Background

Premature ejaculation (PE) is a sexual dysfunction that affects roughly 5-15% of men globally, of which definitions vary, but mostly consist of:

• Ejaculation with minimal stimulation (short ejaculation latency (EL))
• Lack of ability to delay or postpone ejaculation (lack of control)
• Negative consequences including distress, bother, or concern.

There are currently two widely accepted subtypes:

• Lifelong PE (LPE): present for all or nearly all partnered sexual experiences, beginning at or shortly after the first experience, and is associated with biological and physiological risk factors (spinal, cerebral, etc.).
• Acquired PE (APE): occurring after a period of normal ejaculatory function and may be associated with psychological risk factors (anxiety, depression, etc.).

A few other subtypes of PE have been proposed over time; however, these are not as widely accepted. These other subtypes have led to the inclusion of intermittent PE (IPE) in more recent research surrounding PE subtypes.

Study Objectives

1. Describe the characteristics of men with IPE,
2. Compare foreplay and ELs during sexual episodes with and without PE symptoms,
3. Compare EL responses across different partnered sexual activities,
4. Compare EL responses and patient-reported outcomes between partnered sex and masturbation,
5. Examine associations among key measures such as ejaculatory control, foreplay time, and ELs for different sexual activities (characterize specific responses in IPE men).

Methods

• Approximately 331 men who met the criteria for PE completed a questionnaire made up of medical history questions and abridged versions of:
  • The International Index of Erectile Function (IIEF) where lower scores indicate worse sexual function.
  • The Premature Ejaculation Diagnostic Tool (PEDT) – related to ejaculatory control – where higher scores indicate worse PE.
• PE and IPE criteria
  • PEDT responses with scores 10 of higher,
  • Self-reported EL of under 5 minutes for penetrative sex during PE episodes,
  • Subtype determined by response to a question asking about frequency of PE experiences and how long they have been occurring.
    • Only 27 men identified as IPE based on this question and provided full data.
  • PE-specific questions
    • Frequency of occurrence and ELs over lifespan,
    • Typical foreplay and EL parameters for when they experienced PE symptoms (YES-PE) and when they did not (NO-PE),
    • ELs estimated for three conditions: vaginal penetrative sex, anal penetrative sex, partnered sex in general (including foreplay), as well as during masturbation.

Key Results/Analysis

• Men with IPE experience PE symptoms during partnered sex (YES-PE) 69.3% of the time, with their first sexual experience at around 17 years old and first PE experience at around 19.
• The average PEDT scores for ejaculatory control revealed that IPE men about equally fall into each of “definite PE” (44.4%) and “no PE” (55.6%) categories for partnered sex, and similarly with masturbation.
  • IPE men may not fall into the category of PE but are still experiencing PE often enough to find it bothersome.
• Over time, 22.7% of IPE men said their symptoms stayed about the same, 68.2% said they had worsened, and 9.1% said their symptoms had improved (ELs became longer). These results are similar to YES-PE frequency.
• Sexual responses between YES-PE and NO-PE episodes in IPE men:
  • ELs for NO-PE conditions were significantly longer (minutes) than those of YES-PE conditions:
    • Overall: 6.52 vs. 2.12
    • Vaginal: 5.28 vs. 0.81
    • Anal: 2.93 vs. -0.07
  • EL responses between different types of partnered sexual activity:
    • EL was longest across the board for overall, then vaginal, then anal sex for each NO-PE and YES-PE condition.
  • EL was longer under YES-PE conditions during masturbation than during partnered sex. Under NO-PE conditions, there was not a significant difference.
  • IPE men are capable of normal sexual response intermittently with PE response.
• Higher PEDT scores during both partnered sex and masturbation were correlated with shorter YES-PE ELs involving vaginal or anal sex.
• The men with IPE included in this study would fall into the broad criteria of PE, but not necessarily the operational details like consistency and frequency, potentially leaving them out of the general diagnosis.

Key Takeaways

• Intermittent PE patterns can coexist between APE and LPE subtypes.
• Researchers encourage clinicians and future studies to explore the inclusion of IPE in diagnostic criteria and treatment consultations.
  • Pay careful attention to men’s lived experiences with their sexual dysfunction.

Resources:

• Rowland, D. L., Althof, S. E., & Cote-Leger, P. (2025). Intermittent premature ejaculation: Exploring an understudied phenomenon. The Journal of Sexual Medicine, 22(8), 1373–1382. https://doi.org/10.1093/jsxmed/qdaf113