Abstract Introduction To provide an evidence based consensus on the diagnosis and management of premature ejaculation (PE). The authors take 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. Objective General practitioners tend to rely on local guidance, and international guidelines which are heterogeneous, indicating diagnostic and therapeutic approaches that are often inconsistent. Different international and local guidelines on PE are currently in force. They have several similarities but also many differences that reflect prevalence rates and cultural variations. The latter appear particularly evident when analyzing the definitions of PE and the recommendations on the management of the patient with PE. The aim of this position statement is to improve the management of PE. Methods A comprehensive review of Local, National and International guidelines was undertaken with a literature review of the management of premature ejaculation. A multidisciplinary team reviewed the documents and reached a consensus on diagnosis and management of premature ejaculation. Results A male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of penetration, and the inability to delay ejaculation on all or nearly all penetrations, and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy. Lifelong PE generally has a lower response to medication and is more likely to be a long-term problem. Acquired PE occurs in men with a previously normal sex life in relation to ejaculation and erection. Before commencing any treatment, it is essential to define the subtype of PE and discuss patient and partner expectations thoroughly. Pharmacotherapy is usually the first option for lifelong PE, whereas treating associated co-morbidities is important in acquired PE. Various behavioral techniques are more likely to be effective for subjective PE, or for patients who wish to avoid drug treatment. However, the evidence for effectiveness and long-term benefit for psychological interventions is limited. interventions for interventions is limited Conclusions TREATMENT OPTIONS FOR PREMATURE EJACULATION Treat erectile dysfunction, other sexual dysfunction or genitourinary infection such as prostatitis first. Dapoxetine or lidocaine/prilocaine spray first line for lifelong premature ejaculation. Use daily PDE5 inhibitor treatment alone or in combination with other therapies in those with or without erectile dysfunction. Acquired PE Consider dapoxetine as first line licenced treatment. Consider off label on demand clomipramine. Consider daily SSRI if frequent intercourse, after discussion of sexual side effects and withdrawal problems.Additional measures include: Psychosexual counselling, masturbation training, biofeedback, exercise regimes, E-Health techniques, e.g. smart phone, combination therapy, medication with behavioural techniques Disclosure No
Kirby et al. (Mon,) studied this question.