Guidelines

Sexual and Reproductive Health

4. EPIDEMIOLOGY AND PREVALENCE OF SEXUAL DYSFUNCTION AND DISORDERS OF MALE REPRODUCTIVE HEALTH

4.1. Erectile dysfunction

Epidemiological data have shown a high prevalence and incidence of ED worldwide [185]. Among others, the Massachusetts Male Aging Study (MMAS) [186] reported an overall prevalence of 52% ED in non-institutionalised men aged 40-70 years in the Boston area; specific prevalence for minimal, moderate, and complete ED was 17.2%, 25.2%, and 9.6%, respectively. In the Cologne study of men aged 30-80 years, the prevalence of ED was 19.2%, with a steep age-related increase from 2.3% to 53.4% [187]. The incidence rate of ED (new cases per 1,000 men annually) was 26 in the long-term data from the MMAS study [188] and 19.2 (mean follow-up of 4.2 years) in a Dutch study [189]. In a cross-sectional real-life study among men seeking first medical help for new-onset ED, one in four patients was younger than 40 years, with almost 50% of the young men complaining of severe ED [190]. Differences among these studies can be explained by differences in methodology, ages, and socio-economic and cultural status of the populations studied. The prevalence rates of ED studies are reported in Table 7.

4.2. Premature ejaculation

As evidenced by the highly discrepant prevalence rates reported in Table 8 [191], the method of recruitment for study participation, method of data collection and operational criteria can all greatly affect reported prevalence rates of premature ejaculation (PE). The major problem in assessing the prevalence of PE was the lack of a universally recognised definition at the time the surveys were conducted [192]. Vague definitions without specific operational criteria, different manners of sampling, and non-standardised data acquisition have led to heterogeneity in estimated prevalence [192-196]. The highest prevalence rate of 31% (men aged 18-59 years) was found by the National Health and Social Life Survey (NHSLS), which determines adult sexual behaviour in the USA [197]. Prevalence rates were 30% (18-29 years), 32% (30-39 years), 28% (40-49 years) and 55% (50-59 years). It is, however, unlikely that the PE prevalence is as high as 20-30% based on the relatively low number of men who seek medical help for PE. These high prevalence rates may be a result of the dichotomous scale (yes/no) in a single question asking if ejaculation occurred too early, as the prevalence rates in European studies have been significantly lower [198]. Two separate observational, cross-sectional surveys from different continents found that overall prevalence of PE was 19.8 and 25.8%, respectively [199,200]. Further stratifying these complaints into the classifications defined by Waldinger et al. [201], rates of lifelong PE were 2.3 and 3.18%, acquired PE 3.9 and 4.48%, variable PE 8.5 and 11.38% and subjective PE 5.1 and 6.4% [199,200]. Both studies showed that men with acquired PE were more likely to seek treatment compared to men with lifelong PE. Treatment-seeking behaviour may have contributed to errors in the previously reported rates of PE, as it is possible that men with lifelong PE came to terms with their problem and did not seek treatment. The additional psychological burden of a new change in ejaculatory latency in acquired PE may have prompted more frequent treatment seeking [202]. Thus, it is likely that there is disparity between the incidence of the various PE sub-types in the general community and in men actively seeking treatment for PE [203,204]. This disparity could be a further barrier to understanding the true incidence of each sub-type of PE. An approximately 5% prevalence of acquired PE and lifelong PE in the general population is consistent with epidemiological data indicating that around 5% of the population have an ejaculation latency of < 2 minutes [205].

