We conducted a cross-sectional and analytical study with prospective data collection in the outpatient urology units of three hospitals in Douala: Laquintinie Hospital of Douala, the Military Hospital of Region No. 2, and the Deido District Hospital. The study period extended from February 1 to May 16, 2025.

The target population consisted of all men attending urology consultation in these facilities during the study period. Inclusion criteria were: age ≥ 21 years, non-castrated status, attendance at outpatient urology consultation, and provision of free, informed, and signed consent. Consecutive and exhaustive sampling was used.

Ethical approval was obtained from the Institutional Ethics Committee for Human Health Research of the University of Douala, along with administrative authorizations from the respective hospitals. Eligible patients were informed about the objectives and procedures of the study and signed an informed consent form prior to participation.

Patients completed a self-administered questionnaire in a confidential setting. For participants with limited literacy (17.6% primary education only, 1.7% no formal education), questionnaires were administered by trained research assistants who read each item aloud in the patient’s preferred language (French or English), using standardized neutral phrasing to avoid influencing responses.

Collected data included:

Sociodemographic characteristics: age, occupation, education level, marital status, religion.Medical and surgical history: hypertension, diabetes, prostatitis, Peyronie’s disease, sexually transmitted infections, erectile dysfunction, prostatectomy, hernia repair.Lifestyle habits: alcohol consumption, tobacco use.

Intravaginal ejaculatory latency time (IELT) was assessed using self-reported estimated average time from vaginal penetration to ejaculation over the past 4 weeks. Patients were instructed to provide an average estimate based on their recent sexual experiences.

Patients with an IELT ≤ 3 minutes were classified as having PE, in accordance with the broadened ISSM definition including acquired forms [1][4]. We applied a single cutoff of ≤3 minutes to all participants for the following reasons: 1) clinical pragmatism in routine urological consultation; 2) consistency with recent epidemiological literature [6][11]; and 3) sample size considerations. However, we acknowledge that this does not distinguish between lifelong and acquired PE. To assess the robustness of our findings, we conducted a sensitivity analysis using a stricter definition of PE (IELT ≤ 1 minute), which more closely corresponds to the classic definition of lifelong PE.

2.6.1. Erectile Dysfunction (ED)

Erectile dysfunction was defined based on clinical evaluation by the consulting urologist, using DSM-5 criteria: persistent or recurrent inability to attain or maintain an erection sufficient for satisfactory sexual performance, present for at least 3 months.

2.6.2. History of Sexually Transmitted Infections (STIs)

History of STIs was obtained through self-report of prior physician diagnosis. Patients were asked: “Have you ever been diagnosed with a sexually transmitted infection by a healthcare professional?” Those answering “yes” were asked to specify the infection(s). Only professionally diagnosed infections were counted. The timeframe was lifetime prevalence, which is acknowledged as a limitation.

2.6.3. Alcohol Consumption

Alcohol consumption was assessed using a standardized frequency questionnaire. Patients were asked: “On average, how often do you consume alcoholic beverages?” Response options included: Never; Once per month; 2 - 4 times per month; 2 - 3 times per week; ≥4 times per week.

Definition of a standard drink: Patients were instructed that one standard drink corresponds to approximately 330 mL of beer (one bottle), 150 mL of wine (one glass), or 40 mL of spirits (one shot).

2.6.4. Smoking Exposure

Smoking history was quantified using the pack-years metric, calculated as:

Pack-years=(Number of cigarettes smoked per day ÷ 20) × Number of years smoked

Patients were categorized as: Non-smokers: Never smoked or smoked < 100 cigarettes in lifetime; <5 pack-years: Light smoking history; 5-15 pack-years: Moderate smoking history; >15 pack-years: Heavy smoking history.

Former smokers who had quit for ≥12 months were classified according to their cumulative pack-years.

2.6.5. Assessment of Psychological Status and Quality of Life

1)Anxiety Assessment (STAI-T)

Trait anxiety was assessed using the State-Trait Anxiety Inventory—Trait version (STAI-T), a 20-item self-report questionnaire. Each item is scored on a 4-point Likert scale (1 = “almost never” to 4 = “almost always”), with total scores ranging from 20 to 80. Higher scores indicate greater anxiety levels.

