ORIGINAL ARTICLE Correlation between premature ejaculation and female vaginal penetration difficulties G Bronner 1 , ND Kitrey 2 , N Uziel 3 , I Eli 3 , G Raviv 2 , J Ramon 2 and E Elran 1 Male and female sexual dysfunctions encompass biological, psychological and interpersonal aspects. Premature ejaculation (PE) and female vaginal penetration difficulties (VPD) are problems that may concurrently impair the couple's sexual relationship. We have studied the correlation between PE and VPD in the female partner, in a cross-sectional study of 125 heterosexual couples (male age 35.01 ± 10.63; female age 32.36 ± 10.07). VPD included tampon insertion, gynecological examination, inserting self-finger or partner-finger and penile-vaginal intercourse. Female sexual function index (FSFI) and a validated PE questionnaire were used to measure the female sexual function and PE in their male partners. We found that female partners of men with anteportal ejaculation were found to experience significantly more VPDs, especially with regard to difficulties in penile penetration and tampon use. The intensity of pain in VPD was higher in females whose male partners presented anteportal ejaculation. No significant correlation was found between total male PE score and the total FSFI or separate domains of female sexual function. The results suggest that female VPD and male anteportal ejaculation are interrelated. Such severe couple sexual problems should be addressed in parallel. Further research is required to study the causation of PE and VPD. International Journal of Impotence Research (2015) 27, 152–156; doi:10.1038/ijir.2015.3; published online 26 February 2015 INTRODUCTION Premature ejaculation (PE) is a highly prevalent lifelong or acquired sexual problem in men of all ages with significant sexual and psychosocial comorbidities. 1–7 Estimates of prevalence using various definitions are between 10 and 40% of the male population at some stage during their life. 1–4 The International Society for Sexual Medicine published a unified definition of PE, as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 min of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 min or less (acquired PE); (ii) the inability to delay ejaculation on all, or nearly all, vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustra- tion and/or the avoidance of sexual intimacy. 5 Consequently, PE has a significant psychological burden on men, their partners and their sexual relationship. 3,4,8,9 Men with PE rated their quality of life, their sexual functioning and satisfaction lower than men without PE, and reported higher levels of personal distress and interpersonal difficulty. 8,10 Hartmann et al. 11 found that men without PE had positive thoughts relating to their own and their partner sexual arousal and satisfaction. Men with PE, conversely, were totally preoccupied with distracting thoughts about controlling their orgasm, keeping their erection, anxiously anticipating a possible failure and negative feelings like embar- rassment and guilt. Despite the psychosocial burden associated with PE, most men do not seek assistance. 2 Female sexual function is a complex process involving physio- logical, psychosocial and interpersonal factors. 12,13 Regardless of the underlying condition, female sexual dysfunction (FSD) is a multicausal and multidimensional problem combining biological and psychological components, strongly modulated by psycho- social factors and by interpersonal determinants. Four categories of FSD were classified by an international consensus group and include sexual desire disorder, sexual arousal disorder, orgasmic disorder and sexual pain disorder. 14 These sexual problems are considered as FSD when they appear persistently or recurrently and cause personal distress to the woman. 12 Based on epidemio- logical data from the National Health and Social Life Survey in the US, sexual problems affect ~ 43% of women. 1 In another representative national US sample, while the prevalence of any sexual problem was 44.2%, sexually related personal distress was evident in 22.8% of women. 15 Female sexual pain is one of the frequent FSD, and is best classified into two diagnostic entities: vaginismus and dyspare- unia. 12,14,16 Fugl-Meyer et al. 16 provide an overview of the most common somatic disorders causing female sexual pain, such as endometriosis, pelvic inflammatory disease, estrogen deficiency, pelvic organ prolapse, cancer therapy and irritable bowl syn- drome. These women might confront difficulties with penile- vaginal intercourse. More and beyond, these women may have difficulties in maintaining their reproductive and sexual health, in undergoing routine gynecological examinations inserting a tampon or enjoying any intimate activity. There are almost no studies referring to the various aspects of vaginal penetration difficulties, other than penile-vaginal intercourse. Studies investigating the correlation between male PE and the partner's sexual function support the idea that sexual dysfunction is a couple problem, affecting both man and woman. 8,10,11,17 Few studies have reported on ejaculatory problems in male partners of women with sexual dysfunction. PE is a common diagnosis (28.2%) among partners of women with sexual 1 Sexual Medicine Center, Department of Urology, Sheba Medical Center, Tel-Hashomer, Israel; 2 Department of Urology, Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and 3 Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel. Correspondence: G Bronner, Sexual Medicine Center, Sheba Medical Center, Tel-Hashomer 52621, Israel. E-mail: Gilab@netvision.net.il Received 21 March 2013; revised 29 November 2014; accepted 7 January 2015; published online 26 February 2015 International Journal of Impotence Research (2015) 27, 152 – 156 © 2015 Macmillan Publishers Limited All rights reserved 0955-9930/15 www.nature.com/ijir