ORIGINAL RESEARCH—EJACULATORY DISORDERS: Changing Paradigms from a Historical DSM-III and DSM-IV View Toward an Evidence-Based Definition of Premature Ejaculation. Part I—Validity of DSM-IV-TR


  • Marcel D. Waldinger MD, PhD,

    Corresponding author
    1. Department of Psychiatry and Neurosexology, HagaHospital Leyenburg, The Hague;
    2. Department of Psychopharmacology, Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute for Neurosciences, Utrecht University, Utrecht;
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  • Dave H. Schweitzer MD, PhD

    1. Department of Internal Medicine and Endocrinology, Reinier de Graaf Groep, Delft-Voorburg, the Netherlands
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Marcel D. Waldinger, MD, PhD, Department Psychiatry and Neurosexology, HagaHospital Leyenburg, Leyweg 275, 2545 CH The Hague, the Netherlands. Tel: +31-70-3592086; Fax: +31-70-3594902; E-mail: md@waldinger.demon.nl


Background.  In former days, information obtained from randomized well-controlled clinical trials and epidemiological studies on premature ejaculation (PE) was not available, thereby hampering the efforts of the consecutive DSM Work Groups on Sexual Disorders to formulate an evidence-based definition of PE. The current DSM-IV-TR definition of PE is still nonevidence based. In addition, the requirement that persistent self-perceived PE, distress, and interpersonal difficulties, in absence of a quantified ejaculation time, are necessary to establish the diagnosis remains disputable.

Aim.  To investigate the validity and reliability of DSM and ICD diagnosis of premature ejaculation.

Methods.  The historical development of DSM and ICD classification of mental disorders is critically reviewed, and two studies using the DSM-IV-TR definition of PE is critically reanalyzed.

Results.  Reanalysis of two studies using the DSM-IV-TR definition of PE has shown that DSM-diagnosed PE can be accompanied by long intravaginal ejaculation latency time (IELT) values. The reanalysis revealed a low positive predictive value for the DSM-IV-TR definition when used as a diagnostic test. A similar situation pertains to the American Urological Association (AUA) definition of PE, which is practically a copy of the DSM-IV-TR definition.

Conclusion.  It should be emphasized that any evidence-based definition of PE needs objectively collected patient-reported outcome (PRO) data from epidemiological studies, as well as reproducible quantifications of the IELT. Waldinger MD, and Schweitzer DH. Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence-based definition of premature ejaculation. Part I—Validity of DSM-IV-TR. J Sex Med 2006;3:682–692.