There are several problems with diagnostic criteria for premature ejaculation (PE) that lack objectivity, clarity and precision. They hamper accurate determination of PE prevalence estimates, investigations into the etiology of the dysfunction, impact on partners, development of validated Patient Reported Outcomes, regulatory authority oversight, and which men might benefit from specific treatment interventions.
We sought to review, analyze and comment on the evolution of the definitions of PE and offer suggestions for future directions for PE definitions. Our goal is to propose strategies whereby the criterion sets are useful to researchers, clinicians and governmental oversight agencies alike and bring harmony and scientific rigor among the conflicting and confusing definitions.
There are several premature ejaculation definitions published in the peer reviewed medical literature. The PUBMED electronic database from 1970 to 2021 was searched for published definitions. Search terms included the medical subject headings of premature ejaculation, definition and diagnosis. In chronological order, Table 1 lists the various diagnosis and criteria sets for PE. We discuss the process by which constructs, which make up diagnostic criteria sets, are operationalized and validated.
We review definitions of PE beginning with Masters and Johnson\'s focus on partner orgasmic attainment and move through the nebulous and subjective criterion sets found in the early Diagnostic and Statistical Manuals and International Classification of Disease series, to the more evidenced-based definitions found in International Society of Sexual Medicine, Diagnostic and Statistical Manuals-5 and the American Urological Association (AUA) definitions. Additionally, we discuss how constructs and criteria sets have been adopted to minimize errors of inclusion and exclusion in defining disease/dysfunction.
This manuscript offers a careful chronological analysis of the published definitions of PE. This historical lens allows the reader to perceive the shifting science underlying the development of PE definitions. The manuscript is limited regarding our comments on acquired PE as evidenced-based research is incomplete.
Over the past 50 years there has been considerable forward momentum in defining PE based on well conducted scientific studies. We support the American Urological Association\'s modification in Intravaginal ejaculatory latency time to 2-minutes for lifelong PE, concur with the 11th revision of the International Classification of Diseases recommendation for changing the terminology from premature ejaculation to early ejaculation. We also recommend ongoing validation of definitions, moving away from the current heterosexist definition of PE based on penile-vaginal sex and urge further population based research into acquired PE to develop stronger evidenced-based criterion sets for this subtype.

There are several problems with diagnostic criteria for premature ejaculation (PE) that lack objectivity, clarity and precision. They hamper accurate determination of PE prevalence estimates, investigations into the etiology of the dysfunction, impact on partners, development of validated Patient Reported Outcomes, regulatory authority oversight, and which men might benefit from specific treatment interventions.
We sought to review, analyze and comment on the evolution of the definitions of PE and offer suggestions for future directions for PE definitions. Our goal is to propose strategies whereby the criterion sets are useful to researchers, clinicians and governmental oversight agencies alike and bring harmony and scientific rigor among the conflicting and confusing definitions.
There are several premature ejaculation definitions published in the peer reviewed medical literature. The PUBMED electronic database from 1970 to 2021 was searched for published definitions. Search terms included the medical subject headings of premature ejaculation, definition and diagnosis. In chronological order, Table 1 lists the various diagnosis and criteria sets for PE. We discuss the process by which constructs, which make up diagnostic criteria sets, are operationalized and validated.
We review definitions of PE beginning with Masters and Johnson\'s focus on partner orgasmic attainment and move through the nebulous and subjective criterion sets found in the early Diagnostic and Statistical Manuals and International Classification of Disease series, to the more evidenced-based definitions found in International Society of Sexual Medicine, Diagnostic and Statistical Manuals-5 and the American Urological Association (AUA) definitions. Additionally, we discuss how constructs and criteria sets have been adopted to minimize errors of inclusion and exclusion in defining disease/dysfunction.
This manuscript offers a careful chronological analysis of the published definitions of PE. This historical lens allows the reader to perceive the shifting science underlying the development of PE definitions. The manuscript is limited regarding our comments on acquired PE as evidenced-based research is incomplete.
Over the past 50 years there has been considerable forward momentum in defining PE based on well conducted scientific studies. We support the American Urological Association\'s modification in Intravaginal ejaculatory latency time to 2-minutes for lifelong PE, concur with the 11th revision of the International Classification of Diseases recommendation for changing the terminology from premature ejaculation to early ejaculation. We also recommend ongoing validation of definitions, moving away from the current heterosexist definition of PE based on penile-vaginal sex and urge further population based research into acquired PE to develop stronger evidenced-based criterion sets for this subtype. Althof SE, McMahon CG, Rowland DL. Advances and Missteps in Diagnosing Premature Ejaculation: Analysis and Future Directions. J Sex Med 2022;19:64-73.

Premature ejaculation (PE) and delayed/inhibited ejaculation (DE) are 2 ejaculatory problems that may negatively affect the sexual relationship and cause distress. Although no specific cause explains these problems when they have been lifelong conditions, understanding both biological and psychological factors may be relevant to treatment choices, with options ranging from pharmacologic to psychobehavioral. Integrating treatment modalities may lead to better outcomes but may also require greater psychological and resource investment from the patient or couple.

