Video platforms and sexual healthcare in China: assessment of content on premature ejaculation

Introduction

Premature ejaculation (PE) is estimated to affect over 20.9% of males seeking care in andrology and sexual medicine clinics in China (1) and represents one of the most commonly reported sexual dysfunctions globally. PE has a detrimental impact not only on men but also on their sexual partners, contributing to emotional distress and interpersonal challenges (2). Given the stigma and embarrassment often associated with this condition, individuals experiencing ejaculatory issues are more likely to turn to the Internet for healthcare-related information rather than to seek professional assistance from a therapist or consult a physician about this sensitive matter (1).

The healthcare industry is being increasingly influenced by the growing accessibility of video platforms and social media (3). As online content continues to expand, healthcare services are encountering new challenges, including the spread of online misinformation, prompting shifts in service delivery models. A study has shown that up to 50% of adults initially seek advice for health concerns online (4). Notably, YouTube has been identified as a key platform for medical information, with its content verified and scrutinized across various disciplines due to its extensive reach and significant user engagement (5,6). However, it is important to recognize that YouTube is restricted in regions with stricter information access policies, and the quality of online healthcare content in such areas, as well as the prevalence of online misinformation, has yet to be thoroughly evaluated.

It is widely known that platforms such as Google and YouTube are not accessible to the general public in mainland China, except for those with specific regulatory allowances (7). Consequently, the influence of internet-based content in this context requires focused evaluation. As the prevalence of PE continues to rise in China, more individuals are turning to online platforms for medical advice (8). However, previous research has highlighted concerns regarding misleading information on both social media and online encyclopedia platforms (9,10). Given the growing reliance on online video content for health information, this study aims to evaluate the quality and accuracy of online videos related to PE and issues in disinformation, emphasizing the need for improved content standards and reliable health communication.

Methods

Search strategy and data collection

According to the 44th Statistical Report on Internet Development in China (11) released by the China Internet Network Information Center (CINIC) and Statista (12), the 10 top online video platforms in mainland China are iQiyi (https://www.iqiyi.com/), QQ.video (https://v.qq.com), Youku (https://www.youku.com), MGTV (https://www.mgtv.com), Bilibili (https://www.bilibili.com), Sohu (https://tv.sohu.com), CCTV (https://v.cctv.com), LeTV (http://www.le.com), PPTV (https://www.pptv.com), and 56.com (http://www.56.com). On July 1, 2023, we searched these websites to locate video clips using the search terms “PE” and “PE remedy”, along with equivalent Chinese terms, and copied the links of all searched videos. Although most people tend to only view the content from the first pages in their search (13), all videos from the search in each website were included and documented to minimize omission-related bias. All videos were viewed and scrutinized by two independent clinicians with over a decade of experience specializing in urology and andrology. We excluded videos with poor quality, irrelevant content, or commercials; those requiring member fee charged VIP access; those on topics other than PE; and duplicate and/or replicated videos.

Video review and scoring

Parameters such as number of views and upload time were unanalyzable because these data were only provided by Bilibili and Sohu. Some other sites list “months or years ago” and “trend or popular rate” to indicate audience feedback and pageview. Hence, only the video length, uploader type, number of views, uploading time, programming form, speaker, and comment number for each video were documented. Each video was categorized into reliable and non-reliable groups depending on its content and quality as determined by method and tools used in previous studies (14-17). Disagreements between reviewers were solved via discussion with a third doctor with greater seniority. In addition, the quality of each video’s health information and overall quality was scored using the DISCERN scale and Global Quality Score (GQS) scale in similar fashion to other studies (4,5,18). Uploaders were categorized as certified healthcare organizations, We-media, and independent users. Moreover, videos were categorized into independent user, physician, voice-over narration and other types. The diagnostic criteria for PE were referenced based on the “European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction (2).

Statistical analysis

Quantitative data were analyzed by descriptive statistical parameters. Cohen’s kappa and intraclass correlation coefficients (ICCs) were used to quantify the interrater agreement and interobserver reliability of GSQ and DISCERN score. The applicable numerical variables are expressed as the mean ± standard deviation (SD). Statistical differences among multiple groups and categorical variables were compared using the Chi-squared test, one-way analysis of variance (ANOVA), and the Fisher exact test. A value of P<0.05 was considered significant.

