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.