4.3. Other ejaculatory disorders

4.3.1. Delayed ejaculation

Due to its rarity and uncertain definitions, the epidemiology of delayed ejaculation (DE) is not clear [206]. However, several well-designed epidemiological studies have revealed that its prevalence is around 3% among sexually active men [197,207]. According to data from the NHSLS, 7.78% of a national probability sample of 1,246 men aged 18-59 years reported inability achieving climax or ejaculation [197]. In a similar stratified national probability sample survey completed over 6 months among 11,161 men and women aged 16-44 years in Britain, 0.7% of men reported inability to reach orgasm [208]. In an international survey of sexual problems among 13,618 men aged 40–80 years from 29 countries, 1.1-2.8% of men reported that they frequently experience inability to reach orgasm [209]. Another study conducted in the United States (USA), in a national probability sample of 1,455 men aged 57-85 years, 20% of men reported inability to climax and 73% reported that they were bothered by this problem. [210]. Considering the findings of these epidemiological studies and their clinical experiences, some urologists and sex therapists have postulated that the prevalence of DE may be higher among older men [211-213]. Similar to the general population, the prevalence of men with DE is low among patients who seek treatment for their sexual problems. An Indian study that evaluated the data on 1,000 consecutive patients with sexual disorders who attended a psychosexual clinic demonstrated that the prevalence of DE was 0.6% and it was more frequent in elderly people with diabetes [214]. Nazareth et al. [215] evaluated the prevalence of International Classification of Diseases 10th edition (ICD-10) diagnosed sexual dysfunctions among 447 men attending 13 general practices in London, UK and found that 2.5% of the men reported inhibited orgasm during intercourse. Similar to PE, there are distinctions among lifelong, acquired and situational DE [216]. Although the evidence is limited, the prevalence of lifelong and acquired DE is estimated at 1 and 4%, respectively [217].

4.3.2. Anejaculation and Anorgasmia

Establishing the exact prevalence of anejaculation and anorgasmia is difficult since many men cannot distinguish between ejaculation and orgasm. The rarity of these clinical conditions further hampers the attempts to conduct epidemiological studies. In a report from the USA, 8% of men reported unsuccessfully achieving orgasm during the past year [197].

According to Kinsey et al. [218], 0.14% of the general population have anejaculation. The most common causes of anejaculation were spinal cord injury, diabetes mellitus and multiple sclerosis. Especially in most cases of spinal cord injury, medical assistance is the only way to ejaculate. While masturbation leads to the lowest rates of ejaculation, higher response rates can be obtained with penile vibratory stimulation or acetylcholine esterase inhibitors followed by masturbation in patients with spinal cord injury [219].

4.3.3. Retrograde ejaculation

Similar to anejaculation, it is difficult to estimate the true incidence of retrograde ejaculation (RE). Although RE is generally reported in 0.3-2% of patients attending fertility clinics [220], diabetes may increase these rates by leading to autonomic neuropathy. Autonomic neuropathy results in ED and ejaculatory dysfunctions ranging from DE to RE and anejaculation, depending on the degree of sympathetic autonomic neuropathy involved [221]. In 54 diabetic patients with sexual dysfunction, RE was observed with a 6% incidence [222]. In a controlled trial, RE was observed in 34.6% of diabetic men [223]. A more recent trial reported the rate of RE among 57 type-1-diabetes mellitus patients (aged 18-50 years) was at least 8.8% [224]. Retrograde ejaculation was also reported in studies of patients who had undergone transurethral resection of prostate (TURP) or open prostatectomy due to disrupted bladder neck integrity. A study of the effect of prostatectomy on QoL in 5,276 men after TURP, found that 68% reported post-surgical RE [225]. However, with the development of less invasive techniques, the incidence of RE decreases following the surgical treatment of LUTS [226-230].

4.3.4. Painful ejaculation

Painful ejaculation is a common but poorly understood clinical phenomenon, which is associated with sexual dysfunction. Several studies demonstrated its prevalence to range between 1-10% in the general population [231-233]; however, it may increase to 30-75% among men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) [234-238]. It should be noted that the design of most of these studies was not scientifically sound and the condition was probably under-reported due to the lack of an evidence-based definition and well-defined prognostic criteria.

4.3.5. Haemospermia

The exact incidence and prevalence of haemospermia are difficult to elucidate due to a number of factors including its covert presentation, usually self-limiting nature and patient embarrassment. The symptom represents 1-1.5% of all urological referrals and occurs in all age groups, with a mean age of 37 years [239,240]. In a PCa screening study of 26,126 men, aged > 50 years or older than 40 with a history of PCa or of black ethnicity, haemospermia was found in 0.5% on entry to the trial [241].

4.4. Low sexual desire

The global prevalence of low sexual desire in men is 3-28% [209,242,243]. Low solitary and dyadic sexual desires, have been reported in 68% and 14% of men, respectively [244]. Also, low sexual desire has been observed as a common complaint in gay men, with a prevalence of 19-57% [245,246]. Despite its relationship with age, low sexual desire has been reported among young men (18-29 years), with prevalence of 6-19% [197,247,248].

