Experiences of patients with attention-deficit/hyperactivity disorder and premature ejaculation: a phenomenological study

Premature ejaculation is listed in the Diagnostic and Statistical Manual of Mental Disorders and is one of the most common ejaculation disorders in the male population. This study aimed to describe the experiences of men with attention-deficit/hyperactivity disorder (ADHD) and premature ejaculation. This is a descriptive qualitative study based on Merleau-Ponty’s hermeneutic phenomenology. Twenty-three patients diagnosed with ADHD who experience premature ejaculation participated. Thematic analysis was used for data analysis with ATLAS.ti computer software. Two main themes were drawn from the data analysis: (1) “Virility in question: ejaculation time as the measure of masculinity” and (2) “Restoring sexual identity and function”. Premature ejaculators with ADHD experience heightened emotional challenges stemming from traditional masculine norms and the social pressure to conform, which has a negative impact on their sexual well-being. Furthermore, they encounter difficulties in their relationships, resulting in sexual dissatisfaction for both partners. In a quest to reclaim their sexual identity and function, the participants sought assistance from healthcare professionals and explored potential triggers for this sexual dysfunction, including the influence of ADHD.

Attention-deficit/hyperactivity disorder; Mental health nursing; Premature ejaculation; Qualitative research; Sexual dysfunction; Sexual relationship; Sexual satisfaction

[1] Ermeç B, Yucetas U, Güler H, Culha MG, Kadıhasanoğlu M. Evaluation of the quality of life of patients with premature ejaculation (lifelong and acquired). The Journal of the Brazilian Medical Association. 2022; 68: 1303–1307.

[2] Prieto-Castro R, Puigvert-Martínez AM, Artigas-Feliu R, Illán-Mateo P, Cruz-Culebra N, Artés-Ferragud M; PANDORA Project Regional Committee. Opinions, attitudes, and perceptions in relation to erectile dysfunction and premature ejaculation in the undiagnosed Spanish male population. Results of the PANDORA project. The Journal of Sexual Medicine. 2020; 17: 1495–1508.

[3] American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edn. American Psychiatric Association: Washington, DC. 2022.

[4] Chung E, Gilbert B, Perera M, Roberts MJ. Premature ejaculation: a clinical review for the general physician. Australian Family Physician. 2015; 44: 737–743.

[5] Lee SW, Lee JH, Sung HH, Park HJ, Park JK, Choi SK, et al. The prevalence of premature ejaculation and its clinical characteristics in Korean men according to different definitions. International Journal of Impotence Research. 2013; 25: 12–17.

[6] Liu T, Jia C, Peng YF, Zhong W, Fang X. Correlation between premature ejaculation and psychological disorders in 270 Chinese outpatients. Psychiatry Research. 2019; 272: 69–72.

[7] Verze P, La Rocca R, Spirito L, Califano G, Venturino L, Napolitano L, et al. Premature ejaculation patients and their partners: arriving at a clinical profile for a real optimization of the treatment. The Archives of Italian Urology and Andrology. 2021; 93: 42–47.

[8] Corona G, Rastrelli G, Limoncin E, Sforza A, Jannini EA, Maggi M. Interplay between premature ejaculation and erectile dysfunction: a systematic review and meta-analysis. The Journal of Sexual Medicine. 2015; 12: 2291–2300.

[9] Rowland DL, Althof SE, McMahon CG. The unfinished business of defining premature ejaculation: the need for targeted research. Sexual Medicine Reviews. 2022; 10: 323–340.

[10] Amani Jabalkandi S, Raisi F, Shahrivar Z, Mohammadi A, Meysamie A, Firoozikhojastefar R, et al. A study on sexual functioning in adults with attention-deficit/hyperactivity disorder. Perspectives in Psychiatric Care. 2020; 56: 642–648.

[11] Hertz PG, Turner D, Barra S, Biedermann L, Retz-Junginger P, Schöttle D, et al. Sexuality in adults with ADHD: results of an online survey. Frontiers in Psychiatry. 2022; 13: 868278.

