Premature Ejaculation

International experts from ten countries have teamed up to develop the first ever evidence-based definition of lifelong premature ejaculation (PE) in the hope that it will aid future diagnosis, treatment and research.

The results of their in-depth study, conducted by the Standards Committee of the International Society for Sexual Medicine, have just been published online by two leading Wiley-Blackwell publications, the urology journal BJU International and The Journal of Sexual Medicine.

They developed their definition after lengthy critical evaluation of the evidence presented in more than 100 studies on PE published over the last 65 years. It was unanimously agreed by the experts that the definition of lifelong PE should be a combination of three key factors:

* "Ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration."

* "The inability to delay ejaculation on all or nearly all vaginal penetrations."

* "Negative personal consequences such as distress, bother, frustration and/or the avoidance of sexual intimacy."

However, the team have concluded that at the moment there is insufficient evidence to develop an evidence-based definition of acquired PE, which develops at a stage in a man's life rather than being a life-long problem.

They have also stressed that more research is needed into the PE issues faced by homosexual men as there is also insufficient evidence to develop a definition for this patient group.

The multi-disciplinary team was made up of 21 experts from the USA, UK, Singapore, Argentina, France, Egypt, Denmark, The Netherlands, Australia and Germany.

It included urologists, psychologists, psychiatrists, a sexual health physician, a primary care physician, a neuro-urology researcher, a clinical pharmacologist, an endocrinologist and a radiation oncologist.

"PE has been a recognised condition for many years and the first topical anaesthetic cream to delay ejaculation was described as far back the 1930s" explains co-author Dr Chris G McMahon, Associate Professor at the University of Sydney and Director of the Australian Centre for Sexual Health in Sydney.

"The premise that PE is a psychosomatic disturbance was first suggested in 1943 and men with PE were recommended to try various treatments such as the stop-start method.

"Various drug treatments have been developed over the last 30 years and in the past 15 years an increasing number of well-controlled, evidence-based studies have demonstrated the effectiveness and safety of selective serotonin reuptake inhibitor drugs in delaying ejaculation.

"More recently clinicians and the pharmaceutical industry have been paying more attention to the psychosocial consequences of PE.

"But what has been lacking is a consensus on how lifelong PE should be defined. As a result everyone - from urologists and clinicians working in sexual medicine to the pharmaceutical industry - have been working to different parameters.

"That is why the International Society for Sexual Medicine felt it was vital to bring together international experts to look at the wealth of published data and formulate an evidence-based definition of lifelong PE."

Men with lifelong PE suffer from a cluster of core symptoms, including early ejaculation nearly every time they have intercourse. Approximately 90 per cent ejaculate within 30 to 60 seconds of vaginal penetration and the remaining 10 per cent within one to two minutes.

The definition developed by the Society does not cover men with acquired PE, which develops in men who have previously had normal ejaculatory experiences. This may be due to psychological or relationship problems, erectile dysfunction, an inflamed prostate gland or thyroid dysfunction.

Because the definition has not been put into practice yet, it is not possible to quantify retrospectively how many men fall into the lifelong PE category based on the new evidence-based definition. However, previous research has suggested that as many as 35 per cent men suffer from premature ejaculation of some kind, making it even more common than erectile dysfunction (ED). Unlike ED, which increases with age, PE affects men more or less equally across all age ranges.

"Numerous organisations have tried to define lifelong PE but this is the first evidence-based definition to be developed" stresses Dr McMahon. "It is a vital step forward for men with PE and the clinicians who treat them as it can be used to provide consistent diagnosis and treatment and enable the results of any clinical trials to be compared."