Review literature: (Althof, 2006) (Montague et al, 2004).
Premature ejaculation is one of the most common sexual complaints. It is characterized by an unwanted early ejaculation before or after minimal sexual stimulation, this may interfere with sexual or emotional well-being in patient or partner and may possibly disturbe the (sexual) relationship. There are many different definitions of premature ejaculation. The most frequently cited definitions refer to the following components of the disease:
The prevalence rate of premature ejaculation in sexually active men is around 20%, it varies between studies and due to different definitions of premature ejaculation between 5–50%. Premature ejaculation is equally prevalent in all age groups.
Anxiety, poor communication between partners, lack of ejaculation techniques or psychodynamic causes.
Penile hypersensitivity, 5-hydroxytryptamine (5-HT) receptor hyper- or hyposensitivity (depending on the receptor subtype), erectile dysfunction.
The clinical course of the disease is variable. Primary premature ejaculation is usually a lifelong disease and is caused by physical causes (see above). Secondary premature ejaculation is the acquired form, psychogenic causes are more prevalent.
In addition to a detailed sexual history (vaginal latency time, partners, techniques, ...), further questions aime to exclude erectile dysfunction or to assess other sexual complaints.
The benefits of behavioral therapy are the lack of side effects, it improves the communication of sexual partners and may result next to the treatment of premature ejaculation in a more satisfying partnership. Disadvantages are the delayed and inconstant effect of behavioral therapy. In addition, it requires a high human and financial burden to patients (or society), and the cooperation of the sexual partner is mandatory.
The sexual arousal is reduced just before ejaculation by compression of the glans penis, until the sexual arousal decreases. Thereafter, the sexual stimulation is continued.
Shortly before ejaculation, the sexual stimulation is paused, until the decreased sexual arousal allows further stimulation without ejaculation.
Desensitivation of the glans penis is reached by wearing multiple condoms and/or the use of ointments with local anesthetics (such as lidocaine).
Pharmacological therapy of premature ejaculation is possible with the use serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants. The problem are the side effects of the antidepressants and the lack of approval for the indication premature ejaculation. Since 2009, dapoxetine (a short-acting SSRI) received approval for the treatment of premature ejaculation.
Paroxetine is a long-acting SSRI. Dosage 20–40 mg daily. Onset of action after 1–2 weeks.
Fluoxetine is a long-acting SSRI. Dosage 20–40 mg daily. Onset of action after 1–2 weeks.
Tricyclic antidepressant, which can be used as on-demand treatment. Dosage 10–50 mg five hours before sexual intercourse.
PDE 5-inhibitors are indicated for the treatment of erectile dysfunction, which may also be the cause for the premature ejaculation. PDE 5-inhibitors are also combined with SSRIs (off-label use).
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Deutsche Version: Vorzeitige Ejakulation
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Dr. med. Dirk Manski
man...@urologielehrbuch.de