Premature ejaculation
Premature ejaculation is ejaculation with minimal stimulation that occurs earlier than desired, most objectively measured by an intravaginal ejaculatory latency time under 1 minute causing psychological distress. Diagnosis is made entirely by history, and first-line treatment is a daily SSRI (paroxetine), a topical lidocaine-prilocaine anesthetic, or their combination with a PDE5 inhibitor.
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What this article covers
- Overview
Ejaculation with minimal stimulation that occurs earlier than desired: premature ejaculation (male early ejaculation) is one of the most common sexual disorders in men, and treatment is indicated…
- Epidemiology
One of the most common sexual disorders in men, and the most common of the ejaculatory disorders specifically.
- Risk factors
Underlying anxiety, depression, or other mood disorder: psychological distress is both a common antecedent and a defining consequence of the condition.
- Pathophysiology
Specific mechanism is unknown, but dysfunction of 5-hydroxytryptamine (serotonin, 5-HT) receptors is thought to be central, which is why serotonergic drugs are first-line therapy.
- Clinical features
Ejaculation with minimal stimulation occurring earlier than the patient desires, the defining and diagnostic feature; the hallmark objective correlate is an intravaginal ejaculatory latency time under 1 minute.
- Differential diagnosis
Erectile dysfunction: difficulty achieving or maintaining an erection rather than early ejaculation with normal erectile function; distinguished by direct history of erectile rigidity and…
- Diagnosis
The diagnosis is made solely on history, defined as ejaculation with minimal stimulation occurring earlier than desired and causing self-reported psychological distress; there is no laboratory or…
- Management
First, confirm the diagnosis causes distress, since treatment is indicated only when premature ejaculation causes self-reported psychological distress in the patient or partner; asymptomatic short…
- Complications
Psychological distress, anxiety, and low self-esteem: the direct and defining consequence of unaddressed premature ejaculation.
- Prognosis
Good with appropriate pharmacotherapy: most long-term treatment options (topical anesthetics, paroxetine, PDE5 inhibitors, other SSRIs, clomipramine) are more effective than placebo at increasing intravaginal ejaculatory latency time.
- Prevention
No formal screening program or preventive intervention exists; the practical preventive step is early recognition and treatment of the underlying mood disorder (anxiety, depression) that commonly accompanies and can perpetuate the condition.
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