available at www.sciencedirect.com journal homepage: www.europeanurology.com The Impact of Premature Ejaculation on Partners and Relationships Tricia Barnes * 90 Harley Street, London W1G 7HS, United Kingdom Article info Keywords: Intravaginal ejaculatory latency time Premature ejaculation Sexual dysfunction Abstract Objectives: Premature ejaculation (PE) is a common condition in adult males that remains underdiagnosed and undertreated, partially because the sensitive nature of the topic discourages open discussions between affected males, their partners, and physicians. In addition to reduced sexual satisfaction, PE can have emotional consequences such as distress and dissatisfaction with the overall relationship, not only for the males but also their partners, the perspectives of whom have not been widely studied. Methods: An online survey of female partners of men with PE was conducted to determine how the condition affects women and their relationships. Results: The results revealed that the relatively short intravaginal ejaculatory latency time (IELT) associated with PE causes emotional distress for the female partners (N = 115). The majority of female partners wanted to experience a prolonged IELT and considered that this would enhance both their sexual and overall relationship with their partner. Conclusions: Increased awareness of the nature of the emotional and relationship ramifications of PE on men and their sexual partners should enhance the development of treatment options beyond pharmacotherapy alone. # 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Tel. +44 0208 241 1201; Fax: +44 0208 241 1201. E-mail address: t.barnes@tbapractice.co.uk. 1. Introduction The short intravaginal ejaculatory latency time (IELT) experienced with premature ejaculation (PE) can be associated with distress and dissatisfaction with sexual intercourse for the affected men and their partners [1 3]. For female partners, PE may result in disappointment at being unable to share and contribute to the sexual experience and may trigger feelings that the man is behaving selfishly sexually and that she is merely a vehicle for his sexual pleasure, which results in frustration and resentment. This can lead to a lack of sexual satisfaction and erosion of intimacy in the relationship [4]. Although the distress of the partner has been a motivating factor in convincing men with PE to seek medical help, relatively few objective or prospective 1569-9056/$ see front matter # 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eursup.2007.04.007
776 evaluations of the effects of PE on the partner have been reported [4]. In this study, female partners of men with PE were asked to respond to an online survey designed to investigate the effects of PE on these partners. The survey assessed the female partners attitudes toward their sexual and overall relationships and provides insights into the expectations of women who are in sexual relationships with men with PE. 2. Methods 2.1. Participants and study design Eligible respondents were the female partners of men with PE between the ages of 18 and 60 yr from the United Kingdom, Italy, France, Spain, and Germany. Female survey respondents were prospectively recruited as partners of men with PE. For the purpose of this survey, the women were selected based on their assessment of their male sexual partner in the following three parameters: reported IELT of <2 min or before penetration occurs, control over ejaculation reported as poor or very poor, and the time to ejaculation reported as a problem for one or both members of the relationship. Respondents were invited to complete an online questionnaire. No interviewer was present during the survey. 2.2. Assessments The variables analyzed included each woman s responses to questions in the following areas: (1) perception of IELT, for example, Which one of these four statements best describes how your typical length of time from penetration to ejaculation has affected your relationship? (not a problem for either me or my partner; not a problem for me, but a problem for my partner; a problem for me, but not my partner; a problem for both me and my partner); (2) satisfaction with sexual intercourse, for example, Over the past month, was your satisfaction with sexual intercourse... (rated from very poor to very good on a five-point scale); (3) desire to increase IELT, for example, How high is your desire to increase your partner s time from penetration to ejaculation? (rated from very low to very high on a five-point scale); (4) expressed worry regarding IELT, for example, In general, how worried are you about your partner s ability to last long enough from penetration to ejaculation during sexual intercourse? (rated from not worried to extremely worried on a five-point scale); (5) anticipated effect that an increased IELT could have on the sexual and overall relationship, for example, If there were a way to increase the length of time between your first penetration and ejaculation, what do you think would be the impact on your overall relationship with your partner? On your sexual relationship with your partner? (rated from no impact at all to dramatic impact on a fivepoint scale); (6) expressed desire (wish) to improve elements in sexual and general relationship, for example, Given your current situation, which of the following elements do you want to improve the satisfaction of my partner with our sexual relationship, the quality of my sexual relationship, the frustration that I experience, or the confidence in my partner s sexual ability? (highest three ratings on a five-point scale: desire to improve; strong desire to improve; very strong desire to improve); (7) attitude toward seeking professional help regarding sexual health, for example, Which of the following statements best represents your conversations on sexual health with doctors? (have had conversations, which were always helpful; have had conversations, which were sometimes helpful; have had conversations, which were never helpful; have never had conversations but would consider in the future; have never had conversations and won t in the future). 