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Premature Ejaculation
fact sheet

Premature Ejaculation (PE) is the most common male sexual
dysfunction in men <60 years, yet it is one of the most under-diagnosed
and under-treated.
It affects around 1 in 5 men (according to the DSM-IV definition)
worldwide and regardless of age. It’s a complex medical condition which can be caused by various factors and can be described as short
ejaculatory latency time, a low or absent sense of control over
ejaculation and negative personal consequences.
Essentially, for men with PE, the sexual response presents an ejaculation sequence that is compressed, occurring more quickly and
with less control than for non-PE men. In fact, the excitement phase is
very quick, with generally a normal erection, a brief plateau followed by
Issue and prevalence
According to the ISSM (International Society for Sexual Medicine) PE is 1. Ejaculatory latency time (IELT) of about 1 minute - Ejaculation
which always or nearly always occurs prior or within about one 2. Lack of control over ejaculation - Inability to delay ejaculation in
all or nearly all vaginal penetration 3. Negative personal problems related to the condition - Negative
personal consequences, such as distress, frustration and/or the The IELT (Intravaginal Ejaculatory Latency Time – it’s the time from vaginal penetration to ejaculation) limit of about 1 minute is based on the observation that approximately 90% of men with Lifelong PE report IELTs of less than 1 minute and 10% have an IELT of 1 to 2 minutes. IELT has a direct effect on the man’s sense of control over ejaculation, but does not directly influence satisfaction or personal distress. A man’s level of perceived control over ejaculation is linked to
whether he also experiences negative consequences associated with
PE, including low satisfaction with sexual intercourse and personal
distress related to ejaculation.
1. Primary PE (also referred as “lifelong”) – characterised by onset
from the first sexual experience, which continues throughout life. In these cases ejaculation occurs too fast, before vaginal penetration or less than 1-2 minutes after 2. Secondary PE (also referred as “acquired”) – characterised by
gradual or sudden onset with ejaculation previously being PE is more prevalent in men < 60 years than Erectile Dysfunction (ED) and is not age-related. Approximately 50% of men with symptoms of PE indicated that these symptoms had been present since their first Despite its prevalence, PE stil represents an underdetected and undertreated medical condition as men are often unwil ing to discuss
their symptoms with their doctors, often due to embarrassment or the
perception that there are no solutions. Also, men with PE believe there
is no promising treatment for their condition. As a result, only 9% of
those with self-reported PE consulted a doctor and of this small group nearly 70% did so at a visit scheduled for another reason. Of the 91% of men that had not consulted a physician 52.2% noted that they had The sexual response in men has been described as a cycle of characteristic physical changes, composing 4 phases: desire,
excitement, orgasm (ejaculation) and resolution. Male sexual
dysfunction general y occurs in one or more of the first 3 phases of the sexual response cycle, including dysfunctions of sexual desire (i.e. hypoactive sexual desire), arousal (i.e. erectile dysfunction and longer time needed until getting sexual y aroused) and orgasm/ejaculation (i.e. premature ejaculation, delayed ejaculation and anejaculation).xvi i PE results from the rapid progression of the first 2 phases of the sexual response cycle but is not necessarily related to elevated or altered arousal.Ejaculation is primarily influenced by central nervous system
control and current evidence suggests that PE is a more
neurobiological than psychological phenomenon.
The process of ejaculation is central y regulated and involves a range of
neurotransmitters, including serotonin (5-HT), dopamine, oxytocin and
others. Many data suggests that serotonin and specific 5-HT receptors
subtypes are predominantly involved in the process of delaying Consequently, PE might be associated with the presence of low
synaptic levels of serotonin in regions of the CNS that modulate
ejaculation.

Secondary PE can be caused by both psychological and physical factors.
Common physical causes of Acquired Premature Ejaculation include: • Prostate diseases, especially prostatitis
PE&Personal Distress – PE&Couples