Table 7: Prevalence rates of erectile dysfunction [185]

Date

Authors

Population

Response
rate

Age
(years)

Measurement
technique

Principal 
findings

Correlates

1993

Solstad
et al.
[249]

439 men; random population sample (Denmark)

81%

51

Interview and self- administered questionnaire

Overall, 4% of men had ED as assessed by questionnaire, interviews identified a higher frequency of
ED (40%)

Not reported

1994

Feldman
et al. [186]

*MMAS

1,290 men; random population sample
(United States)

40%

40-70

Self-administered questionnaire

Overall, 52% of men had ED

17.2% of men had minimal ED

25.2% of men had moderate ED

9.6% of men had complete ED

Age

1995

Panser et al. [250]

2,155 men; random population sample
(United States)

55%

40-79

Self-administered questionnaire

1% ED in men aged 40-49 years

6% ED in men aged 50-59 years

22% ED in men aged 60-69 years

44% ED in men aged 70-79 years


1996

Helgason
et al. [251]

319 men; random population sample (Sweden)

73%

50-80

Self-administered questionnaire

3% ED in men aged 50–59 years

24% ED in men aged 60–69 years

49% ED in men aged 70–80 years

Age, Prostate cancer, Diabetes, Myocardial infarction, Diuretic use, Warfarin use, H2 receptor blocker use

1996

MacFarlane et al. [252]

1,734 men; random population sample (France)

86%

50-80

Self-administered questionnaire

20% ED in men aged 50–59 years

33% ED in men aged 60–69 years

38% ED in men aged 70–80 years

Age

1996

Fugl-Meyer [242]

1,288 men; random population sample men (Sweden)

52%

18-74

Structured interview

Overall, 5% of men had ED

3% ED in men aged 18–24 years

2% ED in men aged 25–34 years

2% ED in men aged 35–49 years

7% ED in men aged 50–65 years

24% ED in men aged 66–74 years

Age

1999

Laumann
et al. [197]

*NHSLS

1,244 men; random population sample
(United States)

70%

18-59

Structured interview

Overall, 10% of men had ED (moderate plus severe)

7% ED in men aged 18–29 years

9% ED in men aged 30–39 years

11% ED in men aged 40–49 years

18% ED in men aged 50–59 years

Age, Race, Emotional stress, Urinary symptoms, Poor health, Low income

1999

Pinnock
et al. [253]

427 men; random

population sample

(Australia)

69.8%

> 40

Self-administered questionnaire

6% ED in men aged 40–49 years

12% ED in men aged 50–59 years

41% ED in men aged 60–69 years

63% ED in men aged 70–79 years

81% ED in men aged 80+ years

Age, Hyper-cholesterolemia,

2000

Braun
et al. [187] (COLOGNE Study)

8,000 men

56%

30-80

Self-administered questionnaire by mail

(Cologne ED Questionnaire)

Prevalence of ED was 19.2%

Age, Hypertension, Diabetes, Pelvic surgery, LUTS

2001

Moreira
et al. [254]

1,170 men;

attending public places (heavy bias toward younger men)

(Brazil)

91%

>18

Self-administered questionnaire

Overall, 14.7% of men had ED (moderate plus severe);

9.4% ED in men aged 18–39 years

15.5% ED in men aged 40–49 years

22.1% ED in men aged 50–59 years

37% ED in men aged 60–69 years

39.6% ED in men aged >70 years

Age, Education, Racial origin, Diabetes, Hypertension, Depression

2001

Meuleman et al. [255]

1,233 men; random population sample (the Netherlands)

70%

40-79

Self-administered questionnaire

Overall, 13% of men had ED

6% ED in men aged 40–49 years

9% ED in men aged 50–59 years

22% ED in men aged 60–69 years

38% ED in men aged 70–79 years

Age

2001

Blanker
et al.
[232,256]

1,688 men; random population sample (the Netherlands)

50%

50-75

Self-administered questionnaire

3% ED in men aged 50–54 years

5% ED in men aged 55–59 years

11% ED in men aged 60–64 years

19% ED in men aged 65–69 years

26% ED in men aged 70–78 years

Age, Smoking, Obesity, LUTS, COPD, Treatment for CV disease

2001

Martin- Morales
et al. [257]

