What are the DSM-5 diagnostic criteria for premature ejaculation (PE)?

Answer

The specific DSM-5 criteria for premature (early) ejaculation are as follows^[4]:

In almost all or all (75-100%) sexual activity, the experience of a pattern of ejaculation occurring during partnered sexual activity within 1 minute after vaginal penetration and before the individual wishes it
The symptoms above have persisted for at least 6 months
The symptoms above cause significant distress to the individual
The dysfunction cannot be better explained by nonsexual mental disorder, a medical condition, the effects of a drug or medication, or severe relationship distress or other significant stressors

The severity of premature (early) ejaculation is specified as follows:

Mild (occurring within approximately 30 seconds to 1 minute of vaginal penetration)
Moderate (occurring within approximately 15-30 seconds of vaginal penetration)
Severe (occurring before sexual activity, at the start of sexual activity, or within approximately 15 seconds of vaginal penetration)

The duration of the dysfunction is specified as follows:

Lifelong (present since first sexual experience)
Acquired (developing after a period of relative normal sexual functioning)

In addition, the context in which the dysfunction occurs is specified as follows:

Generalized (not limited to certain types of stimulation, situations, or partners)
Situational (limited to specific types of stimulation, situations, or partners)

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Raveendran AV, Agarwal A. Premature ejaculation - current concepts in the management: A narrative review. Int J Reprod Biomed. 2021 Jan. 19 (1):5-22. [Medline]. [Full Text].
Masters WH, Johnson VE. Premature ejaculation. Human Sexual Inadequacy. Boston, Mass: Little Brown & Company; 1970. 92-115.
Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, et al. An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. J Sex Med. 2014 Jun. 11 (6):1423-41. [Medline].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Washington, DC: APA Press; 2013.
Buvat J. Pathophysiology of premature ejaculation. J Sex Med. 2011 Oct. 8 Suppl 4:316-27. [Medline].
Canat L, Değirmentepe RB, Atalay HA, Alkan İ, Özbir S, Çulha MG, et al. The relationship between female sexual function index domains and premature ejaculation. Int Urol Nephrol. 2018 Apr. 50 (4):633-637. [Medline].
Yang X, Gao M, Zhang L, Liu L, Liu P, Sun J, et al. Central Neural Correlates During Inhibitory Control in Lifelong Premature Ejaculation Patients. Front Hum Neurosci. 2018. 12:206. [Medline]. [Full Text].
Peeters M, Giuliano F. Central neurophysiology and dopanergic control of ejaculation. Neurosci Biobehav Rev. 2008. 32(3):438-53. [Medline].
Yusof F, Sidi H, Das S, Midin M, Kumar J, Hatta MH. Understanding the Pathophysiology of Premature Ejaculation: Bridging the Link between Pharmacological and Psychological Interventions. Curr Drug Targets. 2018. 19 (8):856-864. [Medline].
Corona G, Jannini EA, Mannucci E et al. Different testosterone levels are associated with ejaculatory dysfunction. J Sex Med. August 2008. 8:1991-8. [Medline].
Yao B, Li XY, Zhao ZM et al. Semen biochemical markers and their significance in the patients with premature ejaculation. Zhonghua Nan Ke Xue. December 2007. 13(12):1084-6. [Medline].
Corona G, Mannucci E, Jannini EA, Lotti F, Ricca V, Monami M, et al. Hypoprolactinemia: A New Clinical Syndrome in Patients with Sexual Dysfunction. J Sex Med. 2009 Feb 10. [Medline].
Patrick DL, Althof SE, Pryor JL, Rosen R, Rowland DL, Ho KF, et al. Premature ejaculation: an observational study of men and their partners. J Sex Med. 2005 May. 2(3):358-67. [Medline].
Patrick DL, Rowland D, Rothman M. Interrelationships among measures of premature ejaculation: the central role of perceived control. J Sex Med. 2007 May. 4(3):780-8. [Medline].
Verma KK, Khaitan BK, Singh OP. The frequency of sexual dysfunctions in patients attending a sex therapy clinic in north India. Arch Sex Behav. 1998 Jun. 27(3):309-14. [Medline].
Lee SW, Lee JH, Sung HH, Park HJ, Park JK, Choi SK, et al. The prevalence of premature ejaculation and its clinical characteristics in Korean men according to different definitions. Int J Impot Res. 2013 Jan. 25 (1):12-7. [Medline].
Giuliano F, Patrick DL, Porst H, La Pera G, Kokoszka A, Merchant S, et al. Premature ejaculation: results from a five-country European observational study. Eur Urol. 2008 May. 53(5):1048-57. [Medline].
