18 partner. Ejaculatory latency of 2 minutes or less (9) may qualify the diagnosis . Estimated prevalence rates of erectile dysfunction (1,2,4,10) (ED) among men are about 22 to 52% and reported rates of premature ejaculation (PE) range from 17 to 30%(4). It is intuitive that one partner’s SD is likely to impact on the sexual function and wellbeing of the other, and this has been conrmed by clinical investigations. Effect of MSD on partner’s sexual function It has been generally assumed that partner’s ED or PE play a signicant role in determining female sexual dysfunction (FSD). Several studies have aimed to evaluate the role of the male partner’s sexual function in determining FSD. Partners of men with ED report that their sexual desire, levels of arousal, frequency of orgasm and overall satisfaction with sexual activity diminish after the (11–13) onset of their partner’s sexual dysfunction . In a cross sectional study to investigate the association between female sexual function and the male partners' erectile function, they found a signicant correlation between FSD and male erectile (14) function . A large UK study that included the clinic records of female as well as male patients showed that half of the female patients with sexual problems such as “not enjoying sex” or anorgasmia, (15) had partners with PE . (16) Maseroli et al concluded that the presence of male sexual dysfunction (MSD) may not act as a primary contributing factor to the development of sexual dysfunction in the partner, but that women’s sexuality seems to be mostly impaired by the perceived reduction in their partner’s sexual interest. Effects of MSD on relationship Intimate relationships are built on physical and emotional connections, and MSD can disrupt both aspects. In a study by Fisher et al investigating the shared sexual concerns of couples with ED, they found that 81% of couples believed that the relationship with their partner was one of the most (12) important things in their life . The quality of sexual intimacy is relevant in relationships to maintain a high degree of sexual satisfaction and bonding. It is thus important to understand the impact of MSD on a relationship. Studies have shown that sexual dysfunctions in both men and woman negatively affects sexual as well (17) as relationship satisfaction . In a review on the impact of premature ejaculation the authors found that PE greatly affect relationships and that a signicant proportion of partners of men with PE (18) reported interpersonal difculties . As sexual intimacy wanes, couples may nd themselves struggling to maintain closeness, which can lead to increased conicts and reduced relationship satisfaction. Misunderstandings might arise, with partners misinterpreting the dysfunction as a lack of interest or effort. In turn, this can lead to resentment and a breakdown in communication. Psychosocial consequences and quality of life consequences MSD can induce a range of emotions in partners, including frustration, insecurity, and worry. Partners may internalise these challenges, questioning their desirability or attributing the dysfunction to their inadequacies. Over time, these feelings can contribute to anxiety, depression, and diminished self-esteem. Partners may feel an emotional Phase Desire/drive/interest Arousal/excitement Sexual pain/other Male Low interest Excessive interest Erectile dysfunction Premature ejaculation Retarded ejaculation Dyspareunia Sexual Phobias (8) Table 1: Classication of sexual dysfunction Partner’s perception of premature ejaculation “What is wrong with him?” * “Why can’t he control himself?” * “Why does he let me down every time?” * “Why doesn’t he care for me?” (5) Table 2 Different perceptions of partners of men with PE and ED Partner’s perception of erectile dysfunction “What is wrong with me?” * “Am I not attractive enough?” * “Am I not beautiful enough?” * “Am I not sexy enough?” * “He must have another woman” Female Low interest Excessive interest Impaired arousal Anorgasmia Duspareunia Vaginismus Sexual phobias Information taken from presentation by A Graziottin “Out of the shadow: How to manage the couple with PE” at the 12th Congress of the European Society of Sexual Medicine. Lyon, France; Nov 15-18, 2009 UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
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