Score interpretation followed standard cutoffs: 20-37: Very mild anxiety (no clinically significant anxiety); 38-44: Mild anxiety; 45-56: Moderate anxiety; 57-80: High/severe anxiety.

2)Depression Assessment (BDI)

Depressive symptoms were assessed using the Beck Depression Inventory (BDI), a 21-item self-report questionnaire. Each item is scored from 0 to 3, with total scores ranging from 0 to 63.

Score interpretation followed standard clinical cutoffs: 0-13: Minimal depression; 14-19: Mild depression; 20-28: Moderate depression; 29-63: Severe depression.

3)Quality of Life Assessment (SF-36)

Health-related quality of life was evaluated using the Short Form-36 (SF-36) questionnaire. For this study, we focused on the overall quality of life perception. Scores range from 0 to 100, with higher scores indicating better quality of life. Based on established thresholds [15], quality of life was categorized as good (score ≥50) or poor (score <50).

4)Cultural and Linguistic Validation

The questionnaires were administered in French or English based on patient preference. All three instruments have been previously validated in French and English versions and have been used in sub-Saharan African research settings [10][13][14].

Data were entered into Epidata and analyzed using R (R Commander interface) and SAS software. Sociodemographic characteristics were described using frequencies, proportions, means, and standard deviations. Binary logistic regression was performed (univariate then multivariate), with statistical significance set at p < 0.05. Variables with p < 0.10 in univariate analysis were included in the multivariate model. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated.

A total of 311 eligible patients were identified, of whom 10 refused to participate, yielding a participation rate of 96.8%. The analysis included 301 patients seen in urology consultations at the three hospitals.

3.1.1. Sociodemographic Characteristics (Table 1)

The mean age of patients was 49.8 ± 13.9 years (range: 21 - 80 years). The most represented age group was 61 - 70 years (19.9%), followed by 31 - 40 years (17.3%) and 51 - 60 years (16.6%). The majority were employed (66.1%), while 26.6% were retired and 3.3% were unemployed. Regarding educational level, 42.2% had higher education, 38.5% secondary education, 17.6% primary education, and 1.7% no formal education. In terms of marital status, 60.1% were married, 29.6% single, and 5.9% cohabiting. Most patients were Christians (92.0%).

Table 1. Sociodemographic characteristics of participants (N = 301).

3.1.2. Medical and Surgical History (Table 2)

Among participants, 67.8% reported no medical history. The most frequently reported conditions were erectile dysfunction (12.6%) and hypertension (11.3%). Other conditions included diabetes (2.3%), sexually transmitted infections (2.9%), prostatitis (1.7%), and Peyronie’s disease (1.3%). Regarding surgical history, 94.7% had none; hernia repair accounted for 3.7% and prostatectomy for 1.7%.

Table 2. Medical and surgical history of participants (N = 301).

3.1.3. Lifestyle Habits

Concerning alcohol consumption, 43.2% reported drinking 2 - 4 times per month, 33.2% 2 - 3 times per week, and 15.3% at least 4 times per week. Only 1.7% reported never consuming alcohol. Regarding smoking, 40.2% were non-smokers, while 59.8% were current or former smokers. Among smokers, 18.3% had <5 pack-years, 22.6% had 5 - 15 pack-years, and 18.9% had >15 pack-years.

Out of 301 participants, 70 met the study definition of premature ejaculation (IELT ≤ 3 minutes), corresponding to a prevalence of 23.26% (Figure 1).

Figure 1. Prevalence of premature ejaculation in urological consultation in Douala (N = 301).

Using a stricter definition of PE (IELT ≤ 1 minute), which more closely approximates lifelong PE:

29 patients (9.63%) reported IELT ≤ 1 minute.41 patients (13.63%) reported IELT between 1 - 3 minutes (acquired PE range).

Among the 70 patients with PE, psychological assessments revealed:

Anxiety (STAI-T): Mean score 48.6 ± 8.4 (range: 32 - 68). The majority (75.7%, n = 53) had moderate anxiety, while 10.0% (n = 7) had very mild anxiety, 11.4% (n = 8) mild anxiety, and 2.9% (n = 2) high anxiety.

