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Reviewed research
Authors Akre C, Berchtold A, Gmel G, & Suris J
Review Date October 2014
Citation Journal of Adolescent Health 2014; DOI: http://dx.doi.org/10.1016/j.jadohealth.2014.05.014 (online)
Background
Premature ejaculation (PE) and erectile dysfunction (ED) are common male sexual dysfunctions. However, very few studies have considered these conditions among younger men; some believe that such conditions only affect older men. The authors of the current paper previously found that 29.9% of 18-25 year old Swiss men report ED and 11.4% report PE. Given the age of these men it is possible that lack of sexual experience may have contributed to this relatively high prevalence and that these conditions may therefore improve over time (with presumably more experience).
Aim
To examine how sexual dysfunction evolves in young men, and to determine the predictive factors for this evolution and the differentiating characteristics between those who continue to report sexual dysfunction and those who do not.
Methods
A prospective cohort study was conducted in two Swiss military recruitment centres (mandatory for all Swiss men aged 18-25 years). Two surveys were administered: a baseline survey and a follow-up 15 months later. The final sample was required to have completed both surveys and to be sexually active; 3700 men met these criteria. The main outcome measures were self-reported PE and ED.
PE and ED were analysed separately using the same method. Independent variables (smoking, alcohol misuse, cannabis use, drug use, medications use, BMI, depression, mental health problem, physical health problem, employment status, number of previous sexual partners, age at first intercourse, age at baseline) were first tested separately with PE and ED using a chi-square test of independence (called bivariate analyses). Any variables that were found to have a significant independent relationship with the outcome variable were then entered into a model together while controlling for age and duration of sexual experience using logistic regression (called multivariate analysis).
Results
Overall, 43.9% of young men who reported PE and 51% of those who reported ED at baseline continued to report it at follow-up. Further, 9.9% developed a PE problem and 14.4% an ED problem within the 15 month timeframe.
Premature ejaculation
Bivariate analyses: There were no significant differences on any of the independent factors for men who had PE at baseline and continued to have it at follow-up.
Those men who did not have PE at baseline but who developed it later were more likely to have started or continue smoking, continued alcohol consumption, and to have started or continue to take medication without prescription compared with those who continued not to have PE after baseline. They were also more likely to develop or to continue to have depression, have poor physical and mental health, be older at their first sexual intercourse, and have less sexual experience.
Multivariate analysis: When compared with men who did not develop PE after baseline, those who did were more likely to have continued using alcohol and to have started taking medication without prescription. They were also more likely to have continued to be depressed, continued having poor mental health or worsened, and continued having poor physical health or worsened. Finally, those with more sexual experience were less likely to report developing PE over the study timeframe.
Erectile dysfunction
Bivariate analyses: Men who had ED at baseline and at follow-up were more likely to have started or continued taking medication without prescription, started or continued to be depressed, have poor mental health, and to be older at first sexual intercourse compared with those who did not have ED anymore at follow-up.
Among those who did not have ED at baseline, those who developed it at follow-up were more likely to have started or ceased use of medication without prescription, developed or continued to have depression, continued to have poor mental health, and increased their number of sexual partners when compared to those who do not have ED at follow-up.
Multivariate model: Men who continued to have ED at follow-up were more likely to have developed or continued to have depression, continued to have poor mental health, and maintained or increased number of sexual partners compared to those who no longer had ED at follow-up.
Those who did not have ED at baseline but who developed it at follow-up were more likely to have continued taking medication without prescription, maintained or developed depression, and maintained or developed a poor mental health state compared to those who did not develop ED.
Conclusion
The findings of this paper suggest that PE and ED are significant problems among young men. While half of the men reported their condition/s to resolve spontaneously over time, it remained for others. The authors suggest that health professionals routinely inquire about sexual dysfunction when taking a psychosocial assessment in young men. They can also reassure them that PE and ED are often associated with sexual inexperience* and, in most cases, will resolve in time.
Points to Note
- This is the first longitudinal study to examine sexual dysfunctions among young men.
- This study aimed to examine the evolution of premature ejaculation and erectile dysfunction among young men, including the factors associated with evolution and the differences among those who and did not report persistent or new symptoms.
- Poor mental health and consumption of medication without prescription were predictive factors for PE and ED. Poor physical health, alcohol consumption, and less sexual experience were predictive factors for PE only. ED persistence was associated with multiple sexual partners.
- *The authors failed to acknowledge that sexual experience is not necessarily increased by number of partners. Men who have been in a long-term relationship where both partners feel more comfortable communicating their sexual needs may also increase how ‘experienced’ they are.
- There is no mention of participants’ sexual identity. As such, it is difficult to know whether such findings apply to young men who do not identify as heterosexual.
- Clinicians should include questions about sexual functioning in their routine psychosocial assessments of young men. They can also assure these men that PE and ED are likely to resolve in time.
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