Changing Paradigms from a Historical DSM-III and DSM-IV View Toward an Evidence-Based Definition of Premature Ejaculation. Part II—Proposals for DSM-V and ICD-11

Abstract

Background. In the Diagnostic and Statistical Manual of Mental Disorders (DSM), a descriptive definition for premature ejaculation (PE) that was based on historical assumptions has been accepted. Aim. To formulate a new functional definition of PE in the DSM. Methods. A "syndrome" approach instead of a "complaint" approach is applied and evidence-based data from epidemiological and clinical studies are used. Results.A new functional definition of PE should pertain to a cluster of "symptoms" of a distinct "syndrome." A syndrome rather than a descriptive definition should distinguish Lifelong and Acquired PE variants. Evidence-based data also suggest another PE type "Natural Variable PE," which is not a typical syndrome but rather a cluster of inconsistent symptoms of rapid ejaculation. Moreover, in "Natural Variable PE" the occurrence of rapid ejaculation is not based on neurobiological or psychological pathology, but belongs to the normal variability of sexual performance. Its prevalence is probably much higher than that of Lifelong and Acquired PE. We propose three separate operationalized definitions of these three PE types for the pending DSM-V and ICD-11, which include a quantification of the ejaculation time (intravaginal ejaculation latency time), inability of ejaculatory control, and a description of severity of PE in terms of psychological distress.

Further evidence of the reliability and validity of the premature ejaculation diagnostic tool

“…2,4 However, recent research by Patrick et al 11 has questioned the usefulness of IELT as a primary or sole criterion for diagnosis because of the observed cultural variability. Furthermore, it is known that men will generally overestimate their IELT, 2,3 which also brings into question the validity of IELT in diagnosis when objective measurement is not utilized, although men with very short IELTs do estimate Abbreviations: PE, premature ejaculation; no-PE, no premature ejaculation.…”

“…Furthermore, it is known that men will generally overestimate their IELT, 2,3 which also brings into question the validity of IELT in diagnosis when objective measurement is not utilized, although men with very short IELTs do estimate Abbreviations: PE, premature ejaculation; no-PE, no premature ejaculation. 2,4 have appropriately questioned the vagueness of terms such as 'minimal', 'before the person wishes' and 'persistent' used in DSM-IV-TR (and earlier DSM versions) in the diagnosis of PE. The PEDT was developed specifically to address this issue, the results of earlier research, 7 and this study, demonstrating that a simple tool can be used to standardize these somewhat vague terms.…”

“…IELT has been used as a primary diagnostic criterion and is considered by some experts to be the most important aspect of any diagnosis for PE [2][3][4] and should be incorporated into any new definition of DSMV diagnosis of PE. 2,4 However, recent research by Patrick et al 11 has questioned the usefulness of IELT as a primary or sole criterion for diagnosis because of the observed cultural variability.…”

“…Waldinger et al 3 have suggested an alternative definition of PE that is time dependent -an Intravaginal ejaculation latency time (IELT) of o1 min in 90% of coital attempts. More recently, Waldinger and Schweitzer 4 have suggested that IELT (o1.5 min) be incorporated into any planned DSM-V definition, alongside some quantification of control, distress and interpersonal difficulty issues. Broderick 5 and Rowland 6 go further and consider there needs to be a paradigm shift from the unidimensional construct of time for diagnosis of PE to a multidimensional construct, which includes an assessment of control and distress.…”

Pathophysiology of Acquired Premature Ejaculation

“…Some international epidemiologic studies demonstrated lower prevalence for PE in Middle East, confirming this presumption (36). However, clinical studies regarding the penile sensitivity, PE status and sexual satisfaction report conflicting results are not conclusive (11,(141)(142)(143)(144)(145).…”