Premature ejaculation (PE) is ejaculation occurring without control, on or shortly after vaginal penetration and before the subject wishes it, causing marked distress or interpersonal difficulties.
PE is the most common male sexual complaint. Primary (lifelong) PE has a physiological basis.
Therapy should involve the man and his partner. The primary aims of therapy are for the man to regain a sense of control over his ejaculation time and for him and his partner to feel satisfaction with sexual intercourse.
The most effective therapies for primary PE are certain selective serotonin reuptake inhibitors, given on a daily basis or “on demand” before sexual activity. Topical anaesthetics have also been shown to be effective.
The most common cause of secondary PE is declining erectile function. The approach to treating secondary PE is to treat the underlying condition.
- 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: APA, 2000.
- 2. Waldinger MD, Berendsen HH, Blok BF, et al. Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: the involvement of the serotonergic system. Behav Brain Res 1998; 92: 111-118.
- 3. International Society for Sexual Medicine. ISSM definition of premature ejaculation. http://www.issm.info/prod/system/main/index.asp (accessed Mar 2008).
- 4. Waldinger MD. Premature ejaculation: state of the art. Urol Clin North Am 2007; 34: 591-599.
- 5. Astbury-Ward E. From Kama Sutra to dot.com: the history, myths and management of premature ejaculation. Sex Relat Ther 2002; 17: 367-379.
- 6. Rosen RC. Prevalence and risk factors of sexual dysfunction in men and women. Curr Psychiatry Rep 2000; 2: 189-195.
- 7. Waldinger MD, Rietschel M, Nöthen MM, et al. Familial occurrence of primary premature ejaculation. Psychiatr Genet 1998; 8: 37-40.
- 8. Hite S. The Hite report: study of male sexuality. 2nd ed. London: Ebury Press, 1990.
- 9. Masters WH, Johnson VE. Human sexual inadequacy. Boston: Little Brown, 1970.
- 10. Waldinger MD, Quinn P, Dilleen M, et al. A multinational population survey of intravaginal ejaculation latency time. J Sex Med 2005; 2: 492-497.
- 11. Waldinger MD. The neurobiological approach to premature ejaculation. J Urol 2002; 168: 2359-2367.
- 12. Kimura Y, Miyamoto A, Urano S, et al. The spinal monoaminergic systems relating to ejaculation. I. Ejaculation and dopamine. Andrologia 1982; 14: 341-346.
- 13. Waldinger MD, Olivier B. Selective serotonin reuptake inhibitor-induced sexual dysfunction: clinical and research considerations. Int Clin Psychopharmacol 1998; 13 Suppl 6: S27-S33.
- 14. Patrick DL, Rowland D, Rothman M. Interrelationships among measures of premature ejaculation: the central role of perceived control. J Sex Med 2007; 4: 780-788.
- 15. Carani C, Isidori AM, Granata A, et al. Multicenter study on the prevalence of sexual symptoms in male hypo- and hyperthyroid patients. J Clin Endocrinol Metab 2005; 90: 6472-6479.
- 16. Semans JH. Premature ejaculation: a new approach. South Med J 1956; 49: 353-358.
- 17. Wolpe J, Lazarus AA. Behavior therapy techniques: a guide to the therapy of neuroses. New York: Pergamon, 1968.
- 18. Dinsmore WW, Hackett G, Goldmeier D, et al. Topical eutectic mixture for premature ejaculation (TEMPE): a novel aerosol-delivery form of lidocaine–prilocaine for treating premature ejaculation. BJU Int 2007; 99: 369-375.
- 19. Busato W, Galindo CC. Topical anaesthetic use for treating premature ejaculation: a double-blind, randomized, placebo-controlled study. BJU Int 2004; 93: 1018-1021.
- 20. Choi HK, Jung GW, Moon KH, et al. Clinical study of SS-cream in patients with lifelong premature ejaculation. Urology 2000; 55: 257-261.
- 21. Sharlip ID. Guidelines for the diagnosis and management of premature ejaculation. J Sex Med 2006; 3 Suppl 4: 309-317.
- 22. Kim SC, Seo KK. Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: a double-blind, placebo controlled study. J Urol 1998; 159: 425-427.
- 23. Althof SE, Levine SB, Corty EW, et al. A double-blind crossover trial of clomipramine for rapid ejaculation in 15 couples. J Clin Psychiatry 1995; 56: 402-407.
- 24. McMahon CG. Treatment of premature ejaculation with sertraline hydrochloride: a single-blind placebo controlled crossover study. J Urol 1998; 159: 1935-1938.
- 25. McMahon CG, Touma K. Treatment of premature ejaculation with paroxetine hydrochloride. Int J Impot Res 1999; 11: 241-245.
- 26. de Jong TR, Veening JG, Olivier B, Waldinger MD. Oxytocin involvement in SSRI-induced delayed ejaculation: a review of animal studies. J Sex Med 2007; 4: 14-28.
- 27. McMahon CG, Touma K. Treatment of premature ejaculation with paroxetine hydrochloride as needed: 2 single-blind placebo controlled crossover studies. J Urol 1999; 161: 1826-1830.
- 28. Pryor JL, Althof SE, Steidle C, et al. Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials. Lancet 2006; 368: 929-937.
- 29. McMahon CG, Stuckey BG, Andersen M, et al. Efficacy of sildenafil citrate (Viagra) in men with premature ejaculation. J Sex Med 2005; 2: 368-375.
- 30. Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH. The majority of men with lifelong premature ejaculation prefer daily drug treatment: an observation study in a consecutive group of Dutch men. J Sex Med 2007; 4: 1028-1037.
- 31. Assalian P. Guidelines for the pharmacotherapy of premature ejaculation. World J Urol 2005; 23: 127-129.
- 32. Salonia A, Maga T, Colombo R, et al. A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation. J Urol 2002; 168: 2486-2489.
- 33. Chen J, Mabjeesh NJ, Matzkin H, Greenstein A. Efficacy of sildenafil as adjuvant therapy to selective serotonin reuptake inhibitor in alleviating premature ejaculation. Urology 2003; 61: 197-200.
- 34. Earle CM, Stuckey BG, Ching HL, Wisniewski ZS. The incidence and management of priapism in Western Australia: a 16 year audit. Int J Impot Res 2003; 15: 272-276.
- 35. Chew KK, Stuckey BG, Earle CM, et al. Penile fibrosis in intracavernosal prostaglandin E1 injection therapy for erectile dysfunction. Int J Impot Res 1997; 9: 225-229.
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