II. Definitions
- Premature Ejaculation
- Persistent or recurrent semen or seminal fluid emission before or shortly after sexual penetration
- Ejaculatory latency typically is less than 1 minute from time of sexual penetration
III. Epidemiology
- Affects 4 to 39% of men
IV. Causes
- Sexual Performance Anxiety
- Sexual relationship problems
- Mental Health Disorders
- Erectile Dysfunction
- Medication Withdrawal
- Recreational Drug Withdrawal
- Prostatitis (rare cause)
- Hyperthyroidism (rare cause)
V. Complications
- Personal distress
- Avoidance of sexual intimacy
VI. Management: Non-Pharmacologic
- Behavioral Therapy (e.g. psychosexual counseling, psychotherapy, cognitive distraction, Hypnotherapy)
- Meditation and other Relaxation Techniques
- Precoital masturbation
- Increased frequency of sex
- Alternate sexual positions
- Extended foreplay
- Pelvic Floor Exercises
- Stop-start and squeeze techniques to delay ejaculation
- Multiple Condoms worn
VII. Management: Pharmacologic
- Topical Anesthetic cream
- Antidepressants (esp. SSRI, SNRI) - Effective but high discontinuation rate for side effects