[12] Ramos-Quiroga JA, Montoya A, Kutzelnigg A, Deberdt W, Sobanski E. Attention deficit hyperactivity disorder in the European adult population: prevalence, disease awareness, and treatment guidelines. Current Medical Research and Opinion. 2013; 29: 1093–1104.

[13] Soydan H, Ates F, Adayener C, Akyol I, Semiz UB, Malkoc E, et al. Attention-deficit hyperactivity disorder in patients with premature ejaculation: a pilot study. International Urology and Nephrology. 2013; 45: 77–81.

[14] Morillo Z, Guzmán DS. Prevalence of disorder due to deficit of attention and hyperactivity, patients from 6 to 12 years old, Robert Reid Cabral Children’s Hospital, during the period November 2016–April 2017. Science and Health. 2018; 2: 67–73. (In Spanish)

[15] Bijlenga D, Vroege JA, Stammen AJM, Breuk M, Boonstra AM, van der Rhee K, et al. Prevalence of sexual dysfunctions and other sexual disorders in adults with attention-deficit/hyperactivity disorder compared to the general population. Attention-Deficit and Hyperactivity Disorder. 2018; 10: 87–96.

[16] Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry. 2007; 164: 942–948.

[17] Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, et al. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. European Neuropsychopharmacology. 201; 28: 1059–1088.

[18] Salvi V, Ribuoli E, Servasi M, Orsolini L, Volpe U. ADHD and bipolar disorder in adulthood: clinical and treatment implications. Medicina. 2021; 57: 466.

[19] Soldati L, Bianchi-Demicheli F, Schockaert P, Köhl J, Bolmont M, Hasler R, et al. Sexual function, sexual dysfunctions, and ADHD: a systematic literature review. The Journal of Sexual Medicine. 2020; 17: 1653–1664.

[20] Flory K, Molina BS, Pelham WE Jr, Gnagy E, Smith B. Childhood ADHD predicts risky sexual behavior in young adulthood. Journal of Clinical Child & Adolescent Psychology. 2006; 35: 571–577.

[21] Beşiktepe Ayan Ü, Gıynaş Ayhan M. Lifelong premature ejaculation and attention-deficit hyperactivity disorder: a controlled study. Alpha Psychiatry. 2022; 23: 135–139.

[22] Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, et al. An update of the international society of sexual medicine’s guidelines for the diagnosis and treatment of premature ejaculation (PE). Sexual Medicine. 2014; 2: 60–90.

[23] Barais M, Costa M, Montalvo C, Rannou V, Vaillant-Roussel H, Costa D, et al. Talking about premature ejaculation in primary care: the GET UP cluster randomised controlled trial. BJGP Open. 2022; 6: BJGPO.2021.0168.

[24] Young S, Klassen LJ, Reitmeier SD, Matheson JD, Gudjonsson GH. Let’s talk about sex… and ADHD: findings from an anonymous online survey. International Journal of Environmental Research and Public Health. 2023; 20: 2037.

[25] Merleau-Ponty M, Landes DA. Phenomenology of Perception. 1st edn. Routledge: London. 2013.

[26] Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007; 19: 349–357.

[27] Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & Quantity. 2018; 52: 1893–1907.

[28] Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Medical Teacher. 2020; 42: 846–854.

[29] Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology. 2021; 18: 328–352.

[30] Guedes DD, Moreira V. The critical phenomenological research methodology based on Merleau-Ponty’s philosophy. Terapia psicológica. 2009; 27: 247–257.

[31] Guba E, Lincoln Y. Competing paradigms in qualitative research. In Denzin N, Lincoln Y (eds.) Handbook of qualitative research (pp. 105–117). 1st edn. Sage: Thousand Oaks. 1994.

[32] Kaufman Horowitz. Masculine Sexuality: Towards a Theology of Liberation. Men: Pleasure, Power, and Change. 1st ed. República Dominicana: Kaufman. 1989.

[33] Montesinos R. The Routes of Masculinity: Essays on Cultural Change and the Modern World. 1st ed. Barcelona: Gedisa; 2002.

[34] Burri A, Buchmeier J, Porst H. The importance of male ejaculation for female sexual satisfaction and function. The Journal of Sexual Medicine. 2018; 15: 1600–1608.

