446 Sexual Dysfunctions
Ejaculatory concerns that do not meet diagnostic criteria. It is necessary to identify
males with normal ejaculatory latencies who de sire longer ejaculatory latencies and males
who have episodic premature (early) ejaculat ion (e.g., during the fi rst sexual encounter
with a new partner when a short ejaculatory la tency may be common or normative). Neither
of these situations would lead to a diagnosis of premature (early) ejaculation, even though
these situations may be d istressing to some males.
Comorbidity 
Premature (early) ejaculation may be associated  with erectile problems. In many cases, it
may be difficult to determin e which difficulty preceded the other. Lifelong premature
(early) ejaculation may be associated with ce rtain anxiety disorders.  Acquired premature
(early) ejaculation may be associated with pros tatitis, thyroid disease, or drug withdrawal
(e.g., during opioid withdrawal).
Substance/Medication-Induced
 Sexual Dysfunction
Diagnostic Criteria
A. A clinically significant disturbance in sexual function is predominant in the clinical picture.
B. There is evidence from the history, physical examination, or laboratory findings of both
(1) and (2):
1. The symptoms in Criterion A developed during or soon after substance intoxication
or withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in Crite-
rion A.
C. The disturbance is not better explained by a sexual dysfunction that is not substance/
medication-induced. Such evidence of an independent sexual dysfunction could in-
clude the following:
The symptoms precede the onset of the substance/medication use; the symptoms
persist for a substantial period of time (e.g., about 1 month) after the cessation of
acute withdrawal or severe intoxication; or there is other evidence suggesting the