Recent advances in the classification, neurobiology and treatment of premature ejaculation

Premature ejaculation (PE) is distinguished as a 'complaint' versus a 'syndrome'. Complaints of PE in men with normal ejaculation time durations are highly prevalent among the general male population. However, PE syndromes characterized by a rigid pattern of very short ejaculation times have a much lower prevalence. A major insufficiency of the DSM-IV-TR definition of PE is the absence of a cut-off point of its short ejaculation time criterion. Recently, a new classification of PE has been proposed for the pending DSM-V. It has been proposed to distinguish four PE categories; lifelong PE, acquired PE, natural variable PE and premature-like ejaculatory dysfunction. The syndromes differ in ejaculation time duration, frequency and pattern of PE complaints, and its course in life. The difference in underlying pathophysiology and etiology of the different syndromes determines the first choice of treatment. Lifelong PE need to be treated by medication, acquired PE by treatment of its medical cause, medication or psychotherapy. Psychoeducation and reassurance is indicated for men with natural variable PE. Finally, psychotherapy and/or counselling is the first choice of treatment of men with premature-like ejaculatory dysfunction.