DSM: premature ejaculation (men) Flashcards
(5 cards)
criteria
Criteria
A. A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it.
Note: Although the diagnosis of premature (early) ejaculation may be applied to individuals engaged in nonvaginal sexual activities, specific duration criteria have not been established for these activities.
B. The symptom in Criterion A must have been present for at least 6 months and must be experienced on almost all or all (approximately 75%–100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts).
C. The symptom in Criterion A causes clinically significant distress in the individual.
D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.
Specify whether:
- Lifelong: The disturbance has been present since the individual became sexually active.
- Acquired: The disturbance began after a period of relatively normal sexual function.
Specify whether:
- Generalized: Not limited to certain types of stimulation, situations, or partners.
- Situational: Only occurs with certain types of stimulation, situations, or partners.
Specify current severity:
- Mild: Evidence of mild distress over the symptoms in Criterion A.
- Moderate: Evidence of moderate distress over the symptoms in Criterion A.
- Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.
associated features en prevalence
Associated features supporting diagnosis
Many males with premature (early) ejaculation complain of a sense of lack of control over ejaculation and report apprehension about their anticipated inability to delay ejaculation on future sexual encounters.
Prevalence
Estimates of the prevalence of premature (early) ejaculation vary widely depending on the definition utilized. Internationally, more than 20%–30% of men ages 18–70 years report concern about how rapidly they ejaculate. With the new definition of premature (early) ejaculation (i.e., ejaculation occurring within approximately 1 minute of vaginal penetration), only 1%–3% of men would be diagnosed with the disorder. Prevalence of premature (early) ejaculation may increase with age.
Development and course
By definition, lifelong premature (early) ejaculation starts during a male’s initial sexual experiences and persists thereafter. Some men may experience premature (early) ejaculation during their initial sexual encounters but gain ejaculatory control over time. It is the persistence of ejaculatory problems for longer than 6 months that determines the diagnosis of premature (early) ejaculation.
In contrast, some men develop the disorder after a period of having a normal ejaculatory latency, known as acquired premature (early) ejaculation. There is far less known about acquired premature (early) ejaculation than about lifelong premature (early) ejaculation. The acquired form likely has a later onset, usually appearing during or after the fourth decade of life. Lifelong is relatively stable throughout life.
Little is known about the course of acquired premature (early) ejaculation. Reversal of medical conditions such as hyperthyroidism and prostatitis appears to restore ejaculatory latencies to baseline values. Lifelong premature (early) ejaculation begins with early sexual experiences and persists throughout an individual’s life. In approximately 20% of men with premature (early) ejaculation, ejaculatory latencies decrease further with age. Age and relationship length have been found to be negatively associated with prevalence of premature (early) ejaculation
risico en cultuur
Risk and prognostic factors
Temperamental. Premature (early) ejaculation may be more common in men with anxiety disorders, especially social anxiety disorder (social phobia).
Genetic and physiological. There is a moderate genetic contribution to lifelong premature (early) ejaculation. Premature (early) ejaculation may be associated with dopamine transporter gene polymorphism or serotonin transporter gene polymorphism. Thyroid disease, prostatitis, and drug withdrawal are associated with acquired premature (early) ejaculation. Positron emission tomography measures of regional cerebral blood flow during ejaculation have shown primary activation in the mesocephalic transition zone, including the ventral tegmental area.
Culture-related diagnostic issues
Perception of what constitutes a normal ejaculatory latency is different in many cultures. Measured ejaculatory latencies may differ in some countries. Such differences may be explained by cultural or religious factors as well as genetic differences between populations.
functionele consequenties, differentiele diagnose en comorbiditeit
Functional consequences of premature ejaculation
A pattern of premature (early) ejaculation may be associated with decreased self-esteem, a sense of lack of control, and adverse consequences for partner relationships. It may also cause personal distress in the sexual partner and decreased sexual satisfaction in the sexual partner. Ejaculation prior to penetration may be associated with difficulties in conception.
Differential diagnosis
- Substance/medication induced sexual dysfunction;
- Ejaculatory concerns that do not meet diagnostic criteria.
Comorbidity
Premature (early) ejaculation may be associated with erectile problems. In many cases, it may be difficult to determine which difficulty preceded the other. Lifelong premature (early) ejaculation may be associated with certain anxiety disorders. Acquired premature (early) ejaculation may be associated with prostatitis, thyroid disease, or drug withdrawal (e.g., during opioid withdrawal).
