Results of March survey 2006

The definition of Premature Ejaculation (PE) is often vague and subject to personal interpretation. An operational definition of PE:

1) should rely on the intravaginal ejaculation latency time (IELT), considering normal a latency time of 2 minutes or more: Percentage of answers: 33,3%
2) should rely on the intravaginal ejaculation latency time (IELT), considering normal a latency time of 1 minute or more: Percentage of answers: 16,7%
3) should not insist on the IELT as a main diagnostic criterium: ejaculation can be defined “premature” when occurs sooner than desired, thus causing distress: Percentage of answers: 50%
4) should insist mainly on objective, instrumental measures, e.g. penile vibratory stimulation and neurophysiologic tests: Percentage of answers: 0%

Comments

The definition of premature ejaculation has long been questionable. The DSM defines it as “persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the persons wishes it”. And require for the diagnosis that “the disturbance causes marked distress or interpersonal difficulty” [1] The American Association of Urology Guidelines issued in 2004, proposed a similar definition: “an ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners” [2].
These definitions explain how 50% of responders selected answer 3. Both of them, however are very vague and scarcely useful, as rather than setting clear diagnostic criteria, rely on imprecise expression as “…shortly after”, “…sooner than desired”, “…marked distress” etc, strongly affected by subjective judgment and inter-observator variability.
Recently, the IELT cut-off has been set after a stopwatch study on 491 men randomly selected in five different european countries.3,4 According with the authors of the study, men with an intravaginal ejaculation latency time (IELT) < 1 min. belong to the 0.5 percentile, and can be considered affected with “definite” premature ejaculation. Men with IELTs between 1 and 1.5 min. (between 0.5 and 2.5 percentile) should be considered affected by “probable” PE.
This definition has two major differences compared with the previous one: 1) precise cutoff points are identified; 2) the personal and interpersonal distress is not considered an obligatory accompanying characteristic. Although these may not be the definitive or most accurate cutoff levels, and future larger studies may somewhat move the threshold of normality, nevertheless it is very welcome the attempt to identify some objectively measurable markers of this largely underdiagnosed disease.
Finally, all responders agreed about the total inaccuracy of objective neurophysiological test in distinguish between normal and abnormal ejaculation. This correct position reflect a conspicuous body of evidence reported in the literature.

References

1. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Washington D.C.: published by the American Psychiatric Association

2. Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, Nehra A, Sharlip ID, UA Erectile Dysfunction Guideline Update Panel. AUA guideline on the pharmacologic management of premature ejaculation. J Urol 2004, 172:290-4.

3. Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M. A multinational population survey of intravaginal ejaculation latency time. J Sex Med 2005, 2:492-7.

4. Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH. Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data. J Sex Med 2005, 2:498-507.