Premature Ejaculation Clinical Presentation

  • Author: Aaron Benson, MD; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Jan 20, 2012
 

History

The history of the patient's premature ejaculation (rapid ejaculation) is helpful because it ultimately guides the treatment that is best suited to the patient (and his partner). One should determine whether premature ejaculation is lifelong (ie, primary) or acquired (ie, secondary) and assess the severity of the problem.

For completeness, a general medical history should be taken to screen for other medical conditions that might be relevant. For example, if the patient has angina with subsequent fear of myocardial infarction during sexual activity, he might present with premature ejaculation when the actual underlying problem is his cardiac disease and his mental insecurity regarding his cardiac disease. Resolution of the cardiac problem usually solves the premature ejaculation, with no specific therapy for the premature ejaculation. For the purpose of this discussion, the patient is assumed to be healthy, and sexual dysfunction is the only significant problem.

If the patient has always experienced premature ejaculation from the time he began coitus, then he has primary premature ejaculation. If he had successful coital relationships in the past, yet began experiencing premature ejaculation with the current relationship, then he has secondary premature ejaculation. In most cases, secondary premature ejaculation is easier to treat and has a better prognosis.

  • Primary premature ejaculation
    • In addition to the general medical history, inquire about any prior psychological difficulties, as psychiatric conditions are more common in males with primary premature ejaculation than in the general population.
    • The history should include questions about the patient's early sexual experiences. Did he experience a traumatic sexual episode as a child or teenager? An example might be discovery by a parent during masturbation, with subsequent feelings of guilt. Alternatively, the patient may have been punished or threatened with punishment for masturbation.
    • Inquire about the patient's family relationships while he was growing up. How did he relate to his mother, father, brother(s), sister(s)? Does his family have a history of incest or sexual assault? Males can be sexually assaulted by other males and, in rare instances, by females, including siblings.
    • What were peer relationships like? Did he have other male friends, any female friends? How does he regard himself with respect to peers (eg, inferior, superior, athletic, frail, more intelligent, less intelligent)?
    • Does the patient have any difficulties with work (or school, if still a student)?
    • What is the patient's general attitude toward sex (ie, whether it is regarded as dirty), and what is the patient's sexual preference, fantasy, and arousal pattern?
    • Did the patient have a strict religious upbringing? If so, what was he taught about sex?
    • If the premature ejaculation began with an initial nonmarital relationship, does he feel guilt about this?
    • If the first coital experience was within a marital relationship that involved premature ejaculation from the start, inquire about premarital, noncoital sexual play between the partners.
    • Ask about the sexual attitude and response of the female partner; if she is having a problem, such as dyspareunia, it could relate to the male's problem or may have preceded it.
    • What is the nonsexual part of the relationship like? Does the couple fight or are they going through a power struggle?
    • If the patient’s sexual partner is not present for this interview, ask why (ie, whether the partner is not supportive or is blaming him).
    • Clues from these and similar questions usually point toward causation factors that may be addressed specifically with therapy.
  • Secondary premature ejaculation
    • In addition to a general medical history, the history should include details about prior relationships in which premature ejaculation was not a problem for this individual and any prior relationships in which transient episodes of premature ejaculation occurred.
    • In the current relationship, was premature ejaculation always a problem or did it start after an initial time frame when coitus was satisfactory to both partners?
    • Inquire specifically about the quality of the relationship with respect to nonsexual factors. Do the partners get along on most issues, or is conflict present? Who is dominant in the relationship, or is the relationship generally equal?
    • Did the patient’s female sexual partner accompany him to the clinic? If not, ask why. She may regard the problem as only his rather than a problem of the couple, which may be an important clue.
    • Does he have an impotence problem? If he has erectile dysfunction (ED), did is begin after the premature ejaculation or before? If the patient does not have ED, what is the general timing for the male (ie, commencement of intromission to climax)?
    • Can actual coitus be achieved or is it prevented by premature ejaculation?
    • Is the patient experiencing premature ejaculation with self-stimulation (ie, masturbation), with nonintercourse stimulation by the partner, or just with coitus?
    • What is the time required for the female partner to reach climax? Can she reach climax with intercourse, or does she require direct clitoral stimulation (oral or manual) to be able to climax?
    • If the patient has ED that began after the premature ejaculation, then treatment of both conditions may be required; sometimes, the ED resolves when the patient gains confidence in controlling his ejaculation. If the ED started initially, the premature ejaculation may be a secondary sexual dysfunction, which resolves when the patient is confident in being able to maintain his erection.
    • Clarification of these and other factors usually proves very helpful when arriving at a treatment plan.
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Physical

Physical examination findings are normal in males whose only presenting condition is premature ejaculation.

