During the last decades, different and diverse criteria have been used to define this entity, although since 2013 it has adopted the definition of the International Society for Sexual Medicine (ISSM). Premature ejaculation may be primary (occurs from the time an individual begins sexual relations) or acquired (appears at some point in his life, with previous normal sexual performance), and is characterised by:
Two other premature ejaculation syndromes have also been recently proposed:
As for the frequency of this pathology, the biggest problem in measuring it is that, at the time when the largest studies were carried out, there was no agreed definition of the entity, so percentages of up to 31% of men aged 18-59 years have been described in the literature. Today, it is considered to affect around 5% of the older male population.
For the acquired type, the causes may be varied, such as the presence of urethritis, hormonal disorders or psychogenic factors. However, there is no clear etiology for the vast majority of the cases.
» Clinical interview with a super-specialised andrologist..
Personal background will be assessed and research will be done on the onset of symptoms, latency time, erectile function, time since the onset of symptoms, perception of control over the disease and distress caused by the problem. There will also be a guided physical exam.
» Validated questionnaires.
They help to establish, as objectively as possible, the severity of the pathology and the effect it has on the individual.
» Laboratory study.
Lipid profile, blood sugar level, hormone profile, thyroid function, kidney and liver function, prostate pathology. It helps to establish associations and discover secondary cases of the disease.
» Urethral discharge.
It rules out the presence of urethritis, which can cause or aggravate the pathology.
There are different therapeutic alternatives to premature ejaculation. As mentioned, in cases where a possible causal effect is found, it will first be necessary to act on it, given that resolution may improve or even make the symptoms disappear. When not possible, there are different therapeutic alternatives as described:
» Oral treatments:
Numerous agents have been described, although the only one with official approval is dapoxetine (Priligy®). It is a selective serotonin reuptake inhibitor (SSRI) with a short half-life that, when administered before sex, increases the latency time.
» Topical treatments:
Mostly, these are local anaesthetics that, when administered on the glans, reduce the glans sensitivity and increases the latency time. There are specific formulations with very convenient administration, such as Fortacin®.
» Behavioural therapies:
These are strategies aimed at increasing control over the ejaculation, in order to increase the latency time. Although there are some relatively simple ones to practice, they usually require prior psychological evaluation, and they will be carried out with the help of collaborating sexologists.