PE Definition per DSM IV
(Diagnostic and Statistical Manual, 4th Edition)

Although you might question whether or not premature ejaculation is in fact a psychiatric condition, there is a definition present in the DSM IV manual of the American Psychiatric Association. This is a manual which lists all mental health disorders in both children and adults, describing not only the symptoms, but the statistics, prevalence, prognosis and causes of these conditions. You might also question whether or not a psychiatric manual is a good place for a definition of premature ejaculation, a condition which is much more the preserve of psychologists and sexual therapists than psychiatrists, but such is the nature of medicine (that is to say, in my opinion, wishing to medicalize what may well be natural conditions in human existence).

It will be interesting to see whether the DSM fifth edition, due in June 2013, a full 18 years after the publication of the fourth edition, makes any change to the highly criticized DSM IV definition which has been quoted widely in all kinds of places across the Internet. It is as follows:

Premature ejaculation, also known as rapid or early ejaculation, is defined as the persistent or recurrent onset of orgasm and ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. (This DSM definition also states that the condition must also cause marked distress or interpersonal difficulty.)

As you can see, in this definition, the criteria for defining male sexual performance is premature ejaculation are multifactorial, with concepts of personal distress, interpersonal difficulty, latency, and control over ejaculation or coming into the definition. That in itself, because many of these criteria are subjective, presents huge difficulty in formalizing a scientific definition of what is in some ways an impressionistic diagnosis.

Moreover, a lot of research in the past few years has demonstrated that many of these criteria are not supported by empirical scientific evidence. For example, as a sex therapist, I'm well aware that many men who ejaculate quickly experience intercourse as profoundly satisfying and rewarding, and have no issues of shame or guilt around their rapid ejaculation. In many cases this lack of emotional distress is shared by the partner, either because intercourse is not important to her, or because the partner ensures that she reaches orgasm through oral or manual stimulation before intercourse begins.

I'd also make the observation that subjective control over ejaculation is both variable from one sexual event to another, and between types of sexual events. So if a man begins intercourse when he's not particularly aroused, he's likely to be able to continue thrusting vaginally quite some time rather longer than he would if he were highly aroused when he penetrated his partner. Secondly, there is definitely a large influence around the man's intention in sexual "performance". When a man intends to make sex last longer, he takes the trouble to notice the warning signs that his ejaculation is about to occur, and he tends to take action to intervene and prevent it happening. By contrast, if he's not interested in controlling his ejaculation he is likely to ignore these warning signs and simply surrender to the physical pleasure of orgasm and ejaculation. To complicate matters even further, in my work as a therapist, I've come across many women who would definitely like intercourse to last longer, but who never say as much, or at least never admit as much to their partner, since they have accepted the compromise of orgasm through manual stimulation before intercourse begins. There can be many reasons why woman accept such a compromise, but the most frequent of them, in my experience, is to maintain the harmony of the relationship.

So once again it's quite clear that defining premature ejaculation is not a simple matter: when we move away from the simplistic time based observations of Alfred Kinsey and the unjustifiable assumptions of Masters and Johnson about female orgasmic capacity, to a definition that encompasses partner satisfaction, the waters become muddied even more. How then, can these difficulties to be resolved? One approach would be to simply define PE on the basis of objective, identifiable factors such as duration of intercourse, leaving out any issues of partner satisfaction or dissatisfaction. In a way this makes sense, because it's objective and measurable. However, an emerging body of evidence seems to suggest that when a man perceives he has little or no control over his ejaculation he really does experience a degree of stress, which certainly supports the DSM IV approach around the diagnosis and definition of premature ejaculation, an approach which clearly links PE to a negative emotional outcome for the man and woman concerned. You may know that such negative outcomes are an essential part of the diagnostic criteria for many conditions, such as depression, hypertension, and even osteoporosis.

Premature ejaculation definition  Definition by Masters and Johnson  Definition by Alfred Kinsey  Definition by DSM IV  Definition by Helen Singer Kaplan  Definition of premature ejaculation today

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