3. Results 3.1. Population Data were collected from 1074 women. Of these, 115 met all three inclusion criteria, and only these respondents were included in the final survey. Available subject or respondent demographics and baseline characteristics for the total sample of 1072 respondents, as well as the subsample of 115 respondents whose partners had PE, are presented in Table 1. 3.2. Satisfaction with the sexual relationship Of the 115 women whose partners had PE, 53.9% (n = 62) reported that the IELT typically experienced was a problem that affected the relationship for both her and her partner, 19.2% (n = 22) reported that IELT was a problem for her alone, and 26.9% (n =31) affected the male partner alone (Fig. 1). Only 13% (n = 15) of female partners reported satisfaction with their current sexual relationship as being good or very good, whereas 38.8% (n = 45) of female partners reported poor or very poor satisfaction. 3.3. Anticipated effect of an increased intravaginal ejaculatory latency time on sexual and overall relationships The majority of the female partners (79.7%, n = 92) were at least slightly worried about their male partner s IELT, and 70.4% (n = 81) reported a high to very high desire to increase IELT (Fig. 2). The majority of female partners believed that an increased IELT would have a dramatic or important impact on both their sexual (77.4%, n = 89) and overall (57.9%, n = 66) relationships (Table 2). This belief was reflected in the fact that 86.0% (n = 99) of the partners responded that they would like to improve the male s satisfaction with the sexual relationship, and 84.5% (n = 97) responded that they would like to improve the quality of their own sexual
777 Table 1 Respondent demographics and baseline characteristics * Total respondents (%) Germany (n = 301) Italy (n = 212) France (n = 206) UK (n = 208) Spain (n = 145) Total (N = 1072) Age range (yr) 18 35 42.5 47.6 49.5 49.5 57.2 48.3 36 45 27.6 25.5 22.3 23.1 24.1 24.8 46 60 29.9 26.9 28.2 27.4 18.6 26.9 Relationship status Involved 90.1 88.2 92.7 90.8 88.3 90.0 Not involved 9.9 11.8 7.2 9.1 11.6 9.8 Health Poor 3.7 2.8 1.0 2.9 6.2 3.2 Fair 27.0 27.6 18.4 24.2 38.4 26.5 Good 42.0 44.9 50.2 41.5 37.0 43.5 Very good 22.0 19.2 23.7 24.2 14.4 21.2 Excellent 5.3 5.6 6.8 7.2 4.1 5.9 Respondents whose partners have premature ejaculation (%) Germany (n = 39) Italy (n = 14) France (n = 25) UK (n = 17) Spain (n = 20) Total (N = 115) Age range (yr) 18 35 43.2 40.0 36.0 33.3 31.6 37.7 36 45 13.5 46.7 28.0 38.9 42.1 29.8 46 60 43.2 13.3 36.0 27.8 26.3 32.5 Relationship status Involved 76.3 93.3 96.0 100.0 90.0 88.7 Not involved 23.7 6.7 4.0 0.0 10.0 11.3 Health Poor 2.6 0.0 3.8 0.0 10.0 3.4 Fair 31.6 46.7 23.1 23.5 50.0 33.6 Good 26.3 33.3 57.7 47.1 35.0 38.8 Very good 15.8 6.7 11.5 23.5 5.0 12.9 Excellent 23.7 5.9 3.8 5.9 0.0 11.2 * Number of valid cases is different from total count in the cross-tabulation table because the cell counts have been rounded. relationship (Table 3). Moreover, the majority of respondents reported a desire to improve the quality of their overall relationship (67.9%, n = 78) and also their partner s satisfaction with the overall relationship (62.3%, n = 72). With regard to the women s subjective experience of sexual intercourse, 73.6% (n = 85) of female partners indicated a desire to decrease their own levels of frustration, 70.4% (n = 81) indicated a desire to reduce the level of distress with their current situation, and 72.2% (n = 83) wanted to improve their confidence in their male partner s sexual ability (Table 3). 3.4. Attitudes toward seeking medical help Fig. 1 Intravaginal ejaculatory latency time is a problem for the majority of female partners of men with premature ejaculation. Results are in response to the question Which one of these four questions best describes how your typical length of time from penetration to ejaculation has affected your relationship? The majority of partners of men with PE (80.1%, n = 92) had never had a conversation about PE with a physician (Table 4), although 53.4% (n = 61) of respondents would consider doing so in the future. Of the 19.8% (n = 23) female partners who had
