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Premature ejaculation is one of the most common sexual dysfunctions in men. Recent epidemiological studies suggest its prevalence in Australia may range from 21–31%. This article will discuss the current definition of premature ejaculation from a urological perspective. It will provide an understanding of the pathogenesis of premature ejaculation, as well as assessment and management options. Premature ejaculation can have a significant adverse effect on the quality of life for the patient and his sexual partner’s. It can potentially lead to psychological distress, diminished self-esteem, anxiety, erectile dysfunction, reduced libido and poor interpersonal relationships. Most men feel reluctant to discuss premature ejaculation with their general practitioner despite its psychological, emotional and relational effects.

Effective, evidence-based treatment options are available and physicians should feel confident when exploring ways to improve the quality of life for men with sexual dysfunction. Premature ejaculation is one of the most common sexual dysfunctions, affecting up to 21–31% of the Australian adult male population, irrespective of their age, marital status or ethnicity. This sexual condition is likely is under report. Treated because of the patients’ perceived shame and low self-esteem. This is in addition to many physicians feeling uncomfortable or uncertain about the management of premature ejaculation. The impact of premature ejaculation is mostly felt psychologically and in interpersonal relationships.

The aim of this article is to provide general practitioners (GPs) with an overview to assess and manage patients with premature ejaculation and other associated sexual dysfunction.

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Premature ejaculation is defined as the inability to control or delay ejaculation, which results in dissatisfaction or distress for the patient. Recently, the International Society of Sexual Medicine (ISSM) classified premature ejaculation as lifelong or acquired, and proposed inclusion of an objective, quantifiable time to ejaculation, which is the intravaginal ejaculatory latency time (IELT). The IELT is define as the time from vaginal penetration to ejaculation. Lifelong premature ejaculation is the IELT of <1 minutes since first intercourse, whereas IELT of <3 minutes at any point in a man’s life is considered to be acquired premature ejaculation.12 Premature ejaculation can be further divided into authority-based subtypes’ variable’ and ‘subjective’ (Table 1), which describes individuals experiencing significant distress and dissatisfaction with ejaculation.

Psychological components often contribute to acquired premature ejaculation. However, it is likely that a complex interplay between neurophysiological factors predominantly influences premature ejaculation. In particular, genetic predisposition for impairment of inhibitory serotonergic pathways that regulate ejaculation, modulated by 5-HT2c, 5-HT1a, 5-HT1b receptors, and serotonin synaptic transporters, repoets for premature ejaculation for life. Other conditions, such as chronic ejaculation, prostatitis, and hyperthyroidism, is associate to the with acquired premature ejaculation.15,16

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Erectile dysfunction and premature ejaculation frequently coexist,5,17 as men with erectile dysfunction may try to ejaculate before losing their erection.17,18 Therefore, detection of comorbid erectile dysfunction is crucial to guide management. therapeutic implementation.19Patients with premature ejaculation may come to general practice because of personal or partner-initiated reports of erectile or sexual dysfunction and relationship difficulties. However, when the clinician is unsure of the context of the presenting complaint, or unsure what to ask, an open-ended question, such as “How are things at home?”, may evoke the disclosure of relevant symptoms.

A full evaluation of the patient’s medical, sexual, psychological, social, and drug history, along with her partner’s sexual history, is necessary to identify any potentially reversible factors. It is also important to explore the perceived degree of ejaculatory control, the estimated IELT (a precise time is not necessary), previous attempts to correct premature ejaculation, and the impact on interpersonal relationships and quality of life. Various screening questionnaires, such as the Premature Ejaculation Diagnostic Tool (PEDT), when combined with clinical assessment, are accurate in diagnosing premature ejaculation if it is unclear. It is particularly crucial to determine whether the diagnosis is due to premature ejaculation. Life or acquired, and be aware that erectile dysfunction may exacerbate the presentation. Simply asking about the loss of an erection before ejaculation can help distinguish erectile dysfunction from premature ejaculation.

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The physical examination of patients experiencing premature ejaculation is often unremarkable. Complete abdominal, neurological, lower limb, and genital examinations is recommend For This. Although the exam has a low diagnostic yield, it provides important reassurance to the patient that it is anatomically normal. There are no specific investigations to confirm or exclude premature ejaculation. Any further investigation should investigate suspected contributing factors identified during the history and examination.

Ideally, management discussions should involve the patient and her regular sexual partner. The choice of treatment requires consideration of symptom severity, reversible causes, psychosocial impact, side effects, and patient preferences. In clinical practice, management is complex and requires a combination of pharmacological, psychological, and behavioral treatments (Figure 1).