Evaluation of Premature Ejaculation

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Premature ejaculation (PE) has given rise to various and sometimes highly contrasting theories, approaches, and treatments. PE was believed to be mainly a psychological disorder for the first half of the twentieth century and regarded as a symptom of a neurosis that had to be treated by psychoanalysis in order to solve the unconscious conflicts that were assumed to have caused the neurosis. Years ahead of his time, Bernard Schapiro advocated oral and local anesthetic drug treatment to delay ejaculation. In 1994, Waldinger introduced the intravaginal ejaculation latency time (IELT) as a scientific measure of the ejaculation time, using a stopwatch. In addition to Schapiro’s two PE subtypes (Lifelong and Acquired), Waldinger and Schweitzer postulated the existence of two additional PE subtypes: Subjective PE and Variable PE. The classification of PE into four PE subtypes is relevant for pharmacotherapy and counseling of men with complaints of PE. The pathophysiology of lifelong PE is mediated by a very complex interplay of central and peripheral serotonergic, dopaminergic, oxytocinergic, endocrinological, genetic, and probably also epigenetic factors. This chapter discusses the progress in PE research including evidence based evaluation methods.