Frewen A, Rapee RM, Bowden P, Lagios K. Regional differences in men attending a sexual health clinic in Sydney for premature ejaculation. J Sex Med. 2007 Nov. 4(6):1733-8. [Medline].
[Guideline] Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med. 2014 Jun. 11 (6):1392-422. [Medline]. [Full Text].
Corona G, Rastrelli G, Limoncin E, Sforza A, Jannini EA, Maggi M. Interplay Between Premature Ejaculation and Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med. 2015 Dec. 12 (12):2291-300. [Medline].
Lee JH, Lee SW. Relationship between premature ejaculation and chronic prostatitis/chronic pelvic pain syndrome. J Sex Med. 2015 Mar. 12 (3):697-704. [Medline].
[Guideline] Sansone A, Aversa A, Corona G, Fisher AD, Isidori AM, La Vignera S, et al. Management of premature ejaculation: a clinical guideline from the Italian Society of Andrology and Sexual Medicine (SIAMS). J Endocrinol Invest. 2021 May. 44 (5):1103-1118. [Medline]. [Full Text].
Mohee A, Eardley I. Medical therapy for premature ejaculation. Ther Adv Urol. 2011 Oct. 3(5):211-22. [Medline]. [Full Text].
Kilic S, Ergin, H, Baydinc YC. Venlafaxine extended release for the treatment of patients with premature ejaculation: a pilot, single-blind, placebo-controlled, fixed-dose crossover study on short-term administration of an antidepressant drug. Int J Androl. 2005. 28:47. [Medline].
Porst H. An overview of pharmacotherapy in premature ejaculation. J Sex Med. 2011 Oct. 8 Suppl 4:335-41. [Medline].
Choi HK, Jung GW, Moon KH, et al. Clinical study of SS-cream in patients with lifelong premature ejaculation. Urology. 2000 Feb. 55(2):257-61. [Medline].
Xin ZC, Choi YD, Seong DH, Choi HK. Sensory evoked potential and effect of SS-cream in premature ejaculation. Yonsei Med J. 1995 Nov. 36(5):397-401. [Medline].
Busato W, Galindo CC. Topical anaesthetic use for treating premature ejaculation: a double-blind, randomized, placebo-controlled study. BJU Int. 2004 May. 93(7):1018-21. [Medline].
Henry R, Morales A. Topical lidocaine-prilocaine spray for the treatment of premature ejaculation: a proof of concept study. Int J Impot Res. 2003 Aug. 15(4):277-81. [Medline].
Berkovitch M, Keresteci AG, Koren G. Efficacy of prilocaine-lidocaine cream in the treatment of premature ejaculation. J Urol. 1995 Oct. 154(4):1360-1. [Medline].
Pu C, Yang L, Liu L, Yuan H, Wei Q, Han P. Topical anesthetic agents for premature ejaculation: a systematic review and meta-analysis. Urology. 2013 Apr. 81(4):799-804. [Medline].
Porst H, Burri A. Novel Treatment for Premature Ejaculation in the Light of Currently Used Therapies: A Review. Sex Med Rev. 2018 Jul 26. [Medline].
Colpi GM, Fanciullacci F, Aydos K, Grugnetti C. Effectiveness mechanism of chlomipramine by neurophysiological tests in subjects with true premature ejaculation. Andrologia. 1991 Jan-Feb. 23(1):45-7. [Medline].
Girgis SM, El-Haggar S, El-Hermouzy S. A double-blind trial of clomipramine in premature ejaculation. Andrologia. 1982 Jul-Aug. 14(4):364-8. [Medline].
Haensel SM, Rowland DL, Kallan KT. Clomipramine and sexual function in men with premature ejaculation and controls. J Urol. 1996 Oct. 156(4):1310-5. [Medline].
Kim SC, Seo KK. Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: a double-blind, placebo controlled study. J Urol. 1998 Feb. 159(2):425-7. [Medline].
Choi JB, Kang SH, Lee DH, Kim YS, Jeon JS, Choi WS, et al. Efficacy and Safety of On-Demand Clomipramine for the Treatment of Premature Ejaculation: A Multicenter, Randomized, Double-Blind, Phase III Clinical Trial. J Urol. 2018 Aug 4. [Medline].
Wu PC, Hung CS, Kang YN, Wu CC. Tolerability and Optimal Therapeutic Dosage of Clomipramine for Premature Ejaculation: A Systematic Review and Meta-Analysis. Sex Med. 2021 Feb. 9 (1):100283. [Medline]. [Full Text].
Siroosbakht S, Rezakhaniha S, Rezakhaniha B. Comparative study of on-demand and daily use of sertraline in treatment of premature ejaculation: A randomized clinical trial. Asian J Urol. 2021 Apr. 8 (2):209-214. [Medline]. [Full Text].
Pryor JL, Althof SE, Steidle C, Rosen RC, Hellstrom WJ, Shabsigh R, et al. Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials. Lancet. 2006 Sep 9. 368(9539):929-37. [Medline].
Safarinejad MR. Comparison of dapoxetine versus paroxetine in patients with premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. Clin Neuropharmacol. 2006 Sep-Oct. 29(5):243-52. [Medline].
Safarinejad MR. Safety and efficacy of dapoxetine in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. Neuropsychopharmacology. 2008 May. 33(6):1259-65. [Medline].
