Markers of Prenatal Androgen Exposure Correlate With Online Sexual Compulsivity and Erectile Function in Young Men

Pornography addiction and sexual dysfunction are increasingly prevalent in young men. Previous studies suggest that prenatal androgen exposure plays a role in addiction and sexual functionality. Here, we tested whether lower second-to-fourth finger length ratio (2D:4D) and later age at spermarche, both putative indicators of higher androgen levels in utero, correlate with online sexual compulsivity (OSC scale of ISST), erectile function (IIEF-5), and ejaculatory control (PEPA) in 4,370 young men (age IQR: 25–26 years) of the Cohort Study on Substance Use Risk Factors. Statistical analyses revealed that lower 2D:4D correlated with higher scores on the OSC scale. Moreover, higher age at spermarche correlated with higher OSC scores and decreased erectile function. Interestingly, OSC severity, but not the frequency of pornography use, correlated negatively with erectile function and ejaculatory control. This is the first study to associate two independent proxies of prenatal testosterone level with OSC. These findings provide novel insight into intrauterine predisposition of sexual behavior and related sexual function in adulthood.

Diagnostic Criteria for Premature Ejaculation: Clarifying the Role of “Ejaculatory Control” and “Bother/Distress”

“Ejaculatory control” and “bother/distress” are key criteria for diagnosing men with premature ejaculation (PE), yet compared with ejaculatory latency (EL), these constructs have received only minimal attention. In addition, they have not been characterized in men having different sexual orientations or subtypes of PE. This study aimed to characterize relationships among ejaculatory control, bother/distress, and EL; to assess differences across men having different sexual orientations, PE status, and PE subtypes (i.e., lifelong vs. acquired); and to determine the importance of ejaculatory control to men’s sexual partners. In total, 1071 men and sexual partners of men rated their ejaculatory control and bother/distress and estimated their EL; these measures were compared across sexual orientation, PE status, PE subtype, and male and female partners of men. Results revealed a monotonic though slightly curvilinear relationship between ejaculatory control and bother/distress. These PE criteria differed significantly between PE and non-PE men, to a lesser extent between gay and straight men, and not at all between men having lifelong vs. acquired PE. Female and male partners of men affirmed the importance of ejaculatory control during partnered sex, indicating lack of control as a potential reason for ending a relationship.

Evolving therapeutic strategies for premature ejaculation: The search for on-demand treatment – topical versus systemic

Premature ejaculation (PE) is a common sexual dysfunction affecting20% to 30% of men worldwide. Definitions of PE vary, but itis typically characterized by short intravaginal ejaculatory latencytime (IELT) with concomitant sexual dissatisfaction and distress.PE may be lifelong or acquired, but its etiology remains unclear.Treatment of PE typically involves pharmacotherapy, particularlywhen lifelong. Although there are numerous reports on the offlabeluse of selective serotonin reuptake inhibitors (SSRIs) andother compounds, only 2 treatments have been evaluated in randomizedcontrolled phase 3 clinical trials: PSD502 and dapoxetine(SSRI). Both significantly improved IELT and patient-reportedoutcome domains of ejaculatory control, sexual satisfaction, anddistress as measured by the index of premature ejaculation (IPE),compared with placebo. They constitute the focus of this review.Evidence demonstrated that PSD502, dapoxetine and other SSRIsall significantly improve the symptoms of PE. Systemic use of SSRIspresents risks associated with the known pharmacology of thisclass. PSD502 allows for topical on-demand treatment appliedapplied immediately before intercourse, and is not associated withsystemic adverse events.

Secondary Premature Ejaculation

Secondary premature ejaculation is a definite entity which can be due to a variety of causes — physical, pharmacological and psychological. The sparse literature on this subject is reviewed and a series of 25 cases of diverse and sometimes unusual aetiology reported. The fact that ejaculatory control can be adversely affected by a variety of physical and psychological conditions has implications for theories as to the cause of the much commoner entity of primary premature ejaculation, for which there is still no generally agreed-upon aetiological formulation.