AUA guideline on the pharmacologic management of premature ejaculation.

The three major forms of male sexual dysfunction are ejaculatory dysfunction, erectile dysfunction (ED), and decreased libido (hypoactive sexual desire disorder). While survey findings vary considerably, most epidemiological studies suggest that premature ejaculation (PE) (also known as early ejaculation or rapid ejaculation) may be the most common male sexual disorder. Data from the National Health and Social Life Survey have revealed a prevalence of 21% in men ages 18 to 59 in the United States.1 Using various definitions, other studies report prevalences ranging from less than 5%2 to greater than 30%.3–5 A universally accepted definition of PE has yet to be established. Masters and Johnson proposed one of the earliest definitions that focused on the inability to delay ejaculation long enough for the woman to achieve orgasm fifty percent of the time, assuming that PE is the sole cause of the female anorgasmia.6 Kaplan first suggested that PE is primarily a problem of voluntary control over timing of ejaculation, a concept on which the current definition is based.7 The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (4th ed, text revision) (DSM-IV TR) (2000) defines PE with an added emphasis on the emotional and interpersonal impact of ejaculation that occurs earlier than the male desires.8 Premature ejaculation has been subclassified into two forms: a primary (lifelong) form that begins when a male first becomes sexually active and a secondary (acquired) form.9, 10 The present guidelines and recommendations are based on the following definition, which assumes the absence of partner sexual dysfunction: Premature ejaculation is ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners. The exact etiology of PE is unknown. Psychological/behavioristic and biogenic etiologies have been proposed. Consequently, the treatment of PE has encompassed psychological, behavioral, and pharmacologic interventions. Current treatments are largely based upon logical solutions (decreasing sensory input), behavior modification therapies, and observations of drug side effects (those with serotonin reuptake inhibiting activity). This guideline will address only pharmacologic therapies, as other therapies are not routinely prescribed by our target audience. To facilitate informed treatment decisions by physicians and their patients, recommendations on the use of medications currently available in the United States are provided. The majority of the recommendations contained herein are based on a consensus of expert opinion following review of the literature. In some cases, expert consensus is supplemented with a focused review of the limited data. This guideline does not preempt physician judgment in individual cases. Variations in patient subpopulations, physician experience, and available resources necessarily will influence choice of clinical strategy. Adherence to the recommendations presented in this document cannot assure a successful treatment outcome. For ease of review, the recommendations are bolded and followed by supporting text. The evidence supporting the recommendations is summarized in Appendices 1 to 3 (www.auanet.org).