madman
Super Moderator
Management of premature ejaculation: a clinical guideline from the Italian Society of Andrology and Sexual Medicine (SIAMS)
A. Sansone · A. Aversa · G. Corona · A. D. Fisher · A. M. Isidori · S. La Vignera · E. Limoncin · M. Maggi · M. Merico · E. A. Jannini
Abstract
Premature ejaculation (PE) is the most prevalent male sexual dysfunction, and the most recently defined. PE is often mistakenly considered a purely psychosexological symptom by patients: the lacking awareness in regards to the pathophysiology and treatments often leads to resignation from the patients’ side, making PE the most underdiagnosed sexual complaint. However, an ever-growing body of evidence supporting several organic factors has been developed in the last decades and several definitions have been suggested to encompass all defining features of PE. In the present document by the Italian Society of Andrology and Sexual Medicine (SIAMS), we propose 33 recommendations concerning the definition, pathophysiology, treatment, and management of PE aimed to improve patient care. These evidence-based clinical guidelines provide the necessary up-to-date guidance in the context of PE secondary to organic and psychosexological conditions, such as prostate inflammation, endocrine disorders, and other sexual dysfunctions, and suggest how to associate pharmacotherapies and cognitive-behavioral therapy in a couple-centered approach. New therapeutic options, as well as combination and off-label treatments, are also described
Introduction
The inclusion of premature ejaculation (PE) in the radar of science and medicine is relatively recent and still debated: the perception that PE is a psychological or, at the best, sexological symptom, almost exclusively due to behavioral relational derangements is indeed well-rooted [1–3]. Patients and media are only partially aware of the solid body of evidence produced in the context of diagnosis, pathogenesis, and treatment of PE.
Being one of the “youngest” topics for sexual medicine, many aspects of PE still need to be clarified on the basis of adequate evidence. The aim of this clinical guideline is to examine the current findings able to impact on the clinical management of the patient and the couple with PE.
Definitions of premature ejaculation
Evidence
Pathophysiology of premature ejaculation
Genetics
Evidence
Remarks
Hyperthyroidism
Evidence
Remarks
Prostatitis/chronic pelvic pain syndrome
Evidence
Remarks
Other factors
Evidence
Remarks
Other sexual comorbidities
Erectile dysfunction
Evidence
Remarks
Infertility
Evidence
Remarks
Diagnosis
Evidence
Remarks
Psychometry, psychology, psychotherapy
Evidence
Remarks
On‑label therapies
Evidence
Remarks
Off‑label therapies
Evidence
Remarks
Surgical treatment
Evidence
Conclusion
PE is a frequent and multifaceted symptom, which has only recently been considered of interest to the physician. As a consequence, only a few drugs have been developed and approved yet for PE, and in many countries, no treatment has been approved so far. Hence, management of PE remains relatively complex and might become a source of dissatisfaction for both patients and clinicians. While DE is destroying the quantitative aspect of sexuality, being the intercourse impossible in the majority of impotent men, PE is affecting the quality of sex itself. Many patients are apparently refractory to simple pharmacological treatment or psychological therapy alone. Hence, its management and the patient and partner expectations appear more difficult, possibly explaining the disappointment encountered by many doctors with a simplistic approach to PE. While PE should always be thoroughly investigated by a specialist, all physicians can (and should) ask their patients whether any sexual dysfunction is present in their life: a flowchart summarizing most of the present guidelines’ recommendations could be helpful to guide all necessary steps in diagnosis and treatment (Figs. 1 and 2). Our clinical guideline has been therefore developed to introduce new elements that are likely to have critical repercussions for the daily clinical practice and for the successful treatment of PE.
A. Sansone · A. Aversa · G. Corona · A. D. Fisher · A. M. Isidori · S. La Vignera · E. Limoncin · M. Maggi · M. Merico · E. A. Jannini
Abstract
Premature ejaculation (PE) is the most prevalent male sexual dysfunction, and the most recently defined. PE is often mistakenly considered a purely psychosexological symptom by patients: the lacking awareness in regards to the pathophysiology and treatments often leads to resignation from the patients’ side, making PE the most underdiagnosed sexual complaint. However, an ever-growing body of evidence supporting several organic factors has been developed in the last decades and several definitions have been suggested to encompass all defining features of PE. In the present document by the Italian Society of Andrology and Sexual Medicine (SIAMS), we propose 33 recommendations concerning the definition, pathophysiology, treatment, and management of PE aimed to improve patient care. These evidence-based clinical guidelines provide the necessary up-to-date guidance in the context of PE secondary to organic and psychosexological conditions, such as prostate inflammation, endocrine disorders, and other sexual dysfunctions, and suggest how to associate pharmacotherapies and cognitive-behavioral therapy in a couple-centered approach. New therapeutic options, as well as combination and off-label treatments, are also described
Introduction
The inclusion of premature ejaculation (PE) in the radar of science and medicine is relatively recent and still debated: the perception that PE is a psychological or, at the best, sexological symptom, almost exclusively due to behavioral relational derangements is indeed well-rooted [1–3]. Patients and media are only partially aware of the solid body of evidence produced in the context of diagnosis, pathogenesis, and treatment of PE.
Being one of the “youngest” topics for sexual medicine, many aspects of PE still need to be clarified on the basis of adequate evidence. The aim of this clinical guideline is to examine the current findings able to impact on the clinical management of the patient and the couple with PE.
Definitions of premature ejaculation
Evidence
Pathophysiology of premature ejaculation
Genetics
Evidence
Remarks
Hyperthyroidism
Evidence
Remarks
Prostatitis/chronic pelvic pain syndrome
Evidence
Remarks
Other factors
Evidence
Remarks
Other sexual comorbidities
Erectile dysfunction
Evidence
Remarks
Infertility
Evidence
Remarks
Diagnosis
Evidence
Remarks
Psychometry, psychology, psychotherapy
Evidence
Remarks
On‑label therapies
Evidence
Remarks
Off‑label therapies
Evidence
Remarks
Surgical treatment
Evidence
Conclusion
PE is a frequent and multifaceted symptom, which has only recently been considered of interest to the physician. As a consequence, only a few drugs have been developed and approved yet for PE, and in many countries, no treatment has been approved so far. Hence, management of PE remains relatively complex and might become a source of dissatisfaction for both patients and clinicians. While DE is destroying the quantitative aspect of sexuality, being the intercourse impossible in the majority of impotent men, PE is affecting the quality of sex itself. Many patients are apparently refractory to simple pharmacological treatment or psychological therapy alone. Hence, its management and the patient and partner expectations appear more difficult, possibly explaining the disappointment encountered by many doctors with a simplistic approach to PE. While PE should always be thoroughly investigated by a specialist, all physicians can (and should) ask their patients whether any sexual dysfunction is present in their life: a flowchart summarizing most of the present guidelines’ recommendations could be helpful to guide all necessary steps in diagnosis and treatment (Figs. 1 and 2). Our clinical guideline has been therefore developed to introduce new elements that are likely to have critical repercussions for the daily clinical practice and for the successful treatment of PE.
