Sexual Health

New insights into premature ejaculation pave way for better treatments

A man is seated on the bed in a bedroom.  He has his head in his hands and is looking away from the camera.  Horizontally framed shot.

A man is seated on the bed in a bedroom. He has his head in his hands and is looking away from the camera. Horizontally framed shot.  (Andersen Ross)

Though premature ejaculation (PE) is estimated to affect anywhere from 5 to 30 percent of the male population worldwide, it wasn’t until 2010 that a clear definition for the disorder emerged.

Now, two new studies in the Journal of Sexual Medicine aim to expand the definition of PE and improve diagnosis and treatment recommendations for the disease.

“The International Society for Sexual Medicine [ISSM] first created a definition for premature ejaculation in 2010…but it was only for what we call lifelong premature ejaculation,” Stanley Althof of the Case Western Reserve University School of Medicine in West Palm Beach, Florida, told “[It] defined PE as men having an intravaginal ejaculatory latency (IEL) of approximately one minute, the inability to delay ejaculation and as having negative personal consequences.”

However, Althof and his colleagues felt the guidelines should continue to be updated. One of their priorities: Expanding the definition to include acquired PE, a condition in which PE develops in men with previously normal function.  

“For the current guidelines, we included the acquired subtype…so we used expert opinions to come up with [a definition of acquired PE as having] an IEL of approximately three minutes, the inability to delay ejaculation and also negative personal consequences,” Althof said.  

The second study, authored by Althof, sought to expand recommendations for the diagnosis and treatment of PE, to aid primary care physicians or non-sexual health physicians who may treat patients with the condition.

“All of the treatments are updated and given levels of evidence recommendation so physicians who have a patient come to their offices can use this to look at evidence on the treatments and the adverse events and treat their patients,” Althof said.

The recommendations cover a variety of treatment options including addressing potential underlying conditions, utilizing psychological counseling, behavioral therapy or couples therapy or recommending various pharmacological treatment options.

Currently, no drugs have been approved by the U.S. Food and Drug Administration to treat PE, though some medications, including the selective-serotonin reuptake inhibitors (SSRIs) Paxil and Zoloft, have been shown to have off-label benefits.

Though a drug called Dapoxetine has been approved to treat PE in approximately 60 countries around the world, Althof said it hasn’t been approved by the FDA – possibly because PE had previously been an ill-defined disorder, making it difficult to prove the drug’s efficacy.

“When Dapoxetine started its clinical trials, the ISSM definition didn’t exist, you just had the [Diagnostic and Statistic Manual of Mental Disorders 4] recommendation, which was very vague and subjective, and said that a man [with PE] ejaculated before he wished, which you know, what does that mean?” Althof said.

Overall, Althof said he hopes the new guidelines for PE will facilitate more open discussion about the disorder between patients and physicians, in addition to encouraging more research into the disease.

“I think really the problem of not having a definition created research problems because nobody was looking at the same group of men; some men were [lasting] two minutes in the PE group, and there were several studies with guys [lasting] five minutes,” Althof said. “So I’m hoping that having the definition allows for the continuity of research over the next several years, where we’re all looking at the same thing.”