Advances and Missteps in Diagnosing Premature Ejaculation: Analysis and Future Directions

Area of Science:

• Urology
• Sexual Medicine
• Medical Diagnostics

Background:

• Current diagnostic criteria for premature ejaculation (PE) lack objectivity, clarity, and precision.
• These limitations hinder accurate prevalence estimates, etiological investigations, and treatment development.
• Existing definitions impact patient-reported outcomes and regulatory oversight.

Purpose of the Study:

• To review and analyze the evolution of PE definitions.
• To offer suggestions for future directions in PE diagnostic criteria.
• To propose strategies for harmonizing definitions for researchers, clinicians, and oversight agencies.

Main Methods:

• Conducted a chronological review of PE definitions published in peer-reviewed literature from 1970 to 2021.
• Utilized the PUBMED electronic database with search terms including "premature ejaculation," "definition," and "diagnosis."
• Discussed the operationalization and validation of diagnostic criteria constructs.

Main Results:

• Traced the evolution of PE definitions from early subjective criteria to more evidence-based approaches (e.g., ISSM, DSM-5, AUA).
• Highlighted the adoption of criteria to minimize diagnostic errors.
• Acknowledged limitations in current research on acquired PE.

Conclusions:

• Significant progress has been made in defining PE based on scientific studies over the past 50 years.
• Support for the AUA's modification of intravaginal ejaculatory latency time to 2 minutes for lifelong PE.
• Recommendations include ongoing definition validation, moving beyond heterosexist definitions, and further research into acquired PE.