Condition: Premature Ejaculation (PE)
Brief Overview: According to UpToDate, “PE can be divided into lifelong or acquired premature ejaculation. According to the 2020 American Urological Association (AUA) Disorders of Ejaculation Guidelines, lifelong premature ejaculation is defined as consistently poor ejaculatory control, associated bother, and ejaculation within approximately two minutes of initiation of penetrative sex that has been present since sexual debut. Acquired premature ejaculation is defined as consistently poor ejaculatory control, associated bother, and ejaculation latency that is markedly reduced from prior sexual experience during penetrative sex.”
Prevalence: According to Cleveland Clinic, “Between 30% and 40% of people experience premature ejaculation at some point in their lives.”
Etiology:
- Anxiety, depression, stress
- Relationship problems
- Low self-esteem
- Erectile dysfunction (ED)
- Hormonal conditions
- Penile sensitivities
- Prostatitis
- Dysregulation in serotonin levels
Risk Factors:
- Relationship stress/difficulties
- Erectile dysfunction
- Diabetes, metabolic syndrome
- Thyroid dysfunction
- Low sexual frequency
Commonly Associated Conditions:
- Erectile dysfunction
- Low testosterone
- Depression, anxiety
- Thyroid dysfunction
Common Medications:
- SSRIs – paroxetine, sertraline, fluoxetine, citalopram, escitalopram
- Clomipramine
- Topical anesthetics – lidocaine-prilocaine spray
- Phosphodiesterase inhibitors if coexisting ED
- Tramadol
Common Labs, Imaging, and Tests:
- Additional testing is not typically needed. Diagnosis is typically made based on history and physical exam.
Common Symptoms:
- Premature ejaculation
Common Treatments:
- Medications, as above
- Psychotherapy
- Behavioral strategies:
- “Start-stop” and “squeeze” techniques.
- Gradual desensitization and mindfulness during sexual activity.
- Use of condoms to reduce sensitivity.
Physical Findings:
- Often normal physical exam
Potential Complications and Contraindications:
- Depression, increased stress
- Relationship difficulties, intimacy difficulties
General Health and Lifestyle Guidance:
- Encourage open discussion of sexual concerns with partner and healthcare provider; normalize the condition.
- Encourage to avoid excessive alcohol use
- Promote regular exercise (as tolerated and approved by healthcare provider), adequate sleep, and stress reduction.
- Encourage to address underlying anxiety with healthcare provider, and/or relationship strain with partner, therapist, and/or healthcare provider.
- Encourage adherence to therapy — improvement often takes several weeks.
- Reinforce realistic expectations and gradual progress.
Suggested Questions to Ask Patients:
- How long have you been experiencing premature ejaculation?
- Is this a lifelong issue or did it develop recently?
- Do you also experience erectile difficulties or performance anxiety?
- How is this affecting your relationship or emotional well-being?
- Have you tried any behavioral strategies or medications before?
- Are you interested in combining medication with counseling or therapy?
Suggested Talking Points:
- Premature ejaculation is common and can be treatable — you are not alone.
- There are effective medications and behavioral techniques that can help improve control.
- Treatment may involve both medical and psychological approaches.
- Addressing any underlying anxiety or erectile issues with your healthcare provider(s) can improve results.
- Most men experience improvement within a few weeks of consistent treatment.
- Consider asking your healthcare provider if you have any medical conditions or are taking any medications that might contribute to premature ejaculation.
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
Sources:
- https://www.uptodate.com/contents/treatment-of-male-sexual-dysfunction?search=premature%20ejaculation&source=search_result&selectedTitle=1~15&usage_type=default&display_rank=1#H408493675
- https://my.clevelandclinic.org/health/diseases/15627-premature-ejaculation
- https://www.urologyhealth.org/urology-a-z/p/premature-ejaculation#Causes