A proposition supporting that premature ejaculation is a psychosomatic disturbance was first suggested during 1943. Men with problems of PE were recommended to try various manual treatments. The stop and start method was one of the oldest do it yourself techniques used for treating premature ejaculation. Dating further back to the 1930’s, the first topical anesthetic cream was used to delay ejaculation, as explained by Dr Chris G McMahon, Associate Professor at the University of Sydney and Director of the Australian Centre for Sexual Health in Sydney. Apparently, premature ejaculation problems and solutions have been around for some time now.

Along the way many types of drugs have been developed for treatment over the last 30 years. In the past 15 years an increasing number of well-controlled, evidence-based studies have showed the effectiveness and safety of selective serotonin reuptake inhibitor drugs to help delay ejaculation.

Recently experts with the association of the pharmaceutical industry have been focusing more attention to the psychosocial consequences of PE. But what they have not been able to agree on, is the consensus of how lifelong premature ejaculation should be defined. As a result, the International Society for Sexual Medicine (ISSM) founded in 1982, felt it was important to gather all international experts to look into the resources of their published data and develop an evidence-based definition for lifelong PE. The team was made up of 21 experts from the USA, UK, Singapore, Argentina, France, Egypt, Denmark, The Netherlands, Australia and Germany in the hope that it would aid future diagnosis, treatment and research.  

The purpose of the ISSM is to promote and encourage the highest standards of practice, education, training and research in the field of sexual medicine. Experts from everywhere including urologists, psychologists, psychiatrists, a sexual health physician, a primary care physician, a neuro-urology researcher, a clinical pharmacologist, an endocrinologist and a radiation oncologist have been working together to define the parameters of PE. 

After a lengthy critical evaluation of the evidence presented in more than 100 case studies of PE (published over the last 65 years), a standard definition was developed. It was unanimously agreed by the experts that the definition of lifelong PE should be a combination of 3 key factors:

1. Ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration.
2. The inability to delay ejaculation on all or nearly all vaginal penetrations.
3. Negative personal consequences such as distress, bother, frustration and/or the avoidance of sexual intimacy.

However, the teams have concluded that at the moment there is not enough proof to develop an evidence-based definition for acquired PE, which develops at a later stage in a man’s life. This is for those males who previously had normal ejaculatory experiences rather than it being a life-long problem. This may be due to psychological or relationship problems, erectile dysfunction, an inflamed prostate gland or thyroid dysfunction. They also stressed that more research is needed in the PE issues faced by homosexual men as there is insufficient evidence to develop a definition for this group.

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

The definition has not been put into practice yet, hence it is not possible to quantify retrospectively how many men fall into the lifelong PE category supported by the new evidence-based definition. However, previous research has suggested that as many as 35 per cent of 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 organizations have tried to define lifelong PE but this is the first evidence-based definition to be developed stresses Dr McMahon. It is an important step 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.