004 Development and Validation of Holding Time (HoT), a Novel Tool to Measure the Control Over Ejaculation in Males
Authors: Bhat G. , Shastry A. 
Published: May 2022

ABSTRACT

Introduction
As per ISSM definition, premature ejaculation is based on the assessment of three constructs, namely, ejaculatory latency, control over ejaculation and its associated bother. There is an objective tool to measure ejaculatory latency. There are tools to measure bother as well. However, there is no objective tool to measure ejaculatory control in males.

Objective
To develop and validate a novel objective tool, namely, Holding Time (HoT) to measure control over ejaculation in males.

Methods
After obtaining ethical committee approval and written informed consent from the participants and their heterosexual partners, study was initiated. A group of sexually active heterosexual healthy male volunteers as controls and another group of voluntary sexually active heterosexual participants who reported premature ejaculation (PE) in our outpatient department were administered Premature Ejaculation Diagnostic Tool (PEDT). Each participant underwent sexual stimulation sessions in adequate privacy, wherein the audio-visual stimuli as well as stimulation by their heterosexual partner were used for sexual arousal. Following this, they masturbated, which began after reaching the level seven of Mosher's scale of genital sensations, which is the highest point of sexual arousal prior to reaching orgasm. Their heart rate was monitored throughout the session, which was recorded using digital pulse oxymeter. This was taken as additional objective biological evidence to record highest point of arousal. The heterosexual partner's opinion with regard to increase in size of glans as well as increased pulsations in penis was also taken into account to record the highest point of arousal, which was an additional crosscheck mechanism. The time from the highest point of sexual arousal to the point at which the study participant expressed inability to hold ejaculation to any further point of time was recorded using stopwatch by the investigator as the HoT. The test was repeated after 6 weeks to assess test-retest reliability, which was measured using Pearson's coefficient (r). Correlations between PEDT diagnosed PE and self-reported PE, with stopwatch measured HoT was assessed to validate HoT.

Results
Ten healthy controls (Mean age 30.3±4.64 years) and ten volunteers with self-reported PE (Mean age 29.6±4.25 years) participated in the study conducted from May 2020 to April 2021. The mean stopwatch measured HoT in seconds, recorded by healthy volunteers and self-reported PE were 119.6±33.6 and 32.4±12.8 respectively. Test-retest reliability was good for both the healthy volunteers (r =0.983) and volunteers with PE (r =0.839). It had a sensitivity of 90% and specificity of 91% for diagnosis of PE. The positive predictive value was 79.4% and negative predictive value was 95.5%. Excellent correlations between PEDT and HoT with respect to the diagnosis of PE demonstrated construct validity of HoT.

Conclusions
The development of an objective tool to evaluate the control over ejaculation helps to develop more objective definition and better management of ejaculatory dysfunctions in males. As per preliminary validation data, Holding Time (HoT) is a reliable objective tool to measure control over ejaculation in males.

Disclosure
Work supported by industry: no.