Premature Ejaculation: Aetiology and Treatment Strategies

Abstract

Premature ejaculation (PE) is a highly prevalent male sexual dysfunction that is often neglected, presenting a currently unmet therapeutic need. The classification of PE has historically been varied and at times ambiguous, contributing to inaccurate prevalence estimates. This review uses the International Society for Sexual Medicine (ISSM) definition of PE, which includes reduced ejaculatory latency, lack of control and associated negative personal consequences. Patient assessment and management options differ depending on the classification of PE and it is the role of the clinician to appropriately classify patients and be aware of the correct management strategies. This review provides an overall background of PE in terms of classification and underlying physiology, patient assessment and management strategies along with the scientific rationale for treatment. Patients with lifelong and acquired PE are most likely to benefit from combination therapy of pharmacological treatment in the form of selective serotonin re-uptake inhibitor dapoxetine, psychosexual behavioural therapy and psychological therapy.

Keywords: aetiology; premature ejaculation; treatment.

Figure 1

Normal sexual response cycle in men compared to men with premature ejaculation (PE). The steps are labelled in the order in which they occur. (1) Sexual arousal/excitement and penile tumescence. (2) Plateau period. (3) Increase in excitement/arousal to the point or ejaculation and orgasm. (4) Postejaculatory detumescence and resolution. It is important to note that patients with PE will experience a sharp excitement phase, followed by a short plateau and subsequent ejaculation.

Figure 2

A schematic summary of some components of the central control of ejaculation.

Figure 3

Suggested management algorithm for patients presenting with suspected PE.