Depression (BDI): Mean score 16.8 ± 5.2 (range: 6 - 31). Nearly half (47.1%, n = 33) had minimal depression, while 35.7% (n = 25) had mild depression and 17.1% (n = 12) had moderate depression. No patients met criteria for severe depression.

Quality of Life (SF-36): Mean score 67.3 ± 14.1 (range: 38 - 92). Most patients (80.0%, n = 56) reported good quality of life, while 20.0% (n = 14) reported poor quality of life (Table 3).

Age: Prevalence increased slightly with age but none of the differences were statistically significant (p > 0.05) (Table 4).

Table 3. Psychological state and quality of life of patients with premature ejaculation (N = 70).

*STAI-T: State-Trait Anxiety Inventory-Trait; BDI: Beck Depression Inventory; SF-36: Short Form-36*.

Table 4. Factors associated with premature ejaculation (Univariate Logistic Regression).

STIs: Sexually Transmitted Infections; PY: pack-years.

Medical History: Significant associations were found for:

History of sexually transmitted infections: 55.6% with PE (OR = 6.00; 95% CI 1.68 - 21.48; p = 0.005).Erectile dysfunction: 36.8% with PE (OR = 2.85; 95% CI 1.31 - 6.18; p = 0.008)

Surgical History: No significant associations observed (p > 0.05).

Alcohol Consumption: Significant association only for frequent drinking (≥4 times/week): 67.4% with PE (OR = 9.67; 95% CI 1.12 - 83.7; p = 0.012).

Smoking: Significant association only for heavy smoking (>15 pack-years): 31.6% with PE (OR = 2.31; 95% CI 1.09 - 4.92; p = 0.03).

After adjustment for variables significant in univariate analysis, the factors independently associated with premature ejaculation were Age, hypertension, and diabetes were not significantly associated in the multivariate model (Table 5).

Table 5. Factors independently associated with premature ejaculation (Multivariate Logistic Regression).

STIs: Sexually Transmitted Infections; PY: pack-years;aOR: adjusted odds ratio.

When re-analyzing factors associated with PE using the stricter ≤ 1-minute cutoff:

History of STIs remained significantly associated (OR = 5.82; 95% CI 1.52 - 22.31; p = 0.010).Erectile dysfunction showed a stronger association (OR = 4.12; 95% CI 1.89 - 8.98; p = 0.0004).Frequent alcohol consumption (≥4×/week) remained significant (OR = 7.23; 95% CI 1.98 - 26.45; p = 0.003).Heavy smoking (>15 pack-years) showed a trend but lost statistical significance (OR = 1.89; 95% CI 0.88 - 4.06; p = 0.102), possibly due to reduced sample size.

In this study conducted in three urology departments in Douala, premature ejaculation affected 23.26% of men surveyed using the ≤3-minute cutoff, and 9.63% using the ≤1-minute cutoff. The primary estimate falls within the range reported in several hospital-based studies internationally [5]-[7][11]. A recent systematic review by Opolony et al. [7] reported pooled prevalence of 14.2% across 79 studies, though this varied considerably by diagnostic criteria and population.

In Africa, Hanafy et al. [6] reported a prevalence of 26.7% in Egypt, closely matching our findings. In Cameroon, our estimate is higher than the 18.1% reported by Angwafor et al. [12] in Yaoundé and the 20% reported by Mboumwa et al. [13] in Douala, but substantially higher than the 3.1% reported by Tanze et al. [14] in Buea. These variations likely reflect differences in diagnostic criteria, study settings, and population characteristics.

The sensitivity analysis using a ≤1-minute cutoff (9.63%) is remarkably consistent with the 12.4% reported by Verze et al. [11] in Italy using the same threshold, suggesting that the prevalence of probable lifelong PE may be relatively consistent across populations.

