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Response to comment on: Men with delayed ejaculation report lower sexual satisfaction and more depressive symptoms than those with premature ejaculation: findings from a cross-sectional study

International Journal of Impotence Research (2026)Cite this article

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We commend Dr. Rowland for his thoughtful and supportive comments on our study [1, 2]. Dr. Rowland rightly emphasized that the etiologies of delayed ejaculation and/or inhibited ejaculation (DE) and premature ejaculation (PE) are complex and multifactorial, encompassing not only biological and psychosexual factors but also potentially influencing distinct aspects of both intra- and inter-individual relationships [3, 4]. This complexity underpins our rationale for conducting a cross-sectional study aimed at better characterizing the baseline features of men with DE compared to those with PE, with a specific focus on the psychological correlates of these conditions. One of the key points raised in our discussion concerns the attention that Sexual Medicine experts (i.e., Andrologists) should devote during baseline evaluation, despite their absence of formal training in psychology, psychosexual medicine, or sexual therapy. Based on validated questionnaires [5, 6], clinicians should avoid concentrating exclusively on the symptoms of the sexual dysfunction itself and should not overlook the potential need for psychological counseling, which may contribute to improved outcomes in more refractory cases. The first issue to address relates to the potential role of symptom severity. We concur that differences between the two subgroups might reflect varying degrees of severity rather than the specific type of sexual dysfunction. Although our classification of DE and PE was based on qualitative, binary definitions (yes/no), we considered whether indirect indicators of severity could be inferred from the International Index of Erectile Function (IIEF). In this regard, the IIEF intercourse satisfaction (IIEF-IS) and overall satisfaction (IIEF-OS) domains can reasonably serve as proxy measures, as they are sensitive to both the functional impact and perceived burden of sexual difficulties. When comparing these domains between subgroups, no significant differences emerged. This finding suggests that the functional repercussions—and thus the overall severity—of the sexual problem are comparable across subgroups, or at least not sufficiently divergent to influence satisfaction levels. This observation supports our speculative hypothesis that mechanisms beyond severity alone may contribute to the development of the observed symptoms. Furthermore, Dr. Rowland raised important methodological considerations, particularly regarding the potential influence of confounding variables that could compromise the validity of our subgroup comparisons. We greatly appreciate the insightful observation concerning additional variables—such as age, comorbidities, and level of sexual desire—that differed between the DE and PE subgroups and may have contributed to the observed differences in anxiety and depression. We agree that a multivariable regression model would represent the most rigorous approach to isolate the independent effect of dysfunction type while statistically controlling for potential confounders. However, the primary aim of our study was descriptive and exploratory, focusing on characterizing the psychological and sexual profiles of men with DE and PE rather than establishing causal or predictive relationships. For this reason, we opted for unadjusted comparisons to preserve the descriptive framework. Nonetheless, we fully acknowledge that the absence of multivariable adjustment limits the ability to attribute differences in anxiety and depression specifically to the type of sexual dysfunction. We appreciate the suggestion for future research, which would greatly benefit from incorporating multivariable modeling in a larger sample and employing quantitative measures.

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References

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Author notes

  1. These authors contributed equally: Fausto Negri, Christian Corsini.

Authors and Affiliations

  1. Division of Experimental Oncology/Unit of Urology – Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy

    Fausto Negri, Christian Corsini & Andrea Salonia

  2. Vita-Salute San Raffaele University,, Milan, Italy

    Fausto Negri, Christian Corsini & Andrea Salonia

Authors
  1. Fausto Negri
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  2. Christian Corsini
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  3. Andrea Salonia
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Conceptualization: FN, CC, and AS. Supervision: AS. Writing—original draft: FN and CC. Writing review and editing: AS.

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Correspondence to Andrea Salonia.

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Negri, F., Corsini, C. & Salonia, A. Response to comment on: Men with delayed ejaculation report lower sexual satisfaction and more depressive symptoms than those with premature ejaculation: findings from a cross-sectional study. Int J Impot Res (2026). https://doi.org/10.1038/s41443-026-01241-8

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