DÄ internationalArchive12/2008Introduction Into the Diagnostics and Treatment of Premature Ejaculation: In Reply


Introduction Into the Diagnostics and Treatment of Premature Ejaculation: In Reply

Dtsch Arztebl Int 2008; 105(12): 223. DOI: 10.3238/arztebl.2008.0223b

Mathers, M J

LNSLNS We are pleased to have triggered an interdisciplinary discussion with our article on premature ejaculation – the best result that an introductory article could hope for. Professor Bosinski is right to emphasize the importance of sexual medicine as an interdisciplinary, cross-sectional subspecialty.

In the same way, the medical/scientific problem of premature ejaculation has been discussed since the 19th century – when it was known as dysgenesia anticipans. Ejaculation itself may be the final part in the sequence of male sexual function "libido – erection – penetration – reaching orgasm," but it has many facets and many aspects, including biopsychosocial phenomena.

By worldwide consensus, ICD-10 and DSM-IV use premature ejaculation as the term, although the problem may well affect the couple, as mentioned in our article. However, it seems necessary to point out that single men may also be affected. Whether the strong emphasis on the couple aspect is therefore always useful for subject and patient will certainly require discussion. We see parallels to the discussion about erectile dysfunction, some 10 years ago, which was initially conducted in a similar manner. The authors agree that an understanding of the biosocial aspects of sexuality is important. But it is doubtful whether this should be the subject of a scientific-clinical introduction into an important interdisciplinary topic. We welcome the commentary as a valuable stimulus for a vocational discussion.

Casting doubt on the prevalence rates of premature ejaculation is certainly legitimate, but the argument that these may be a variant of the norm because of their dimension (30%) is something of a surprise. All renowned medical societies have defined premature ejaculation as an illness. We therefore cannot agree with our colleagues Dr Haufs and Gruhn. Whether medical interventions should be financed by the statutory health insurance companies is another question. The same question is relevant for organ-related erectile dysfunction.

We can only agree that qualifications and further education in sexual medicine are important. Sexual medicine has not been included as an optional subject in any study regulations in Germany. The Academy for Sexual Medicine is thankfully active in the area of continuing medical education and further professional training and is lobbying for an inclusion of sexual medicine as an additional subspecialism into the template for further education laid out by the German Medical Association. However, these efforts have not been successful so far. The additional qualification in andrology is a first attempt to emphasize aspects of sexual medicine. We can only hope that these measures will contribute to the training/teaching in sexual medical history taking that Professor Bosinski is demanding. DOI: 10.3238/arztebl.2008.0223b

Dr. med. Michael J. Mathers F.E.B.U.
Urologische Gemeinschaftspraxis Remscheid
Kooperationspraxis der Klinik für Urologie und Kinderurologie
Klinikum Wuppertal, Universität Witten/Herdecke
Fastenrathstr. 1
42853 Remscheid, Germany

Conflict of interest statement
The authors of all articles declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.