Premature ejaculation

The definition given by the International Society of Sexual Medicine (ISSM) is the most commonly accepted. PE is defined as that ejaculation that always or almost always happens within the first minute after vaginal penetration (Intravaginal Ejacultatory Latency Time, IELT <1min), with inability to delay by the patient in all or nearly all penetrations and that leads to negative personal consequences such as distress, bother, frustration, and/or the avoidance of sexual intimacy. It is estimated that approximately 5% of the population suffers from PE.

There are several types of PE,

  • Lifelong PE. It starts from the very first sexual relations. The cause is unknown, although there seem to be psychological and biological factors (anxiety disorders, penile hypersensitivity, alterations in the serotonin receptor).
  • Acquired PE. It occurs in a moment of the lifetime without symptoms previously. It responds to a cause (erectile dysfunction, prostatitis, hyperthyroidism, or relationship problems). In this case, an IELT <3min is considered pathological.
  • Variable PE. Irregular course. It does not meet the criteria to be defined as a real PE. It doesn't require treatment.
  • Subjective PE. Subjective perception of rapid ejaculation during intercourse with normal IELT. It should not be considered a symptom or pathology. It doesn't require treatment neither.

Diagnosis is made through the medical and sexual history of the patient, evaluating the IELT, frequency, evolution, as well as the perception of control of ejaculation and the negative consequences for the patient. If acquired PE is suspected, complementary tests should be performed (prostatic and hormonal evaluations).

Treatment will be focused at solving the triggering factors, in the case of acquired PE, and at improving the patient's sexual life. Generally the combined psychotherapeutic and pharmacological treatment offers better long term results. Oral serotonin reuptake inhibitors and topical anesthetics are clasically prescribed, but the only approved drug is dapoxetine on demand. Behavioral techniques are also recommended, such as “stop and start” technique by Semans, “squeeze” technique by Masters and Johnson or sensory focus.

Garcia-Baquero R.

Hospital Puerta del Mar. Cadiz. Spain.

Suggested readings

  • Hatzimouratidis K, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. European Association of Urology. 2018.
  • Lujan S, et al. Are urology residents ready to treat premature ejaculation after their training? J Sex Med 2012;9:404-10.
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