McMahon CG, Giuliano F, Dean J, Hellstrom WJ, Bull S, Tesfaye F, et al. Efficacy and Safety of Dapoxetine in Men with Premature Ejaculation and Concomitant Erectile Dysfunction Treated with a Phosphodiesterase Type 5 Inhibitor: Randomized, Placebo-Controlled, Phase III Study. J Sex Med. 2013 Jul 11. [Medline].
Giuliano F, Hellstrom WJ. The pharmacological treatment of premature ejaculation. BJU Int. 2008 Sep. 102(6):668-75. [Medline].
Black K, Shea C, Dursun S, Kutcher S. Selective serotonin reuptake inhibitor discontinuation syndrome: proposed diagnostic criteria. J Psychiatry Neurosci. 2000 May. 25(3):255-61. [Medline].
Abdel-Hamid IA. Phosphodiesterase 5 inhibitors in rapid ejaculation: potential use and possible mechanisms of action. Drugs. 2004. 64(1):13-26. [Medline].
Mattos RM, Marmo Lucon A, Srougi M. Tadalafil and fluoxetine in premature ejaculation: prospective, randomized, double-blind, placebo-controlled study. Urol Int. 2008. 80(2):162-5. [Medline].
Chen J, Keren-Paz G, Bar-Yosef Y, Matzkin H. The role of phosphodiesterase type 5 inhibitors in the management of premature ejaculation: a critical analysis of basic science and clinical data. Eur Urol. 2007 Nov. 52(5):1331-9. [Medline].
Abu El-Hamd M. Efficacy and safety of daily use of tadalafil in treatment of patients with premature ejaculation: A randomised placebo-controlled clinical trial. Andrologia. 2018 Jun. 50 (5):e13005. [Medline].
Martyn-St James M, Cooper K, Ren S, Kaltenthaler E, Dickinson K, Cantrell A, et al. Phosphodiesterase Type 5 Inhibitors for Premature Ejaculation: A Systematic Review and Meta-analysis. Eur Urol Focus. 2017 Feb. 3 (1):119-129. [Medline]. [Full Text].
Blier P, Bergeron R, de Montigny C. Selective activation of postsynaptic 5-HT1A receptors induces rapid antidepressant response. Neuropsychopharmacology. 1997 May. 16(5):333-8. [Medline].
Safarinejad MR. Once-daily high-dose pindolol for paroxetine-refractory premature ejaculation: a double-blind, placebo-controlled and randomized study. J Clin Psychopharmacol. 2008 Feb. 28(1):39-44. [Medline].
Safarinejad MR, Hosseini SY. Safety and efficacy of tramadol in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. J Clin Psychopharmacol. 2006 Feb. 26(1):27-31. [Medline].
Salem EA, Wilson SK, Bissada NK, Delk JR, Hellstrom WJ, Cleves MA. Tramadol HCL has promise in on-demand use to treat premature ejaculation. J Sex Med. 2008 Jan. 5(1):188-93. [Medline].
Hamidi-Madani A, Motiee R, Mokhtari G, Nasseh H, Esmaeili S, Kazemnezhad E. The Efficacy and Safety of On-demand Tramadol and Paroxetine Use in Treatment of Life Long Premature Ejaculation: A Randomized Double-blind Placebo-controlled Clinical Trial. J Reprod Infertil. 2018 Jan-Mar. 19 (1):10-15. [Medline].
Yang L, Qian S, Liu H, Liu L, Pu C, Han P, et al. Role of Tramadol in Premature Ejaculation: A Systematic Review and Meta-Analysis. Urol Int. 2013 Jun 6. [Medline].
Sharma AP, Sharma G, Tyagi S, Devana SK, Mavuduru RS, Bora GS, et al. Safety and efficacy of "on-demand" tramadol in patients with premature ejaculation: an updated meta-analysis. Int Braz J Urol. 2021 Feb 11. 47:[Medline].
Kilinc MF, Aydogmus Y, Yildiz Y, Doluoglu OG. Impact of physical activity on patient self-reported outcomes of lifelong premature ejaculation patients: Results of a prospective, randomised, sham-controlled trial. Andrologia. 2018 Feb. 50 (1):[Medline].
Pastore AL, Palleschi G, Fuschi A, Al Salhi Y, Zucchi A, Bozzini G, et al. Pelvic muscle floor rehabilitation as a therapeutic option in lifelong premature ejaculation: long-term outcomes. Asian J Androl. 2018 Jul 3. [Medline]. [Full Text].
[Guideline] Stanley E. Althof, Ph.D1., Chris G. McMahon, M.D.2, Marcel D. Waldinger, M.D., et al. An Update of the International Society of Sexual Medicine’s Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). International Society for Sexual Medicine. Available at https://www.issm.info/images/uploads/PE_Guidelines_v12_-_FEB_2014.pdf. February 2014; Accessed: May 25, 2021.
[Guideline] Drogo K. Montague, MD, Co-Chairman; Jonathan Jarow, MD, Co-Chairman; Gregory A. Broderick, MD; Roger R. Dmochowski, et al. Pharmacologic Management of Premature Ejaculation. AUA Clinical Guidelines. Available at https://www.auanet.org/guidelines/premature-ejaculation-(2004-reviewed-and-validity-confirmed-2010). 2010; Accessed: May 25, 2021.
David Prologo J, Snyder LL, Cherullo E, Passalacqua M, Pirasteh A, Corn D. Percutaneous CT-guided Cryoablation of the Dorsal Penile Nerve for Treatment of Symptomatic Premature Ejaculation. J Vasc Interv Radiol. 2013 Feb. 24(2):214-9. [Medline].