2,476 men; random population sample (Spain)

75%

25-70

Self-administered questionnaire and single question

Overall, 12.1% of men had ED (single question) and 18.9% for questionnaire

According to single question:

3.9% ED in men aged 25–39 years

6.3% ED in men aged 40–49 years

15.9% ED in men aged 50–59 years

32.2% ED in men aged 60–70 years

IIEF identified milder ED, and single question identified more moderate and severe ED

Age, Hypertension, Diabetes, Cardiac disease, Pulmonary disease, Circulatory disease, Rheumatic disease, High cholesterol, Prostatic disease, Allergy,

Medication “for nerves”, Sleeping tablets, Heavy smoking, Alcohol abuse

2002

Moreira

et al. [258]

602 men; random population sample (Brazil)

92%

40-70

Interview

Overall, 14.4% of men had ED (moderate or severe)

9.9% ED in men aged 40–49 years

11.8% ED in men aged 50–59 years

31.7% ED in men aged 60–69 years

Age, Marital
status, Diabetes,

Depression, IPSS, Decreased physical activity

2002

Moreira

et al. [258]

342 men; random population sample (Brazil)

47.6%

40-70

Self-administered questionnaire

Overall, 12.0% of men had ED (moderate or severe)

3.5% ED in men aged 40–49 years

16.7% ED in men aged 50–59 years

39.6% ED in men aged 60–69 years

Age, Diabetes, Hypertension, Heavy smoking

2002

Morillo et al. [259]

1,963 men; random population sample (Columbia, Venezuela and Ecuador)

82%

> 40

Standardised questionnaire

Overall, 19.8% of men had ED (moderate or severe)

Age, Diabetes, Hypertension, BPH

2003

Richters

et al. [260]

8,517 men; random population sample (Australia)

69.4%

16-59

Computer-assisted telephone interview

Overall, 9.5% of men had ED

4.3% ED in men aged 16–19 years

4.5% ED in men aged 20–29 years

5.1% ED in men aged 30–39 years

12.5% ED in men aged 40–49 years

19.2% ED in men aged 50–59 years

Age

2003

Rosen et al. [261]

12,815 men; random population sample (multinational: United States, United Kingdom, France, Germany, the Netherlands, Italy, Spain)

36.8%

50-80

Self-administered questionnaire (IIEF and DAN-PSS)

According to DAN-PSS: Overall, 48.9% of men had ED

30.8% ED in men aged 50-59 years

55.1% ED in men aged 60-69 years

76% ED in men aged 70-80 years

Age, LUTS, Diabetes, Hypertension, Cardiac disease, Hyperlipidemia, Tobacco use

2004

Rosen et al. [262]

*MALES

27,839 men random population sample (multinational: United States, United Kingdom, Germany, France, Italy, Spain, Mexico, and Brazil)

US: 45%; UK: 48%; Germany: 45%; France: 48%; Italy: 53%; Spain: 50%; Mexico: 55% and Brazil: 51%.

20-75

Random digit dialing and interviewed via computer-assisted telephone interviewing. A standardised questionnaire

Overall prevalence
of ED in the MALES sample was 16%

Age, Hypertension, Heart trouble or angina, High cholesterol, Diabetes, Depression or anxiety

2004

Shiri et al. [263]

2,198 men; stratified birth cohort (Finland)

70%

50,60, and 70 at first survey 55, 65, and 75 at second survey

Self-administered questionnaire at two separate time points,

5 years apart

48% of men had minimal ED

15.2% of men had moderate ED

13.2% of men had complete ED

Age, Diabetes, Hypertension, Heart disease, Cerebrovascular disease,Smoking

2005

Laumann

et al. [209]

*GSSAB

13,750 men; random population sample (world)

19%

40-80

Telephone survey (random dialed digit)

Overall:

In Northern Europe, 13.3% had ED

In Southern Europe, 12.9% had ED

In non-European West,

20.6% had ED

In Central/South America,

13.7% had ED

In Middle East, 14.1% had ED

In East Asia,

13.3% had ED

In Southeast Asia, 28.1% had ED

Age

2005

Moreira

et al. [264]

750 men; random population sample (Spain)

