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Premature Ejaculation

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Premature Ejaculation

  • Definitions
  1. Premature Ejaculation
    1. Persistent or recurrent semen or seminal fluid emission before or shortly after sexual penetration
    2. Ejaculatory latency typically is less than 1 minute from time of sexual penetration
  • Epidemiology
  1. Affects 4 to 39% of men
  • Causes
  1. Sexual Performance Anxiety
  2. Sexual relationship problems
  3. Mental Health Disorders
  4. Erectile Dysfunction
  5. Medication Withdrawal
  6. Recreational Drug Withdrawal
  7. Prostatitis (rare cause)
  8. Hyperthyroidism (rare cause)
  • Complications
  1. Personal distress
  2. Avoidance of sexual intimacy
  • Management
  • Non-Pharmacologic
  1. Behavioral Therapy (e.g. psychosexual counseling, psychotherapy, cognitive distraction, Hypnotherapy)
  2. Meditation and other Relaxation Techniques
  3. Precoital masturbation
  4. Increased frequency of sex
  5. Alternate sexual positions
  6. Extended foreplay
  7. Pelvic Floor Exercises
  8. Stop-start and squeeze techniques to delay ejaculation
  9. Multiple Condoms worn
  • Management
  • Pharmacologic
  1. Topical Anesthetic cream
  2. Antidepressants (esp. SSRI, SNRI) - Effective but high discontinuation rate for side effects
    1. Clomipramine (Anafranil, Tricyclic Antidepressant)
    2. Dapoxetine (Priligy)
    3. Paroxetine (Paxil)
    4. Sertraline (Zoloft)
    5. Citalopram (Celexa)
    6. Fluoxetine (Prozac)
    7. Sathianathen (2021) Cochrane Database Syst Rev (3):CD012799 [PubMed]