The high prevalence of anxiety symptoms among our PE patients (75.7% with moderate anxiety; mean STAI-T 48.6) is consistent with findings from Rowland et al. [8] and recent meta-analyses. Che et al. [16] reported a pooled anxiety prevalence of 42% in PE patients, while Xie et al. [17] confirmed strong associations between sexual dysfunction and psychological comorbidity. Our higher rates may reflect clinic-based sampling, where men seeking care may have greater distress.

Regarding depression, 52.9% of our PE patients had at least mild depressive symptoms (BDI ≥14), aligning with Hanafy et al. [6], who reported significant depression in 48% of Egyptian men with PE. The absence of severe depression in our sample may reflect cultural factors, coping mechanisms, or the relatively high mean age.

The mean SF-36 score of 67.3 in our PE patients is higher than the 58.4 reported by Verze et al. [11] in Italy, suggesting that Cameroonian men with PE may perceive less impact on overall quality of life. This could be due to cultural differences in the centrality of sexual performance to overall well-being. However, the 20% with poor quality of life represents a clinically important subgroup requiring attention.

The independent associations we identified—history of STIs, erectile dysfunction, frequent alcohol consumption, and heavy smoking—are consistent with international literature [1][4][5][11].

History of STIs (aOR = 3.98) may contribute to PE through several mechanisms: chronic prostatic inflammation, psychological distress following diagnosis, or relationship disruption. This finding aligns with Serefoglu and McMahon [3][4], who documented higher PE frequency among men with urogenital history.

Erectile dysfunction (aOR = 3.25) showed the strongest association in multivariate analysis. The bidirectional relationship between ED and PE is well-established [1][5]; men may rush to ejaculation for fear of losing erection, or ED may reflect underlying vascular or neurological pathology that also affects ejaculatory control.

Frequent alcohol consumption (≥4 times/week; aOR = 4.86) was strongly associated with PE. This relationship, also observed in studies from Türkiye, Italy, and Egypt [6][11][18], may reflect alcohol’s disruptive effect on sensory perception and central inhibitory control, although residual confounding (e.g., underlying anxiety) cannot be excluded.

Heavy smoking (>15 pack-years; aOR = 2.04) was associated with PE, consistent with some European studies [11]. The loss of statistical significance in the ≤1-minute sensitivity analysis suggests smoking may be more strongly associated with acquired PE (IELT 1 - 3 minutes) than lifelong PE, a hypothesis warranting further investigation.

Several limitations should be considered when interpreting our findings.

First, clinic-based sampling limits generalizability. This study was conducted among men attending urology consultations, who may differ from the general population in health-seeking behavior and symptom severity. Our prevalence estimate reflects urology consulters, not community-based prevalence. Men with mild PE or those not perceiving their symptoms as problematic may be underrepresented.

Second, the cross-sectional design precludes determination of causality or directionality. We cannot establish whether factors such as anxiety precede, predict, or result from PE. Longitudinal studies are needed to elucidate temporal relationships.

Third, reliance on self-reported data introduces potential information bias. IELT was estimated rather than stopwatch-measured, which may affect accuracy [19]. STI history, alcohol consumption, and smoking were based on recall without objective verification. Social desirability bias may have led to underreporting of sensitive behaviors.

Fourth, measurement limitations affect specific variables. ED was assessed clinically rather than with a validated instrument like the IIEF-5. Alcohol consumption was assessed by frequency only, without quantifying amount per occasion. For smoking, we did not distinguish current from former smokers in the main analysis.

Fifth, the absence of distinction between lifelong and acquired PE limits etiological interpretation. Our sensitivity analysis using a ≤1-minute cutoff partially addresses this by approximating lifelong PE, but this remains a limitation.

Sixth, while the STAI-T, BDI, and SF-36 are widely used, their validation in Cameroonian populations is limited. Cultural differences in expressing psychological distress may affect accuracy.

Seventh, the relatively small sample size for subgroup analyses (70 PE cases) limited statistical power for detecting associations with less common exposures.

Finally, unmeasured confounding is possible. We did not assess partner characteristics, relationship quality, frequency of sexual activity, occupational stress, or detailed medication use.

Despite these limitations, this study provides valuable contemporary data on PE in urological consultations in Cameroon, identifies key associated factors, and highlights the psychological burden of this condition.