Premature ejaculation (PE) is present in up to 30% of men with erectile dysfunction (ED).
To assess the clinical features of men complaining of both ED and PE (ED-PE) as compared to men reporting only ED or PE.
A consecutive series of 4024 men (mean age 51.2 ± 13.2 years) consulting for sexual dysfunction was studied. The population was categorized into ED-only (n = 2767; 68.8%), PE-only (n = 475; 1.8%), and ED-PE (n = 782; 19.4%). Sexual symptoms were evaluated using the structured interviews SIEDY and ANDROTEST. Penile color Doppler ultrasound (PDCU) parameters were also assessed.
When compared to PE alone, ED-PE reported more sexual complaints, including impaired morning erections [OR = 5.8 (4.1; 8.3)], decreased sexual desire [OR = 2.6 (1.8; 3.7)], decreased ejaculate volume [OR = 2.7 (1.8; 4.0)], and reduced frequency of sexual intercourse [OR = 1.4 (1.0; 2.0)]. Conversely, ED-PE and ED-only men had a similar prevalence of sexual symptoms. In ED-PE men, the characteristics of ED were similar to ED-only men, whereas the characteristics of PE were milder than in PE-only men. ED-PE men had a significantly higher prevalence of hypertension, diabetes, and cardiovascular (CV) diseases [OR = 1.8 (1.1; 3.0), 2.7 (1.3; 5.6) and 2.7 (1.1; 6.5), respectively] than PE-only subjects. Moreover, ED-PE men showed worse dynamic peak systolic velocity at PDCU [B = -12.0 (-17.7; -6.2)] and a greater 10-year estimated CV risk [B = 3.8 (2.5; 5.1)] than PE-only patients. Conversely, comorbidities and PDCU parameters were similar in ED-PE and ED-only men.
The present results suggest that men reporting ED and PE should be considered as patients with ED-only, at least at first glance. Consequently, the diagnosis-including the CV risk stratification-and treatment should be primarily focused on the erectile problem.
Erectile dysfunction-PE patients present several similarities with those consulting only for ED, whereas their characteristics are different from PE-only men. In agreement with the guidelines, our results confirm that ED-PE men might be considered (and managed) primarily as patients with ED.
Andrology. 2018 Dec 16 [Epub ahead of print]
G Rastrelli, S Cipriani, G Corona, L Vignozzi, M Maggi
Sexual Medicine and Andrology Unit, Department of Experimental Clinical and Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy.