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Do the diagnostic criteria for premature ejaculation apply to non-straight men and to sexual activities other than penile–vaginal intercourse?


Professional standards committees have generally applied the diagnostic criteria for premature ejaculation only to situations involving (presumed) heterosexual men having penile–vaginal intercourse. This paper reviews the existing evidence supporting expansion of the criteria for use among non-straight men engaging in sexual activities that do not include vaginal intercourse. In brief, estimated ejaculation latencies appear similar across men identifying with different sexual orientations, and various partnered sexual activities (oral, vaginal, and manual) tend to be well correlated. In contrast, masturbation latency patterns are different between men with and without premature ejaculation, and ejaculatory control and bother/distress may be less critical to gay men than straight men during partnered sex. Finally, it should be noted that existing patient report outcomes (PROs) require modification for use with non-straight men.

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  1. 1.

    McMahon CG, Althof SE, Waldinger MD, Porst H, Dean J, Sharlip ID, et al. 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. J Sex Med. 2008;5:1590–606.

    Article  Google Scholar 

  2. 2.

    American Urological Association. Disorders of ejaculation: an AUA /SMSNA guideline. Baltimore, Maryland, USA: American Urological Association; 2020.

  3. 3.

    American Psychiatric Association. The diagnostic and statistical manual of mental disorders (DSM-V). 5th ed. Washington, DC: American Psychiatric Association; 2013.

  4. 4.

    International Classification of Diseases 11th Revision (ICD-11). Definition of male early ejaculation. Geneva, Switzerland: ICD-11; 2018.

  5. 5.

    Peixoto M, Nobre P. Prevalence of sexual problems and associated distress among lesbian and heterosexual women. J Sex Marital Ther. 2015;41:427–39.

    Article  PubMed  Google Scholar 

  6. 6.

    Jern P, Santtila P, Johansson A, Alanko K, Salo B, Sandnabba NK. Is there an association between same-sex sexual experience and ejaculatory dysfunction? J Sex Marital Ther. 2010;36:303–12.

    Article  PubMed  Google Scholar 

  7. 7.

    Breyer BN, Smith JF, Eisenberg ML, Ando KA, Rowen TS, Shindel AW. The impact of sexual orientation on sexuality and sexual practices in North American medical students. J Sex Med. 2010;7:2391–400.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Lau JT, Kim JH, Tsui HY. Prevalence and factors of sexual problems in Chinese males and females having sex with the same-sex partner in Hong Kong: a population-based study. Int J Impot Res. 2006;18:130–40.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Bancroft J, Carnes L, Janssen E, Goodrich D, Long JS. Erectile and ejaculatory problems in gay and heterosexual men. Arch Sex Behav. 2005;34:285–97.

    Article  PubMed  Google Scholar 

  10. 10.

    Barbonetti A, D’Andrea S, Cavallo F, Martorella A, Francavilla S, Francavilla F. Erectile dysfunction and premature ejaculation in homosexual and heterosexual men: a systematic review and meta-analysis of comparative studies. J Sex Med. 2019;16:624–32.

    Article  PubMed  Google Scholar 

  11. 11.

    Cote-Leger P, Rowland DL. Estimations of typical, ideal, premature ejaculation, and actual latencies by men and female sexual partners of men during partnered sex. J Sex Med. 2020;17:1448–56.

    Article  Google Scholar 

  12. 12.

    Cote-Leger P, Rowland DL. Diagnostic criteria for premature ejaculation: Clarifying the role of “ejaculatory-control” and “bother/distress”. Sexes. 2020;1:72–86.

    Article  Google Scholar 

  13. 13.

    Rowland DL, Sullivan SL, Hevesi K, Hevesi B. Orgasmic latency and related parameters in women during partnered and masturbatory sex. J Sex Med. 2018;15:1463–71.

    Article  PubMed  Google Scholar 

  14. 14.

    Rowland DL, Kolba TN. Understanding orgasmic difficulty in women. J Sex Med. 2016;13:1246–54.

    Article  PubMed  Google Scholar 

  15. 15.

    Grulich A, de Visser R, Badcock P, Smith A, Heywood W, Richters J, et al. Homosexual experience and recent homosexual encounters: the Second Australian Study of Health and Relationships. Sex Health. 2014;11:439–50.

