study included which aspects of premature ejaculation are most distressing to women.

Overall, the study shows that among this group of women, there was a significant relationship between the importance of ejaculatory control and their distress.

As the study surveyed women from Mexico, Italy and South Korea, the findings may not be representative of how UK women feel about premature ejaculation.

There are other limitations of the study worth considering, including:

Premature ejaculation status was self-reported by the women, so not all of the women's partners may have met the clinical criteria for a diagnosis of premature ejaculation. That said, the researchers did ask the women if their partner had received a clinical diagnosis and less than 10% reported this was the case. The researchers also note that previous studies have shown that men over-report premature ejaculation and say this may be the case for women as well.
As this was a cross-sectional study, it cannot establish cause and effect, so the effect of premature ejaculation on female sexual functioning and relationship status cannot be determined. The study only highlights that there is an association, but other factors may be at play in this association.
It is not clear why – and is rather surprising – that the researchers from Switzerland, France, Australia and Germany did not survey women from any of these countries.
The potential conflict of interest that this study was funded by a pharmaceutical company that manufactures three drugs for premature ejaculation should not be ignored.

If you are troubled by premature ejaculation, the sensible first step is to ask your GP for advice. Aside from any difficulties that premature ejaculation causes your sex life, the condition can often be a symptom of a serious underlying health condition, such as type 2 diabetes, high blood pressure or prostate disease, so further diagnosis is recommended.