Comparison of Current International Guidelines on Premature Ejaculation: 2024 Update
Abstract
:1. Introduction
2. Materials and Methods
3. Evidence Synthesis
3.1. Definition and Classification of PE
“A. A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 min following vaginal penetration and before the individual wishes it; B. Present for at least 6 months and must be experienced on almost all or all (approximately 75–100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts); C. Clinically significant distress in the individual; D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition”.
3.2. Epidemiology and Pathophysiology of PE
3.3. Recommendations/Statements on the Diagnosis and Therapy of PE
3.4. Quality of Guidelines on PE
3.5. Strengths, Limitations, and Future Perspectives
4. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Lucas Bustos, P.; Parrón Carreño, T.; Moreno Gutiérrez, S.; Fernández Agis, I. Progressive arousal: A new concept and definition for premature ejaculation. Sex. Med. 2023, 11, qfad014. [Google Scholar] [CrossRef] [PubMed]
- Rowland, D.L.; Kolba, T.N. Understanding the effects of establishing various cutoff criteria in the definition of men with premature ejaculation. J. Sex. Med. 2015, 12, 1175–1183. [Google Scholar] [CrossRef]
- Jannini, E.A.; Maggi, M.; Lenzi, A. Evaluation of premature ejaculation. J. Sex. Med. 2011, 8, 328–334. [Google Scholar] [CrossRef]
- Napolitano, L.; Barone, B.; Spirito, L.; Trama, F.; Pandolfo, S.D.; Capece, M.; García-Rojo, E.; Fernández-Pascual, E.; Crocetto, F.; Fusco, F.; et al. Voice Assistants as Consultants for Male Patients with Sexual Dysfunction: A Reliable Option? Int. J. Environ. Res. Public Health 2023, 20, 2612. [Google Scholar] [CrossRef]
- El-Hamd, M.A.; Saleh, R.; Majzoub, A. Premature ejaculation: An update on definition and pathophysiology. Asian J. Androl. 2019, 21, 425–432. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Kondoh, N. Ejaculatory dysfunction as a cause of infertility. Reprod. Med. Biol. 2011, 11, 59–64. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Ermeç, B.; Yucetas, U.; Güler, H.; Culha, M.G.; Kadıhasanoğlu, M. Evaluation of the quality of life of patients with premature ejaculation (lifelong and acquired). Rev. Assoc. Médica Bras. 2022, 68, 1303–1307. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Salonia, A.; Bettocchi, C.; Boeri, L.; Capogrosso, P.; Carvalho, J.; Cilesiz, N.C.; Cocci, A.; Corona, G.; Dimitropoulos, K.; Gül, M. EAU Guidelines on Sexual and Reproductive Health; EAU Guidelines Office: Arnhem, The Netherlands, 2024; ISBN 978-94-92671-23-3. [Google Scholar]
- Shindel, A.W.; Althof, S.E.; Carrier, S.; Chou, R.; McMahon, C.G.; Mulhall, J.P.; Paduch, D.A.; Pastuszak, A.W.; Rowland, D.; Tapscott, A.H.; et al. Disorders of Ejaculation: An AUA/SMSNA Guideline. J. Urol. 2022, 207, 504–512. [Google Scholar] [CrossRef]
- Althof, S.E.; McMahon, C.G.; Waldinger, M.D.; Serefoglu, E.C.; Shindel, A.W.; Adaikan, P.G.; Becher, E.; Dean, J.; Giuliano, F.; Hellstrom, W.J.G.; et al. An Update of the International Society of Sexual Medicine’s Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). J. Sex. Med. 2014, 2, 60–90. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; American Psychiatric Association: Washington, DC, USA, 2013. [Google Scholar] [CrossRef]
- European Society for Sexual Medicine. The ESSM Manual of Sexual Medicine, 2nd ed.; European Society for Sexual Medicine: Ukkel, Belgium, 2015. [Google Scholar]
- World Health Organization (WHO). International Classification of Diseases, Eleventh Revision (ICD-11), 2019/2021. Available online: https://icd.who.int/browse11 (accessed on 5 July 2024).