23%

40-80

Telephone survey (random digit dialing)

Overall, 12.7% had ED

Age

2005

Moreira

et al. [265]

750 men; random population sample (Germany)

17.4%

40-80

Telephone survey (random digit dialing)

Overall, 7.9% had ED

Age

2005

Moreira Junior et al. [265]

471 men; random population sample (Brazil)

18%

40-80

Telephone survey (random digit dialing)

Overall, 13.1% of men had ED

Age, Depression

2006

Brock et al. [266]

500 men; random population sample (Canada)

9.7%

40-80

Telephone survey (random digit dialing)

Overall, 16% of men had ED

Age, Depression, Diabetes

2007

De Almeida Claro et al. [267]

2,000 men; random population study (Brazil)

Not reported

>20

Standardised interview with self-reported questionnaire (IIEF)

Overall, 1.7% of men had ED

0.2% ED in men aged 20-30 years

0.22% ED in men aged 31-40 years

1.0% ED in men aged 41-50 years

2.8% ED in men aged 51-60 years

7.0% ED in men aged > 61 years

Age

2007

Ahn et al. [268]

1,570 men; geographically stratified random population study

Not reported

40-79

Self-administered questionnaire (IIEF-5)

Overall, 13.4% had self-reported ED ED prevalence as defined by IIEF-5 score less than 17 was 32.4%

According to single question:

4.2% ED in men aged 40-49 years

13.0% ED in men aged 50-59 years

30.1% ED in men aged 60-69 years

41.1% ED in men aged 70-79 years

Age, Single status, Low income, Diabetes, Hypertension, Hyperlipidemia, Heart disease, Musculoskeletal disorders, Alcohol, Depression, Coffee intake

2008

Moreira

et al. [269]

750 men; random population sample (Australia)

16.9%

40-80

Telephone survey (random digit dialing)

Overall, 32% of men had ED

Age

2008

Chew et al. [270]

1,580 men; random population sample (Australia)

37.3%

>20

Postal survey Self-administered questionnaire (IIEF-5)

15.7% ED in men aged 20-29 years

8.7% ED in men aged 30-39 years

12.9% ED in men aged 40-49 years

31.6% ED in men aged 50-59 years

52.4% ED in men aged 60-69 years

69.4% ED in men aged 70-79 years

68.2% ED in men aged > 80 years

Age, Marital status

2008

Teles et al. [271]

3,067 men; random population sample (Portugal)

81.3%

40-69

Self-administered questionnaire, including IIEF

Overall, 48.1% of men had ED

29% ED in men aged 40-49 years

50% ED in men aged 50-59 years

74% ED in men aged 60-69 years

Age, Diabetes, Cardiac insufficiency, Psychiatric illness

2008

Moreira

et al. [272]

750 men; random population sample (United Kingdom)

17%

40-80

Telephone survey (random digit dialing)

Overall, 17.8% of men had ED

Age

2009

Laumann

et al. [273]

742 men; random population sample (United States)

9%

40-80

Telephone survey (random digit dialing)

Overall, 22.5% of men had ED

Age, Depression

2009

Buvat et al. [274]

750 men; random population sample (France)

23.8%

40-80

Telephone survey (random digit dialing)

Overall, 15% of men had ED

Age

2010

Corona

et al. [275]

3,369 men; random population study (Europe: Italy, Belgium, United Kingdom, Spain, Poland, Hungary, Estonia)

40%

40-80

Self-administered questionnaire

Overall, 30% of men had ED

6% ED in men aged 40-49 years

19% ED in men aged 50-59 years

38% ED in men aged 60-69 years

64% ED in men 70 and over

Age, Depression, LUTS, Cardiovascular disease, Diabetes, Obesity

2016

Oyelade

et al. [276]

241 men; random sampling cross-sectional population based survey (Nigeria)

99%

30-80

Self-administered questionnaire (IIEF-5)

General prevalence of ED was 58.9%

Age, Hypertension, Use of anti-hypertensive drugs, Diabetes mellitus, Heart disease

2017

Cayan et al. [277]

2,760 men; random population study (Turkey)

Non-reported

> 40

Self-administered questionnaire (IIEF-5)

Prevalence of ED was calculated as 33% among all men aged > 40 years.

