What Is the Role of Ejaculation Latency in the Diagnosis of Premature Ejaculation and Does the Ejaculation Latency Threshold Matter?

Abstract Purpose of Review Current definitions of premature ejaculation (PE) include three concepts: ejaculation upon minimal stimulation, commonly defined by a short ejaculation latency (EL); a lack of ability to delay or postpone ejaculation; and negative consequences related to distress, bother, or concern. However, consensus regarding the role of ejaculation latency (EL)—and more specifically, an EL threshold—in the definition and diagnosis of PE is lacking. In this paper, we consider four aspects of this diagnostic criterion: (1) the value of, but problems with, the concept of EL as a diagnostic criterion for PE; (2) the challenge of operationally defining a specific EL threshold for diagnosing men with PE; (3) the use of EL criteria in research and intervention studies; and (4) the practice and use of the EL diagnostic criterion by clinicians in their decision to treat men who presumably have PE. Recent Findings We examined measurement validation and highlight that neither EL nor a specific EL threshold has undergone adequate validation using standardized procedures. We then reviewed a number of studies that have used different methods to establish ELs in men with PE, noting not only the substantial variation in average ELs across studies but also how specific methodologies—some of which are more consistent with standard validation procedures than others—account for this variation. We further reviewed the use of EL criteria in research and intervention studies over the past 15 years, and conclude with a short survey that delineates clinicians’ perspectives regarding the use and value of EL in determining both their decision-to-treat men with PE and their corresponding evaluation of successful treatment. Summary This four-pronged analysis concludes that EL is an imprecise measure of “ejaculation in response to minimal stimulation” and should be used with caution; that validating evidence supporting the use of the 1 min criterion for PE has not been adequate; that the majority of studies using accepted procedures for criterion validation supports average ELs for men with PE in the neighborhood of 0–2 min; that research and clinically-based treatment studies generally extend ELs for men with PE well beyond the purported 1-min threshold; and that clinicians tend to use EL as a guideline rather than a rigid diagnostic criterion. The paper ends with an overall conceptualization and contextualization of EL in the diagnosis and treatment of men with PE.