A satisfying sex life is essential to any successful relationship, and
sexual well-being is crucial to a person's overal health. The World
Health Organisation (WHO) defines health as: “A state of complete physical, mental and social well-being and not merely the absence of Many aspects of the lives of both men and their partners are impacted
• a “very poor” or “poor” control over ejaculation (95%) • personal distress “moderate” to “extreme” (90%) • a “very poor” or “poor” satisfaction with intercourse (57%) • interpersonal difficulty related to ejaculation (63%) IELT was significantly shorter in men with PE compared with men without PE (1.8 median IELT for PE and 7.3 for non-PE men).xxi The negative impact of PE can have a detrimental effect on self-confidence and may cause mental distress, anxiety, embarrassment, frustration
and depression.
Partners of men with PE are also affected by this condition. • more than 60% of the partners of PE men are not satisfied with • 60% of men with PE stated to believe that their relationship would be stronger if they were better able to satisfy the partner • the majority of men with PE (60%) would seek medical treatment if their partner suggested it and approximately 75% of those who have sought solutions have done so especially to improve their partner’s sexual satisfactionxxvi
Treatment options
PE was initially seen as a psychological problem and for decades was treated with behavioural and cognitive therapies. Subsequently, pharmacological treatments such as prescription drugs and topical PE, both chronic (Lifelong) or Acquired, is often a condition of organic/neurobiological etiology that can be treated. If PE is caused by another disease (for instance by a non-diagnosed chronic prostatitis), the treatment of that disease wil have positive effects also on PE. Even for treatment of Lifelong PE there are different options the doctor can In any case, a doctor’s consultation is strongly recommended for a
correct diagnosis and treatment.
Here are some of the treatments generally used in men with PE symptoms, that include a range of cognitive/behavioural approaches (e.g., special positions during sex, interrupted stimulation), topical desensitising agents, and prescription drugs.xxvi
Behavioural and cognitive therapy
These include different psychological and physical techniques aimed at training men to recognise pre-ejaculatory signs enabling them to • The most often used behavioural techniques are the “stop-start”
technique (first introduced by Dr. J. Semans in 1956) and the “squeeze” technique (described by Masters and Johnson, 1970).
(Porst, 2012) Several modifications of these techniques are available, but
after initial success rates of 50-60%, clinical experience shows that they often fail to provide long term improvements. Instead of the “stop-start” technique, which can be unsatisfactory for the female partner, it is better for men to learn how to modulate and reduce the level of arousal and excitement by doing slow, sensual
movements while breathing deeply and slowly. The goal is to keep
the level of arousal below the ejaculation threshold, while maintaining a good erection. These breathing control techniques seem to have a calming effect and, at that moment, seem to really work. But clinical experience and scientific studies suggests that improvements achieved with these methods are generally not • Masturbation before sexual intercourse is a technique used by
many younger men. Fol owing masturbation, the penis can be desensitised, possibly resulting in greater ejaculatory delay after the recovery period. In a different approach, the man learns to recognise the signs of increased sexual arousal and how to keep his level of sexual excitement below the intensity that final y triggers the ejaculatory reflex.Such self-help techniques, while partially effective in the short term, may actually exacerbate rather than alleviate PE, as they deliberately ignore or dampen the sexual sensations that need to be control ed in order to improve the condition. Furthermore, bad masturbation practice, i.e. a non-stop rush to climax, can further impede the development of ejaculation In general, there is no control ed research to support the efficacy of
Pharmacological treatment
Different oral treatments have been successfully used under medical Topical creams or sprays containing anaesthetic compounds such as lidocaine and prilocaine, that desensitise the penis and thus help delaying ejaculation, provided moderate success-rates in smaller studies.xxxii But these topical anaesthetic medications are often difficult to dose and may therefore cause numbness of the glans/penis resulting in a loss of erection and/or ejaculation if they are overdosed. There is also the possibility of transferring the anaesthetic compound to the partner, thus reducing pleasurable sensations resulting in
Other methods
Other self-help techniques, including double condoms or condoms containing anaesthetics (“delay” condoms), which produce a slight numbing effect, while partially effective in the short term, they may ultimately exacerbate rather than alleviate PE, as they deliberately ignore or dampen the sexual sensations that need to be control ed in i Lindau 2007, McCarty 2012, Sotomayor 2005 vi Giuliano et al. 2008, Patrick et al. 2007 viii Giuliano et al. 2008, Patrick et al. 2007 ix McMahon 2013, EAU 2012, Waldinger 2007, Jannini 2007, Broderick 2006 x McMahon 2013, EAU 2012, Buvat 2011, Rowland 2010, Waldinger 2007, Jannini 2007, Broderick 2006 xiv Lindau 2007, McCarty 2012, Sotomayor 2005 xxi McMahon 2011, Buvat 2011, McCarty 2012 xxxv Sotomayor M, 2005; Atikeler MK, 2010

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