Interrelationships among measures of premature ejaculation: The central role of perceived control

Introduction. Domains of premature ejaculation (PE) include short intravaginal ejaculatory latency time (IELT), poor perceived control over ejaculation, decreased satisfaction with sexual intercourse, and personal distress and interpersonal difficulty related to ejaculation. How these measures interrelate is unknown. Aim. Here, we evaluated the interrelationships between these PE-specific variables, applying cross-sectional data from a large U.S. observational study of men with PE. Methods. We analyzed data from men with PE identified in a previously reported observational study. PE was diagnosed by experienced clinicians using the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. Main Outcome Measures. Subjects reported their stopwatch-measured IELT, perceived control over ejaculation, satisfaction with sexual intercourse, personal distress related to ejaculation, and interpersonal difficulty related to ejaculation. Relationships between variables were assessed using bivariate correlations, and the strength and significance of direct or indirect effects between variables were evaluated using a form of regression analysis known as path analysis. Results. Bivariate Pearson correlation coefficients for all relationships were significant at the P <= 0.05 level, with the exception of IELT and interpersonal difficulty related to ejaculation. When all variables were included in the model, IELT showed a significant direct effect on perceived control over ejaculation but did not show a significant direct effect on ejaculation-related personal distress or satisfaction with sexual intercourse. Perceived control over ejaculation showed a significant direct effect on both ejaculation-related personal distress and satisfaction with sexual intercourse, which each showed direct effects on interpersonal difficulty related to ejaculation. Conclusions. The patient's perception of control over ejaculation is central to understanding how PE is associated with satisfaction with sexual intercourse and ejaculation-related distress. In contrast, the association of IELT with satisfaction with sexual intercourse and distress related to ejaculation is mediated by perceived control over ejaculation.