P1: LMF/GDW/GEC
P2: GCR
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Archives of Sexual Behavior, Vol. 30, No. 3, 2001
Defining Premature Ejaculation for Experimental and Clinical Investigations David L. Rowland, Ph.D.,1,2 Stewart E. Cooper, Ph.D.,1 and Michelle Schneider, B.Sc.1
Researchers investigating premature ejaculation (PE) have employed widely diverse definitions of it, thereby limiting progress in the field. This study summarizes available research on PE, notes patterns that emerge from these studies, compares patterns across several types of studies, and suggests a common model for defining PE groups to guide future research. We surveyed two bibliographic databases, identifying 45 studies employing a definition or description of a PE group. From these, we extracted a range of information, including descriptions of the participants, recruitment procedures, if PE subtypes were identified, operational criteria for PE classification, relationship and partner information, and additional inclusion/exclusion criteria. Over 50% of studies reported no criteria, or relied on simple self-identification by participants to establish the PE group. Quantifiable behavioral criteria were used in 49% of the studies, with ejaculatory latency reported most frequently. This measure was also used as a criterion more frequently in studies focusing on assessment of sexual response, whereas the number of penile thrusts was used more frequently in studies prior to 1989. Partner information was often included but seldom used as part of the assessment procedure. Progress on research and treatment of PE will continue to be limited by the absence of commonly accepted criteria for PE group membership and by a lack of identification of relevant PE subtypes and etiologies. This paper suggests a flowchart, based on data and a rational analysis of 40 years of research, for characterizing PE in ways that could assist the development of the field. KEY WORDS: premature ejaculation; sexual dysfunction; ejaculatory latency and control.
1 Department
of Psychology, Valparaiso University, Valparaiso, Indiana 46383. whom correspondence should be addressed at Department of Psychology, Valparaiso University, Valparaiso, Indiana 46383; e-mail:
[email protected].
2 To
235 C 2001 Plenum Publishing Corporation 0004-0002/01/0600-0235$19.50/0 °
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Rowland, Cooper, and Schneider
INTRODUCTION Important to the clinical and experimental investigation of any sexual dysfunction are the criteria used in defining the disorder. For clinical investigations, a correct diagnosis for individuals seeking help increases the likelihood of appropriate and effective treatment. For experimental investigations, preselected criteria are typically used to establish dysfunctional study groups and to distinguish them from sexually functional comparison groups. To categorize a set of responses as sexually dysfunctional, consensus regarding the relevant criteria needs to be established. In 1993, an NIH Consensus Panel (NIH Consensus Development Panel on Impotence, 1993) provided such criteria for defining erectile dysfunction (ED), and an analogous conference was recently convened to focus on female sexual dysfunction (Basson et al., 2000). However, with respect to premature ejaculation (PE), a problem affecting 20%–30% of men (Laumann et al., 1994; Spector and Carey, 1990), criteria for establishing PE group membership have been decidedly inconsistent. Early clinical investigations into PE—those by Masters and Johnson (1970) and Kaplan (1974)—focused on simple objective criteria such as the number of penile thrusts and latency to ejaculation. Subsequent reports have further emphasized subjective elements such as ejaculating prior to the desired time (Levine, 1992), a lack of control over the ejaculatory response (Grenier and Byers, 1995; Rowland, Cooper et al., 1997), and partner dissatisfaction (Shilon and Paz, 1984). Since much research on PE is aimed at its understanding, diagnosis, and treatment, a number of investigations have referred to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association [APA], 1994, p. 509) description for guidance. DSM-IV defines PE by three criteria. First, it involves “persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before the person wishes it.” Second, “the disturbance must cause marked distress or interpersonal difficulty.” And third, “the premature ejaculation is not due exclusively to the direct effects of a substance.” As with other diagnostic categories, DSM-IV describes associated features such as relationship avoidance and typical etiological factors such as emergence in a new relationship or cessation of alcohol use prior to sex. As with several other sexual problems, DSM-IV includes three subtype specifiers: lifelong versus acquired, generalized versus situational, and psychological versus combined etiology. However, despite its multiple parameters and subtype specifiers, DSM-IV makes no attempt to operationalize any component of the description. Although this approach permits flexibility on the part of the clinician, it may also result in an overly subjective diagnostic process, substantial variation in criteria and, at least from an experimental perspective, inconsistency regarding which individuals fall within the dysfunctional classification and which do not. Such consequences are counter to the central purpose of the DSM to
P1: LMF/GDW/GEC
P2: GCR
Archives of Sexual Behavior [asb]
pp062-295246
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February 19, 2001
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Style file version Nov. 19th, 1999
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produce a classification system with improved reliability and validity (Nathan and Langenbucher, 1999). Problems in defining PE undoubtedly arise from several sources. First, responses that lead to ejaculation (e.g., number of thrusts, latency, etc.) are continuous measures (Grenier and Byers, personal communication, January 10, 2000), yet for purposes of experimental investigation, these continuous variables are dichotomized to form functional and dysfunctional groups (e.g.,
