ORIGINAL RESEARCH—EJACULATION DISORDERS: A Multinational Population Survey of Intravaginal Ejaculation Latency Time



      Intravaginal ejaculation latency time (IELT), defined as the time between the start of vaginal intromission and the start of intravaginal ejaculation, is increasingly used in clinical trials to assess the amount of selective serotonin reuptake inhibitor‐induced ejaculation delay in men with premature ejaculation. Prospectively, stopwatch assessment of IELTs has superior accuracy compared with retrospective questionnaire and spontaneous reported latency. However, the IELT distribution in the general male population has not been previously assessed.


      To determine the stopwatch assessed‐IELT distribution in large random male cohorts of different countries.


      A total of 500 couples were recruited from five countries: the Netherlands, United Kingdom, Spain, Turkey, and the United States. Enrolled men were aged 18 years or older, had a stable heterosexual relationship for at least 6 months, with regular sexual intercourse. The surveyed population were not included or excluded by their ejaculatory status and comorbidities. This survey was performed on a “normal” general population. Sexual events and stopwatch‐timed IELTs during a 4‐week period were recorded, as well as circumcision status and condom use.

      Main Outcome Measures

      The IELT, circumcision status, and condom use.


      The distribution of the IELT in all the five countries was positively skewed, with a median IELT of 5.4 minutes (range, 0.55–44.1 minutes). The median IELT decreased significantly with age, from 6.5 minutes in the 18–30 years group, to 4.3 minutes in the group older than 51 years (P < 0.0001). The median IELT varied between countries, with the median value for Turkey being the lowest, i.e., 3.7 minutes (0.9–30.4 minutes), which was significantly different from each of the other countries. Comparison of circumcised (N = 98) and not‐circumcised (N = 261) men in countries excluding Turkey resulted in median IELT values of 6.7 minutes (0.7–44.1 minutes) in circumcised compared with 6.0 minutes (0.5–37.4 minutes) in not‐circumcised men (not significant). The median IELT value was not affected by condom use.


      The IELT distribution is positively skewed. The overall median value was 5.4 minutes but with differences between countries. For all five countries, median IELT values were independent of condom usage. In countries excluding Turkey, the median IELT values were independent of circumcision status.


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        • Waldinger M.D.
        • Hengeveld M.W.
        • Zwinderman AH.
        Paroxetine treatment of premature ejaculation: A double‐blind, randomized, placebo‐controlled study.
        Am J Psychiatry. 1994; 151: 1377-1379
        • Tanner BA.
        Two case reports on the modification of the ejaculatory response with the squeeze technique.
        Psychother Res Pract. 1973; 10: 297-298
        • Cooper A.J.
        • Magnus RV.
        A clinical trial of the beta blocker propranolol in premature ejaculation.
        J Psychosom Res. 1984; 28: 331-336
        • Althof S.E.
        • Levine S.B.
        • Corty E.W.
        • Risen C.B.
        • Stern E.B.
        • Kurit DM.
        A double‐blind crossover trial of clomipramine  for  rapid  ejaculation  in  15  couples.
        J Clin Psychiatry. 1995; 56: 402-407
        • Waldinger M.D.
        • Hengeveld M.W.
        • Zwinderman A.H.
        • Olivier B.
        Effect of SSRI antidepressants on ejaculation: A double‐blind, randomized, placebo‐controlled study with fluoxetine, fluvoxamine, paroxetine and sertraline.
        J Clin Psychopharmacol. 1998; 18: 274-281
        • Waldinger M.D.
        • Hengeveld M.W.
        • Zwinderman A.H.
        • Olivier B.
        An empirical operationalization study of DSM‐IV diagnostic criteria for premature ejaculation.
        Int J Psychiatry Clin Pract. 1998; 2: 287-293
        • Waldinger M.D.
        • Zwinderman A.H.
        • Schweitzer D.H.
        • Olivier B.
        Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: A systematic review and meta‐analysis.
        Int J Impot Res. 2004; 16: 369-381
        • Waldinger M.D.
        • Olivier B.
        Selective serotonin reuptake inhibitors (SSRIs) and sexual side effects: Differences in delaying ejaculation.
        in: Sacchetti E Spano P Advances in preclinical and clinical psychiatry, Vol I: Fluvoxamine: Established and emerging roles in psychiatric disorders. Excerpta Medica, ; 2000:: 117-130
        • Waldinger MD.
        The neurobiological approach to premature ejaculation (review).
        J Urol. 2002; 168: 2359-2367
        • Pattij T.
        • De Jong T.
        • Uitterdijk A.
        • Waldinger M.D.
        • Veening J.G.
        • Van Der Graaf P.H.
        • Olivier B.
        Individual differences in male rat ejaculatory behavior: Searching for models to study ejaculation disorders.
        Behav Pharmacol. 2003; 14: 80-81
      1. Waldinger MD, Olivier B. Animal models of premature and retarded ejaculation. World J Urol 2005 (in press).

        • Obuchowski N.A.
        Statistical methods in diagnostic medicine..
        Wiley‐Interscience;, 2002
        • Waldinger MD.
        Lifelong premature ejaculation: From authority‐based to evidence‐based medicine.
        Br J Urol Int. 2005; 95: 191
        • Laumann E.O.
        • Masi C.M.
        • Zuckerman EW.
        Circumcision in the United States: Prevalence, prophylactic effects, and sexual practice.
        JAMA. 1997; 277: 1052-1057
        • O'Hara K.
        • O'Hara J.
        The effect of male circumcision on the sexual enjoyment of the female partner.
        BJU Int. 1999; 83: 79-84
        • Fink K.S.
        • Carson C.C.
        • DeVellis RF.
        Adult circumcision outcomes study: Effect on erectile function, penile sensitivity, sexual activity and satisfaction.
        J Urol. 2002; 167: 2113-2116
        • Waldinger MD.
        Towards evidence‐based drug treatment research on premature ejaculation: A critical evaluation of methodology.
        Int J Impot Res. 2003; 15: 309-313
        • Waldinger MD.
        Lifelong premature ejaculation: From authority‐based to evidence‐based medicine.
        Br J Urol Int. 2004; 93: 201-207
      2. Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH. Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data. J Sex Med 2005;2: –.

        • Waldinger M.D.
        • Olivier B.
        Selective serotonin reuptake inhibitor‐induced sexual dysfunction: Clinical and research considerations.
        Int Clin Psychopharmacol. 1998; 13: 27-33