    Article  Google Scholar 

  16. 16.

    McDonagh LK, Nielsen EJ, McDermott DT, Davies N, Morrison TG. “I want to feel like a full man”: Conceptualizing gay, bisexual, and heterosexual men’s sexual difficulties. J Sex Res. 2018;55:783–801.

    Article  PubMed  Google Scholar 

  17. 17.

    Vanden Broucke H, Everaert K, Peersman W, Claes H, Vanderschueren D, Van Kampen M. Ejaculation latency times and their relationship to penile sensitivity in men with normal sexual function. J Urol. 2007;177:237–40.

    Article  PubMed  Google Scholar 

  18. 18.

    Corty E. Perceived ejaculatory latency and pleasure in different outlets. J Sex Med. 2008;5:2694–702.

    Article  PubMed  Google Scholar 

  19. 19.

    Jern P, Gunst A, Sandqvist F, Sandnabba NK, Santtila P. Using Ecological Momentary Assessment to investigate associations between ejaculatory latency and control in partnered and non-partnered sexual activities. J Sex Res. 2011;48:316–24.

    Article  PubMed  Google Scholar 

  20. 20.

    Strassberg DS, Kelly MP, Carroll C, Kircher JC. The psychophysiological nature of premature ejaculation. Arch Sex Behav. 1987;16:327–36.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Rowland DL, Strassberg DS, de Gouveia Brazao CA, Slob AK. Ejaculatory latency and control in men with premature ejaculation: an analysis across sexual activities using multiple sources of information. J Psychosom Res. 2000;48:69–77.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Horvath Z, Smith BH, Sal D, Hevesi K, Rowland DL. Body image, orgasmic response, and sexual relationship satisfaction: understanding relationships and establishing typologies based on body image satisfaction. Sex Med. 2020;8:740–51.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Pascoal PM, Narciso Ide S, Pereira NM. What is sexual satisfaction? Thematic analysis of lay people’s definitions. J Sex Res. 2014;51:22–30.

    Article  PubMed  Google Scholar 

  24. 24.

    Rowland DL, Hamilton B, Bacys K, Hevesi K. Sexual response differs during partnered sex and masturbation in men with and without sexual dysfunction: implications for treatment. J Sex Med. 2021. In press.

  25. 25.

    Donatucci C. Etiology of ejaculation and pathophysiology of premature ejaculation. J Sex Med. 2006;3 Suppl 4:303–8.

    CAS  Article  Google Scholar 

  26. 26.

    Waldinger M. The pathophysiology of lifelong premature ejaculation. Transl Androl Urol. 2016;5:424–33.

    Article  Google Scholar 

  27. 27.

    Rosen RC, Althof S. Impact of premature ejaculation: the psychological, quality of life, and sexual relationship consequences. J Sex Med. 2008;5:1296–307.

    Article  Google Scholar 

  28. 28.

    Patrick DL, Giuliano F, Ho KF, Gagnon DD, McNulty P, Rothman M. The premature ejaculation profile: validation of self-reported outcome measures for research and practice. BJU Int. 2009;103:358–64.

    Article  Google Scholar 

  29. 29.

    Jern P, Piha J, Santtila P. Validation of three early ejaculation diagnostic tools: a composite measure is accurate and more adequate for diagnosis by updated diagnostic criteria. PLoS ONE. 2013;8:e77676.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Symonds T, Perelman M, Althof S, Giuliano F, Martin M, May K, et al. Development and validation of a premature ejaculation diagnostic tool. Eur Urol. 2007;52:565–73.

    Article  Google Scholar 

  31. 31.

    McDonagh L, Bishop CJ, Brockman M, Morrison T. A systematic review of sexual dysfunction measures for gay men: how do current measures measure up?. J Homosex. 2014;61:781–816.

    Article  PubMed  Google Scholar 

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Conceptualization: DR, literature search: DR, CR, writing: DR, editing: DR, CR, and formatting: CR.

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Correspondence to David L. Rowland.

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The authors declare no competing interests.

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Rowland, D.L., Roberson, C.B. Do the diagnostic criteria for premature ejaculation apply to non-straight men and to sexual activities other than penile–vaginal intercourse?. Int J Impot Res (2021).

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