Management of PE raises clinical hopes, ethical issues

Q The definition of premature ejaculation seems very subjective. Criteria stated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are:

A I think the DSM criteria are purposefully very broad because a precise definition of premature ejaculation doesn't really exist. We can safely say there are certain rather broad parameters that can be used to indicate whether or not a man has premature ejaculation.

Q Please comment briefly on some of the causes of premature ejaculation.

A It has been associated with some comorbid conditions such as diabetes and renal insufficiency. The majority of men we see with PE probably don't have any clearly identifiable cause. For some men, it's episodic; that is, they don't experience it every time they have sexual activity. But the majority probably have some imbalance that we don't fully understand. It may be a psychological problem rather than a physical one, but it's still real enough that it interferes with a man's ability to have sexual activity with his partner.

A There's no question that there is potential for abuse in defining, diagnosing, and potentially in treating this condition. But I'm convinced that it's a real entity that recent data suggest is more prevalent than erectile dysfunction in men.

I'm also concerned that we turn a condition that is real into one that's more than real. We have to be very careful that new agents for this condition are used appropriately and not simply as recreational drugs. There is a real danger that that could happen.