How to define premature ejaculation

Several definitions for PE have been proposed, including ejaculation before or within 30 seconds, one minute, or two minutes after penetration, but these criteria have not been universally accepted.

The Diagnostic and Statistical Manual of Mental Disorders definition encompasses not only the time from penetration to ejaculation (normal values of which are still controversial), but also the devastating psychological impact of this condition on the affected man's quality of life and relationship with his partner. The American Urological Association's definition, proposed in 2004, is similar: "Premature ejaculation is ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners". The common threads in most definitions of PE are lack of ejaculatory control, ejaculation much quicker than desired, and its psychological effect on the man or couple, resulting in poor sexual satisfaction. Recently, several experts have considered any ejaculation occurring less than one minute following the development of full erection as premature. However, this definition is not yet widely accepted.

Unfortunately, subjective terminology like "shortly after" or "sooner than desired" creates confusion in PE's identification and management. This vagueness is compounded by lack of consensus on the time to use as a diagnostic criterion, which ranges in published reports from less than one minute to seven minutes. Intravaginal ejaculatory time (IVELT; the total time of vaginal penetration prior to ejaculation) is normally between five and seven minutes, with a mean of nine minutes in healthy men. In a study involving 1,346 men who reported "quick ejaculation," about 63% ejaculated in less than 30 seconds, 77% in less than 60 seconds, and about 6% even before penetration. The perceived normal time to ejaculation also differs among men from different countries: 13.6 minutes in the United States, 9.9 in the United Kingdom, 9.3 in France, 6.9 in Germany - and these perceptions do not always correspond to somewhat accepted medical norms.

Clearly couples' perceptions of PE vary widely; that is, what may be perceived as quick ejaculation by one couple may be considered normal by another. This has led some researchers to define PE not in actual minutes but as a "condition of perception involving poor confidence, low sexual satisfaction, or unrealistic expectations". Because men who ejaculate rapidly are not a homogeneous group, an optimal definition of PE would include an objective measurement of ejaculatory latency, the loss of voluntary control over ejaculation, the presence of interpersonal disturbance, the marked distress produced for the man or couple, and the exclusion of causal factors such as opiate withdrawal.