The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision as an Appropriate Diagnostic for Premature Ejaculation

INTRODUCTION: The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) criteria for premature ejaculation (PE) are multifactorial, and include concepts of latency, perceived control over ejaculation, and personal distress and interpersonal difficulty related to the condition. Recent publications have suggested that these criteria are not supported by empirical evidence, leading to the proposal that a PE diagnosis should be based solely on intravaginal ejaculatory latency time (IELT), while the presence of other factors (such as perceived lack of control over ejaculation) may be used to guide treatment decisions. AIM: To examine the evidence supporting the elements of the DSM-IV-TR criteria for PE. MAIN OUTCOME MEASURES: Literature searches on IELT, perceived control over ejaculation, and personal distress and interpersonal difficulty related to ejaculation. RESULTS: From a historical perspective, there has been a lack of large observational studies that evaluated the contributions of the DSM-IV-TR components in men with PE. However, recently performed large observational studies have generated data supporting the inclusion of perceived control over ejaculation and personal distress related to ejaculation in the definition of PE. Furthermore, emerging evidence indicates that a perceived lack of control over ejaculation is directly associated with elevated personal distress related to ejaculation and decreased satisfaction with sexual intercourse, while the effects of IELT on these parameters are indirect, and mediated by perceived control over ejaculation. A key advantage of the DSM-IV-TR approach to the diagnosis of PE is that it firmly links PE to a negative outcome for the patient, which is an element common to diagnostic criteria for other conditions, including depression, hypertension, and osteoporosis. CONCLUSIONS: This new evidence strongly suggests that the DSM-IV-TR criteria for PE encompass aspects of the condition that patients describe as important.