Recently, it has been proposed to distinguish PE as a “complaint” versus PE as a “syndrome” PE as a complaint may belong to the normal variation of ejaculatory performance in men, but may also be the manifestation of medically or psychologically determined pathological ejaculatory performance. In 2006, Waldinger and Schweitzer proposed a new PE classification and PE definitions for the pending DSM-V and ICD-11. In contrast to the current DSM edition, it has been proposed that PE should be classified according to a “syndromal” approach incorporating well-controlled clinical and epidemiological stopwatch studies. PE has for the first time been classified by Bernard Schapiro in 1943. He distinguished Types B and A that in 1989 were termed “lifelong PE (LPE)” and “acquired PE (APE)” by Godpodinoff. Recently, Waldinger proposed also the existence of two other PE syndromes, which have been called “Natural Variable PE (NVPE)” and “ Premature-like Ejaculatory Dysfunction (PLED)”. The key characteristics of the four PE syndromes show remarkable functional differences which may be represented by a continuum with LPE and PLED at the two extreme ends. For example, the IELT in men with Lifelong PE is consistently very short, i.e. less than 1-1.5 minutes, the cause is mainly neurobiologically and genetically determined, its prevalence is estimated to be rather low (2-5%), and treatment consists of medication alone or with additional counselling in case of serious coping problems. On the other hand, men with Premature-like Ejaculatory Dysfunction complain of early ejaculations while their IELTs are consistently in the normal range (i.e., between 3-7 minutes) or even of long duration (i.e. longer than 10 minutes). The cause is mainly psychologically determined, and its prevalence is estimated to be rather high (i.e., 15-20%). Treatment should consist of psychotherapy or counselling and not of medication. The in Acquired PE is (in)consistently short or very short (i.e., less than 2 minutes), and is either due to organic disorders like thyroid dysfunction, prostatitis and erectile dysfunction, or due to psychological problems as for example relationship problems. The prevalence is unknown but may well be in the rather lower range. Natural Variable PE is actually not a real syndrome. These men may inconsistently and irregularly have IELT early ejaculations, the IELT is objectively short or may be perceived as short. Its prevalence is as yet unknown. NVPE is most likely a manifestation of normal variation of ejaculatory performance. Treatment consists of reassurance and psycho-education in explaining that irregular early ejaculation is part of normal ejaculatory performance.
Conflict of Interest: None disclosed
Financial Support/Funding: None disclosed
Recorded: Sydney, Australia, April 2007
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