Premature Ejaculation Among Internet Users Living in the Metropolitan Region of Sao Paulo, Brazil: A Cross-Sectional Comparison Between the Premature Ejaculation Diagnostic Tool (PEDT) and Patient-Reported Latency Time and Perception

Background: Premature ejaculation (PE) prevalence can vary according to different definitions, assessment methods and populational demographics and culture. Aims: To investigate the differences between men classified as having "probable PE" (PEDT >= 11), "possible PE" (PEDT = 9 or 10) or "no PE" (PEDT <= 8) according to the Premature Ejaculation Diagnostic Tool (PEDT) criteria in regard to sociodemographic characteristics, and sexual and relational behavior. To assess the agreement of prevalence of PE according to 3 assessment methods: (i) the ejaculation latency time (ELT) according to the participant's memory; (ii) PEDT and (iii) a direct question about the self-perception of ejaculation as being normal, too early (premature) or retarded. Methods: In this web-based cross-sectional study, men aged >= 18 years living in the metropolitan region of Sao Paulo, Brazil, responded anonymously to an online survey. We used multinomial regression to estimate the association between PE according PEDT criteria and other features and the kappa coefficient to estimate agreement between the assessment methods. Outcomes: Association between PEDT-PE, sociodemographic characteristics and sexual and relational behaviors; agreement between PEDT, ELT and self-perception of PE. Results: Obesity, trying to hold back ejaculation, short or nonexistent foreplay and age <30 years were associated with PEDT >= 11. Men who considered that latency was shorter for oral, anal and vaginal sex than for masturbation were more likely to have probable PE according to PEDT. Possible PE (PEDT scores 9/10) was associated with trying to hold back ejaculation and considering time for ejaculation shorter for vaginal sex. There was fair agreement between assessments (kappa 0.39; CI:0.28 -0.42; P < .001). Conclusion: PE prevalence varies according to instruments and cut-offs used, with fair agreement between them. This finding shows that the methods evaluate different aspects of the EP syndrome and they must be combined to allow the discrimination between the different types of PE and treatments. Clinical approaches should consider the sexual behavior and relationship of the patient and their distress. Copyright (C) 2021 The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine.