Premature ejaculation: Advantages of a new classification for understanding etiology and prevalence rates

Abstract

Premature ejaculation (PE) is a frequent male sexual complaint. The current DSM definition of PE has a low positive predictive value with an increased risk of false-positive diagnoses of PE. A recent proposal is to distinguish PE as a “complaint” versus a “syndrome”. In addition, a classification of four well-defined PE syndromes has been proposed for the pending DSM-V. The proposed classification encompasses lifelong PE, acquired PE, natural variable PE and premature-like ejaculatory dysfunction. Some of these syndromes are more neurobiologically determined, others more psychologically based. Their distinction has implications for treatment. Some need medication, others counselling, psychoeducation or psychotherapy or both medication and counselling. The high prevalence of PE of 20–30% presumably represents the high percentage of men with “complaints” of PE. However, there is insufficient evidence that PE as a “disorder” has such a high prevalence. Epidemiological studies into the prevalence of the four distinguished syndromes are needed.