Are some forms of delayed/inhibited ejaculation more intractable than others? Establishing delayed ejaculation subtypes based on severity of symptomology during partnered sex and masturbation.

Abstract

Background: Men with delayed ejaculation (DE) do not represent a homogenous group, yet only a handful of studies have investigated the subtypes, etiology, and significant covariates of this sexual dysfunction.

Aim: To identify differences in sexual functioning/responsivity and sexual behavior between DE subtypes characterized by men who experience symptomology during both partnered sex and masturbation (DE-ALLSEX group) vs men who experience symptomology only during partnered sex (DE-PARTSEX group).

Method: After categorizing men into subtypes, groups were compared on variables related to demographics, sexual history, sexual response and functioning, preferred sexual activities during partnered sex and masturbation, and perceived causes of/attributions for their DE problem. Using logistic regression, a set of non-collinear differentiating variables was then used to predict DE-ALLSEX vs DE-PARTSEX group membership.

Results: Relative to the DE-PARTSEX group, higher age, higher medication use, having multiple partners, and lower affinity for and pleasure during masturbatory activity predicted DE-ALLSEX group membership. Lower perceived penile sensitivity during masturbation, greater engagement in insertive anal intercourse, and perceived insufficient levels of masturbatory arousal also characterized this group. The strongest predictors of group membership were age and capacity to reach/frequency of orgasm during masturbation, with arousal level during masturbation and likelihood of engaging in penetrative anal sex also distinguishing between the two groups.

Clinical translation: Although the relationship between masturbation activities and subtype membership is most likely bidirectional, the pervasiveness of masturbation activities as group-differentiating factors suggests avenues of clinical exploration in men presenting with DE symptomology.

Strengths and limitations: This is the first study to attempt to understand and differentiate DE-ALLSEX and DE-PARTSEX subgroups, with a number of factors emerging as significant. However, cause-effect relationships between covariates and group membership remain elusive, and a larger sample size would have enabled investigation of a select group of DE men having only the most severe symptomology.

Conclusion: Factors related to more pervasive problems with DE that affect ejaculatory capacity during both partnered and solo sex include medical, relational, arousal-related, and behavioral (masturbation and partnered sex) variables. Such factors represent potential discussion points during intake and treatment for men experiencing problems reaching ejaculation.