778 Table 4 Discussions between female partners and physicians regarding sexual health Status Response * n (%) Female partners have never had conversations and will not in the future 31 (26.7%) would consider in the future 61 (53.4%) Female partners have had conversations in the past, which were never helpful 7 (6.0%) sometimes helpful 14 (12.1%) always helpful 2 (1.7%) Fig. 2 Female partners desire to increase intravaginal ejaculatory latency time. Response to the question How high is your desire to increase your partner s time from penetration to ejaculation? conversations with physicians, over two-thirds (n = 16) reported that they were somewhat helpful. Interestingly, however, 30% (7 of 23) of the partners who had reported they discussed PE with medical Table 2 Female partners believe increased intravaginal ejaculatory latency time will positively impact Partners with premature ejaculation (N = 115) Overall relationship a 57.9% Sexual relationship b 77.4% Partners reporting important impact or dramatic impact, the highest ratings on a five-point scale. If there were a way to increase the length of time between your first penetration and ejaculation, what do you think would be the impact... a Q27: on your overall relationship with your partner? b Q26: on your sexual relationship with your partner? Table 3 Relationship elements that partners of men with premature ejaculation desire to improve Desired elements to improve % Response * (N = 115) Satisfaction of my partner with the 86.0 sexual relationship Quality of my sexual relationship 84.5 Frustration that I experience 73.6 Confidence in my partner s sexual ability 72.2 Level of distress that I experience 70.4 Quality of my overall relationship 67.9 Satisfaction of my partner with our 62.3 overall relationship * Percentage of partners reporting desire to improve, strong desire to improve, or very strong desire to improve (highest ratings on a five-point scale) in response to the question Given your current situation, which of the following elements do you want to improve? * In response to the question, Which of the following statements best represents your conversations on sexual health with doctors? professionals indicated that such conversations were never helpful, highlighting significant clinical and training issues that need to be addressed. 4. Discussion The results of the pan-european online survey indicate that the female partners of men with PE are significantly affected by this condition. The data also illuminate the extent of emotional distress experienced in both the sexual and overall relationships of the couple. Consistent with the literature, the majority of surveyed female partners reported that their partners IELT was problematic, resulting in diminished satisfaction with sexual intercourse and a desire on their part to increase the IELT [3 5]. These female partners reported that they expected such an increase to have a positive effect on their sexual and overall relationships. Lack of effective communication with health care professionals about sexual functioning was reported to be a major barrier to treatment. Only 19.8% of the female partners reported having discussed PE with physicians. Notably, only 1.7% (n = 2) of these respondents thought those conversations were always helpful, while 30% (n = 7) indicated that such conversations were not helpful. These data are especially discouraging because effective therapeutic options for PE are currently available. In addition, in the last few years health care professionals have had opportunities for training in the assessment and treatment of erectile disorders, which included the development of relevant communication skills. These skills should be readily applicable in treating PE. Currently available medical therapeutic agents can increase IELT, but they do not address the emotional impact of PE on men and their partners. The data on subjective aspects of living with the
779 condition suggest that, in many cases, combination therapy such as short-term psychosexual or couples counselling may be required in addition to pharmacotherapy to improve longer-term treatment efficacy and enhanced sexual and relationship satisfaction. To increase the number of patients and partners willing to seek treatment for PE, there needs to be greater awareness of the underlying aetiologies and an understanding of the physical, psychological, and emotional impact that living with PE has on the male and his partner, as well as on the overall relationship. To provide effective treatment delivery to the patient and his partner, health professionals in the field of sexual health, sexual medicine, and sexual therapy need updated information on treatment options and combination therapies, as well as training in effective communication in human sexuality. Conflicts of interest Ms. Barnes has received an honorarium from Janssen-Cilag EMEA and Johnson & Johnson Pharmaceutical Services LLC for speaking at a satellite symposium. In addition, she is currently a member of an advisory board funded by Pfizer Inc. Acknowledgements Janssen-Cilag EMEA and Johnson & Johnson Pharmaceutical Services LLC provided funding for the EOSS study and its analysis and interpretation. References [1] Symonds T, Roblin D, Hart K, Althof S. How does premature ejaculation impact a man s life? J Sex Marital Ther 2003;29:361 70. [2] Sotomayor M. The burden of premature ejaculation: the patient s perspective. J Sex Med 2005;2(Suppl 2):110 4. [3] Byers ES, Grenier G. Premature or rapid ejaculation: heterosexual couples perceptions of men s ejaculatory behavior. Arch Sex Behav 2003;32:261 70. [4] Patrick DL, Althof SE, Pryor JL, et al. Premature ejaculation: an observational study of men and their partners. J Sex Med 2005;2:358 67. [5] McCabe MP. Intimacy and quality of life among sexually dysfunctional men and women. J Sex Marital Ther 1997;23: 276 90.