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ICD-10 (International Classification Of Diseases) Definition Of Premature Ejaculation (PE)The International Classification of Diseases, a reference book known as the ICD, was developed by the World Health Organization, and PE was specifically mentioned the first time in 1992 in ICD 10, which actually contains two separate definitions. Essentially PE was defined as "the inability to control ejaculation sufficiently for both partners to enjoy sexual interaction. In severe cases ejaculation may occur before vaginal entry or in the absence of an erection." They also specified that PE is unlikely to be organic in origin and can occur as a psychological reaction and that the symptoms must have existed for at least six months for the condition to be known as premature ejaculation. Unfortunately they also defined PE as a sexual dysfunction, thereby implicitly giving the extra criteria of any sexual dysfunction to the definition. These extra criteria were as follows:
The ICD 10 committee were, however, perceptive enough to acknowledge that for a meaningful definition to be formulated, the speed with which a man ejaculated should not be a reflection of prolonged abstinence from sexual activity. After all, you'd hardly expect much of a delay under those circumstances. Problems, ProblemsOnce again, we are faced with the fact that definition of "premature" or "early" is not based on any kind of scientific evidence, and has a massive subjective element. The lack of essential elements of any sexual dysfunction such as the frequency with which it happens, the duration of intercourse, and the severity with which it occurs is remarkable. There are other, more problematic issues with these definitions as well: although we can think of ejaculation and orgasm as the same event, they are in fact two separate events, using two separate biological nervous system circuits. Ejaculation is a spontaneous reflex reaction in the genital organs, whereas the sensations of orgasm, even though experienced partly in the genitals, are mainly an event that takes place in the brain. This been amply demonstrated by the independence of ejaculation and orgasm in both clinical conditions and in everyday life. There is a condition known as anesthetic ejaculation, or in more informal language a "numb come", where the absence of orgasmic sensations is remarkable. Men with premature ejaculation tend to have a very rapid ejaculation but they do experience normal orgasmic sensations. And a criterion of "marked interpersonal difficulty", or any similar subjective requirement in a definition of premature ejaculation, is even more confusing. This is because the word "distress" can be used in two ways: as part of the definition, or as a medical term. In other words, to define something that only becomes a disorder when the person is distressed by it seems a little challenging, to say the least! And if you specify a condition – in this case a lack of delay in premature ejaculation – as something that happens "before the individual wishes it", then diagnosis may well become dependent upon the subjective experience as reported by the man concerned. This makes an objective measurement of the time between penetration and ejaculation irrelevant in the definition, which hardly seems reasonable! Such a criterion introduces a selection bias into any study, because any man who does not complain about his ejaculation time is automatically placed in the category of men who do not have PE – regardless of how quickly he actually does ejaculate. In addition, any man who complains that
he does not have PE, or that he is not
distressed by it, becomes a man without the dysfunction, even though he
may simply be ill-informed about the speed with which the average man
ejaculates.
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