Treatment Guideline Chart
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.

Premature%20ejaculation Signs and Symptoms


  • A male sexual dysfunction characterized by:
    • Short, easily stimulated ejaculation that occurs always or nearly always before or within about 1 minute of vaginal penetration or other relevant sexual stimulation or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less
      • The American Urological Association (AUA) utilizes a more permissive cut-off of within 2 minutes of vaginal penetration since about 20% men with suspected PE ejaculate for >1 minute
    • Either present from the first sexual experience or following a new bothersome change in ejaculatory latency
    • Involuntarily controlled or there is inability to delay ejacuation
    • Causes negative personal consequences eg distress, bother, embarrassment, frustration, avoidance of sexualintimacy and interpersonal difficulty
    • Must be present for 6 months and experienced in almost all or all occasions
  • The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) classifies PE depending on when ejaculation occurs
    • Mild: Before or within 15 seconds of penetration
    • Moderate: 15-30 seconds after penetration
    • Severe: 30-60 seconds after penetration


  • Affects about <5% of men; with up to 30% of men in community surveys
  • Most common male sexual dysfunction with prevalence not affected by age


  • Unknown exact etiology with few data to support the following suggested biological and psychological hypotheses including:
    • Anxiety
    • Penile hypersensitivity
    • Serotonin or 5-hydroxytryptamine (5-HT) receptor dysfunction receptor dysfunction
  • Erection and ejaculation are triggered by the integration of tacticle (eg genital sensation) and non-tactile (eg audio and visual inputs) stimuli in the brain
  • Studies have shown that lesions in the galaninergic neurons within the central spinal cord is associated with ejaculatory failure
    • Galaninergic neurons may be responsible for the integration of central and peripheral stimuli and triggering ejaculatory reflex
  • Alteration in the bladder neck and prostate functions (eg surgery, radiation) also alters ejaculation

Risk Factors

  • Risk factors include:
    • Genetic influences (lifelong PE)
    • Prostatic inflammation and chronic bacterial prostatitis (acquired PE)
    • Hormonal aberrations (eg low prolactin levels, high testosterone levels) or thyroid hormone disorders
    • Poor overall health status (including lack of physical activity) and obesity
    • Psychological factors that may precipitate PE are historical factors (eg sexual abuse, attitude towards sex in the home), individual psychological factors (eg body image, depression, performance anxiety) or relationship factors (eg intimacy, anger)
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