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Premature Ejaculation
Advances in Treatment for Premature Ejaculation
a report by
Marcel D Waldinger
Neuropsychiatrist, Department of Psychiatry and Neurosexology, HagaHospital Leyenburg, The Hague, and
Associate Professor, Sexual Psychopharmacology, Department of Psychopharmacology, Faculty of Pharmaceutical Sciences, University of Utrecht
Not every complaint of ejaculation is the result of an ejaculatory from PE when he consistently ejaculated within one minute after
‘disorder’. For example, a man may believe himself to be ejaculating penetration. In 1970, William Masters and Virginia Johnson rejected
prematurely, even though he is doing so within a normal ejaculation this idea by stating that a man has PE when he is unable to control his
time. On the other hand, some men regularly complain of early ejaculation to satisfy his female partner in more than 50% of
ejaculation occurring very soon after penetration. Both examples are intercourses.
5
Masters and Johnson strongly refuted a short ejaculation
part of a debate on the definition of premature ejaculation (PE) that time as a criterion for the definition of PE. Their view influenced the first
has existed since the 1970s, and which has given rise to sometimes official definition of PE, made in the DSM-III in 1980. According to the
fierce debate. DSM-III, a man is defined as having PE when “ejaculation occurs before
the individual wishes it, because of recurrent and persistent absence of
History of Premature Ejaculation reasonable voluntary control of ejaculation and orgasm during sexual
Since the beginning of the last century, PE has been regarded as an activity.”
6
It is clear that the DSM-III defined PE solely in terms of an
expression of an unconscious psychological conflict. It has also been absence of voluntary ‘control’, without paying attention to the time
attributed to urological disturbances, and many different treatments that passes before a man actually ejaculates (the ejaculation time). After
have been recommended over the years.
1
A clearer understanding of its publication, the DSM-III definition of PE has given rise to debate
the differences in aetiology and treatment has resulted from the among psychiatrists about the meaning of the word ‘control’. The
classification, introduced in 1943 by the German endocrinologist result of this debate was that in the next version, the DSM-III-R,
Bernhard Schapiro, of two types of PE: A and B.
2
Later, the types published in 1987, the word control was no longer mentioned in the
became known as primary (lifelong) PE and secondary (acquired) PE, definition. Instead, PE was defined as “persistent or recurrent
respectively,
3
and were included in the Diagnostic and Statistical ejaculation with minimal sexual stimulation before, on, or shortly after
Manual of Mental Disorders, Fourth Edition (Text Revision) (DSM-IV- penetration and before the person wishes it.”
7
The new defining
TR), which is the American Psychiatric Association (APA) classification criterion ‘short ejaculation time’ remained in the two other DSM
system of mental disorders.
4
editions: the DSM-IV (1994) and the DSM-IV-TR (2000).
4
However, as
little evidence-based research into ejaculation time had been conducted
The Diagnostic and Statistical Manual of Mental Disorders in the 1980s, a quantification of the ‘short’ ejaculation time was not
Fourth Edition (Text Revision) Definition mentioned in the DSM-IV definition. In contrast, the definition of PE in
Until 1980, the year in which the DSM-III was published by the APA, the International Statistical Classification of Diseases and Related Health
there was no official definition of PE. In the first part of the 20th Problems, 10th Revision (ICD-10), which is the classification system of
century, psychoanalysts considered a man to be suffering from PE when the World Health Organization (WHO), does mention a cut-off point for
ejaculation occurred so quickly after vaginal penetration that a woman the ejaculation time.
8
According to the ICD-10, a man has PE when he
had little chance of getting sexually aroused. In the absence of any ejaculates within 15 seconds after penetration. However, the ICD-10
official definition, it was a loosely accepted idea that a man suffered makes no reference to any study where this figure had been reported
as outcome data.
9
Marcel D Waldinger is a Neuropsychiatrist in the
Department of Psychiatry and Neurosexology at
Research into Ejaculation Time
HagaHospital Leyenburg in The Hague, and an Associate
In the mid-1990s, Waldinger et al. postulated that in the general male
Professor of Sexual Psychopharmacology in the Department
population there is variability in the intravaginal ejaculation latency time
of Psychopharmacology, Faculty of Pharmaceutical Sciences
at the University of Utrecht. He is internationally renowned (IELT), which is defined as the time between vaginal penetration and
as an expert on premature ejaculation. Dr Waldinger is
intravaginal ejaculation.
10
However, it was only in 2005 that such
involved in both human and animal research with main
variability was demonstrated in men.
11
interests in ejaculatory disorders, particularly the
In a stopwatch study, financed by
psychopharmacological research of premature ejaculation and antidepressant-induced sexual Pfizer International, the IELT was measured in a random cohort of men
side effects. He is Co-Chairman of the International Society for Sexual Medicine (ISSM)
in the general population of five countries – The Netherlands, UK, Spain,
Standard Committee of Orgasm and Ejaculation Disorders and Chairman of the Ethics
Subcommittee of the European Society for Sexual Medicine (ESSM). Dr Waldinger is also a
Turkey and the US – during a one-month period.
11
The study
member of the Editorial Board of various scientific journals, and he has published numerous
demonstrated for the first time that in the general male population the
articles on various aspects of premature ejaculation in leading psychiatric,
psychopharmacological, urological and sexological peer-reviewed journals.
IELT has a skewed distribution, with a median IELT of 5.4 minutes
(confidence interval [CI] 0.55–44.1 minutes). However, such a
E: md@waldinger.demon.nl
continuum of the ejaculation time had previously also been observed
using various cohorts of laboratory male Wistar rats.
12,13
Based on this
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