Research into ejaculatory dysfunction in sexual activities other than penovaginal intercourse is limited due to the absence of well-defined tools to measure ejaculatory latencies in these sexual activities. Our pilot study using Arousal to Ejaculation Time Interval (AETI) and Erection to Ejaculation Time Interval (EETI) as tools to measure ejaculatory latencies in different types of sexual encounters in medical professionals had yielded promising results. Hence, we conducted a similar study using AETI and EETI as tools, measured using stopwatch in healthy, sexually active heterosexual male population in a multinational sample from January 2018 to December 2020. Though mean AETI and EETI differed in different sexual activities, on analysing them across all sexual activities, mean AETI and EETI in normal ejaculators, premature ejaculators and delayed ejaculators were 10.3 ± 5.81 min and 6.8 ± 4.13 min, 4.31 ± 2.98 min and 3.35 ± 3.06 min and 20.9 ± 16.1 min and 16.3 ± 10.6 min respectively. Both AETI and EETI were significantly different from normal to premature as well as normal to delayed ejaculators (p-value < 0.05). It could be concluded that these novel tools can help to measure ejaculatory latencies in sexual activities in heterosexual males.

Ejaculation consists of two synchronized phases: a) emission, the contraction of the vas deferens, prostate and seminal vesicles and bladder neck expelling the seminal fluid to the urethra; it is mediated by sympathetic nerves, and b) expulsion, seminal fluid outward propulsion by the rhythmic contraction of perineal muscles. Ejaculation results from a complex spinal reflex having its essential components within the lumbosacral cord. The main afferent signals derive from mechanical stimulation of the glans penis and are conveyed by sacral sensory roots. The ejaculatory reflex is under strong modulatory influence from the brain through both facilitatory and inhibitory descending signals. Several central neurotransmitters including serotonin and dopamine modulate the ejaculatory reflex. The intravaginal ejaculatory latency time (IELT), measured or estimated, provides clinically useful assessment of the ejaculatory reflex. The new DSM-5 definition of premature ejaculation (PE) includes a specified time to ejaculation criterion (IELT of about one minute or shorter). Four subtypes of PE, showing different prevalence rates, have been proposed. PE etiology is multifactorial with interacting psychological and biological factors contributing to the disorder. A number of genetic polymorphisms related to serotonin and dopamine neurotransmission may predispose the bearers to developing PE. High prevalence rates of PE have been found in patients with chronic prostatitis, hyperthyroidism, and premature ejaculation.

BACKGROUND: Recent developments in the study of men\'s sexual response have raised significant issues related to the definition and diagnosis of premature ejaculation (PE).
OBJECTIVE: We wanted to understand men\'s perceived reasons for \"ejaculating before they wanted,\" whether they selected attributions from the same broad category when allowed to endorse multiple reasons, and whether younger and older cohorts differed in their attributions.
METHODS: A subsample of 376 men who indicated that they \"ejaculated before they wanted\" was drawn from a larger pool of 1,249 men participating in an online survey on men\'s sexual health. This subsample responded to a number of items regarding their ejaculatory patterns, including two questions listing 10 possible self-reported attributions/reasons for their quick ejaculation--one item allowed respondents to endorse multiple reasons, the other limited the response to the most important reason.
METHODS: The primary outcome measure was men\'s attributions for ejaculating before desired, with choices from 10 possible pretested reasons. In addition, concordance across attributions was determined, that is, if a man responded to one category, was he also likely to select another category?
RESULTS: Men who met the ejaculatory latency criterion for PE were generally no different from those who did not. Overall, when required to select the most important attribution, most men identified a specific issue with \"lack of self-efficacy\" (lack of control or aroused too quickly). Few respondents identified erection loss, partner issues, or medical/medication concerns as the reason--and these patterns were independent of age. Concordance was high across self-efficacy attributions but low across other attributions.
CONCLUSIONS: Most men who complain of ejaculating before desired attribute this response to problems with self-efficacy. Only a small percent of men identified other possible reasons for their quick ejaculation. Such findings have implications for both the diagnostic process and definitional language for PE.

BACKGROUND: Circumcision of males is commonly carried out worldwide for reasons of health, medical need, esthetics, tradition, or religion. Whether circumcision impairs or improves male sexual function or pleasure is controversial.
OBJECTIVE: The study aims to conduct a systematic review of the scientific literature.
METHODS: A systematic review of published articles retrieved using keyword searches of the PubMed, EMBASE, and Cochrane databases was performed.
METHODS: The main outcome measure is the assessment of findings in publications reporting original data relevant to the search terms and rating of quality of each study based on established criteria.
RESULTS: Searches identified 2,675 publications describing the effects of male circumcision on aspects of male sexual function, sensitivity, sensation, or satisfaction. Of these, 36 met our inclusion criteria of containing original data. Those studies reported a total of 40,473 men, including 19,542 uncircumcised and 20,931 circumcised. Rated by the Scottish Intercollegiate Guidelines Network grading system, 2 were 1++ (high quality randomized controlled trials) and 34 were case-control or cohort studies (11 high quality: 2++; 10 well-conducted: 2+; 13 low quality: 2-). The 1++, 2++, and 2+ studies uniformly found that circumcision had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, ejaculatory latency, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration. Support for these conclusions was provided by a meta-analysis. Impairment in one or more parameters was reported in 10 of the 13 studies rated as 2-. These lower-quality studies contained flaws in study design (11), selection of cases and/or controls (5), statistical analysis (4), and/or data interpretation (6); five had multiple problems.
CONCLUSIONS: The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.