[35] Chung E. Male sexual dysfunction and rehabilitation strategies in the settings of salvage prostate cancer treatment. International Journal of Impotence Research. 2021; 33: 457–463.

[36] Flurey CA, Pauling JD, Saketkoo LA, Denton CP, Galdas P, Khanna D, et al. ‘I turned in my man card’: a qualitative study of the experiences, coping styles and support needs of men with systemic sclerosis. Rheumatology. 2023; 62: 2160–2167.

[37] Hayfield N, Clarke V. “I’d be just as happy with a cup of tea”: women’s accounts of sex and affection in long-term heterosexual relationships. Women’s Studies International Forum. 2012; 35: 67–74.

[38] Hall KSK, Binik YM. Principles and practice of sex therapy. 6th edn. Guilford Press: New York, NY. 2020.

[39] Bhat GS, Shastry A. Association between post-ejaculatory refractory time (PERT) and premature ejaculation (PE). The Journal of Sexual Medicine. 2019; 16: 1364–1370.

[40] Demirci A, Hızlı F, Hamurcu HD, Başar H. Erectile dysfunction, anxiety, perceived stress, and insomnia are more common among acquired premature ejaculation patients compared to other premature ejaculation syndromes. Andrology. 2023; 11: 425–432.

[41] Rajkumar RP, Kumaran AK. Depression and anxiety in men with sexual dysfunction: a retrospective study. Comprehensive Psychiatry. 2015; 60: 114–118.

[42] Gopalakrishna A, Bole R, Alom M, Meng Y, Jimbo M, Trost L, et al. Characteristics of men who are bothered by rapid ejaculation: results from clinical intake surveys. International Journal of Impotence Research. 2021; 33: 369–375.

[43] Shindel AW, Althof SE, Carrier S, Chou R, McMahon CG, Mulhall JP, et al. Disorders of ejaculation: an AUA/SMSNA guideline. Journal of Urology. 2022; 207: 504–512.

[44] Gao J, Xu C, Zhang J, Liang C, Su P, Peng Z, et al. Effects of adult male circumcision on premature ejaculation: results from a prospective study in China. BioMed Research International. 2015; 2015: 417846.

[45] Mohamed AH, Mohamud HA, Yasar A. The prevalence of premature ejaculation and its relationship with polygamous men: a cross-sectional observational study at a tertiary hospital in Somalia. BMC Urology. 2021; 21: 175.

[46] Bőthe B, Koós M, Tóth-Király I, Orosz G, Demetrovics Z. Investigating the associations of adult ADHD symptoms, hypersexuality, and problematic pornography use among men and women on a largescale, non-clinical sample. The Journal of Sexual Medicine. 2019; 16: 489–499.

[47] Weafer J, de Wit H. Sex differences in impulsive action and impulsive choice. Addictive Behaviors. 2014; 39: 1573–1579.

[48] Weinstein A, Dannon P. Is impulsivity a male trait rather than female trait? Exploring the sex difference in impulsivity. Current Behavioral Neuroscience Reports. 2015; 2: 9–14.

[49] Althof SE. Psychosexual therapy for premature ejaculation. Translational Andrology and Urology. 2016; 5: 475–481.

[50] Kempeneers P, Andrianne R, Bauwens S, Georis I, Pairoux JF, Blairy S. Functional and psychological characteristics of Belgian men with premature ejaculation and their partners. Archives of Sexual Behavior. 2013; 42: 51–66.

[51] Abdo CH. The impact of ejaculatory dysfunction upon the sufferer and his partner. Translational Andrology and Urology. 2016; 5: 460–469.

[52] Huyghe E, Cuzin B, Grellet L, Faix A, Almont T, Burte C. Recommendations for the treatment of premature ejaculation. Progrès en Urologie. 2023; 33: 237–246. (In French)

[53] Wei S, Ma M, Wen X, Wu C, Zhu G, Zhou X. Online public attention toward premature ejaculation in Mainland China: infodemiology study using the Baidu index. Journal of Medical Internet Research. 2021; 23: e30271.

[54] Gul M, Kaynar M. Evaluating the content and quality of information about premature ejaculation on the Internet: what are men being exposed to? Andrologia. 2017; 49.