Determinants of ejaculatory dysfunction in a community-based longitudinal study.

OBJECTIVE To analyse the incidence of ejaculatory dysfunction (EJD) and its associated bother, and to determine which factors predispose to incident EJD. SUBJECTS AND METHODS Men aged 50-78 years, registered in the general practices in Krimpen a/d Ijssel, the Netherlands, were recruited. Men were excluded if they had a history of prostatectomy, carcinoma of the bladder or prostate and neurogenic bladder disease. A baseline study and three follow-up assessments (I-III), all with questionnaires, i.e. the Benign Prostatic Hyperplasia impact index, International Prostate Symptom Score, International Continence Society (ICS)male sex questionnaire, and additional measurements, e.g. prostate volume, prostate specific antigen, were made at a mean of 2.2-year intervals. We assessed the objective variables of EJD as the ability to ejaculate, ejaculatory volume, painful ejaculation, and their associated bother (information extracted from the ICSmale sex questionnaire). RESULTS At baseline 671 of 1661 (40.4%) men already had EJD; the cumulative incidence of EJD was 16.5%, 24.7% and 33.1% after follow-up I, II and III, respectively. The mean percentage of men who were bothered with reduced ejaculatory volume or painful ejaculation was 18.3% and 40.6%, respectively. Multivariate analysis showed age, Sickness Impact Profile 'social' (questions on social impairment) and erectile dysfunction to be predisposing factors of EJD (P < 0.05 and R(2) = 0.048). When EJD was defined as a significantly reduced ejaculatory volume or anejaculation only, age and previous transurethral resection of the prostate (TURP) were determinants of EJD (P < 0.05 and R(2) = 0.083). Of the men who had TURP after the follow-up, 51.6% already had EJD at baseline. CONCLUSIONS The cumulative incidence of EJD after 6.5 years of follow-up was significant (33.1%) and EJD was bothersome, especially in men with painful ejaculation. Determinants of EJD were age, social impairment and erectile dysfunction. Predisposing factors of significant reduction of ejaculatory volume and anejaculation were age and TURP, although 51.6% of men already had EJD before TURP. Age appears to be the most significant predisposing factor of EJD.