- Brouwers, M.C.; Kho, M.E.; Browman, G.P.; Burgers, J.S.; Cluzeau, F.; Feder, G.; Fervers, B.; Graham, I.D.; Grimshaw, J.; Hanna, S.E.; et al. The Global Rating Scale complements the AGREE II in advancing the quality of practice guidelines. J. Clin. Epidemiol. 2012, 65, 526–534. [Google Scholar] [CrossRef]
- Porst, H.; Montorsi, F.; Rosen, R.C.; Gaynor, L.; Grupe, S.; Alexander, J. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: Prevalence, comorbidities, and professional help-seeking. Eur. Urol. 2007, 51, 816–824. [Google Scholar] [CrossRef] [PubMed]
- Laumann, E.O.; Paik, A.; Rosen, R.C. Sexual dysfunction in the United States: Prevalence and predictors. JAMA 1999, 281, 537–544. [Google Scholar] [CrossRef]
- Serefoglu, E.C.; Yaman, O.; Cayan, S.; Asci, R.; Orhan, I.; Usta, M.F.; Ekmekcioglu, O.; Kendirci, M.; Semerci, B.; Kadioglu, A. Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes: Results from the Turkish Society of Andrology Sexual Health Survey. J. Sex. Med. 2011, 8, 540–548. [Google Scholar] [CrossRef]
- Gao, J.; Zhang, X.; Su, P.; Liu, J.; Xia, L.; Yang, J.; Shi, K.; Tang, D.; Hao, Z.; Zhou, J. Prevalence and factors associated with the complaint of premature ejaculation and the four premature ejaculation syndromes: A large observational study in China. J. Sex. Med. 2013, 10, 1874–1881. [Google Scholar] [CrossRef]
- Shindel, A.W.; Vittinghoff, E.; Breyer, B.N. Erectile dysfunction and premature ejaculation in men who have sex with men. J. Sex. Med. 2012, 9, 576–584. [Google Scholar] [CrossRef] [PubMed]
- Di Bello, F.; Creta, M.; Napolitano, L.; Califano, G.; Passaro, F.; Morra, S.; Giovanni, A.d.; Fusco, G.M.; Cirillo, L.; Abate, M.; et al. Male Sexual Dysfunction and Infertility in Spinal Cord Injury Patients: State-of-the-Art and Future Perspectives. J. Pers. Med. 2022, 12, 873. [Google Scholar] [CrossRef] [PubMed]
- Verze, P.; Sokolakis, I.; Manfredi, C.; Collà Ruvolo, C.; Hatzichristodoulou, G.; Romero-Otero, J. Penile prosthesis implant in the management of Peyronies’ disease. Minerva Urol. Nephrol. 2021, 73, 196–214. [Google Scholar] [CrossRef]
- Spirito, L.; Manfredi, C.; La Rocca, R.; Napolitano, L.; Di Girolamo, A.; Capece, M.; Trama, F.; Sciorio, C.; Sokolakis, I.; Creta, M.; et al. Daily low-dose tadalafil may reduce the penile curvature progression rate in patients with acute Peyronie’s disease: A retrospective comparative analysis. Int. J. Impot. Res. 2024, 36, 129–134. [Google Scholar] [CrossRef]
- Garrido-Abad, P.; Senra-Bravo, I.; Manfredi, C.; Fernández-Pascual, E.; Linares-Espinós, E.; Fernández-Arjona, M.; Varillas-Delgado, D.; Martínez-Salamanca, J.I. Combination therapy with topical alprostadil and phosphodiesterase-5 inhibitors after failure of oral therapy in patients with erectile dysfunction: A prospective, two-arm, open-label, non-randomized study. Int. J. Impot. Res. 2022, 34, 164–171. [Google Scholar] [CrossRef]
- Canfield, S.E.; Omar, M.I.; Ribal, M.J.; EAU Guidelines Office Board. Making the GRADE: Providing Clinical Practice Guidance to the European Association of Urology. Eur. Urol. 2024, 85, 405–406. [Google Scholar] [CrossRef]
- Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). Available online: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009 (accessed on 6 July 2024).
