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Marcel D. Waldinger, Dave H. Schweitzer, The DSM-IV-TR is an Inadequate Diagnostic Tool for Premature Ejaculation, The Journal of Sexual Medicine, Volume 4, Issue 3, May 2007, Pages 822–823, https://doi.org/10.1111/j.1743-6109.2007.00501.x
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Extract
In his Letter to the Editor in the January issue of the Journal Sexual Medicine, Hellstrom mentioned several arguments to stay conservative and to leave the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) definition of premature ejaculation (PE) as it is [1]. Hellstrom stated that lack of ejaculatory control and psychological markers are highly relevant in clinical practice to identify men with PE. Moreover, the exclusive use of the intravaginal ejaculation latency time (IELT) is, according to his judgment, cumbersome to establish the diagnosis of PE. In addition, he stated that IELT prevailing over psychological factors in the definition of PE would hamper the identification of many men who suffer from PE.
We do not agree with these statements.
Based on the historical development of the DSM-IV-TR definition of PE, we have to face the fact that this definition of PE is not evidence based but is based merely on the opinions of a few experts in the field [2]. Stopwatch assessment analysis of the DSM-IV-TR has shown a very low positive predictive power, meaning the potential risk of many false-positive diagnoses when only subjective complaints of lack of control and psychological markers, like distress, are being used [2]. In other words, any man who complains of lack of control and distress suffers from PE if the definition is followed regardless of a normal or even long ejaculation time. Unfortunately, the inadequacy of the current DSM-IV-TR definition is an ideal tool for pharmaceutical companies to be used as a “case finding” instrument in large cohorts, or as Hellstrom describes it, as a means to “identify” men with PE. Obviously, the misuse of a high false-positive predictive definition always leads to many false-positive diagnoses, a high prevalence of PE, and erroneous prescriptions of ejaculation-delaying drugs.
