title: An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second international society for sexual medicine ad hoc committee for the definition of premature ejaculation.
abstract: BACKGROUND
  The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE.
  
  
  OBJECTIVE
  The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE.
  
  
  METHODS
  In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence-based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted.
  
  
  RESULTS
  The committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time (IELT) as compared with men with lifelong PE. A self-estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut-off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE); (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.
  
  
  CONCLUSIONS
  The ISSM unified definition of lifelong and acquired PE represents the first evidence-based definition for these conditions. This definition will enable researchers to design methodologically rigorous studies to improve our understanding of acquired PE. Serefoglu EC, McMahon CG, Waldinger MD, Althof SE, Shindel A, Adaikan G, Becher EF, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An evidence-based unified definition of lifelong and acquired premature ejaculation: Report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. Sex Med 2014;2:41-59.
authors.affiliation: Department of Urology, Bagcilar Training & Research Hospital Istanbul, Turkey.
authors.forename: Ege Can
authors.initials: EC
authors.lastname: Serefoglu
authors.affiliation: Australian Center for Sexual Health Sydney, New South Wales, Australia.
authors.forename: Chris G
authors.initials: CG
authors.lastname: McMahon
authors.affiliation: Department of Pharmacology, Utrecht Institute of Pharmaceutical Sciences, University of Utrecht Utrecht, The Netherlands.
authors.forename: Marcel D
authors.initials: MD
authors.lastname: Waldinger
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine West Palm Beach, FL, USA.
authors.forename: Stanley E
authors.initials: SE
authors.lastname: Althof
authors.affiliation: Department of Urology, University of California at Davis Davis, CA, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Shindel
authors.affiliation: Department of Obstetrics and Gynecology, National University of Singapore Singapore.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Adaikan
authors.affiliation: Division of Urology, University of Buenos Aires Buenos Aires, Argentina.
authors.forename: Edgardo F
authors.initials: EF
authors.lastname: Becher
authors.affiliation: St. Peter's Sexual Medicine Centre, The London Clinic London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Dean
authors.affiliation: Neuro-Uro-Andrology Unit, Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital Paris, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Giuliano
authors.affiliation: Department of Urology, Tulane University Health Sciences Center New Orleans, LA, USA.
authors.forename: Wayne Jg
authors.initials: WJ
authors.lastname: Hellstrom
authors.affiliation: Department of Sexological Research, Psychiatric Center Copenhagen, Rigshospitalet Copenhagen, Denmark.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Giraldi
authors.affiliation: Department of Urology, Instituto H. Ellis Sao Paulo, Brazil.
authors.forename: Sidney
authors.initials: S
authors.lastname: Glina
authors.affiliation: Erasmus MC-Daniel den Hoed Cancer Center Rotterdam, The Netherlands.
authors.forename: Luca
authors.initials: L
authors.lastname: Incrocci
authors.affiliation: Endocrinology and Medical Sexology, Department of Experimental Medicine, University of L'Aquila L'Aquila, Italy.
authors.forename: Emmanuele
authors.initials: E
authors.lastname: Jannini
authors.affiliation: School of Psychology, Deakin University Melbourne, Victoria, Australia.
authors.forename: Marita
authors.initials: M
authors.lastname: McCabe
authors.affiliation: Montefiore Medical Center, Department of Medicine, Albert Einstein College of Medicine New York, NY, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Parish
authors.affiliation: Graduate School, Valparaiso University Valparaiso, IN, USA.
authors.forename: David
authors.initials: D
authors.lastname: Rowland
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine Cleveland, OH, USA.
authors.forename: R Taylor
authors.initials: RT
authors.lastname: Segraves
authors.affiliation: Department of Urology, University of California San Francisco, CA, USA.
authors.forename: Ira
authors.initials: I
authors.lastname: Sharlip
authors.affiliation: Clinica de Urologia e Andrologia Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Luiz Otavio
authors.initials: LO
authors.lastname: Torres
keywords: Acquired Premature Ejaculation; Definition; Ejaculatory Control; Interpersonal Distress; Intravaginal Ejaculatory Latency Time; Lifelong Premature Ejaculation; Negative Personal Psychological Consequences; Personal Distress; Premature Ejaculation; Sexual Satisfaction