Patient-reported ejaculatory function and satisfaction in men with lower urinary tract symptoms/benign prostatic hyperplasia

Abstract

This study aimed to investigate perceived ejaculatory function/satisfaction before treatment for lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and to identify associations between specific categories of ejaculatory dysfunctions (EjDs) and LUTS. A total of 1574 treatment-naïve men with LUTS/BPH were included in this study. All patients underwent routine evaluation for LUTS/BPH including the International Index of Erectile Function and a 5-item questionnaire developed to assess ejaculatory volume/force/pain/satisfaction/latency time. Patients who had sexual intercourse over the past 4 weeks were classified as sexually active group. A total of 783 patients were categorized as sexually active group. Decreased ejaculatory volume and force were reported by 53.4% and 55.7% of 783 sexually active men, respectively. There was a strong correlation between ejaculatory volume and force. Ejaculatory pain/discomfort, premature ejaculation (PE), and delayed ejaculation (DE) were reported in 41.0%, 16.3%, and 41.4% of the patients, respectively. Over 40.0% of men without decreased ejaculation volume/force were satisfied with ejaculatory function, whereas approximately 6.0% of men with decreased volume/force were satisfied with ejaculatory function. About 30.0% of men with decreased volume/force had orgasmic dysfunction, while approximately 10.0% of men without decreased volume/force did. Decreased ejaculatory volume or force was associated with LUTS severity after adjusting for other influential factors including testosterone level, erectile function, and prostate size on ultrasonography, but PE or DE or ejaculatory pain/discomfort was not. In conclusion, a considerable portion of men with LUTS/BPH appear to have a variety of EjDs. Ejaculatory volume/force and satisfaction/orgasm do not always appear to be concordant. Ejaculatory volume or force is independently associated with LUTS severity, whereas PE or DE or ejaculatory pain/discomfort is not.

Figure 1

Distribution of (a) perceived ejaculatory volume, (b) ejaculatory force, (c) DoP during ejaculation, (d) degree of ejaculatory satisfaction and (e) ejaculatory latency time, according to the EjQ questionnaire. EjQ: ejaculation questionnaire; DoP: pain or discomfort.

Figure 2

Perceived ejaculatory satisfaction (a) in men whose ejaculatory volume was decreased (EjQ1 of 1 or 2), (b) in those whose ejaculatory volume was not decreased (EjQ1 of ≥3), (c) in those whose ejaculatory force was decreased (EjQ2 of 1 or 2), and (d) in those whose ejaculatory force was not decreased (EjQ2 of ≥3), according to the EjQ4 scores.