Comment on “Similarities and differences between men with self-reported lifelong and acquired difficulty reaching orgasm.”

This is an invited commentary on “Similarities and differences between men with self-reported lifelong and acquired difficulty reaching orgasm” [1]. In their study, individuals with symptoms of delayed ejaculation (DE) were identified from large online populations. The DE individuals were classified as “acquired” or “lifelong” sufferers, and the authors performed a series of statistical comparisons between these two groups. The manuscript is very well written, and statistical methods appear sound. While the study effectively acknowledged its limitations, many are a function of its internet survey methodology; a structure that can fail to offer clinically meaningful information. Those limitations highlight some important issues that require further investigation and inquiry.

This commentary will highlight three points for consideration for both the study’s authors and IJIR readers. First, the use of the common classification system terms “acquired vs. lifelong” requires further consideration by all of us. The study’s methodology does not allow for the exploration necessary to answer many of the key questions discussed in its Introduction section, especially regarding the role of predisposition in the etiology of DE. Second, the conclusion that the subject’s self-rating of anxiety as their orgasmic difficulty’s primary cause does not in and of itself prove that anxiety is indeed the primary cause of their difficulty reaching orgasm, as suggested by the article’s conclusion. Alternatively, it may reflect inadequate self-awareness for men themselves, as well as limitations regarding the options the survey offered. This author proposes that reframed questions and offering of alternative answer choices would result in “inadequate stimulation” emerging as the primary obstacle to successful functioning during partnered sex. Therefore, a future study for these well-suited investigators could undertake would be is to identify the differences in greater detail between men who can masturbate successfully and orgasm during partnered sex, vs. men who are only able to orgasm during masturbation and not with their partners. For sex therapists and many urologists, the latter is the most common clinical presentation independent of whether there are other confounding medical, surgical, and/or pharmacological concurrent etiological factors. The experimental methodology used in this current study failed to obtain that critical information, which would be best accomplished by a directed assessment of the man’s perception of the differences in his experience with masturbation (when he typically reaches orgasm) vs. the experience he has with a partner(s) where he is unable to orgasm and/or finds difficulty doing so. Such an assessment regarding stimulation he is using must include inquiry into the differences in his cognitions during those experiences as well as a detailed investigation into the behavioral differences in terms of type of stimulation, wet, dry, intensity, speed, and location concentration, etc. [2, 3]. While the information obtained by Rowland et al. [1] is useful, a specific assessment of masturbatory style, technique, and thought processes is critical for a comprehensive clinical evaluation and treatment of this type of secondary DE.