Association between serum vitamin D levels and acquired premature ejaculation

Background and objective: Premature ejaculation is one of the most common and complex sexual diseases among men. Although there are four defined subtypes of premature ejaculation, the most common subtype is acquired premature ejaculation. This study investigated the association between serum vitamin D levels and acquired premature ejaculation.

Material and methods: This retrospective cross-sectional study included 94 patients with a complaint of acquired premature ejaculation (the study group) and 92 patients without a complaint of premature ejaculation (the control group) between June 2018 and March 2020. Patients' demographic characteristics, laboratory results, intravaginal ejaculatory latency time, Turkish validated premature ejaculation diagnostic tool (PEDT), International Index of Erectile Function-5 (IIEF-5) and Beck Depression scores were statistically compared between groups.

Results: The patients' mean age was 49.10 ± 14.85 years. There were differences between the two groups regarding serum vitamin D levels, dehydroepiandrosterone sulfate, total testosterone, and follicle-stimulating hormone levels. Upon comparing the questionnaire scores, the PEDT, intravaginal ejaculatory latency time, and Beck depression scores were clinically significant between groups. The cut-off value for serum vitamin D levels was 8.37 ng/mL, with a sensitivity of 93% and specificity of 92%. Conclusion: We revealed that serum vitamin D and follicle-stimulating hormone levels were independent risk factors according to the multivariate analysis. Measurement of serum vitamin D levels in patients with acquired premature ejaculation may be useful for treatment.

Premature ejaculation; Serum vitamin D; Sexual dysfunction; Acquired premature ejaculation

[1] Montorsi F. Prevalence of premature ejaculation: a global and regional perspective. The Journal of Sexual Medicine. 2005; 2: 96–102.

[2] Jannini EA, Lenzi A. Epidemiology of premature ejaculation. Current Opinion in Urology. 2005; 15: 399–403.

[3] Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, et al. An Evidence‐Based Unified Definition of Lifelong and Acquired Premature Ejaculation: Report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. The Journal of Sexual Medicine. 2014; 11: 1423–1441.

[4] Giuliano F, Clément P. Physiology of ejaculation: emphasis on serotonergic control. European Urology. 2005; 48: 408–417.

[5] Waldinger MD. Pathophysiology of Lifelong Premature Ejaculation. Premature Ejaculation. 2013; 50: 71–80.

[6] Jannini EA, Lenzi A. Pathophysiology of Acquired Premature Ejacula-tion. Premature Ejaculation. 2013; 5: 81–97.

[7] Hartmann U, Schedlowski M, Krüger THC. Cognitive and partner-related factors in rapid ejaculation: differences between dysfunctional and functional men. World Journal of Urology. 2005; 23: 93–101.

[8] Carani C, Isidori AM, Granata A, Carosa E, Maggi M, Lenzi A, et al. Multicenter study on the prevalence of sexual symptoms in male hypo-and hyperthyroid patients. The Journal of Clinical Endocrinology & Metabolism. 2005; 90: 6472–6479.

[9] Screponi E, Carosa E, Di Stasi SM, Pepe M, Carruba G, Jannini EA. Prevalence of chronic prostatitis in men with premature ejaculation. Urology. 2001; 58: 198–202.

[10] Jeh SU, Yoon S, Choi JH, Do J, Seo DH, Lee SW, et al. Metabolic syndrome is an independent risk factor for acquired premature ejaculation. The World Journal of Men’s Health. 2018; 17: e1573.

[11] Bronner G, Israeli-Korn S, Hassin-Baer S, Yahalom G. Acquired premature ejaculation in Parkinson’s disease and possible mechanisms. International Journal of Impotence Research. 2018; 30: 153–157.

[12] Majzoub A, El-Hamd M, Saleh R. Premature ejaculation: an update on definition and pathophysiology. Asian Journal of Andrology. 2019; 21: 425.

[13] Canguven O, Al Malki AH. Vitamin D and Male Erectile Function: An Updated. The World Journal of Men’s Health. 2021; 39: 31–37.

[14] Talib RA, Khalafalla K, Cangüven Ö. The role of vitamin D supplementation on erectile function. Turkish Journal of Urology. 2017; 43: 105–111.

[15] Haussler MR, Haussler CA, Whitfield GK, Hsieh J, Thompson PD, Barthel TK, et al. The nuclear vitamin D receptor controls the expression of genes encoding factors which feed the “Fountain of Youth” to mediate healthful aging. The Journal of Steroid Biochemistry and Molecular Biology. 2010; 121: 88–97.

[16] Deeb KK, Trump DL, Johnson CS. Vitamin D signalling pathways in cancer: potential for anticancer therapeutics. Nature Reviews. Cancer. 2007; 7: 684–700.

[17] Nagpal S, Na S, Rathnachalam R. Noncalcemic actions of vitamin D receptor ligands. Endocrine Reviews. 2005; 26: 662–687.

[18] Serefoglu EC, Cimen HI, Ozdemir AT, Symonds T, Berktas M, Balbay MD. Turkish validation of the premature ejaculation diagnostic tool and its association with intravaginal ejaculatory latency time. International Journal of Impotence Research. 2009; 21: 139–144.

[19] Turunç T, Deveci S, Güvel S, Peşkircioğlu L. Uluslararası cinsel işlev indeksinin 5 soruluk versiyonunun (IIEF-5) Türkçe geçerlilik çalışmasının değerlendirilmesi. Türk Üroloji Dergisi/Turkish Journal of Urology. 2007; 33: 45–49.

[20] Canel-Çınarbaş D, Cui Y, Lauridsen E. Cross-Cultural Validation of the Beck Depression Inventory–II across U.S. and Turkish Samples. Measurement and Evaluation in Counseling and Development. 2011; 44: 77–91.

