ABSTRACT
BACKGROUND: Unlike the other 2 criteria for diagnosing premature ejaculation (PE), namely lack of ejaculatory control and short ejaculation latency (EL), the role of bother/distress has received only minimal consideration and investigation. AIM: The specific aim was to determine both why distress is included in the PE diagnosis and whether such inclusion is advantageous to achieving better diagnostic outcomes. To this end, the review explored the historical and theoretical underpinnings of the inclusion of "bother/ distress" in the diagnosis of PE, with reference to the larger role that distress has played in the diagnosis of mental disorders, in an attempt to understand the utility (or lack thereof) of this construct in making a PE diagnosis. METHODS: We reviewed the role of bother/distress across current professional definitions for PE and then expanded this discussion to include the role of distress in other sexual dysfunctions. We then included a brief historical perspective regarding the role that distress has played in the diagnosis of PE. This discussion is followed by a deeper look at 2 nosological systems, namely DSM and ICD, to allow perspective on the inclusion of the bother/distress construct in the diagnosis of mental and behavioral disorders, including the assumptions/arguments put forward to include or exclude bother/distress as an important criterion underlying various professional assumptions. OUTCOME: Determination of the value and/or need of including bother/distress as a necessary criterion for the diagnosis of PE. RESULTS: Based on the research literature, bother/distress does not appear to be as critical for a PE diagnosis as either the lack of ejaculatory control or short EL. It is the weakest of the differences among men with and without PE, and recent evidence suggests that its inclusion is generally redundant with the severity of the 2 other criteria for PE, ejaculatory control and EL. CLINICAL TRANSLATION: Bother/distress appears to serve little purpose in the diagnosis of PE yet its assessment may be important for the treatment strategy and for assessing treatment effectiveness. STRENGTHS AND LIMITATIONS: This review did not provide a critical analysis of the literature regarding the role of bother/distress in PE, but rather focused on its potential value in understanding and diagnosing PE. CONCLUSION: Although bother/distress appears to add little to the improvement of accuracy for a PE diagnosis, understanding and assessing the man's or couple's experience of distress has important implications for the treatment strategy and focus, as well as for assessing treatment success. Rowland DL, Cooper SE. The Tenuous Role of Distress in the Diagnosis of Premature Ejaculation: A Narrative Review. Sex Med 2022;10:100546.
ABSTRACT
Strategies for addressing anxiety-related decrements in performance have been implemented across a variety of domains, including Sex, Sport, and Stage. In this review, we (1) iterate the dominant anxiety-related remediation strategies within each of these domains; (2) identify over-lapping and domain-specific strategies; and (3) attempt to unify the conceptualization of performance-related anxiety across these three areas under the information-processing framework of the Reflective/deliberative-Impulsive/automatic Model (RIM). Despite both diversity and similarity in remediation approaches across domains, we found that many strategies appear to share the common goal of maintaining a dominant automatic style of information processing in high performance demand situations. We then describe how various remediation strategies might hypothetically fit within the RIM framework and its subcomponents, identifying each intervention as falling into one or more broad categories related to achieving and/or maintaining dominance in automatic information processing. We conclude by affirming the benefit of adopting a unifying information-processing framework for the conceptualization of performance-related anxiety, as a way of both guiding future cross- and inter- disciplinary research and elucidating effective remediation models that share common pathways/mechanisms to improved performance.
