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Helen Singer Kaplan & Masters & Johnson's Definition Of Premature Ejaculation (PE)Because Helen Singer Kaplan was one of the most authoritative and respected therapists working in the field of sexual medicine in the 1970s and 80s, her influence over the definition of premature ejaculation in the Diagnostic and Statistical Manual was considerable. In fact it was mainly due to her influence and authority that the early definitions of PE (in DSM III) expressed the criterion of "lacking voluntary control" as part of the definition of this sexual dysfunction.The wording "voluntary control" was not used in any later revisions. It was seen as inappropriate. Even so, the concept of a man's ability to develop greater control over ejaculation has crept into both lay literature and scientific literature, as a concept inextricably linked to what "premature" really means. And indeed, for most men who cannot delay ejaculation, the concept of voluntary control is very significant. So Kaplan defined a man as a premature ejaculator if he could not control
his ejaculation voluntarily. Sidebar - Video on PE - Amusing, after a few seconds silly introduction.....Master and Johnson's Definition Of "Premature"It's clear that Masters and Johnson decided to avoid any definition of PE which involved using either a or an estimate of the time between penetration and ejaculation. They specifically stated that their definition moved away from the stopwatch concept - a clear indication that they wished to disconnect the concept of ejaculatory control from the reality of the duration of sex. Unfortunately, they did propagate the view that ejaculatory control was somehow connected to the satisfaction of the female partner, and that idea of "female sexual satisfaction" has remained part of the definition ever since. This was not an evidence-based definition, but was based instead on the concept that a man's control and a woman's satisfaction were the most important criteria in the definition of premature ejaculation. To this day, the concept of ejaculatory control is still related to the concept of sexual satisfaction, but the subjectivity of feelings around the issue of ejaculation delay make it a very difficult concept to put into practice as a clinical definition. There have been many studies which have demonstrated how the concept of delay, control, satisfaction and distress, can impact on the diagnosis. In one study in the United States a group of experienced clinicians in the field of premature ejaculation were asked to use their clinical judgment based on DSM IV criteria to classify men as either premature ejaculators or not. In this context, of course, ejaculation time is not a criteria to establish a diagnosis of PE, nor is it a part of the definition of PE. Despite this, each man who took part in the study was asked to measure, or have his partner measure, the time between penetration and ejaculation with a stopwatch. The couples were all asked to fill out a questionnaire about their perception of the man's ability to delay coming, their mutual satisfaction with sexual intercourse, and other issues such as personal distress and interpersonal difficulty - things that that all have been referred to in the various definitions of premature ejaculation. Using DSM IV criteria, only 190 men out of a total of 1587 couples met the criteria and were considered to be premature ejaculators. The mean intravaginal ejaculatory latency time or IELT of these men was 1.8 minutes, which admittedly is a significantly shorter delay than that of men who say they do not have PE, among whom delays between penetration and orgasm average 7.3 minutes. However, the results were always going to be unhelpful in formulating a definition of PE because detailed analysis of the data around men's delays demonstrated that 50% of the men who were defined as premature using the DSM IV criteria could in fact delay ejaculation for more than 2 minutes during intercourse; while as many as 15% of the men diagnosed as having premature ejaculation according to DSM IV could last between 15 and 25 minutes during intercourse. You can read about an evidence-based definition of premature ejaculation here.
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