premature%20ejaculation
PREMATURE EJACULATION
Premature ejaculation is a male sexual dysfunction characterized by short, easily stimulated ejaculation that occurs always or nearly always before or within one minute of vaginal penetration.
It is involuntarily controlled and causes negative personal consequences like distress, frustration and avoidance of sexual intimacy.
Exact etiology and risk factors are unknown.

Diagnosis

  • The diagnosis of PE relies mainly on medical & sexual history
    • Intravaginal ejaculatory latency time (IELT), perceived control, distress & interpersonal difficulty due to ejaculatory dysfunction are assessed

Classification

Classification of PE

Lifelong/Primary PE

  • PE w/ onset from the first sexual experience & remains a problem throughout life
  • Ejaculation occurs too quickly, either before vaginal penetration or <1-2 minutes afterwards

Acquired/Secondary PE

  • Onset of PE is gradual or sudden w/ ejaculation being normal prior to onset
  • Time of ejaculation is short but not as fast as in primary PE

Anteportal Ejaculation

  • Men who ejaculate prior to vaginal penetration & is considered the most severe form of PE
    • Such men typically present when they are having difficulty conceiving children

Subclasses

  • Not evidence-based but important as it accurately characterizes men who are not qualified for the diagnosis of PE & these may help health care professionals

Natural Variable PE

  • Characterized by early ejaculations that occur irregularly & inconsistently w/ some subjective sense of diminished control of ejaculation
  • Not considered as a sexual dysfunction or psychopathology but rather a normal variation in sexual performance

Premature-like Ejaculatory Dysfunction (Subjective PE)

  • An imagined early ejaculation or lack of control of ejaculation while ejaculation latency time is in the normal range or can even last longer
  • Ability to control ejaculation (ie to withhold ejaculation at the moment of imminent ejaculation) may be diminished or lacking
  • Preoccupation is not better accounted for by another mental disorder

Assessment

Assessment of Ejaculatory Latency

Stopwatch Assessment of Ejaculatory Latency

  • Widely used in clinical trials & observational studies but have not been recommended in use in routine clinical management of PE
  • Advantage of objective measurement but disadvantage of being intrusive & potentially disruptive of sexual pleasure or spontaneity

Self Estimation of IELT by the patient & partner

  • Recommended method of determining IELT in clinical practice

History

Sexual History

  • Assess frequency & duration of PE, relationship to specific partners, occurrence w/ all or some attempts, degree of stimulus resulting in PE, nature & frequency of sexual activity, impact on sexual activity, types & quality of personal relationships & quality of life, aggravating or alleviating factors, & relationship to drug use or abuse
    • Length of time of ejaculation, degree of sexual stimulus, impact on sexual activity & quality of life & drug use or abuse helps in classifying the type of PE the patient has
  • Differentiate PE from erectile dysfunction (ED)
  • IELT alone is not sufficient to define PE because there is significant overlap between men w/ & w/o PE
    • But, in everyday clinical practice, self-estimated IELT is sufficient

Questionnaires that can be used to characterize PE & determine treatment effects are:

  • Standardized assessment measures include the use of validated questionnaires, in addition to stopwatch measures of ejaculatory latency
  • Premature Ejaculation Diagnostic Tool (PEDT)
    • Short, psychometrically validated measure that can be easily administered to facilitate the diagnosis of PE
    • Assesses control, frequency, minimal sexual stimulation, distress & interpersonal difficulty
    • A total score of >11 suggests a diagnosis of PE, a score of 9 or 10 suggests a probable diagnosis of PE while a score of <8 indicates a low likelihood
  • Premature Ejaculation Profile (PEP)
    • Contains questions regarding perceived control over ejaculation, satisfaction w/ sexual intercourse, personal distress related to ejaculation, interpersonal difficulty related to ejaculation
  • Index of Premature Ejaculation (IPE)
    • Contains questions regarding control, sexual satisfaction & distress
  • Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD)
  • Currently, the role of questionnaires is optional in everyday clinical practice
  • PEP & IPE are currently the preferred questionnaire measures to assess PE, particularly in monitoring responsiveness to treatment
  • These measures may serve as useful adjuncts but should not be used as a substitute for a detailed sexual history performed by a qualified clinician

Physical Examination

  • Brief examination of the vascular, endocrine, & neurologic systems to identify underlying medical conditions associated w/ PE or other sexual dysfunctions
  • Advisable in lifelong PE & acquired PE to assess for associated/causal diseases such as ED, thyroid dysfunction & prostatitis, risk factors & etiologies

Laboratory Tests

Laboratory or Physiologic Testing

  • Should be directed by specific findings from history or physical exam & is not routinely recommended
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