Diagnostic and Statistical Manual - DSM IV - TR Definition Of Premature Ejaculation

Since information from well controlled clinical trials and epidemiological studies of premature ejaculation has become available, it has been possible to work towards a more precise and scientific definition of this condition.

The current DSM-IV-TR definition of premature ejaculation is not evidence-based, and emphasizes that there needs to be personal distress or interpersonal difficulties for the sexual dysfunction to qualify as PE.

Such subjective measures are clearly unsatisfactory, since they limit the chance of replication between different studies and research projects.

Just for the sake of clarity, the DSM-IV-TR definition is as follows: premature ejaculation is persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration before the person wishes it, causing interpersonal difficulty or distress, and where the ejaculation is not due to the effect of some at external influence such as drugs or alcohol.

To remove the element of subjectivity, it's clear that a definition of premature ejaculation should actually be based on evidence-based research.

Delaying The Inevitable?

But how is that to be achieved? Before 1980, which was the date when premature ejaculation was first mentioned in the Diagnostic and Statistical Manual, such well-controlled studies were not available, leading to compromises in the definition.

Now that such studies are available, the working group on revisions of the DSM has proposed several changes: not least that the term premature is replaced by the word early, so the definition becomes that of "early ejaculation", on the grounds that the word premature is both inaccurate and pejorative.

In addition, the working group on revisions for DSM V seeks to remove the element of subjectivity from the definition of premature ejaculation by introducing a time element of the delay within which ejaculation occurs: this is 1 minute from the beginning of sexual activity, although the proposed definition still requires the ejaculation to occur "before the individual wishes it" for this dysfunction to be classified as early ejaculation. 

(It's hard to imagine how, but I guess some men and women might be satisfied with a 1 minute delay before the man experiences orgasm.)

In addition, the working group proposes that persistent or recurrent ejaculation occurring during partnered sexual activity must both occur within 1 minute of the beginning of sexual activity (which presumably means penetration, at least in this context), and must also be experienced on most occasions when a couple make love.

The requirement that premature or early ejaculation causes personal distress or interpersonal difficulties is replaced by a criterion of how the lack of ejaculation delay must cause "clinically significant distress or impairment".

And the criterion that this dysfunction is not attributable to other drugs, medications, other medical conditions, or significant stressors also serves to limit the condition to a dysfunction occurring within the context of a normal sexual relationship.

Types of PE

Short video on types of PE

The work that has been done in the past few years on defining premature ejaculation has led to the recognition of a number of subtypes and qualifiers:

(1) lifelong versus acquired early ejaculation, (2) situational versus generalized, (3) "qualifiers" include emotional factors such as depression or anxiety, and individual vulnerability factors such as poor body image, or a history of sexual or emotional abuse.

These are all helpful changes, designed to reduce the element of subjectivity in the definition in the definition of recorded in the Diagnostic And Statistical Manual, Volume 4. It would seem, therefore, the recent work on an evidence-based definition of this condition has produced a degree of objectivity that was lacking in the past.

It's certainly true that the work of Dr Helen Singer Kaplan was very influential in previous definitions about the meaning of "premature" – in particular she held the view that definitions should involve some reference to a lack of voluntary control over the timing of ejaculation. In other words, this would be about the man's lack of knowing how to delay....

As a result of this, premature ejaculation had been defined as "ejaculation occurring before the individual wishes it, because of recurrent or persistent absence of reasonable voluntary control of ejaculation or orgasm during sexual activity".

 As time went by, it was the therapist or doctor who became charged with taking into account factors which affect the delay before climax - such as the duration of the excitement phase of sexual activity, including factors such as age and the novelty of sexual situation or experience.

Common sense, let alone clinical experience has demonstrated how inadequate all of these DSM definitions have become (I mean, am I really empowered to define what is an inadequate time, pause or wait before a man's climax?), although the search for a more rigorous definition of the appropriate delay has produced a strange paradox.

That is: an individual's own perception of his inability to control his ejaculation, the lack of satisfaction that he experiences with sexual intercourse, and the distress he and his partner feel because of it, are subjective markers which have become accepted as part of a clinical definition.

It's been said that a better alternative would have been to include some kind of quantification of the time delay between penetration and ejaculation to assist in the definition of what's actually normal and abnormal in sexual activity. This is what DSM V intends to do.

Delay - Distressing or Delightful?

Unfortunately there is another paradox here: defining premature as "an ejaculation occurring before or shortly after penetration, causing distress to one or both partners" has an intuitive appeal, even if it isn't based on systematic research.

That, I think, reflects the fact that most men with a lack of control over delays in ejaculation can easily identify themselves as having a problem even if they didn't wish to address it.

Nonetheless in this context it's extremely important to remember that there are men (and women) who have a distinctly unrealistic view of both their own and others' sexual capacity, and it's also highly likely that individual variations in sexual experience will produce massive variations in ejaculatory latency from one sexual experience to the next.

For example, if you read about the occurrence of quick ejaculation in a couple's relationship here, you can see how difficult it can be to formulate an objective definition, in particular any definition that involves the limitation of a set time period between penetration and orgasm.

[ Home ] [ A Premature Ejaculation Cure You Can use At Home ] [ Ways To Delay: An Evidence Based Definition ] [ Diagnostic and Statistical Manual DSM IV Definition Of PE ] [ Kaplan and Masters and Johnson's Definition Of PE ] [ Treatments For Slowing Down Ejaculation ] [ Ways To Delay: The Effects Of Premature Ejaculation On Men ] [ How To Delay: A Better Definition Of Premature Ejaculation ] [ How To Keep Sex Exciting and Your Relationship Vibrant! ] [ How To Delay Ejaculation: Effects Of PE ] [ Delaying Ejaculation: Definition of Premature From The ICD 10 ] [ How To Delay Ejaculation: The Effects Of PE On Women In Relationships ] [ Ways To Delay: The Effects Of PE On A Couple ] [ Delay Your Ejaculation With Anesthetic Spray Lotions And Condoms ] [ How to Slow Ejaculation - The Squeeze Technique and The Stop - Start Technique ] [ Physical Problems As A Cause Of Premature Ejaculation ] [ Anxiety As A Cause Of Premature Ejaculation In Men ] [ Delayed Ejaculation and Erectile Dysfunction ]