An Evidence Based Definition Of Premature Ejaculation

In general, you can establish the definition of some medical disorder or sexual dysfunction in one of two ways.

First is to use authority based opinion and then to check it out in clinical practice. But this depends on the collective agreement of experts - and that might be hard to achieve. Besides, the undue influence of one expert in the field may sway a whole body of thought for decades.

One example of this perhaps, is the way in which Helen Singer Kaplan's definition influenced those set out in the early editions of the diagnostic and statistical manual.

The second way is to collect evidence-based data from reliably conducted epidemiological studies and randomized clinical trials.

By adopting the second approach it is possible to come up with a definition which can be applied regardless of subjective impressions and personal opinions.

This might be important in an area as sensitive as that of premature ejaculation, where the beliefs of men around sexual performance may dramatically influence how they see themselves in relation to this particular dysfunction.

In one piece of research by Marcel Waldinger, it was discovered that among a completely randomly selected group of men, the average intravaginal ejaculatory latency time (in other words, the average delay between penetration and ejaculation) or IELT was 5.4 minutes.

This is a surprisingly long time when commonplace wisdom says that the majority of men ejaculate within 3 minutes of penetration.

However, in formulating a new, evidence-based definition of premature ejaculation, Waldinger conducted a meta analysis of studies between 1943 and 2003, thereby demonstrating that using the IELT, assessed using a stopwatch, was a superior method of identifying premature ejaculation compared to questionnaire studies.

This is important because using data about the delay before ejaculation during sex can be used in randomized clinical trials to study the effectiveness of drugs used to treat PE.

The starting point of this research was a clinical study which found that 80% of men who decided on their own volition to seek medical treatment for premature ejaculation actually could not delay their ejaculation for more than 30 seconds after penetration, and the remaining 20% ejaculated in under 2 minutes' delay.

It appeared these men simply did not know how to delay ejaculation.

Sidebar: A Professional on PE... but a lot more men have PE than he thinks... and SSRIs are heavy duty pharmaceuticals...

Quick Ejaculation Can Be Life Long or Acquired

Other statistical analysis led Waldinger to propose that lifelong premature ejaculation should be defined as ejaculatory dysfunction where a man came within 2 minutes of penetration in the majority of cases on which he had intercourse.

The severity of premature ejaculation – on a scale from non-symptomatic, through mild, through moderate, to severe – could, Waldinger argued, be defined in terms of psychological problems that were linked to the condition.

Now, one of the aspects of Waldinger's study that is very interesting is the fact that he identified a large number of men who complain of difficulty with not knowing how to delay premature ejaculation as having a group of complaints or symptoms that did not have any objective basis.

In other words, a lot of men think they have a problem when their delay before climax is well within normal ranges - for example men who can delay for 10 minutes or more before they climax may still think they have a condition that can be described as "prematurity" (a term I use as shorthand for the opposite of delayed).

To extend this thinking further, this syndrome is characterized by a cluster of symptoms based on objective and reproducible data; so when a man complains about having an IELT of "only" 10 minutes, and his partner's neither distressed by his sexual performance nor interested in seeing him improve it, he may well require psychotherapy rather than medical treatment.

Waldinger proposed that a third type of premature ejaculation be introduced into the classification system - natural variable PE, which he described as a cluster of symptoms of rapid ejaculation. Put simply, just because you think you have PE, it doesn't necessarily mean that you do!

And men who have acquired PE with consistent ejaculatory problems that have developed over a period of time, or perhaps delayed their appearance until later life, may find that their dysfunction is caused by negative feelings about a particular sexual partner, or difficulties within the relationship in general, and  treatment with counseling or psychotherapy is clearly the right way forward.

When man experiences an all-too-soon ejaculation in situations such as having a new partner, a partner who is unsuitable, or a partner who is not sexually attractive, or after abstaining from sex for a long time, you would expect him to ejaculate in a way that is different to his normal sexual behavior. This could be called natural variable premature ejaculation.

It's important in all of this discussion to remember that the concept of delaying control of ejaculation has come down from Masters and Johnson.

 The current view of ejaculatory control is really more about the man's ability to delay ejaculation when he's reached the point of no return. Clearly a man's inability to do this does not necessarily mean that a man is "suffering" from premature ejaculation.

Body and Mind Play A Part In Controlling Delays

The concept of control over the ejaculatory reflex is really describing the neurological function that is experienced subjectively, the ejaculatory process itself being merely a reflex response in the body.

Nonetheless, feelings of control of ejaculation are mediated by the frontal lobe of the cerebral cortex, while the inability to control it is likely to be associated with frontal disinhibition and lumbosacral neuronal processes.

Waldinger's work on all these variables led him to propose three types of PE resulting from evidence-based research, all of them, however, based on quantified measurements of the time between penetration and ejaculation.

Using a cut-off point for the IELT delay of 1.5 minutes to find lifelong premature ejaculation appears to be completely satisfactory although the majority of men seeking treatment lifelong PE usually come within 1 minute of penetration.

Waldinger suggested acquired premature ejaculation could be defined with reference to a 1.5 minute cut-off point for the IELT, while the category of natural variable premature ejaculation needed no quantifiable definition as it is a transient complaint falling within the normal variation of ejaculatory latency among men.

Lifelong PE Definition & Diagnostic Criteria

A Consistent involuntary ejaculation during intercourse which cannot be delayed for more than 1.5 minutes after vaginal penetration

B Early ejaculations occur in 90% or more cases of intercourse

C And with nearly every woman partner

D And have existed since or around the first sexual encounters

E The short delay before ejaculation remains similar throughout life or may become more rapid with aging

F Erectile function is normal but a man's erection may develop without much delay upon sexual stimulation (erectio praecox)

G A man's power to delay ejaculation at the moment of imminent ejaculation may be diminished or lacking, but is not obligatory for the diagnosis of PE

H Consistent experiences of diminished or lacking of control of ejaculation should go along with a short delay before ejaculation (i.e., an ejaculation that occurs within 1.5 minutes after vaginal penetration)

I The ejaculation speed is not due exclusively to the direct physiological effect of any sub-proposals for DSM-V and ICD-11 , substance use or medical condition (e.g., endocrine or urological disorders)

Definitions of PE 705 J Sex Med 2006;3:693–705

Acquired PE Definition & Diagnostic Criteria

A Consistent or inconsistent involuntary rapid ejaculation during intercourse (i.e., an ejaculation that occurs within 1.5 minutes after vaginal penetration) - a lack of ability to delay ejaculation

B This problem may occur with only one particular partner or with nearly every woman partner

C The problem may have started at a certain moment in life before which the person never experienced problems with early ejaculations

D After its onset, the lack of delay before involuntary ejaculation remained similar or aggravated throughout life

E Ability to delay ejaculation (i.e., to withhold ejaculation at the moment of imminent ejaculation) may be diminished or lacking, but is not obligatory for the diagnosis

F Consistent or inconsistent experiences of diminished or lacking of control of ejaculation should go along with a short ejaculation time (i.e., an ejaculation that occurs within 1.5 minutes after vaginal penetration)

G The ejaculation rapidity is either due to the direct physiological effect of any substance or medical condition (e.g., endocrine or urological disorders) or due to psychological and/or interrelationship problems

[ 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 ]