ED prevalence

rates were

17% for 40-49

years,

35.5% for 50-59 years,

68.8% for 60-69 years, and

82.9% for > 70 years

Age, Diabetes, Hypertension,

Atherosclerosis, Dyslipidaemia, LUTS, Educational status, Monthly income

2017

Quilter et al. [278]

Randomly selected age-stratified population-based sample of 2,000 men (New Zealand)

30%

40-70

Self-reported erectile function (IIEF-5) and a single-question self-assessment tool.

Prevalence of ED was 42% (22% mild, 10% mild to moderate, 6% moderate, and 4% severe)

Age, Anxiety or depression

2021

Calzo et al. [279]

2,660 sexually active men (USA)

Not reported

18-31

Self-administered questionnaire (IIEF-5)

Prevalence of mild ED was 11.3% and moderate-to-severe ED was 2.9%

Demographic (age; marital status)

Metabolic (body mass index; waist circumference; history of diabetes, hypertension, hyperch

olesterolaemia)

Mental health (depression, anxiety, antidepressant, tranquiliser use)

2020

Goldstein

et al. [280]

97,159 men from the 2015 and 2016 National Health and Wellness Surveys (Italy, France, China, Spain, Germany, US, UK, Brazil)

Not reported

> 18

Self-reported experiencing difficulty in achieving or maintaining an erection in the past 6 months

(Erection difficulty was rated on a scale from 1= not at all to 5 = a great deal; those who selected a

response of > 2 were categorised as having ED and included in

the study)

Prevalence of ED by country among adult

males

Age/BPH

> 18

40-70

Italy = 48.6%

France = 44.9%

Germany = 44.9%

Spain = 43.5%

UK = 42.6%

US = 42%

China = 41.6%

Brazil = 37.2%

Italy = 52.2%

France = 47.8%

China = 47.4%

Spain = 46.6% Germany = 46.1%

US = 46.1%

UK = 42.6%

Brazil = 42.1%

2020

Molina-Vega et al. [281]

254 young non-diabetic obese men

Not reported

18-49

Self-administered questionnaire (IIEF-5)

Prevalence of ED was 42.1%

Age, components of metabolic syndrome

Four baseline studies estimating the prevalence of Erectile Dysfunction:

MMAS = the Massachusetts Male Aging Study; NHSLS = the National Health of Social Life Survey;

MALES = the multi-national men’s attitudes to life events and sexuality; GSSAB = Global Study of Sexual Attitudes and Behaviours.

BPH = Benign Prostate Hyperplasia; COPD = Chronic Obstructive Pulmonary Disease; ED = Erectile Dysfunction; IIEF = International Index of Erectile Function; IPSS = International Prostate Symptom Score; LUTS = Lower urinary tract symptoms.

Table 8: The prevalence rates of premature ejaculation [191]

Date

Authors

Method of 
Data 
Collection

Method of
Recruitment

Operational 
Criteria

Prevalence 
Rate

Number 
of Men

1998

Dunn et al. [282]

Mail

General practice registers - random stratification

Having difficulty with ejaculating prematurely

14% (past 3 mo)

617

31% (lifetime)

618

1999

Laumann et al. (NHSLS) [197]

Interview

NA

Climaxing/ejaculating too rapidly during the past 12 months

31%

1,410

2002

Fugl-Meyer and Fugl-Meyer [283]

Interview

Population register

NA

9%

1,475

2004

Rowland et al. [284]

Mailed questionnaire

Internet panel

DSM IV

16.3%

1,158

2004

Nolazco et al. [285]

Interview

Invitation to outpatient clinic

Ejaculating fast or prematurely

28.3%

2,456

2005

Laumann et al. [209]

Telephone-personal interview/mailed questionnaires

Random (systematic) sampling

Reaching climax too quickly during the past 12 months

23.75%

(4.26% frequently)

13,618

2005

Basile Fasolo et al. [286]

Clinician-based

Invitation to outpatient clinic

DSM IV

21.2%

12,558

2005

Stulhofer et al. [287]

Interview

Stratified sampling

Often ejaculating in less than < 2 minutes

9.5%

601

2007

Porst et al. (PEPA) [198]

Web-based survey

Self-report

Internet panel

Control over ejaculation,

distress

22.7%

12,133

2008

Shindel et al. [288]

