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Alvaro Morales, Javaad Zargooshi, Patrick Jern, Andrew McCullough, Wayne Hellstrom, Rany Shamloul, Anthony J. Bella, Edgardo F. Becher, Eusebio Rubio-Aurioles, Michael A. Perelman, Neil Palmer, Margaret Rothman, Comments on “Considerations for an Evidence-Based Definition of Premature Ejaculation in the DSM-V”, The Journal of Sexual Medicine, Volume 7, Issue 2_part_1, February 2010, Pages 679–689, https://doi.org/10.1111/j.1743-6109.2009.01682_1.x
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The author of this article is to be congratulated for the impeccable timing and the issues that he brings for consideration. For some of us with long memories in the field of sexual medicine, it appears that the understanding of the pathophysiology, diagnosis, and therapeutics of premature ejaculation (PE) is at the developmental stage of knowledge that erectile dysfunction (ED) was at the time of the National Institutes of Health Consensus Development Conference on Impotence in 1992 [1,2]. From semantics to diagnostic techniques and from definition to therapy, the similarities are conspicuous. The definition of the condition itself is under question, the diagnostic paraphernalia primitive or inconsistent producing conflicting results [3] and the treatments that are largely nonspecific [4].
Extreme care must be exercised in the definition of PE. The stringent criterion of an IELT of ≤60 seconds is appropriate for research purposes, particularly in order to maintain objectivity in the assessment of efficacy of new therapies. Such strictness is wholly unsuitable in clinical practice. The danger here is that new treatments might be assigned restricted indications and become unavailable for couples dissatisfied with the male’s ejaculatory performance if their fulfillment is beyond this arbitrary limit. How often do clinicians base their current therapeutic decisions for treating PE on the stopwatch technique? It is not even standardized! The concept of biological and analytical variation, largely ignored in diagnosing PE, must be seriously considered and the use of reference intervals must be treated with special caution, particularly when current tools are as imperfect and inaccurate as the stopwatch method.
