In this population, both ED and HRPE were associated with greater odds of sexual bother on unadjusted analysis. However, these relationships were accounted for in large part by the interpersonal factors assessed by the SEAR. It is not novel to report that both ED and PE are associated with greater odds of sexual bother. However, the role of SEAR in mediating this effect implies that psychorelational factors play a very important role in subjective feelings about sexual function. This may be due to adaptation of sexual practices to accommodate sexual difficulties (more easily accomplished in the context of a supportive and stable relationship) or a greater incidence of sexual dysfunction stemming from psychological or relationship stress in this young and presumably healthy population. These findings are in line with other reports that have emphasized the importance of the sexual relationship in determining net sexual bother/satisfaction [13
Premature ejaculation is a more subjective and difficult to define sexual concern relative to ED. For this reason, particular attention to psychosocial context and subjective bother are important in diagnosing this condition. PE (as determined by Diagnostic and Statistical Manual IV-TR criteria, the Premature Ejaculation Profile, and ejaculatory latency time less than 2 minutes) has previously been associated with lower mean SEAR scores in a community-based observational study of men in relationships [5
]. To our knowledge, PEDT scores have not been previously associated with SEAR scores in the published literature but our findings are in agreement with those of Rowland et al. [14
Data from the National Health and Social Life survey did not detect an association between “early ejaculation” and life stress [15
]. However, early ejaculation in this study was assessed by response to a single-item question so it is unclear how many of these subjects had clinical PE. More recent data have indicated that men with PE are more likely to endorse bother, anxiety, and sexual dissatisfaction [16
]. Furthermore, successful management of PE has been linked to substantial improvements in personal bother and interpersonal difficulty [17
]. However, Jern et al. suggested that PE may play a limited (albeit significant) role in overall sexual bother, particularly in relationships of long duration [18
]. Jern’s findings are generally congruous with our own.
It is of particular interest that better scores on the SEAR-overall relationship subdomain were associated with lower odds of sexual bother in both models but did not eliminate the significant association between bother and ED/HRPE as did the other SEAR domains. This is likely due to the focus of this particular SEAR subdomain on non-sexual variables in the relationship, whereas all other SEAR domains are focused on sexual issues; ergo, sexual bother may factor only indirectly into the SEAR-overall relationship score. The clear impact of PE and ED on sexual relationships and particularly on male self-esteem and confidence is demonstrated by our data.
The data on respondents with more than one partner over the past 6 months are of particular interest. The prevalence of sexual bother was lowest in the group that had one sexual partner over the preceding 6 months; bother was most prevalent in the population without a regular partner but individuals with more than one partner in that time frame had a rate of bother similar to the unpartnered men. We did not fully characterize the nature of sexual involvements within the preceding 6 months, but it is likely that the individuals with multiple partners were not in stable monogamous relationships and/or had recently changed relationships. It is tempting to speculate based on this finding and our data on the mediating effect of SEAR that the security of a stable sexual relationship largely ameliorates sexual bother. However, this hypothesis is strictly conjectural because of limitations of our dataset. In the multivariate models, number of recent sexual partners was not a statistically significant predictor of sexual bother.
Limitations of this dataset include a lack of subject interview data; in the absence of formalized evaluation and explanation of the survey instruments themselves, it is difficult to be certain how subjects may have interpreted or misinterpreted certain questions. Missing data points led to attrition of almost half of our nonvirgin male dataset from the final analysis; however, this did lead to a more complete dataset on the group of subjects analyzed. Our sample was drawn from a highly educated subject pool and is certainly not representative of the larger population; these associations may not hold true in nonmedical students. The proportion of students from minority ethnic groups was also relatively low. Ethnic minority status has been associated with significant differences in the prevalence of sexual bother and sexual dysfunction [15
]. Our data suggest that this may be irrespective of educational status (itself a known risk factor for greater risk of ED) [15
] as there was a trend toward greater sexual bother in non-Caucasians. However, because of the small number of subjects in this study we cannot definitively comment on this. Lastly, individuals who participate in an uncompensated internet-based sexuality survey may not be representative of the general population and may not provide data that are entirely valid [20
Despite these shortcomings, our data are of value in its assessment of sexual bother and their association with numerous ethnodemographic and sexuality issues in men. It is suggested that the presence of sexual problems in this population may be more often related to interpersonal and psychosocial variables than sexual function/dysfunction.