Primary lifelong delayed ejaculation: characteristics and response to bupropion.

INTRODUCTION: In contrast to premature ejaculation and secondary delayed ejaculation (DE), primary lifelong DE has not been studied extensively. In addition, there is no approved drug treatment.

AIMS: To explore the clinical and laboratory characteristics of a series of men complaining of lifelong DE and to report the response to bupropion.

METHODS: Nineteen consecutive men with primary lifelong DE were prospectively enrolled in this study. Study group was compared with an age-matched group of 19 healthy men. Both groups underwent history taking, physical examination, International Index of Erectile Function (IIEF), anxiety, and depression scores, ejaculation latency time (IELT) using stop watch and measurement of serum prolactin (PRL) and serum total testosterone (T). Patients received open-label bupropion-SR 150 mg/day for 2 months.

MAIN OUTCOME MEASURES: Stopwatch-measured IELT values, global efficacy question, IIEF, anxiety, and depression scores.

RESULTS: The mean age was 30.8 ± 5.5 year (range 25-42 years). Men with DE exhibited significantly higher masturbatory activity during marital period, lower night emissions, longer IELT, lower orgasmic, and intercourse satisfaction domains of IIEF, higher anxiety and depression scores compared with the controls (all P<0.05). Both serum T and PRL levels did not differ significantly between patients and controls (all P<0.05). Four DE patients (21%) showed history of infertility. The percentage of DE men rating control over ejaculation as "fair to good" increased from 0 to 21.1% after bupropion therapy. The fold decreases of the geometric mean IELT was 0.74 after treatment. The intercourse satisfaction and the orgasmic domains of IIEF and depression score were significantly improved from baseline in the bupropion group (all P<0.05).

CONCLUSIONS: Lifelong DE is mainly associated with higher and idiosyncratic masturbatory activity, lower night emissions, infertility, longer IELT, lower orgasmic, and intercourse satisfaction domains of IIEF, higher anxiety and depression scores. Bupropion-SR in a daily dosage of 150 mg seemed to be of limited benefit in lifelong DE.