Questionnaire

Male partners of infertile couples under evaluation

Self-report premature ejaculation

50%

73

2009

Brock et al. [289]

telephone interview

Web-based survey

DSM III

16%

3,816

Control

26%

Distress

27%

2010

Traeen and Stigum [248]

Mailed questionnaire + internet

Web interview + Randomisation


27%

11,746 + 1,671

2010

Son et al. [290]

Questionnaire

Internet panel
(age < 60 years)

DSM IV

18.3%

600

2010

Amidu et al. [291]

Questionnaire

NA

NA

64.7%

255

2010

Liang et al. [292]

NA

NA

ISSM

15.3%

1,127

2010

Park et al. [293]

Mailed questionnaire

Stratified sampling

Suffering from PE

27.5%

2,037

2010

Vakalopoulos et al. [294]

One-on-one survey

Population-based cohort

EED

58.43%

522

ISSM lifelong PE

17.7%

2010

Hirshfeld et al. [245]

Web-based survey

Online advertisement in the United States and Canada

Climaxing/ ejaculating too rapidly during the past 12 months

34%

7,001

2011

Christensen et al. [295]

Interview + questionnaire

Population register (random)

NA

7%

5,552

2011

Serefoglu et al. [199]

Interview

Stratified sampling

Complaining about ejaculating prematurely

20.0%

2,593

2011

Son et al. [296]

Questionnaire

Internet panel

Estimated IELT < 5 mins, inability to control ejaculation, distress

10.5%

334

2011

Tang and Khoo [297]

Interview

Primary care setting

PEDT > 9

40.6%

207

2012

Mialon et al. [298]

Mailed questionnaire

Convenience sampling (age 18-25 years)

Control over ejaculation

Distress

11.4%

2,507

2012

Shaeer and Shaeer [299]

Web-based survey

Online advertisement in Arabic countries

Ejaculate before the person wishes to ejaculate at least sometimes

83.7%

804

2012

Shindel et al. [300]

Web-based survey

Online advertisement targeted to MSM + distribution of invitation to organisations catering to MSM

PEDT > 9

8-12%

1,769

2012

McMahon et al. [301]

Computer assisted interviewing, online, or in-person self-completed

NA

PEDT > 11

16%

4,997

Self-Reported (always/nearly-always)

13%

2012

Lotti et al. [302]

Interview

Men seeking medical care for infertility

PEDT > 9

15.6%

244

2013

Zhang et al. [303]

Interview

Random stratified sample of married men aged 30-60

Self-reported premature ejaculation

4.7%

728

2013

Lee et al. [304]

Interview

Stratified random sampling

PEDT > 11

11.3%

2,081

Self-Reported

19.5%

IELT<1 min

3%

1,035

2013

Gao et al. [200]

Interview

Random stratified sample of monogamous heterosexual men in China

Self-reported premature ejaculation

25.8%

3,016

2013

Hwang et al. [305]

Survey of married couples

Married heterosexual couples in Korea

Estimated IELT
< 2 minutes

21.7%

290

PEDT > 11

12.1%

2013

Vansintejan et al. [306]

Web Based survey

Online and flyer advertisements to Belgian men who have sex with men (Only HIV+ men in this study)

IPE score < 50% of total possible

4%

72

2013

Shaeer et al. [307]

Web Based survey

Targeting English-speaking men aged > 18 years, living most of their lives in the USA, regardless of personal interests and web browsing preferences

ISSM definition [179]

6.3%

1133

PEDT

49.6%

Unfiltered self-reported

77.6%

Filtered self-reported

14.4%

2016

Karabakan [308]

Interview (heavy bias toward younger men)

Targeting police academy students aged 24-30 years who applied for routine urological examination

PEDT > 10

9.2%

1000

2017

Gao et al. [309]

Field survey with face-to-face interviews

Comprising men aged 20-68 years in five cities in the Anhui province

Self-estimated IELT

Lifelong PE 10.98%

1239


DMS = Diagnostic and Statistical Manual of Mental Disorders; NA = not applicable; ISSM = International Society for Sexual Medicine; PEDT = Premature Ejaculation Diagnostic Tool; IELT = intravaginal ejaculatory latency time; IPE = Index of Premature Ejaculation; mo = months.