[21] Pereira-Lourenço M, e Brito DV, Pereira BJ. Premature Ejaculation: From Physiology to Treatment. Journal of Family & Reproductive Health. 2019; 13: 120.

[22] Pludowski P, Holick MF, Pilz S, Wagner CL, Hollis BW, Grant WB, et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-a review of recent evidence. Autoimmunity Reviews. 2013; 12: 976–989.

[23] Tirabassi G, Sudano M, Salvio G, Cutini M, Muscogiuri G, Corona G, et al. Vitamin D and Male Sexual Function: a Transversal and Longitudinal Study. International Journal of Endocrinology. 2018; 2018: 1–8.

[24] Lerchbaum E, Pilz S, Trummer C, Schwetz V, Pachernegg O, Heijboer AC, et al. Vitamin D and Testosterone in Healthy Men: a Randomized Controlled Trial. The Journal of Clinical Endocrinology and Metabolism. 2017; 102: 4292–4302.

[25] Crafa A, Cannarella R, Condorelli RA, La Vignera S, Calogero AE. Is There an Association Between Vitamin D Deficiency and Erectile Dysfunction? A Systematic Review and Meta-Analysis. Nutrients. 2020; 12: 1411.

[26] Canat L, Degirmentepe RB, Atalay HA, Çakir SS, Alkan I, Çulha MG, et al. Low serum vitamin D is associated with an increased likelihood of acquired premature ejaculation. International Brazilian Journal of Urology. 2019; 45: 621–628.

[27] Geng C, Shaikh AS, Han W, Chen D, Guo Y, Jiang P. Vitamin D and depression: mechanisms, determination and application. Asia Pacific Journal of Clinical Nutrition. 2019; 28: 689.

[28] Milaneschi Y, Hoogendijk W, Lips P, Heijboer AC, Schoevers R, van Hemert AM, et al. Low vitamin D and depression-Study and meta-analysis, April 2013. Molecular Psychiatry. 2013.

[29] Xia Y, Li J, Shan G, Qian H, Wang T, Wu W, et al. Relationship between premature ejaculation and depression. Medicine. 2016; 95: e4620.

[30] D’Andrea S, Martorella A, Coccia F, Castellini C, Minaldi E, Totaro M, et al. Relationship of Vitamin D status with testosterone levels: a systematic review and meta-analysis. Endocrine. 2020; 72: 49–61.

[31] Chen C, Zhai H, Cheng J, Weng P, Chen Y, Li Q, et al. Causal Link between Vitamin D and Total Testosterone in Men: a Mendelian Randomization Analysis. The Journal of Clinical Endocrinology & Metabolism. 2019; 104: 3148–3156.

[32] Trummer C, Pilz S, Schwetz V, Obermayer-Pietsch B, Lerchbaum E. Vitamin D, PCOS and androgens in men: a systematic review. Endocrine Connections. 2018; 7: R95–R113.

[33] Pilz S, Frisch S, Koertke H, Kuhn J, Dreier J, Obermayer-Pietsch B, et al. Effect of vitamin D supplementation on testosterone levels in men. Hormone and Metabolic Research. 2011; 43: 223–225.

[34] Lerchbaum E, Trummer C, Theiler-Schwetz V, Kollmann M, Wölfler M, Heijboer AC, et al. Effects of vitamin D supplementation on androgens in men with low testosterone levels: a randomized controlled trial. European Journal of Nutrition. 2019; 58: 3135–3146.

[35] Rafiq R, van Schoor NM, Sohl E, Zillikens MC, Oosterwerff MM, Schaap L, et al. Associations of vitamin D status and vitamin D-related polymorphisms with sex hormones in older men. The Journal of Steroid Biochemistry and Molecular Biology. 2016; 164: 11–17.

[36] Wang N, Han B, Li Q, Chen Y, Chen Y, Xia F, et al. Vitamin D is associated with testosterone and hypogonadism in Chinese men: Results from a cross-sectional SPECT-China study. Reproductive Biology and Endocrinology. 2015; 13: 74.

[37] Motofei IG, Rowland DL. Neurophysiology of the ejaculatory process: developing perspectives. BJU International. 2005; 96: 1333–1338.

[38] Gillman N, Gillman M. Premature ejaculation: Aetiology and treatment strategies. Medical Sciences. 2019; 7: 102.

[39] Hull EM, Du J, Lorrain DS, Matuszewich L. Testosterone, preoptic dopamine, and copulation in male rats. Brain Research Bulletin. 1997; 44: 327–333.

[40] Culha MG, Tuken M, Gonultas S, Cakir OO, Serefoglu EC. Frequency of etiological factors among patients with acquired premature ejacu-lation: prospective, observational, single-center study. International Journal of Impotence Research. 2020; 32: 352–357.

[41] Hewison M, Freeman L, Hughes SV, Evans KN, Bland R, Eliopoulos AG, et al. Differential regulation of vitamin D receptor and its ligand in human monocyte-derived dendritic cells. Journal of Immunology. 2003; 170: 5382–5390.

[42] Almerighi C, Sinistro A, Cavazza A, Ciaprini C, Rocchi G, Bergamini A. 1α,25-Dihydroxyvitamin D3 inhibits CD40L-induced pro-inflammatory and immunomodulatory activity in Human Monocytes. Cytokine. 2009; 45: 190–197.

[43] D’Ambrosio D, Cippitelli M, Cocciolo MG, Mazzeo D, Di Lucia P, Lang R, et al. Inhibition of IL-12 production by 1, 25-dihydroxyvitamin D3. Involvement of NF-kappaB downregulation in transcriptional repression of the p40 gene. The Journal of Clinical Investigation. 1998; 101: 252–262.