The Global Online Sexuality Survey (GOSS): The United States of America in 2011 ChapterIII—Premature Ejaculation Among English-Speaking Male Internet Users DOI: 10.1111/jsm.12470 We read with great interest the recently published manuscript on premature ejaculation (PE), based on the global online sexual survey (GOSS) [1]. Similar in scope to other papers published from the observational Internet-based, cross-sectional GOSS data [2–4], this study focuses on determining the prevalence of erectile dysfunction and PE among English-speaking “Internet users.” Through application of The Premature Ejaculation Diagnostic Tool (PEDT), the author reported that 49.6% of the subjects were diagnosed as having PE, while through application of the Interna- tional Society for Sexual Medicine (ISSM) definition of lifelong PE, a prevalence of 6.3% was reported. In spite of the interesting data presented in the article, we believe that several important pitfalls must be addressed. First of all, the author made a common mistake by using the term “ISSM definition for PE.” The ISSM developed a definition that is spe- cific in regards to “lifelong” PE, and this definition should not be generalized [5]. Additionally, assessing the prevalence of PE through application of PEDT is another limitation. The PEDT is a five-item questionnaire that assesses PE in essence of the Diag- nostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) definition of PE (i.e., control, fre- quency, minimal stimulation, distress, and interpersonal difficulty) [6]. As, this definition of PE is considered to be authority based rather than evidence based, it lacks specific operational criteria and is vague in terms of operational specificity [5]. Thus, data collected from questionnaires using this outdated definition should be regarded with precaution. Moreover, the specificity of this ques- tionnaire (50.5%) [7] hampers its validity to be used as a screening tool in population-based studies and further supports the reason- ing behind the inappropriate application of its use. We hope to clarify these statements as to not artificially inflate the readers understanding of the prevalence of PE. The authors righteously highlighted the need for more preva- lence studies to understand the actual burden of PE. However, a reliable prevalence study cannot be performed without a valid sampling method. Although the author noted that 77.3% of US population are Internet users who should have access to online surveys, they omit to describe the statistics regarding the percent of the sexually active US men (between age 18 and 70) who are actually “Facebook” members, as this social website was used to recruit the subjects of this study. This involves a vast selection bias according to Web-surfing preferences. Also, as a stratified sam- pling method was not performed, the age distribution of the recruited subjects was not congruent with the actual age distribu- tion in the general US population. The mean age of the subjects in this study was 52.38 years and more than 80% of subjects were older than 39 years of age. Although, in the discussion section, the author briefly referred to the first report of GOSS for these dis- advantages, the shortcomings of a method should be extensively described in every publication in order to enable readers to inter- pret the data accurately. These limitations of the population included in the study should be kept in mind when attempting to generalize the results. One must be aware of the limitations of the GOSS data when interpreting the results of this study. When collecting and analyz- ing data, we must always apply up-to-date definitions in order to provide an end product that is accurate and reproducible. We feel that the results reported in this study aid in our ever-evolving understanding of lifelong PE, yet they must be interpreted thoughtfully and analytically. Theodore R. Saitz, MD* and Ege Can Serefoglu, MD † *Department of Urology, School of Medicine, Tulane University, New Orleans, LA, USA; † Department of Urology, Bagcilar Training & Research Hospital, Istanbul, Turkey Conflict of Interest: The authors report no conflicts of interest. Statement of Authorship Category 1 (a) Conception and Design Ege Can Serefoglu; Theodore R. Saitz (b) Acquisition of Data Ege Can Serefoglu; Theodore R. Saitz (c) Analysis and Interpretation of Data Ege Can Serefoglu; Theodore R. Saitz Category 2 (a) Drafting the Manuscript Theodore R. Saitz (b) Revising it for Intellectual Content Ege Can Serefoglu Category 3 (a) Final Approval of the Completed Manuscript Ege Can Serefoglu References 1 Shaeer O. The global online sexuality survey (GOSS): The United States of America in 2011 Chapter III—Premature ejaculation among English-speaking male Internet users. J Sex Med 2013;10:1882–8. 2 Shaeer O, Shaeer K, Shaeer E. The global online sexuality survey (GOSS): Female sexual dysfunction among Internet users in the reproductive age group in the Middle East. J Sex Med 2012;9:411–24. 3 Shaeer O, Shaeer K. The global online sexuality survey (GOSS): Ejaculatory function, penile anatomy, and contraceptive usage among Arabic-speaking Internet users in the Middle East. J Sex Med 2012;9:425–33. 1 © 2014 International Society for Sexual Medicine J Sex Med **;**:**–**