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Author

Samuel G Deem, DO Faculty, Department of Urology, Charleston Area Medical Center

Samuel G Deem, DO is a member of the following medical societies: American College of Surgeons, American Osteopathic Association, American Urological Association, Endourological Society, Society of Urologic Oncology, American Society of Clinical Oncology, American College of Osteopathic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Kevin P Brown, DO Resident Physician, Department of Urology, Charleston Area Medical Center

Kevin P Brown, DO is a member of the following medical societies: American Osteopathic Association, American Urological Association

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Endo.

Acknowledgements

Aaron Benson, MD Staff Physician, Department of Surgery, Division of Urology, Southern Illinois University School of Medicine

Aaron Benson, MD is a member of the following medical societies: American Medical Association, American Urological Association, and Illinois State Medical Society

Disclosure: Nothing to disclose. Leonard Gabriel Gomella, MD, FACS The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, Society for Basic Urologic Research, Society of University Urologists, and Society of Urologic Oncology

Disclosure: GSK Consulting fee Consulting; Astra Zeneca Honoraria Speaking and teaching; Watson Pharmaceuticals Consulting fee Consulting

Milton Lakin, MD Head, Section of Medical Urology, Urological Institute, Cleveland Clinic

Milton Lakin, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, and American Urological Association

Disclosure: Nothing to disclose.

Mark Jeffrey Noble, MD Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Loren B Ost, MD Associate Professor, Department of Surgery, Southern Illinois University School of Medicine; Urologist, SIU Physicians and Surgeons

Loren B Ost, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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