Results

Among the 10 websites reviewed, only 7 provided videos on PE through active searches, yielding a total of 1,461 videos. After the initial screening, 595 videos were excluded due to irrelevant content (n=353), poor quality (n=49), product advertisements (n=126), VIP access restrictions (n=46), and other factors (n=21). This resulted in 866 eligible videos. Further exclusions included duplicated uploads (n=195) and content duplication (n=89), leaving 582 videos for analysis (Figure 1). The majority of excluded videos were from Bilibili.com and Sohu.com. On Bilibili.com, the primary reasons for exclusion were irrelevant content (n=268), content replication (n=56), product advertisements (n=39), VIP access-only videos (n=20), poor quality (n=6), and other factors (n=21). On Sohu.com, videos were mainly excluded due to product advertisements (n=87), irrelevant content (n=62), replicated content (n=59), and poor quality (n=43) (Figure 2A).

Figure 1 Video inclusion and exclusion process.

Figure 2 Distributions of videos for exclusion and annual number of video posts on each platform. (A) Distribution of non-eligible videos by platform. (B) Annual number of eligible videos on each platform.

For the 582 eligible videos (39.84%), the majority were uploaded on Bilibili in 2021, followed by Bilibili and QQTV in 2022 and Sohu in 2023 (Figure 2B), and were included in the content analysis. Of these, 319 videos (54.81%) were classified as reliable, while 263 videos (45.19%) were deemed non-reliable. The interrater agreement between the two reviewing urologists was strong (κ=0.832), with an ICC of 0.948 for DISCERN scoring and 0.856 for GQS scoring.

The video length was comparable between reliable and non-reliable videos; however, their upload times showed significant differences. Since different platforms displayed upload times in varying formats (specific date or month), we manually standardized all upload times with accuracy to the month for consistency in analysis. Reliable videos were more credible and of higher quality than non-reliable ones (P<0.05). Detailed analysis of the DISCERN score for each section highlighted the superior quality of the reliable videos (Table 1). A comparison of scores for videos of each DISCERN question is specifically presented in Figure S1.

In terms of video sources, the majority of reliable videos (56.11%) were uploaded by unidentifiable individuals, followed by media agencies affiliated with certified organizations (12.23%), We-media channels (3.44%), and healthcare organizations (28.21%) providing healthcare services. These videos were typically short, 1-minute question-and-answer sessions featuring senior physicians or urologists, with other formats including TV interviews and academic presentation clips. Three We-media videos were animated, providing concise and accurate information with references.

Conversely, the 263 non-reliable videos were predominantly uploaded by individual users (97.33%), with a smaller contribution from healthcare organizations (1.52%) and private, hospital-affiliated We-media entities (1.14%). The content largely featured unidentified individuals dressed as doctors, broadcasting live from outpatient clinics and addressing viewers with similar symptoms. Other formats included health lectures, TV talk show clips, and advertisements.

Table 1 outlines the differences in video length, GQS, and reliability scores between reliable and non-reliable videos, while Table 2 provides an analysis of the reliable videos, categorized by uploader, source, presentation format, and thematic focus Traditional Chinese medicine (TCM) vs. non-TCM. This analysis reveals the video types most likely to be trustworthy and referable.

Discussion

PE is one of the most common types of sexual dysfunction, imposing a significant psychological burden on both men and women in mainland China (8). With the high prevalence, the challenges surrounding the diagnosis, management, and education of PE are a matter of concern (1). Due to the stigma and embarrassment associated with experiencing sexual dysfunction, many affected individuals are inclined to pursue self-treatment through online consultations rather than through clinical assistance (19). Consequently, the utilization of online resources for information on diagnosis, treatment, and preventive healthcare services is not surprising. However, the widespread availability of online information also raises concerns about misinformation, which may mislead individuals, contribute to ineffective or even harmful self-treatment practices, and further complicate the management of PE.

Online video services are surging in popularity and exert a significant impact on users and audiences. As one of the biggest online video platforms, YouTube has been thoroughly examined in relation to its content on prostatitis (20), prostatic surgery (21,22), erectile dysfunction (23), prostate cancer (24), and PE (5). Although many of major global internet sites are not accessible in mainland China, the Chinese public’s demand for internet services and the number of visits remains considerable. According to the China Internet Network Information Centre report in 2022, mainland China’s online video user size reached 1.051 billion, with a national penetration rate of 74.4% (25). Recently, the quality of online sexual medicine content on a Chinese cyber-encyclopedia platform such as Baidu encyclopedia was reported to be generally poor (9), so it is necessary to conduct dedicated research on network services and quality in this field.

