Diagnostic Features
The essential feature of Premature Ejaculation is the persistent or recurrent onset of orgasm and ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it (Criterion A). The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity. The majority of males with this disorder can delay orgasm during self-masturbation for a considerably longer time than during coitus. Partners’ estimates of the duration of time from the beginning of sexual activity until ejaculation as well as their judgment of whether Premature Ejaculation is a problem can be quite disparate. The disturbance must cause marked distress or interpersonal difficulty (Criterion B). The premature ejaculation is not due exclusively to the direct effects of a substance (e.g., withdrawal from opioids) (Criterion C).
Subtypes
Subtypes are provided to indicate onset (Lifelong versus Acquired), context (Generalized versus Situational), and etiological factors (Due to Psychological Factors, Due to Combined Factors) for Premature Ejaculation.
Associated Features and Disorders
Like other Sexual Dysfunctions, Premature Ejaculation may create tension in a relationship. Some unmarried males hesitate to begin dating new partners out of fear of embarrassment from the disorder. This can contribute to social isolation.
Course
A majority of young males learn to delay orgasm with sexual experience and aging, but some continue to ejaculate prematurely and may seek help for the disorder. Some males are able to delay ejaculation in a long-term relationship but experience a recurrence of Premature Ejaculation when they have a new partner. Typically, Premature Ejaculation is seen in young men and is present from their first attempts at intercourse. However, some males lose the ability to delay orgasm after a period of adequate function. When onset occurs after a period of adequate sexual function, the context is often a decreased frequency of sexual activity, intense performance anxiety with a new partner, or loss of ejaculatory control related to difficulty achieving or maintaining erections. Some males who have stopped regular use of alcohol may develop Premature Ejaculation because they relied on their drinking to delay orgasm instead of learning behavioral strategies.
Differential Diagnosis
Premature Ejaculation should be distinguished from erectile dysfunction related to the development of a general medical condition. Some individuals with erectile dysfunction may omit their usual strategies for delaying orgasm. Others require prolonged noncoital stimulation to develop a degree of erection sufficient for intromission. In such individuals, sexual arousal may be so high that ejaculation occurs immediately. Occasional problems with premature ejaculation that are not persistent or recurrent or are not accompanied by marked distress or interpersonal difficulty do not qualify for the diagnosis of Premature Ejaculation. The clinician should also take into account the individual’s age, overall sexual experience, recent sexual activity, and the novelty of the partner. When problems with Premature Ejaculation are due exclusively to substance use (e.g., Opioid Withdrawal), a Substance-Induced Sexual Dysfunction can be diagnosed.
Diagnostic criteria for 302.75 Premature Ejaculation
A. Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.
B. The disturbance causes marked distress or interpersonal difficulty.
C. The premature ejaculation is not due exclusively to the direct effects of a substance (e.g., withdrawal from opioids).
Specify type:
Lifelong Type
Acquired Type
Specify type:
Generalized Type
Situational Type
Specify:
Due to Psychological Factors
Due to Combined Factors
