The severity classification of lifelong premature ejaculation based on the premature ejaculation diagnostic tool

Grading premature ejaculation (PE) may hold significant value. However, although previous studies have attempted to achieve a uniform severity scale for PE, this has not been widely accepted since design and methodological limitations.

In patients with lifelong PE (LPE), we re-evaluated the items suitable for severity grading and established the appropriate severity classification reference through reasonable statistical methods and logic.

Patient perceived intravaginal ejaculatory latency time (PIELT) and premature ejaculation diagnostic tool (PEDT) scores from 264 men (149 with LPE and 115 without PE) were used to analyze surrogate item suitable for classification. Classification and Regression Trees were used to determine the optimal score interval for different severity levels in patients with LPE.

For the LPE population with PIELT < 3.5 min, PIELT had no value in the classification of severity of LPE patients. PEDT items 1 and 4, showing high correlation (0.84 and 0.89, respectively) with PEDT total score, reflect the physical and mental effects of LPE patients in terms of ejaculatory control and interpersonal relationship. These items may serve as proxy for the severity scale of LPE patients. Hence, patients diagnosed with LPE can be classified into the following grades based on PEDT scores: mild (11-14), moderate (15-17), severe (18-20). Substantial agreement was shown between these predicted and "true" classes (weighted kappa 0.71).

Assessing LPE according to three dimensions is a widely accepted definition. While PIELT showed no statistically significant differences in the classification (p > 0.05), the two subjective dimensions of ejaculation control and negative psychological influence did predict the severity grading of LPE. Not only can grading the subjective feelings of patients with LPE help them to self-assess the extent of the disease, but also provide a valuable reference for further treatment.

Within the PIELT of 3.5 min, the severity of LPE can be classified into severe, moderate, and mild categories based on the PEDT score.