British Society for Sexual Medicine (BSSM) Position Statement on Premature Ejaculation

Abstract

To provide an evidence based consensus on the diagnosis and management of premature ejaculation (PE). The British Society for Sexual Medicine (BSSM) takes issue with the advice to use off label treatments, such as daily selective serotonin reuptake inhibitors treatment, favoring on-demand dapoxetine. There is increasing evidence for the use of PDE5 inhibitors which are superior to a placebo for the treatment of PE. A recent meta-analysis of international PE guidelines supports the need for research to investigate the association of PE with erectile dysfunction (ED), prostatitis and thyroid disease, and supports the early use of PDE5 inhibitors either alone or in combination with dapoxetine or psychosexual interventions. Topical agents and non-pharmacological treatments also have a place, with new agents in the pipeline. The United Kingdom (UK) lacks formal guidance from the National Institute of Clinical Excellence (NICE) on any of the common male sexual dysfunctions, namely ED, PE, ejaculatory disorders, and male hypogonadism. As a result, general practitioners in the UK have relied on local guidance, and international guidelines which are heterogeneous, indicating diagnostic and therapeutic approaches that are often inconsistent. The aim of this position statement is to improve the management of PE in the UK.

Keywords: Erectile dysfunction; Guideline; Premature ejaculation; Therapeutics.

Fig. 1. Prospective comparison of tadalafil 5 mg (group 1), dapoxetine 30 mg (group 2), and the combination of both (group 3) in the treatment of premature ejaculation. Comparison between pre-treatment and post-treatment IELT in the studied groups. IELT: intravaginal ejaculatory latency time. Adapted from the article of Hasan et al (Arab J Urol 2023;22:81-8) [55] with original copyright holder's permission.