Premature ejaculation

Question 1

Premature ejaculation:

Prevalence?

Answer 1

20 -30%

Question 2

Premature ejaculation:

How categorise?

Answer 2

Lifelong = <1min
Acquired = <3min
*can also be variable (normal lifetime variation) or subjective

Question 3

Premature ejaculation:

Pathophysiology and associations?

Answer 3

• psychological
• impairment of inhibitory serotonergic pathways can be genetic
• chronic prostatitis
• hypothyroidism
• erectile dysfunction (intentional early ejaculation prior to loss of erection)

Question 4

Premature ejaculation:

Assessment considerations?

Answer 4

• comorbidities
• sexual health
• psychological health
• relationship health (overall and sexual)
• drug use
• degree of control, past management
• lifelong vs acquired
• any erectile dysfunction

Question 5

Premature ejaculation:

Do you examine and what?

Answer 5

• Low yield but sometimes reassuring

- include abdominal, genital, neurological examinations

Question 6

Premature ejaculation:

Conservative management?

Answer 6

• psychology if clear aetiology or subjective issue
• precoital masturbation
• stop start
• glans squeeze
• multiple condoms
• pelvic floor exercises

Question 7

Premature ejaculation:

Medical management?

Answer 7

• topical anaesthetic creams/sprays with condom to avoid partner impact
• Tramadol 25 - 50mg on demand
• Dapoxetine 30mg on demand (rapid <3hour absorption - less drug interactions than other SSRIs)
• SSRIs (Paroxetine most effective but with most side effects/TCA (doses lower than for depression - best taken daily for spontaneity)
• PDE5i (unclear mechanisms possibly perception of increased control) - most effective if combined with SSRI