Dr. Ira Sharlip, President of the International Society for Sexual Medicine (ISSM) detailed a new definition of premature ejaculation. He addressed the audience of the American Urological Association during the ‘late breaking science forum’, a session designed by AUA to premier newsworthy developments in clinical urology.
The ISSM convened a panel of world experts who met in Amsterdam in the fall of 2007. Each of the 21 members of the panel was selected through a peer review process for their expertise in ejaculatory physiology, pharmacology and dysfunction. The panelists were tasked with creating a new definition of premature ejaculation (PE) based on currently available clinical evidence. Definitions of PE have previously been based on group consensus and not meeting new standards for evidence-based medicine. These definitions of PE include the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 2002) and the AUA definition of (2005).
PE affects 20-30% of men. Although less commonly reported than erectile dysfunction, PE may co-exist in a third of men complaining of ED. (Lauman EO, JAMA 1999;281:537-544.) The etiology of PE is multifactorial with both biologic and psychologic factors. It is generally classified as either primary or secondary. Despite its significant prevalence there are no FDA approved drugs specifically for PE. Multiple treatments have been described including behavioral / sexual exercises and medical therapies. Current clinical trials are focusing on medical management with either oral selective serotonin re-uptake inhibitors (SSRI’s) or topical anesthetics applied as creams or sprays. (http://www.auanet.org)
The most commonly used objective parameter to characterize ejaculatory function or dysfunction is intravaginal ejaculatory latency, ‘number of seconds or minutes between vaginal intromission and ejaculation, typically averaged over a number of attempts’. Looking at the world’s literature, the ISSM panel agreed that several constructs were needed to characterize PE: time to ejaculation, inability to delay ejaculation, and negative consequences from PE. The panelists concluded that the available objective evidence to define PE was at this time limited to men with lifelong PE who engage in vaginal intercourse. The panel noted that the proposed definition would likely apply to men with PE who engage in sexual activities other than vaginal intercourse. The panel also concluded that there was insufficient objective data to support an evidence-based definition of secondary PE.
The ISSM definition of PE: “Premature ejaculation is a male dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and, inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration and or the avoidance of sexual intimacy.”
Presented by Ira Sharlip, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.
Written by Gregory A. Broderick, MD, UroToday.com Contributing Editor
