Premature ejaculation (PE) is one of the most common sexual health problems for men, with estimated prevalence rates of up to 30%. However, sexual health experts view the definition and management of PE in different ways, according to the results of a recent survey.
Classically, PE has been a challenging condition to define. Recently, the International Society for Sexual Medicine (ISSM) put forth this definition:
PE is a male sexual dysfunction characterized by:
• ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE), OR a clinically significant reduction in latency time, often to about 3 minutes or less (acquired premature ejaculation);
AND
• the inability to delay ejaculation on all or nearly all vaginal penetrations;
AND
• negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.
Other organizations, including the American Psychiatric Association and the American Urological Association have also developed definitions and guidelines.
With such differences in mind, a team of researchers developed a 23-item questionnaire to learn more about clinicians’ views and management of PE.
In February 2015, 217 physicians attending the 17th Annual Congress of the European Society for Sexual Medicine (ESSM) in Copenhagen completed the survey. (Note: The ESSM is affiliated with the ISSM.)
The respondents ranged in age between 22 and 74 years with an average age of 47. Approximately 84% were urologists, 9% were psychiatrists, and 7% were general practitioners.
Almost 80% of the respondents said that PE was an important condition to treat. But 9% didn’t think it needed treatment at all and 12% felt treatment was warranted only if a patient felt distress.
The survey also addressed these areas:
• Criteria for diagnosis. Just over half of the respondents chose estimated intravaginal ejaculation latency time as the “pivotal measurement” for PE diagnosis. About a quarter chose “perceived control over ejaculation” and the remaining quarter chose “personal distress.”
• Treatment goals. About two-thirds of the respondents felt that the main goal of treatment was improvement of the patient’s satisfaction. Just over a third stated that the goal should focus on the partner. The remaining respondents cited improved control over ejaculation as the main treatment goal.
• Treatment methods. Sixty-six percent believed that PE is best treated by a combination therapy that includes medications and psychological approaches. About 17% voted for treatment by a sexologist, and the rest advocated pharmacotherapy.
• Education on PE. Almost half of the respondents said there was not enough information about PE available to patients and providers.
The authors stressed that education on PE is important for the implementation of new PE guidelines. With regard to the 9% of respondents who felt that PE does not warrant treatment, they wrote, “We believe that this underestimation of PE is because of the lack of proper education in sexual medicine during medical training.”
They added: “Educational activities might be necessary to increase [sex health experts’] awareness and knowledge about the recent developments and evolved guidelines for the treatment of PE.”
The survey results were first published online in June in Sexual Medicine, the ISSM’s open access journal.
Resources
Sexual Medicine
Shechter, Arik, MD, et al.
“Attitudes of Sexual Medicine Specialists Toward Premature Ejaculation Diagnosis and Therapy”
(Full-text. Published online: June 23, 2016)
http://www.smoa.jsexmed.org/article/S2050-1161(16)30040-X/fulltext