To ensure fewer omissions, we searched the videos from the top 10 online video platforms in mainland China, including the former largest single platform (26). A total of 1,461 videos were found on these websites, but videos on ejaculatory themes were only available or retrievable on some of these websites. On MGTV, PPTV, and CCTV, the available results were either irrelevant to PE or banned from the website. Irrelevant content, including gaming records titled ‘gamer slang’ or entertainment news, was excluded. We believe this is due to different auditing standards or policies restricting each platform’s potentially sex-related content. These sex-related topics and content are deemed to be taboo, and the operating platforms consistently ban or delete this content without clear criteria (27). However, vocabulary related to the genitals and descriptions of sexual activity are critical to discussing PE-related. Accordingly, many searches for sexual disorder–related information produce no results.

Duplication and plagiarism are the most noteworthy issues on these platforms. In our research, 195 and 89 videos from the eligible selections were direct copying or plagiarized content another source, respectively, and thus much of users’ time is spent on redundant or invalid results. Moreover, it has been shown that most users only opt for videos from the very first pages of each website (13). Based on our experience, identifying videos with valid content from these first pages is not feasible. However, duplication is less apparent on some video platforms, indicating that some underlying measures are being taken to reduce duplication on these platforms, allowing users to locate information relevant to their needs. Nevertheless, users should be advised to select and compare websites and choose those with more reliable content.

Among the eligible videos, those with higher DISCERN and GQS scores were more reliable and objective and of higher quality. Videos from both reliable and non-reliable groups were around 2 minutes, and no statistical difference was found between these two groups of videos regarding their length. Due to the video viewing record not being provided on all websites, videos were evenly distributed according to length. Hence, the exposure rate for both groups of videos could be considered equal, and users could choose based on their own decisions. In other words, users could judge the video’s reliability by referring to its content quality and not spend excessive time watching each video. Regarding content, there were 319 reliable videos in comparison to 263 non-reliable videos. These 582 videos focused on a specific PE problem, such as its definition, diagnostic criteria, management, and treatment.

The most common problem with non-reliable videos was the lack of clear, specific aims and organization. This was indicated by the score in the 1^st section of the DISCERN tool, whose purpose is to evaluate the aim and engagement relevant to each work. Specifically, most of the non-reliable videos consisted of a live camera filming an unidentifiable person in a white coat receiving an inquiry from an anonymous person seeking help online or via the phone. The conversation is vague, and the questions are unclear. These videos are designed to allow the audience to match their problems and symptoms with the inquires covered in the video. This is confusing, as these are were always explained with a string of unrelated explanations mixed with TCM theory and resolved by promoting an unauthorized TCM remedy as the cure. Furthermore, the hosts in these videos claim to be capable of curing PE with a non-recognized remedy or therapy but deliberately omit the source of these therapies and the potential risk of adverse reactions. They further exaggerate the benefits of each treatment or even guarantee the treatment outcome in order to be more convincing to the audience. They sometimes deliberately confuse concepts of prostatitis, erectile dysfunction, and urinary tract infection. Although a high prevalence of PE has been reported in patients with prostatitis, erectile dysfunction, or accessory gland infection (28,29), this does not justify attributing the symptoms of all these diseases to PE (19).

In some other videos, the definition of PE is not even correctly described. Notably, one speaker introduce a concept that resembles intravaginal ejaculation latency time (IELT), claiming that PE is present if one’s IELT is shorter than 5 minutes; however, the median IELT in the general male population is 5.4–6.4 minutes (28). Additionally, IELT was initially introduced to assess the efficacy of PE treatment, and calculating IELT alone is not sufficient to establish PE diagnosis (30). Thus, the statement in this video may be needlessly causing viewers to experience heightened anxiety and distress. Some videos even attribute sexual dysfunction to ethical or moral issues. Patients with PE complaints may have considerable anxiety and low self-esteem and may be disinclined to seek external help (31), and this PE-related emotional burden may be a key obstacle to initiating consultations with medical professionals (31,32). Consequently, watching these videos would not benefit the users but rather aggravate their mental burden, resulting in more severe hardship.

