Intra Vaginal Latency Time is not the only Assessment Tool in Premature Ejaculation!

Medical literature contains several univariate and multivariate operational definitions of premature ejaculation (PE). The lack of agreement as to what constitutes premature ejaculation has hampered basic and clinical research into the etiology and management of this condition. Diagnosis of PE in clinical practice is not difficult and is based on patient self-report, clinical history and examination findings alone. However, patient self-report of PE must be interpreted with some caution as both PE and non-PE men tend to overestimate their intravaginal ejaculatory latency time (IELT) compared to stopwatch-recorded IELT. In epidemiological and drug treatment research studies, objective measurement of IELT by stopwatch and subjective validated, reliable and consistent patient reported outcome measures (PROs) of ejaculatory control, sexual satisfaction and bother/distress are essential. Each of these PROs has been operationalized, although not always with consistency. Measurement of IELT by stopwatch is the best method to diagnose PE and assess treatment response and should be used as a primary efficacy endpoint. Recent normative IELT data demonstrates a median IELT of 5.4 minutes (range 0.55-44.1 minutes) and supports an IELT of less than 1 minute as representing “definite” PE. Various authors have proposed the extent of voluntary control over ejaculation as an appropriate measure, suggesting minimal or absent control as defining PE. Ejaculatory control is a subjective measure and difficult to translate in quantifiable terms. However, the dimension of voluntary control over ejaculation does appear to differentiate men with PE with men from men without PE, but is not exclusive to men suffering from PE. Men with PE report lower levels of sexual satisfaction compared to men with normal ejaculatory latency. A recent observational study reported sexual satisfaction ratings of “very poor” or “poor” in 31% of men with premature ejaculation, compared with 1% in a group of normal controls. Existing definitions of PE include “distress” or “bother” as an important dimension of PE. The extent of bother defines the severity of PE. Although partner distress is perhaps the most common reason for men with PE to seek treatment, there is limited information regarding the effect of PE on the partner. Subjective patient reported outcomes (PROs) of ejaculatory control, sexual satisfaction and bother/distress can be evaluated using several validated patient reported outcome instruments. However, a meta-analysis of 35 drug treatment studies has confirmed that the variability of answers of spontaneous reports and questionnaire studies on the IELT are significantly higher than stopwatch assessments. This possibly relates to the observation that PROs are not equally weighted and their importance appears to vary between individual patients. Research into the development of validated, reliable and consistent patient reported outcome measures is ongoing.