Feature Article

Diagnosing and managing premature ejaculation

Chris G McMahon
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Premature ejaculation should be diagnosed on the basis of evidence, rather than subjectively. Pharmacotherapy is effective and psychosexual cognitive behavioural therapy has an important adjunctive role, especially in those men in whom sexual performance anxiety is contributing to the condition.

Key Points

  • Premature ejaculation (PE) is a common sexual dysfunction and is associated with negative psychological consequences that may affect quality of life, partner relationships, self-esteem and self-confidence, and can act as an obstacle to single men forming new partner relationships.
  • The evidence-based International Society for Sexual Medicine definition of lifelong PE should form the basis of the office diagnosis of the condition.
  • There is limited evidence suggesting that lifelong PE has a genetic basis and acquired PE is most often due to sexual performance anxiety, psychological or relationship problems and/or erectile dysfunction.
  • Oral SSRIs, clomipramine and topical anaesthetics are effective and safe in the treatment of PE (off-label use except for one topical anaesthetic preparation).
  • Psychosexual cognitive behavioural therapy has a limited role as a first-line treatment for PE but has an important role as an adjunct to pharmacotherapy, especially in men with acquired PE related to sexual performance anxiety.
  • Men with acquired PE secondary to comorbid erectile dysfunction, hyperthyroidism, chronic lower urogenital infection, prostatodynia or chronic pelvic pain syndrome should receive aetiology-specific treatment alone or in combination with an SSRI or clomipramine.