Concerning the reliable videos, although the video length was equivalent to that of the non-reliable videos, most of these reliable videos appear better produced, with clear themes and concise language. These videos are mainly presented in the form of small lectures with specific questions about PE, such as, “What are the diagnostic criteria for PE?”, “How do I solve my relationship with my partner if I have PE?”, “Does prostatitis cause PE”, and “Are there any side effects of drug treatment to PE?” Although these 2-minute clips are not capable of thoroughly explaining PE from the epidemiology to the treatment strategy, the titles indicate the issues that ordinary users are most concerned about PE. Additionally, these videos provide accurate and valuable insights into current issues related to PE, addressing questions like “Which SSRI should I choose?” (33) and “Why is using an antidepressant a reliable and safe option for treating PE?” They also include guidance on topics such as cognitive behavioral therapy (34), masturbation techniques (35,36), and sphincter control training (37). Some videos aim to show the differences between PE and infertility and persuade the audience to face the related problems in a rational manner (38). These videos offer an objective perspective to the audience and importantly do not present themselves as providing definitive answers to the audience, instead encouraging viewers to seek professional counsel if any confusion remains.

Among the reliable videos, 140 (43.89%) were uploaded by a non-personal account, which is 20 times the percentage of the unreliable videos with misinformation. These accounts included media platforms operated by public departments, certified healthcare organizations, or Non-profiting engaged in health education and knowledge promotion (39). All the content provided by these organizations was verified by licensed physicians and medical professionals, and these organizations are typically run by the physician community (40,41). These accounts, commonly referred to as “famous online doctors” or “doctors face to face”, create and upload video series on diseases such as diabetes, coronary heart disease, gout, and dysmenorrhea (39). These videos are primarily listed in series under an exclusively designed banner and link. Hence, it does not take much time for patients to locate these videos. A renowned popular science We-media account uploaded three videos. They created animations related to some common problems with PE, which are both entertaining and easy to understand.

Moreover, 179 videos were uploaded by individual users from a personal account. Most of these individual users have a background in medical education or professional experience in sharing PE-related issues or knowledge. These videos are mainly presented as lectures with more comprehensive and referenced content; however, the tone remains casual and natural. This may be because the producers and the uploader have autonomy in video production and employ scripting and editing that are more accessible to viewers and tailored to expressing the creator’s perspectives and attitudes.

It has been suggested that physicians should participate more in patients’ education and provide more reliable data (5,6). We found that Chinese physicians participate in medical content production, while the video production, scripting, and editing works are the responsibility of medical social media companies. This mode of collaboration ensures that the produced content is reliable and of satisfactory quality. However, it also appears that personal uploaders, including licensed doctors, are beginning to more actively participate in content production. This may result from the lower technical barriers and platform restrictions in the growing short-video and vlog trend. Therefore, users should be more alert in evaluating the authenticity and objectivity of the content. For example, we noted that false information resembling previous research was provided by individuals posing as physicians (5). However, as the names of doctors and hospitals can be looked up online, it is easy to spot these as fakes. Despite the lack of barriers to uploading content being mainly responsible for the proliferation of false information (42), platforms seem to only place effort in banning videos that contain pornographic, violent, or other offensive content. Additional, there are already official organization-founded accounts on platforms that post series of free, credible videos for raising public awareness. Their influence and popularity should grow when the users compare the content and quality of videos and share the credible ones.

Furthermore, certain websites featured video series created by medical social media accounts, a strategy that could help curb the spread of false information. Hence, collaboration between online video platforms and reputable experts could be established to facilitate the thorough evaluation and rating of medical and healthcare content available online.

Limitations

First, we searched for videos from the top 10 online video platforms in mainland China. The differences in content standards, management, and promotion mode between each platform made it impossible to analyze these videos in depth. Thus, we could not evaluate indicators such as number of views, upload time, average viewing times, or viewer attitude indicators (e.g., thumbs up or likes) that could reflect the video’s impact on the audience. Nevertheless, this fact represents the reality of the internet environment. Our broad-scope search could ensure fewer video omissions, a better reflection of the state of online videos, and a more accurate picture of user experience. Second, the limited keywords in our literature search might have missed relevant videos. However, most websites automatically display related titles as keywords are typed. We believe that the intelligent algorithms these websites provide can maximize exposure to relevant videos, and this experience is similar to that of users. Finally, our study only captured a snapshot of the online information in the Chinese mainland at a particular moment. Some videos may be deleted or updated due to policy changes. Nevertheless, this study is the first to assess online sexual medicine content on Chinese video platforms, and we believe its findings can help users access more trustworthy information.

Conclusions

The resources on online Chinese video platforms vary greatly. Users searching for PE-related information must choose the right platform and identify higher quality videos. Many professional medical personnel have participated in video production. However, with the growing number of videos, efforts need to be made to complete reviews of content and establish an evaluation framework.

Acknowledgments

We appreciate the contribution of Dr. Shanzun Wei in project design and methodology directing.

Footnote

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-2025-104/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2025-104/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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(English Language Editor: J. Gray)