An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE)

Abstract

IntroductionIn 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts.AimThe aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts.MethodA comprehensive literature review was performed.ResultsThis article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients.ConclusionDevelopment of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60–90.

Efficacy and safety of dapoxetine in treatment of premature ejaculation: an evidence-based review

“…The International Society of Sexual Medicine's (ISSM) Guidelines' definition of premature ejaculation (PE) consists of a male sexual dysfunction that shows the following features: ejaculation that always or nearly always occurs before or within about 1 min of vaginal penetration from the first sexual experience (lifelong premature ejaculation -LPE), or a clinically significant reduction in latency time, often to about 3 min or less (acquired premature ejaculation -APE); the inability to delay ejaculation on all or almost all vaginal penetrations; and negative personal consequences, such as frustration, distress, bother and/or the avoidance of sexual intimacy (1). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (2) definition of PE is coherent with the ISSM definition and includes the approximately 1-min intravaginal ejaculatory latency time (IELT) criteria and the presence of negative distress.…”

Orgasm, Serotonin Reuptake Inhibition, and Plasma Oxytocin in Obsessive-Compulsive Disorder. Gleaning From a Distant Randomized Clinical Trial

“…The specificity of serotonergic mechanisms is evident, because serotonergic antidepressants cause a much higher rate of sexual dysfunction than noradrenergic drugs, especially concerning orgasmic function 2, 3. Thus, SRIs seem to affect most specifically orgasmic function, which is further supported by the fact that SSRIs (eg, paroxetine and dapoxetine) currently constitute first-line pharmacologic treatment of premature ejaculation 4 . Despite the usefulness of this side effect of SSRIs in andrology, in psychiatric practice, it is mainly viewed as an undesired adverse effect.…”

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“…Recent guidelines have recommended topical anesthetic creams or daily or on-demand SSRIs as first-line pharmacotherapy for PE 16 . However, psychotherapy (alone or in combination with pharmacotherapy) also can be beneficial.…”