There are not many diseases with various diagnostic criteria like premature ejaculation, and its concept is rapidly changing due to research on the pharmacology and neurophysiology of premature ejaculation. Premature ejaculation can cause significant setbacks and setbacks to men’s confidence.
◆ Grading based on the satisfaction level of sexual partners ◆
The initial researchers (MASTERS and JOHNSON) defined premature ejaculation as the inability of a man to fully prolong ejaculation time, resulting in his sexual partner achieving orgasm in 50% of sexual intercourse. From this perspective, the importance of premature ejaculation lies in the fact that prolonged sexual intercourse can make it easier for women to reach orgasm. There are reports that only 27% of women have experienced orgasm in less than 1 minute of sexual intercourse, while 66% of women often achieve orgasm in more than 12 minutes of sexual intercourse. On average, women reach orgasm in 8 minutes.
◆ Grading based on the duration of sexual intercourse before ejaculation ◆
The definition of premature ejaculation usually requires specifying the normal time from the insertion of the penis into the vagina until ejaculation. An early study on healthy men showed that the average sexual intercourse time was 20 minutes. However, a survey conducted in 1996 on nearly 1000 couples showed that the average sexual intercourse time was 4-7 minutes. Subsequent surveys showed that the average sexual intercourse time among couples in the United States was 10 minutes, slightly longer than that of couples in East Germany (an average of 5 minutes). Other studies have shown that sexual intercourse lasting from less than 1 minute to 10 minutes can be considered premature ejaculation.
◆ Grading based on the number of thrusts and uncontrolled ejaculation ◆
The number of tics is also used to define premature ejaculation, and it is recommended to use less than 8 or 15 tics as diagnostic criteria. Recently, the ability to control ejaculation at will has been used to define premature ejaculation. In fact, many diagnostic criteria, including sexual intercourse time and uncontrolled ejaculation, are recommended.
◆ Graded according to DSM-IV (Fourth Edition Diagnostic and Statistical Manual) ◆
At present, the grading of male sexual dysfunction is based on the DSM-IV of the American Psychiatric Association, which is established on the classic theories of MASTERS and JOHNSON. Dysfunction may occur during one or more stages of the physiological sexual response cycle: sexual desire, arousal (sexual arousal), and orgasm. Premature ejaculation is a functional disorder during the orgasmic stage. Nowadays, the DSM-IV diagnostic criteria for premature ejaculation are the most commonly used, including the following:
1) Continuous or frequent orgasms that occur before self intention and ejaculate before, during, or just after insertion due to minimal sexual stimulation.
2) Obvious distress or difficulties in interpersonal relationships.
3) Not only due to the direct effects of withdrawal symptoms caused by substances like opium.
The precautions for DSM-IV indicate that indirect factors such as age, situational or sexual partner changes, and frequency of sexual activity also need to be taken into account. There are several characteristic parameters in the diagnostic parameters of DSM-IV that are helpful in determining the severity of premature ejaculation, including:
Is it ejaculation at the beginning or during the ongoing process – lifelong or acquired (episodic).
Is it causal or variable – generalized (universal or in any environment) or situational (in a certain environment).
Etiology – is it psychological or mixed (psychological and medical or essential).
◆ Organic or psychological reasons ◆
A typical study was conducted in 1943 on 1130 patients with clinical premature ejaculation. The patients were divided into two groups, one group may have organic or physiological premature ejaculation, and the other group may have psychogenic premature ejaculation.
◆ Primary or secondary premature ejaculation ◆
Other researchers suggest dividing premature ejaculation into two categories – primary and secondary – based on physiological and psychological differences observed in the laboratory. Primary premature ejaculation refers to those who experience premature ejaculation from the first sexual intercourse, equivalent to the lifelong standard in DSM-IV (see section 3.4 above). Secondary premature ejaculation refers to sexual function being normal before onset, equivalent to the acquired standard in DSM-IV.
In a group of males with primary premature ejaculation, it was found that the latency of the bulbocavernosus reflex (BCR) neural response was 30.3 milliseconds, and common clinical features included lifelong sexual dysfunction, fear of failure, restriction of sexual arousal (by reducing stimulation, dispersing attention, using condoms and anesthesia, etc.), transition from participant to observer (observer), reduced frequency of sexual activity, exacerbation of premature ejaculation due to poor sexual relationships (which may develop into secondary ED), and relief from current organic diseases. In a group of males with secondary premature ejaculation, the average incubation period of BCR is 40.45 milliseconds, which is slightly longer than that of primary premature ejaculation, and it usually occurs after erectile dysfunction or difficulty in orgasm worsens. Secondary premature ejaculation is also divided into two subtypes: one with physical illness (75%), and the other without physical illness (25%).
These results seem to confirm the physiological findings reported by other researchers, which suggest that shorter incubation periods cannot evoke potentials in the sacrum and cortex of males with lifelong premature ejaculation.
◆ Other grading methods ◆
There are other grading methods available for premature ejaculation. An authoritative figure views premature ejaculation and delayed ejaculation as dissatisfaction with ejaculation time, while other scholars further divide premature ejaculation patients into two groups: the first group has been shown to have increased sensitivity to sexual stimulation, with patients reporting fast ejaculation during masturbation, less psychological interference, and no ED or frigidity; In the second group of patients, sexual disorders were associated with anxiety. Premature ejaculation only occurred with sexual partners (not during masturbation), and there were some signs of ED during sexual intercourse, as well as sexual frigidity. There is a more complex grading method for premature ejaculation, which takes into account the degree of anxiety and erectile dysfunction and summarizes the following three basic types:
1) Adolescents have onset of illness, normal erections, and are associated with anxiety.
2) Acute onset, poor erection, and widespread anxiety.
3) Hidden onset of the disease and related to erectile dysfunction, low libido, and no obvious anxiety.