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Premature ejaculation (PE) is a prevalent male sexual dysfunction characterized by ejaculation that occurs before or shortly after vaginal penetration, leading to distress and dissatisfaction in sexual relationships. The condition affects approximately 20% to 30% of men at some point in their lives, making it a significant concern in primary care settings (Eid, 2023; Saitz & Şerefoğlu, 2016).
The causes of PE can be summarised as
| Category | Cause | Description |
|---|---|---|
| Psychological Factors | Anxiety | Particularly about sexual performance, leading to a cycle of distress that impairs sexual function. |
| Stress | General stress can exacerbate PE by affecting mental focus and physical responses. | |
| Depression | Mood disorders influencing sexual desire and performance, contributing to PE. | |
| Relationship Problems | Interpersonal issues increasing anxiety and reducing sexual satisfaction, leading to PE. | |
| Early Sexual Experiences or Trauma Past experiences impacting current sexual function through psychological associations. | Past experiences impacting current sexual function through psychological associations. | |
| Strict Upbringing Regarding Sex | May lead to guilt or anxiety during sexual activity, contributing to PE. | |
| Biological Factors | Abnormal Hormone Levels ↑↓ | Imbalances in thyroid hormones, prolactin, or testosterone affecting sexual function. |
| Neurotransmitter Imbalance Particularly serotonin levels affecting ejaculatory control. | Particularly serotonin levels affecting ejaculatory control. | |
| Inflammation or Infection | Of the prostate or urethra causing increased sensitivity and PE. | |
| Erectile Dysfunction | Fear of losing an erection may lead to rushing sexual activity, resulting in PE. | |
| Genetic Predisposition | Family history indicating a genetic component to PE. | |
| Certain Neurological Conditions | Conditions affecting the nervous system can impact ejaculatory control. | |
| Hypersensitivity of the Glans Penis | Increased sensitivity leading to rapid ejaculation due to abnormal reflex pathways. | |
| Other Factors | Substance Use | Use of certain drugs or alcohol affecting sexual performance and control. |
| Age and Experience | Younger men or those with less sexual experience may be more prone to PE. | |
| Type of PE | Lifelong (primary) or acquired (secondary); causes may differ between these types. |
Management - Quick summary
| Management Approach | Details | Notes |
|---|---|---|
| Non-Pharmacological (First-line) |
Behavioral Therapies Techniques like the stop-start method and squeeze technique to enhance ejaculatory control. | Includes stop-start and squeeze techniques; can improve control and confidence. |
| Psychosexual Counseling Therapy addressing psychological factors such as anxiety and relationship issues. | Helps reduce performance anxiety and improve communication between partners. | |
| Pelvic Floor Muscle Training | Strengthening exercises to improve control over ejaculation. | |
| Pharmacological (Second-line) |
Selective Serotonin Reuptake Inhibitors (SSRIs) Medications that increase serotonin levels to delay ejaculation. ↑ Serotonin |
- **Dapoxetine** (only SSRI licensed for PE) - Others (paroxetine, sertraline, fluoxetine) used off-label - Side effects: nausea, dizziness |
| Topical Anesthetics |
- Lidocaine or prilocaine creams/sprays - Reduce penile sensitivity - Available over-the-counter |
|
| Tricyclic Antidepressants |
- **Clomipramine** used off-label - Can delay ejaculation - Monitor for side effects |
|
| Combined Therapy | Pharmacotherapy + Behavioral Techniques | Combining medications with behavioral therapy may enhance effectiveness. |
| Adjunctive Therapies |
- Mindfulness therapy - Cognitive Behavioral Therapy (CBT) - Traditional Chinese Medicine |
|
| Treat Underlying Conditions | Address Erectile Dysfunction | Treat ED first if PE is secondary to it. |
| Patient Education | Communication Skills Improving dialogue with partner about needs and concerns. | Educate about normal sexual function; set realistic expectations. |
**References:**
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