The Use of Old and Recent DSM Definitions of Premature Ejaculation in Observational Studies: A Contribution to the Present Debate for a New Classification of PE in the DSM-V


  • Marcel D. Waldinger MD, PhD,

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

    1. Department of Internal Medicine and Endocrinology, Reinier de Graaf Groep Hospital, Delft-Voorburg, the Netherlands
    Search for more papers by this author

Marcel D. Waldinger, MD, PhD, Department of Psychiatry and Neurosexology, HagaHospital Leyenburg, Leyweg 275, 2545 CH The Hague, the Netherlands. Tel: +31-70-2102086; Fax: +31-70-2104902; E-mail:


Introduction.  The DSM-III definition of premature ejaculation (PE) contains the criterion “control” but not that of “ejaculation time.” In contrast, the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) (DSM-IV-TR) contains the criterion “short ejaculation time,” while it lacks “control.”

Aim.  To review the adequacy and consequent use of all criteria of the DSM-IV-TR definition in previously published PE Internet surveys.

Methods.  Reviewing all published cohort studies on PE from 2004 to 2007. MEDLINE and EMBASE computer bibliographies were used.

Main Outcome Measure.  Definitions of DSM-III, DSM-IV-TR, and International Classification of Diseases.

Results.  Five papers, of which three are original studies, reported inclusion of men with PE according to DSM-IV-TR definition but omitted to apply the required “short ejaculation time” criterion. These studies, which have defined PE according to subjective criteria such as control, actually referred to the DSM-III definition. Using DSM-III-like definitions in three different studies revealed a highly variable prevalence of PE (32.5%, 27.6%, and 13.0%). In contrast, based on studies using a 1-minute cutoff point, being the time that is required to call ejaculation time “short” or using the criterion “persistent occurrence,” PE revealed to be far less prevalent (5–6%).

Conclusions.  Unacceptable discrepancies of PE definitions according to DSM-III (abandoned but still used) and DSM-IV-TR argue strongly in favor of a multidimensional new classification of PE for the DSM-V. Waldinger MD, and Schweitzer DH. The use of old and recent DSM definitions of premature ejaculation in observational studies: A contribution to the present debate for a new classification of PE in the DSM-V. J Sex Med 2008;5:1079–1087.