a Human Sexuality Program, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, and MAP Education and Research Fund , New York , New York , USA.
J Sex Marital Ther. 2017 Oct 3;43(7):633-644. doi: 10.1080/0092623X.2016.1230161. Epub 2016 Sep 3.
Evidence-based definitions improve clinical practice and research. Nonetheless, the International Society of Sexual Medicine (ISSM) and the American Psychiatric Association's (DSM-5) definitions regarding lifelong and acquired premature ejaculation (PE) and delayed ejaculation (DE) require reexamination. Existing Intravaginal Ejaculation Latency Time (IELT) evidence, the ISSM position papers, and articles both supporting and critiquing the ISSM's definitions were reviewed. Disproportionately, the findings from those studies document that the majority of men's IELT range is approximately 4 to 10 minutes. Such robust quantitative evidence should become the basis for determining the temporal criterion when defining both PE and DE. Any bilateral deviation from that majority's ∼4- to 10-minute IELT range should meet the qualification for the temporal diagnostic criterion. However, for a man to be diagnosed with a disorder, a licensed health-care clinician (HCC) must also determine that the man suffers from "lack of control" and "distress." Diagnosis would include subtyping Lifelong or Acquired, Global or Situational, similar to the ISSM guidelines and specifying mild, moderate, or severe-similar to DSM-5 requirements. "Control" and "distress" should trump latency and convey greater weight in the diagnostic process. Loosened latency criteria could result in false positive diagnoses; however, requiring a licensed HCC to evaluate control and distress reduces that risk.
循证定义可改善临床实践和研究。尽管如此，国际性医学会（ISSM）和美国精神病学会（DSM-5）关于原发性和获得性早泄（PE）和延迟射精（DE）的定义仍需重新审查。现有的阴道内射精潜伏期时间（IELT）证据、ISSM 立场文件以及支持和批评 ISSM 定义的文章均被进行了审查。从这些研究中得出的发现不成比例地表明，大多数男性的 IELT 范围约为 4 至 10 分钟。如此有力的定量证据应成为确定 PE 和 DE 时间标准的基础。任何偏离大多数人 4 至 10 分钟 IELT 范围的双侧差异都应符合时间诊断标准的条件。然而，为了诊断男性患有疾病，必须由持照的医疗保健临床医生（HCC）确定该男性患有“缺乏控制”和“苦恼”。诊断将包括类似于 ISSM 指南的原发性或获得性、全球性或情境性的分类，并指定轻度、中度或重度-类似于 DSM-5 的要求。“控制”和“苦恼”应重于潜伏期，在诊断过程中具有更大的权重。放宽潜伏期标准可能会导致假阳性诊断；然而，要求持照 HCC 评估控制和苦恼可降低这种风险。