- Symonds, T.; Perelman, M.A.; Althof, S.; Giuliano, F.; Martin, M.; May, K.; Abraham, L.; Crossland, A.; Morris, M. Development and validation of a premature ejaculation diagnostic tool. Eur. Urol. 2007, 52, 565–573. [Google Scholar] [CrossRef] [PubMed]
- Arafa, M.; Shamloul, R. Development and evaluation of the Arabic Index of Premature Ejaculation (AIPE). J. Sex. Med. 2007, 4, 1750–1756. [Google Scholar] [CrossRef] [PubMed]
- Patrick, D.L.; Giuliano, F.; Ho, K.F.; Gagnon, D.D.; McNulty, P.; Rothman, M. The Premature Ejaculation Profile: Validation of self-reported outcome measures for research and practice. BJU Int. 2009, 103, 358–364. [Google Scholar] [CrossRef] [PubMed]
- Althof, S.; Rosen, R.; Symonds, T.; Mundayat, R.; May, K.; Abraham, L. Development and validation of a new questionnaire to assess sexual satisfaction, control, and distress associated with premature ejaculation. J. Sex. Med. 2006, 3, 465–475. [Google Scholar] [CrossRef]
- Rosen, R.C.; Catania, J.A.; Althof, S.E.; Pollack, L.M.; O’Leary, M.; Seftel, A.D.; Coon, D.W. Development and validation of four-item version of Male Sexual Health Questionnaire to assess ejaculatory dysfunction. Urology 2007, 69, 805–809. [Google Scholar] [CrossRef]
- Yuan, Y.M.; Xin, Z.C.; Jiang, H.; Guo, Y.J.; Liu, W.J.; Tian, L.; Zhu, J.C. Sexual function of premature ejaculation patients assayed with Chinese Index of Premature Ejaculation. Asian J. Androl. 2004, 6, 121–126. [Google Scholar]
EAU Guidelines | AUA/SMSNA Guidelines | ISSM Guidelines |
---|---|---|
Medical and sexual history | ||
Perform the diagnosis and classification of PE based on medical and sexual history, which should include assessment of IELT (self-estimated), perceived control, distress, and interpersonal difficulty due to the ejaculatory dysfunction. Strong | Clinicians should assess medical, relationship, and sexual history to make the diagnosis of PE. Clinical Principle Query on the absence or loss of ejaculatory control, personal or interpersonal bother, and short ELT is essential. NA | It is recommended take a medical history. LOE 5 It is recommended that clinicians utilize the screening questions: - Recommended questions for diagnosis: What is the time between penetration and ejaculation (cumming)? Can you delay ejaculation? Do you feel bothered, annoyed, and/or frustrated by your PE? - Optional questions to differentiate lifelong and acquired PE: When did you first experience PE? Have you experienced PE since your first sexual experience on every/almost every attempt and with every partner? NA It is recommended that self-estimation by the patient and partner of ejaculatory latency be accepted as the method for determining IELT in clinical practice. LOE 2b There was inadequate evidence to recommend screening or case finding for PE, either in a general population or in any subpopulation. However, it is recommended that men with ED be screened for PE. NA |
Psychological evaluation | ||
Assess psychosexual history and psychosexual development. Strong Assess anxiety and interpersonal anxiety; focus on control issues. Strong Include the partner if available (in the psychological assessment); check for the impact of PE on the partner. Strong | A psychological health assessment should also be obtained. NA | It is recommended to take a psychosocial history. LOE 5 |
Physical examination | ||
Include physical examination in the initial assessment of PE to identify anatomical abnormalities that may be associated with PE or other sexual dysfunctions, particularly ED. Strong | Clinicians should perform a focused physical exam to make the diagnosis of PE. Clinical Principle | For lifelong PE, a physical examination is highly advisable but not mandatory and should be conducted in most if not all patients. NA For acquired PE, a targeted physical examination is mandatory to assess for associated/causal diseases such as ED, thyroid dysfunction, or prostatitis. NA |
Questionnaires | ||
Use patient-reported outcomes in daily clinical practice. Weak Several questionnaires can be used for the diagnosis of PE (PEDT, AIPE) and for assessing the therapeutic outcomes of PE interventions (PEP). LOE 2b | Clinicians may use validated instruments to assist in the diagnosis of PE. Conditional Recommendation; LOE: Grade C | Depending on the specific need, the PEP or IPE continue to be the preferred questionnaire measures for assessing lifelong or acquired subtypes of PE, particularly when monitoring responsiveness to treatment. LOE 2b |
Other tests | ||
Do not perform routine laboratory or physiological tests. They should only be directed by specific findings from history or physical examination. Strong | Clinicians should not use additional testing for the evaluation of a patient with lifelong PE. Conditional Recommendation; LOE: Grade C Clinicians may utilize additional testing as clinically indicated for the evaluation of the patient with acquired PE. Conditional Recommendation; LOE: Grade C | No statements. |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Romano, L.; Arcaniolo, D.; Spirito, L.; Quattrone, C.; Bottone, F.; Pandolfo, S.D.; Barone, B.; Napolitano, L.; Ditonno, F.; Franco, A.; et al. Comparison of Current International Guidelines on Premature Ejaculation: 2024 Update. Diagnostics 2024, 14, 1819. https://doi.org/10.3390/diagnostics14161819
Romano L, Arcaniolo D, Spirito L, Quattrone C, Bottone F, Pandolfo SD, Barone B, Napolitano L, Ditonno F, Franco A, et al. Comparison of Current International Guidelines on Premature Ejaculation: 2024 Update. Diagnostics. 2024; 14(16):1819. https://doi.org/10.3390/diagnostics14161819
Chicago/Turabian StyleRomano, Lorenzo, Davide Arcaniolo, Lorenzo Spirito, Carmelo Quattrone, Francesco Bottone, Savio Domenico Pandolfo, Biagio Barone, Luigi Napolitano, Francesco Ditonno, Antonio Franco, and et al. 2024. "Comparison of Current International Guidelines on Premature Ejaculation: 2024 Update" Diagnostics 14, no. 16: 1819. https://doi.org/10.3390/diagnostics14161819