What is the definition of premature ejaculation, and when it is considered pathological?

Premature ejaculation. Two words that ring out condemningly for many men. It is a condition that often creates uncomfortable and difficult situations among partners and it is the one of the most common sexual disorders for men. Fortunately, modern science has learned how to recognize and treat it. The first point that needs to be addressed is to have a clear definition of the disorder. The European Association of Urology (UAE) reports in its 2018 guidelines a definition that takes into account the most recent scientific evidence and which is based on the work done by the International Society for Sexual (ISSM) in 2014.

“Premature ejaculation, lifelong or acquired, is a male sexual disorder characterized by:

  • ejacualtion which always or nearly always occurs before or around one minute from the start of vaginal penetration, from the first sexual encounter (lifelong premature ejaculation), or a significant clinical reduction in latency time, of about 3 minutes (acquired premature ejaculation);
  • the incapacity to delay ejaculation in all or nearly all moments of vaginal penetration;
  • negative personal consequences, such as stress, boredom, frustration and/or avoiding sexual intimacy.

All definitions take into account the time it takes for ejaculation, the inability to control or postpone it, and the negative consequences this can have on a psychological level. However, the main topic of debate among experts is the calculation of the time from the onset of penetration to ejaculation, described in scientific terms as the intravaginal ejaculatory latency time (IELT).

Recently, two more PE syndromes have been proposed:

  • ‘Variable PE’ is characterised by irregular early ejaculations, representing a normal variation in sexual performance.
  • ‘Subjective PE’ is characterised by subjective perception of consistent or inconsistent rapid ejaculation during intercourse, while ejaculation latency time is in the normal range or can even last longer. It should not be regarded as a symptom or manifestation of true medical pathology.

The addition of these two new types of premature ejaculation can aid in patient stratification, diagnosis and treatment. however, more data needs to be accumulated to understand what role they can play in the complex definition of this male sexual disorder.

HFTHQ 20-26

Suggested readings

  • K. Hatzimouratidis (Chair), F. Giuliano, I. Moncada, A. Muneer, A. Salonia (Vice-chair), P. Verze
    Guideline Associates: A. Parnham, E.C. Serefoglu - Male Sexual Dysfunction
    EAU guide Lines 2018
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