Global Andrology Forum Clinical Practice Guidelines on the Management of Premature Ejaculation

Abstract

Purpose: Premature ejaculation (PE) is a commonly encountered male sexual dysfunction (MSD) with various definitions, diagnostic criteria, and treatment options, leading to significant heterogeneity and controversy in its management. This study aimed to explore the global practice patterns of the diagnosis and management of PE.

Materials and methods: A cross-sectional, global, online survey on PE was conducted using a questionnaire developed by an international cohort of experts. Results were analyzed using R version 4.1.2. Additionally, expert recommendations were formulated using a modified Delphi method.

Results: The survey was completed by 264 participants from 41 countries. The majority of respondents were below the age of 45 years and were urologists focusing on andrology and sexual health. PE diagnosis was primarily based (by 61.5%) on an intravaginal ejaculatory latency time of less than one minute. Lifelong PE was the most common category reported (47.7%), and most respondents (84.2%) observed ante-portas PE in less than 25% of cases. Distinguishing PE from erectile dysfunction was challenging for many respondents (60.7%). Diabetes mellitus was the most common comorbidity (17.1%). Pharmacological therapy was the most common treatment method (34.3%), with dapoxetine being the most preferred medication (37.9%). Surgical methods were infrequently used. Emerging treatments like hyaluronic acid gel glans augmentation were favored by only 11.7%. Patient satisfaction was the primary criterion for successful PE treatment (55.9%), and cost was a significant concern for many (35.5%).

Conclusions: This global survey highlights significant diversity in the diagnostic and treatment strategies for PE. Standard diagnostic criteria are generally accepted, off-label medication is widely used in therapy, and the role of surgery is still controversial. A multi-modal therapy approach, tailored to the patient's specific needs, is favored. Further research into the neurobiology of PE and the development of effective and safe options is crucial for improving the management of PE.

Keywords: Ejaculation; Medicine; Premature ejaculation; Sexual health; Surveys and questionnaires; Therapy.

Fig. 1. The overall survey strategy.

Fig. 2. Participants distribution by the country (n=264).

Fig. 3. Distribution by nature of professional background.

Fig. 4. Official definitions of PE used in clinical practice. PE: premature ejaculation, ISSM: International Society of Sexual Medicine, ICD-11 MMS: International Classification of Diseases 11th Revision for mortality and morbidity statistics, DSM-V: American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders Fifth edition.

Fig. 5. Criteria utilized to diagnose PE. PE: premature ejaculation, IELT: intravaginal ejaculatory latency time.

Fig. 6. Premature ejaculation patients' perceptions of “normal” duration of intercourse.

Fig. 7. The most common PE category encountered on practice by the respondents.

Fig. 8. Prevalence of ante-portas premature ejaculation (PE) among all counseled PE patients.

Fig. 9. The distressing situation in the premature ejaculation (PE)-partnership.

Fig. 10. Correlation between testosterone level and premature ejaculation (PE).

Fig. 11. Assessment of the patient's family history of premature ejaculation (PE).

Fig. 12. Medical conditions commonly encountered in patients with premature ejaculation (PE).

Fig. 13. Patient reports on sexual positions that allow longer time to ejaculate.

Fig. 14. Treatment approaches utilized by patients before seeking professional intervention.

Fig. 15. Premature ejaculation (PE) patients' response to behavioral therapy.

Fig. 16. Preferred medications for premature ejaculation.

Fig. 17. Premature ejaculation (PE) patients' causes to discontinue pharmacotherapy.

Fig. 18. Time for occurrence of withdrawal syndrome after abruptly stopping oral SSRIs. SSRI: selective serotonin reuptake inhibitor.

Fig. 19. Recommended time that SSRI should be gradually withdrawn. SSRI: selective serotonin reuptake inhibitor.

Fig. 20. Commonly preferred non-SSRI medications for treating premature ejaculation. SSRI: selective serotonin reuptake inhibitor.

Fig. 21. Percentage of patients who used surgical methods to treat premature ejaculation (PE).

Fig. 22. Percentage of doctors who used different surgical methods to treat premature ejaculation (PE).

Fig. 23. Treatments potentially beneficial for managing premature ejaculation (PE).

Fig. 24. Criteria for successful PE treatment. PE: premature ejaculation, IELT: intravaginal ejaculatory latency time.