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Premature Ejaculation

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Men's Sexual Health and Fertility

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Abstract

Premature ejaculation (PE) is an important male sexual disorder that can significantly impact the well-being of patients and their partners. Only recently an evidence-based definition has been established. Its diagnosis requires the combination of three components: (a) ejaculation which always or nearly always occurs before or within about 1 min of vaginal penetration, (b) the inability to delay ejaculation on all or nearly all vaginal penetrations, and (c) negative personal consequences such as distress, bother, frustration, and/or the avoidance of sexual intimacy. Prior to the establishment of this definition, some studies used the simple complaint of ejaculating more rapidly than desired as a diagnostic criterion, which has led to an overestimation of the prevalence of this disorder. PE is associated with anxiety (both generalized and intercourse associated) and can lead to a decrease in sexual frequency. In couples with fertility issues, PE cannot only represent a significant added stress to both partners and the relationship and, in severe cases, may potentially affect fertility. Shame and a lack of awareness about the condition are barriers to treatment seeking, which leaves many individuals undiagnosed and untreated. There are various therapeutic strategies available for patients with PE, which include behavioral therapy, topical, and oral medications. Behavioral therapy represented the mainstay for treatment until the description of the neurobiological aspects of PE and now represents an adjunct to other treatments. Currently, the FDA has only approved a single topical agent for the treatment of PE. Selective serotonin inhibitors are commonly used off-label for PE, and different regimens have been employed. Particularly in patients with fertility issue, caution is required because some studies suggest that it negatively impacts seminal parameters. Phosphodiesterase type 5 inhibitors have been used with some success in combination with other treatments. PE is a significant medical condition, and effective treatment has the potential to significantly improve the quality of life of patients and their partners.

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Abbreviations

APA:

American Psychiatric Association

AUA:

American Urological Association

ED:

Erectile dysfunction

EMLA:

Eutectic mixture of local anesthetics

ICD:

International Classification of Diseases

IELT:

Intravaginal ejaculatory latency time

ISSM:

International Society for Sexual Medicine

PDE5:

Phosphodiesterase type 5

PE:

Premature ejaculation

PRN:

Pro re nata; as needed

SSRI:

Selective serotonin reuptake inhibitor

WHO:

World Health Organization

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Author information

Authors and Affiliations

  1. Department of General Surgery, Royal Perth Hospital, Perth, Australia

    Patrick E. Teloken

  2. Department of Urology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 435, New York, NY, 10065, USA

    John P. Mulhall

Authors
  1. Patrick E. Teloken
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  2. John P. Mulhall
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Correspondence to John P. Mulhall .

Editor information

Editors and Affiliations

  1. Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    John P. Mulhall

  2. Department of Urology, Kaiser Permanente, Oakland Medical Center, Oakland, California, USA

    Wayland Hsiao

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Teloken, P.E., Mulhall, J.P. (2014). Premature Ejaculation. In: Mulhall, J., Hsiao, W. (eds) Men's Sexual Health and Fertility. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0425-9_8

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  • DOI: https://doi.org/10.1007/978-1-4939-0425-9_8

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