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Current Diagnosis and Management of Premature Ejaculation

  • MALE SEXUAL DYSFUNCTION AND DISORDERS (M KHERA AND SE ALTHOF, SECTION EDITORS)
  • Published:
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Abstract

Premature ejaculation (PE) is a common sexual dysfunction characterized by reduced intravaginal ejaculatory latency time (IELT), inability to delay ejaculation, and personal distress. Increasing understanding of pathophysiologic mechanisms has yielded diverse and effective therapies. The current review discusses contemporary evaluation and management of PE, with a review of all randomized, controlled trials (RCT) performed. Therapies with RCT data include behavioral modification/psychotherapy, topical anesthetics, narcotic-like pain relievers, phosphodiesterase-5 (PDE-5) inhibitors, selective serotonin/norepinephrine reuptake inhibitors and receptor antagonists, tricyclic antidepressants, and surgery. As data are insufficient to define optimal therapies, treatment decisions are based on clinical factors (comorbid conditions, PE mechanism and patient preference), trial outcomes, and adverse event profiles. Combination therapies demonstrate superior efficacy to single agents, with concomitant use of behavioral/psychosexual modifications with pharmacotherapy recommended. The role of surgery in PE remains undefined, with additional data required. Further comparative RCTs are required to define optimal treatment algorithms.

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Abbreviations

AD:

Adverse events

CPPS:

Chronic pelvic pain syndrome

ED:

Erectile dysfunction

FDA:

Food and Drug Administration

IELT:

Intravaginal ejaculatory latency time

ISSM:

International Society for Sexual Medicine

NO:

Nitric oxide

OD:

On demand

ODT:

Orally disintegrating tablet

PC:

Placebo controlled

PDE5:

Phosphodiesterase-5 inhibitors

PE:

Premature ejaculation

RCT:

Randomized controlled trial

SD:

Sexual dysfunction

SNRI:

Serotonin-noreprinephrine reuptake inhibitor

SSRI:

Selective serotonin reuptake inhibitor

TCA:

Tricyclic antidepressant

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George C. Bailey and Landon W. Trost declare that they have no conflict of interest.

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  1. Department of Urology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    George C. Bailey & Landon W. Trost

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  1. George C. Bailey
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  2. Landon W. Trost
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Correspondence to Landon W. Trost.

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This article is part of the Topical Collection on Male Sexual Dysfunction and Disorders

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Bailey, G.C., Trost, L.W. Current Diagnosis and Management of Premature Ejaculation. Curr Sex Health Rep 6, 65–80 (2014). https://doi.org/10.1007/s11930-014-0014-x

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