Using Ecological Momentary Assessment to Investigate Associations between Ejaculatory Latency and Control in Partnered and Non-Partnered Sexual Activities
Jern, Patrick, Gunst, Annika, Sandqvist, Felicia, Sandnabba, N. Kenneth, Santtila, Pekka, The Journal of Sex Research
Premature ejaculation (PE) is widely regarded as one of the most common sexual dysfunctions in men (Jern, 2009; Montorsi, 2005; Salonia et al., 2009). Although recent advances in the field have led to significant improvement in the understanding of the etiology of PE, many aspects of the etiology of ejaculatory dysfunctions are still poorly understood. Hence, formulating definitions and diagnostic criteria remain topics of vigorous debate (Jern, 2009; McMahon et al., 2008; Segraves, 2010). An approach to define and diagnose PE that has gained increasing popularity in recent years is intravaginal ejaculation latency time (IELT; Porst et al., 2007; Waldinger, Zwinderman, Olivier, & Schweitzer, 2005), although many still advocate the use of other indicators, such as subjective experience of PE and ejaculatory control, in PE definition and diagnosis (Hellstrom, 2007). In addition, there is some evidence that subjective indicators of PE are more reliable predictors of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev. [DSM-IV-TR]; American Psychiatric Association, 2000) criteria of PE than IELT (Rosen et al., 2007). Although subjective measures (such as experience of control over one's ejaculation, subjective experience of PE, experiencing distress, and worrying about one's ejaculatory performance) are significantly associated with objective measures (such as IELT and the number of penile thrusts before ejaculation), different indicators of PE are surprisingly poorly intercorrelated (Jern et al., 2008; Patrick, Rowland, & Rothman, 2007; Rowland, Strassberg, de Gouveia Brazao, & Slob, 2000), with correlation coefficients ranging from .01 to .45 in a population-based study (indicators of subjective nature having the strongest correlations between them; Jern et al., 2008). Patrick et al. (2007) explained the surprisingly weak association between "subjective" and "objective" measures by demonstrating a mediatory effect of a variable measuring perceived ejaculatory control on the association between IELT and PE-related distress. Furthermore, Rowland et al. (2000) noted that the association between IELT and control was variable in different contexts (e.g., depending on the sexual activity and how data are collected). However, it should be noted that ejaculatory control is still rather weakly associated with IELT, with correlations ranging from .26 (Jern et al., 2008) to .37 (Patrick et al., 2007) between studies.
One aspect of ejaculatory functioning that has received relatively little attention is how it varies over time. This is especially true for "normal" ejaculatory functioning and latency because most studies on ejaculatory disorders have been conducted using clinical samples (i.e., PE patients). Commonly employed definitions (such as the one for "lifelong PE" proposed by the International Society of Sexual Medicine [ISSM] work group; McMahon et al., 2008) and diagnostic criteria--such as those presented in the DSM-IV-TR (American Psychiatric Association, 2000)--imply temporal stability and continuity in PE, but there is little available evidence regarding variation in ejaculatory functioning over time and which factors influence such variation. For example, the ISSM definition of "lifelong PE" (McMahon et al., 2008) indeed stipulates that the condition should be ever-present, whereas the DSM-IV-TR (American Psychiatric Association, 2000) diagnostic criteria states that the condition should be "persistent"; thus, both imply long-term stability in PE. Furthermore, Jern, Santtila, Johansson, and Sandnabba (2010) reported that the genetic effects that contribute to causing PE at the first sexual intercourse (around 28% of the total phenotypic variation in PE) are virtually the same as the genetic effects that contribute to PE later in life, suggesting that there is some evidence for long-term stability in PE. Also, indirect evidence for long-term temporal stability is indicated in studies in which PE patients have reported long durations for the dysfunction (e. …