Differences between ICD-11 MMS and DSM-5 definition of premature ejaculation: a continuation of historical inadequacies and a source of serious misinterpretation by some European Regulatory Agencies (PART 2)

Waldinger, MD; Schweitzer, DH

Waldinger, MD (reprint author), Drexel Univ, Dept Pharmacol & Physiol, Coll Med, Philadelphia, PA 19104 USA.; Waldinger, MD (reprint author), Sun Yat Sen Univ, Affiliated Hosp 1, Dept Androl, Guangzhou, Guangdong, Peoples R China.; Waldinger, MD (reprint



Recently, the ICD-11 for Mortality and Morbidity Statistics (ICD-11-MMS, 2018 Version) has been published with a new definition of premature ejaculation (PE), including a third PE subtype. This definition differs from Diagnostic and Statistical Manual of Mental Disorders (DSM-5) definition of PE. We hereby address the similarities and differences between ICD-11-MMS and DSM-5 definition of PE and call attention to the illogical policy of some European (EU) National Regulatory Agencies to remain with a 1-min cut-off point of ejaculation time for Lifelong, Acquired and Subjective PE. The advantage of ICD-11-MMS is the inclusion of a third PE subtype, which is congruent with Subjective PE. A serious disadvantage of DSM-5 is that a 1-min criterion is used for both Lifelong and Acquired PE, and that a third PE subtype is not mentioned. Despite the incomplete DSM-5 definition of PE, some EU regulatory agencies adhere to a definition of PE which relies only on the 1-min ejaculation time cut-off point of DSM-5, and do not recognize the more recent PE definitions of ICD-11-MMS and International Society for Sexual Medicine. There is no scientific evidence for this illogical position. The continued use of a 1-min cut-off point for all subgroups of PE ignores the existence of Acquired PE (Intravaginal Ejaculation Latency Time (IELT) <3 min) and Subjective PE (IELT <approx. 6 min), both of which have been shown to be clinically and psychologically important. In conclusion, some EU regulatory agencies are not recognizing ongoing developments in the definition of three different subgroups of PE. We propose combining the DSM-5 and ICD-11 MMS definitions to optimize the whole PE spectrum for future registered drug treatment studies, so that it properly reflects patient needs.

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