Why The New Diagnostic Guidelines For Premature Ejaculation Are A Step Backwards

What exactly does it mean for a man to ejaculate “prematurely?” This has been a topic of considerable scientific debate for quite some time, with many arguing that the current classification criteria for premature ejaculation are vague and unclear. A new report just published in the Journal of Sexual Medicine attempts to remedy this by proposing what is supposedly an objective, evidence-based definition. However, I have some concerns that the new criteria may end up creating more problems than they solve.

Let’s start by taking a look at the newly proposed criteria for premature ejaculation:

(1) Ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired).

(2) The inability to delay ejaculation on all or nearly all vaginal penetrations.

(3) Negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.

I have no quibbles with the third criterion because personal distress is really the hallmark of sexual dysfunction. In fact, in the absence of personal distress, we should be very cautious about applying the “dysfunctional” label to any individuals and their sexual activities.

My concerns stem primarily from the first and second criteria. For one thing, they attempt to establish a strict time limit for when ejaculation “should” occur. The problem with this is not only that it tells men how long they are supposed to last in bed, but it also presumes that everyone is physically capable and desirous of the same sexual duration. The reality is that everyone is different when it comes to sex. Some people are perfectly happy with a briefer sexual event, whereas others want sex to last much longer. Setting a minimum time limit on sex just has the potential to generate anxiety among couples who are perfectly happy with their sex lives the way they are.

The other problem with these criteria is that they focus exclusively on ejaculation within the context of vaginal intercourse. Of course, not all men have vaginal sex. In addition, even among those who do practice it, that’s usually not the only sexual activity in which they routinely experience ejaculation. Isn’t it also possible for ejaculation to occur “prematurely” outside of the vagina?

In all fairness to the scientists who proposed these criteria, there isn’t much data out there on premature ejaculation as it pertains to oral and anal sex, same-sex practices, and other sexual activities (e.g., mutual masturbation); however, one has to wonder why these data don’t exist in this day and age. Why are we only concerned with how long men last during vaginal sex, but seem to not care how long they last during other kinds of sex?

Also, I must admit that I don’t completely fault these scientists for wanting to take duration into account. Duration does matter to a degree. For instance, in some studies, the ejaculatory latencies of men who had been diagnosed with premature ejaculation ranged from zero seconds (ejaculation prior to complete penetration) to nearly a half hour! Clearly, those two ends of the spectrum aren’t the same thing and might not be responsive to the same treatments.

So, duration does need to be taken into account; however, should it be part of the definition for premature ejaculation? I would argue not. Why? Let’s say some guy is very distressed about how quickly he ejaculates but he falls well outside of the time limits set by the definition. Should he therefore be ignored or denied treatment? In my view, no.

The way I see it, the key factor here is whether a man is consistently ejaculating before he and his partner would like and feels as though he has no control over it. If this is creating distress, then it becomes a sexual difficulty that is worthy of being addressed. In determining treatment course, this is where I suspect duration comes into play. For someone who is ejaculating prior to full penetration, a medical treatment might hold the most promise (e.g., SSRIs or desensitizing agents) because we’re probably talking about more of a biological issue. For someone who lasts 1-3 minutes, behavioral therapies (e.g., the stop-start technique) might be the way to go because these men already have at least some degree of ejaculatory control and you’re just trying to build it up further. And for someone who can last 30 minutes or more, treatment might instead involve helping the client to psychologically reappraise his sexual expectations because he is already able to last far longer than average.

My view is that rather than narrowing the definition of premature ejaculation and trying to find a “one size fits all” solution, perhaps we should instead look at it on a continuum, with duration potentially playing a key role in identifying different “types” of premature ejaculation.

In short, when defining premature ejaculation and other sexual difficulties, the criteria should be inclusive and avoid telling people how they are “supposed” to be having sex because our goal is to solve problems—not to create problems where none previously existed.

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To read more about this research, see: Serefoglu, E. C., McMahon, C. G., Waldinger, M. D., Althof, S. E., Shindel, A., Adaikan, G., … & Torres, L. O. (2014). 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. The Journal of Sexual Medicine, 11(6), 1423-1441.

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