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  Premature Ejaculation
 
Author: Peter J. Fagan, Ph.D. Last modified: October 9, 2001
DIAGNOSTIC CRITERIA

  EPIDEMIOLOGY

  • Although some studies report in the < 10% prevalence range, most studies are in the 25-30% range ยท
  • Prevalence suggests that rapid ejaculation may be extreme of normal distribution of ejaculation response rather than a disorder; regardless, it is a relational problem for couples
  • Orgasmic latency increases with age; therefore less premature ejaculation in older men

  RISK FACTORS

  • No personality structure has been correlated with premature ejaculation
  • Anecdotally, clinicians report men who are highly driven, anxious or avoidant as frequently presenting with PE
  • Hyperthyroidism

  SIGNS AND SYMPTOMS

  • Persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before the person wishes it.
  • The clinician must take into account factors that affect duration of the arousal phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.
  • The disturbance causes marked distress or interpersonal difficulty.
  • The premature ejaculation is not caused exclusively by the direct effects of a substance (e.g., withdrawal from opioids).
  • Source: Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association, 1994.

  DIFFERENTIAL DIAGNOSIS

  • Unrealistic expectations, e.g. man expecting to maintain arousal for ejaculation longer than would be reasonable expected
  • Erectile dysfunction – man reports PE but rapid ejaculation is actually sought to have orgasm prior to loosing erection

  LABORATORY FINDINGS

  • No laboratory findings available
  • Interview partner for report of in vivo sexual function of patient
 
TREATMENT
BEHAVIORAL TREATMENT
  • Behavioral treatment is based upon the goal of assisting the man to gain greater voluntary control of his ejaculation response by gradually increasing his awareness of his sexual arousal.
  • “Stop and go” sensate focus therapy involves the slowing and stopping of the penile thrusting
  • “Squeeze” sensate focus technique involves partner squeezing the coronal ridge of the erect penis to cause temporary detumescence
ORAL PHARMACOTHERAPIES
  • SSRIs (fluoxetine 20mg; paroxetine 20mg; sertraline 50mg; fluvoxamine 100mg), 5-24 hrs prior to sexual activity; increases ejaculation latency 1-9 minutes; effect seen in some men at lower dosages
  • Clomipramine (25mg), 5-24 hrs prior to sexual activity; increases ejaculation latency 2-7 minutes; contraindicated for men taking MAO inhibitors, combination may result in seizure, coma and death
PHARMACO-ERECTION
  • Prolonging tumescence (post ejaculation) may be remedy for some couples with PE. See treatment of erectile disorders.
TOPICAL ANESTHESIA
  • Lidocaine-prilocaine 2.5g; should use with condom to avoid desensitizing and irritation effects on partner; inappropriate for men who ejaculation prior to intromission; 80% effective increasing orgasm
 
IMPORTANT POINTS/RECOMMENDATIONS
  • Effectiveness of SSRI treatment of premature ejaculation should not obscure therapeutic opportunity to assist couple to increase sexual communication and thereby facilitate tapering of medication
 
REFERENCES
  1. APA ;  Diagnostic and Statistical Manual of Mental Disorders - IV. ;  Washington, DC: American Psychiatric Association, 1994.

  2. Fagan PJ, Burnett AL, Rogers L, Schmidt CW ;  Sexuality and Sexual Disorders ;  In: Burton J, Fiebach, Kern D, Zieve TP, Ziegelstein, R, editors. Principles of Ambulatory Medicine. Philadelphia: Lippincott, Williams & Wilkins, in press.

  3. Rowland DL, Burnett AL. ;  Pharmacotherapy in the treatment of male sexual dysfunction ;  The Journal of Sex Research 37:248-257, 2000.

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