Erectile dysfunction and premature ejaculation: a continuum movens supporting couple sexual dysfunction

Abstract

Purpose: The specific underlying mechanisms supporting the association between erectile dysfunction (ED) and premature ejaculation (PE) are still not completely clarified. To summarize and discuss all available data supporting the relationship between PE and ED.

Methods: A comprehensive narrative review was performed. In addition, to better clarify the specific factors underlining ED and PE, a meta-analytic approach of the selected evidence was also performed. In particular, the meta-analytic method was selected in order to minimize possible sources of bias derived from a personal interpretation of the data.

Results: Current data confirm the close association between ED and PE and the bidirectional nature of their relationship. In particular, PE was associated with a fourfold increased risk of ED independently of the definition used. In addition, the risk increased in older patients and in those with lower education, and it was associated with higher anxiety and depressive symptoms. Conversely, ED-related PE was characterized by lower associations with organic parameters such as diabetes mellitus, arterial hypertension, dyslipidemia and with smoking habit. Finally, when ED was defined according to the International Index of Erectile Function questionnaire, the presence of a stable relationship increased the risk.

Conclusions: ED and PE should be considered in a dimensional prospective way considering the possibility that both clinical entities can overlap and influence each. Correctly recognizing the underlying factors and sexual complaint can help the clinician in deciding the more appropriate diagnostic and therapeutic work-up.

Keywords: Couple; Erectile dysfunction; PDE5i; Premature ejaculation; Sexual desire.

Fig. 1

Odds ratio (95% CI) for erectile dysfunction (ED)-related to premature ejaculation (PE)

Fig. 2

Influence of age (A), smoking habit (B), education (C), anxiety (D) and depressive (E) symptoms, diabetes mellitus (F), hypertension (G), dyslipidaemia (H) and prevalence of acquired premature ejaculation (I; PE) on PE-related risk of erectile dysfunction (ED). The size of the circles reflects the sample dimension

Fig. 2

Influence of age (A), smoking habit (B), education (C), anxiety (D) and depressive (E) symptoms, diabetes mellitus (F), hypertension (G), dyslipidaemia (H) and prevalence of acquired premature ejaculation (I; PE) on PE-related risk of erectile dysfunction (ED). The size of the circles reflects the sample dimension

Fig. 2

Influence of age (A), smoking habit (B), education (C), anxiety (D) and depressive (E) symptoms, diabetes mellitus (F), hypertension (G), dyslipidaemia (H) and prevalence of acquired premature ejaculation (I; PE) on PE-related risk of erectile dysfunction (ED). The size of the circles reflects the sample dimension

Fig. 3

Effect size (with 95%CI) of erectile function component (including studies using International Index of Erectile Function (IIEF)-erectile function domain or IIEF-5 score as possible outcome) in subjects with or without premature ejaculation (PE)

Fig. 4

Mean (with 95%CI) score on International Index of Erectile Function (IIEF) domains in subjects with or without premature ejaculation (PE). Total IIEF-15 score has been reported as standardized mean (with 95%CI) for graphical purposes. Diff, differences; LL, lower limits; UP, upper limits

Fig. 5

Mean (with 95%CI) Intravaginal ejaculatory latency time (seconds) in men with or without erectile dysfunction (ED)