Disorders of Ejaculation

Question 1

Definition of lifelong premature ejaculation

Answer 1

poor ejaculatory control since puberty
+bother
+latency about 2 mins or less

Question 2

Definition of acquired premature ejaculation

Answer 2

Poor control markedly reduced from prior experiences

Question 3

What labs should be checked for lifelong PE?

Answer 3

None

Question 4

What labs should be checked for acquired PE?

Answer 4

T, thyroid, A1c if clinical suspicion

Question 5

Does circumcision change ejaculatory latency?

Answer 5

No

Question 6

management of PE

Answer 6

Sex therapy
Treat the ED too
Daily SSRI (paroxetine 10-40mg or sertraline 50-200mg)
Topical agents (promescent)
on demand SSRI (paroxetine) is modestly efficacious)
On demand tramadol is second line
Alpha antagonists are an option

Question 7

Describe serotonin syndrome

Answer 7

Clonus, tremor, hyperreflexia, agitation, diaphoresis, fever, seizure, rhabdo

Question 8

Lifelong delayed ejaculation definition

Answer 8

Lifelong consistent bothersome inability to achieve ejaculation despite adequate stimulation

Question 9

Testing for DE

Answer 9

T
(A1c, BMP, lipids)
Check med list

Question 10

Management for DE

Answer 10

Sex therapy
Modify sexual practices
Change offending meds
Limited evidence for PO options (sudafed, ephedrine, midodrine, bethanecol, cabergoline, imipramine)
Oxytocin spray
Fix T if abnormal
Treat ED