Advantages and limitations of current premature ejaculation assessment and diagnostic methods: a review

Abstract

Premature ejaculation (PE) is the most common male sexual dysfunction worldwide.Characteristic symptoms of PE are unexpected, rapid, complete ejaculation, which negatively impacts the sexual act for both sexual partners. Despite the existence of a definitive PE classification system and various diagnostic tools, diagnosing PE is still challenging due to the limitations associated with the assessment of this condition. Hence, it is necessary to review the diagnostic methods and processes of the physical examination that are currently performed in the medical setting. It is also important to analyze any controversial results of each main PE assessment method and propose novel diagnostic and assessment methods. To date, it is important to verify the accuracy of the PE evaluation method due to the ambiguity of previous definitions and proven invalidity of current examining techniques. Clinical diagnosis is based mainly on the patient history, patient-reported outcome scores, and diagnostic tools. Introduction of intravaginal ejaculatory latency time, penile biothesiometry, and the electrophysiological test provided objective means of evaluating PE. Due to the controversial and inconclusive findings in PE psychogenic and neurogenic etiology, utilizing a single parameter to describe and qualify PE using the aforementioned diagnostic methods provides valuable, but insufficient information for PE diagnosis. There is still a lack of a feasible and plausible means of objective measurement to evaluate the ejaculatory latency and control over ejaculation.Consequently, a comprehensive penile stimulation that simulates sexual intercourse could be useful to record intensity and duration parameters before the ejaculatory threshold, providing a more accurate method of describing and diagnosing PE versus a single chronological observation.

Premature Ejaculation Among Internet Users Living in the Metropolitan Region of São Paulo, Brazil: A Cross-Sectional Comparison Between the Premature Ejaculation Diagnostic Tool (PEDT) and Patient-Reported Latency Time and Perception

“…They found that men with lifelong PE had significantly higher PEDT scores than men with other types of PE, and lower scores were found among men with premature-like ejaculatory dysfunction. Wei et al 15 state that one single tool is not enough to detect PE. The authors propose the use of tests including penile stimulation to simulate a sexual relationship to obtain objective measures of latency time and intensity of ejaculation.…”

“…These different categorizations make it difficult to compare the studies’ results. 15 In addition, some authors point out the fact that the PEDT is an outdated instrument, as it has not been revised to meet the most current version of the DSM and uses a definition based on expert consensus, not scientific evidence. 59 Moreover, PEDT presents low specificity (50.5%) and positive predictive value (probability of a man actually having PE, given that he has PE according to the PEDT; of 31.2%).…”

“…13 The main methods used involve the measurement of the latency time between vaginal penetration and ejaculation and the use of standardized questionnaires. 15 Different cutoff points have been used for the latency time until ejaculation (less than 1 minute, less than 2 minutes or "before desired") and different ways of measuring it (using a stopwatch by the man, partner or by an observer or the subject's memory) 15 Among the existing standardized questionnaires, the Premature Ejaculation Diagnostic Tool (PEDT), 6 published in 2007 and translated and validated for different languages 16−18 is widely used. This questionnaire has two cutoffs: ≥11 (referred to as "probable PE") and 9 −10 ("possible PE").…”

“… 13 The main methods used involve the measurement of the latency time between vaginal penetration and ejaculation and the use of standardized questionnaires. 15 Different cutoff points have been used for the latency time until ejaculation (less than 1 minute, less than 2 minutes or “before desired”) and different ways of measuring it (using a stopwatch by the man, partner or by an observer or the subject's memory) 15 …”

Evaluation of Medical Information on Male Sexual Dysfunction on Baidu Encyclopedia and Wikipedia: Comparative Study

“…As the most common male sexual dysfunctions, erectile dysfunction (ED; the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance) and premature ejaculation (PE; poorly controlled and rapid ejaculation) greatly affect the quality of life of patients [ 9 , 10 ]. Furthermore, sexual dysfunction is closely associated with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS; urologic pain or discomfort in the pelvic region associated with lower urinary tract symptoms) and is the most common complication [ 11 , 12 ].…”