PREMATURE EJACULATION (PE)
(Correction of wrong self made definitions in our population)

Introduction
Although PE is a very common male sexual dysfunction, it is poorly understood. Patients are often unwilling to discuss their symptoms and many physicians do not know about effective treatments. As a result, patients may be misdiagnosed or mistreated.These guidelines provide an evidence-based analysis of published data on definition, clinical evaluation and treatment. It provides recommendations to help clinicians with the diagnosis and treatment of PE.

Definition of PE

 OverviewThere have previously been two official definitions of PE, neither of which have been universally accepted:

• In the Diagnostic and Statistical Manual of Mental Disorders IV-Text Revision (DSM-IV-TR), PE isdefined as a ‘persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity’ .

• In the World Health Organization’s International Classification of Diseases-10 (ICD-10), PE is defined as ‘the inability to delay ejaculation sufficiently to enjoy lovemaking, which is manifested by eitheran occurrence of ejaculation before or very soon after the beginning of intercourse (if a time limit is required: before or within 15 seconds of the beginning of intercourse) or ejaculation occurs in the absence of sufficient erection to make intercourse possible. The problem is not the result of prolonged absence from sexual activity’ .

More recently, two more definitions have been proposed:
 

• The Second International Consultation on Sexual and Erectile Dysfunction defined PE as ‘ejaculationwith minimal stimulation and earlier than desired, before or soon after penetration, which causesbother or distress, and over which the sufferer has little or no voluntary control’ .
 

• The International Society for Sexual Medicine (ISSM) has adopted a completely new definition of PE which is the first evidence-based definition, 

‘Premature ejaculation is a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and inability to delay ejaculation on all or nearly all vaginal penetrations; and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy’. It must be noted that this definition is limited to men with lifelong PE who engage in vaginal intercourse since there are insufficient objective data to propose an evidence-based definition for acquired PE .

All four definitions have taken into account the time to ejaculation, the inability to control or delay ejaculation, and negative consequences (bother/distress) from PE. However, the major point of debate is quantifying the time to ejaculation, which is usually described by intravaginal ejaculatory latency time (IELT).

Premature ejaculation (clinician guideline)

Erectile dysfunction, other sexual dysfunction or genitourinary infection (e.g. prostatitis) should be treated first.
Pharmacotherapy should be given as first-line treatment of lifelong PE.

Pharmacotherapy includes either dapoxetine on demand (a short-acting SSRI that is theonly approved pharmacological treatment for PE) or other off-label antidepressants, i.e. daily SSRIs and clomipramine, that are not amenable to on-demand dosing. With all antidepressant treatment for ED, recurrence is likely after treatment cessation.
 

Off-label topical anaesthetic agents can be offered as a viable alternative to oral treatment with SSRIs.
Behavioural and sexological therapies have a role in the management of acquired PE. They are most likely to be best used in combination with pharmacological treatment.