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Causes

The cause of premature ejaculation is considered psychological, although this has not been definitively confirmed.

  • Primary premature ejaculation
    • In patients with primary premature ejaculation, in which the male has never experienced sexual relations without also experiencing premature ejaculation, a deep-seated emotional disturbance (see History) may be present and the causes may be multiple.
    • Sometimes, the behavior is a conditioned response resulting from teen masturbation practices (see Introduction), but, sometimes, the patient has deep anxiety about sex that relates to one or more traumatic experiences encountered during development. Examples may include family incest, sexual assault, conflict with one or both parents, or other serious disturbances.
    • In most cases, a primary care physician or a urologist should consult with a psychiatrist, psychologist, or other professional in cases of primary premature ejaculation.
  • Secondary premature ejaculation
    • With regard to secondary premature ejaculation, some type of performance anxiety is often a major factor.
    • Performance pressure (ie, fear of failure to satisfy the partner) can arise from various precipitating events. ED is a common precipitating event. If the male is afraid his erection will not last, because of either actual instances of previous ED or imagined failure of his erection, this may precipitate premature ejaculation. The patient may have used the phrase, "Honey, you excited me so much I just could not hold back," which might be a way for him to avoid admitting to the humiliation of being unable to keep his erection throughout intercourse. If he climaxes quickly, he then has an excuse to justify his inability to maintain his erection.
    • However, a careful history (see History) is needed because the situation may be complex.
    • Perhaps ED is not a part of the problem. Possibly, his partner has belittled him with comments such as "You must not be much of a man, since you cannot stay hard until I am satisfied." In addition, she actually may have difficulty achieving climax through intercourse and may require direct clitoral stimulation to reach a climax. If she does not communicate this to him (and she may conceal it because of feelings about her own inadequacy), then he will always fail to provide coital satisfaction for her.
    • Because most physicians are not trained sex therapists, sorting out conflicts in the relationship and then referring couples for counseling to professionals with experience and training in that area is important. Physician who have some training or experience in the treatment of premature ejaculation and who are comfortable managing the problem may choose to begin treatment (eg, counseling, medication, both). If the patient does not respond favorably or if the physician is not comfortable with the treatment of premature ejaculation, then referral to a sex therapist, psychologist, or psychiatrist is the next step.
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Contributor Information and Disclosures
Author

Aaron Benson, MD  Staff Physician, Department of Surgery, Division of Urology, Southern Illinois University School of Medicine

Aaron Benson, MD is a member of the following medical societies: American Medical Association, American Urological Association, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Loren B Ost, MD  Associate Professor, Department of Surgery, Southern Illinois University School of Medicine; Urologist, SIU Physicians and Surgeons

Loren B Ost, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Mark Jeffrey Noble, MD  Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Milton Lakin, MD  Head, Section of Medical Urology, Urological Institute, Cleveland Clinic

Milton Lakin, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, and American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard Gabriel Gomella, MD, FACS  The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, Society for Basic Urologic Research, Society of University Urologists, and Society of Urologic Oncology

Disclosure: GSK Consulting fee Consulting; Astra Zeneca Honoraria Speaking and teaching; Watson Pharmaceuticals Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS  Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA Press; 1994.

  2. Buvat J. Pathophysiology of premature ejaculation. J Sex Med. Oct 2011;8 Suppl 4:316-27. [Medline].

  3. Peeters M, Giuliano F. Central neurophysiology and dopanergic control of ejaculation. Neurosci Biobehav Rev. 2008;32(3):438-53. [Medline].

  4. Corona G, Jannini EA, Mannucci E et al. Different testosterone levels are associated with ejaculatory dysfunction. J Sex Med. August 2008;8:1991-8. [Medline].

  5. Yao B, Li XY, Zhao ZM et al. Semen biochemical markers and their significance in the patients with premature ejaculation. Zhonghua Nan Ke Xue. December 2007;13(12):1084-6. [Medline].

  6. Corona G, Mannucci E, Jannini EA, Lotti F, Ricca V, Monami M, et al. Hypoprolactinemia: A New Clinical Syndrome in Patients with Sexual Dysfunction. J Sex Med. Feb 10 2009;[Medline].

  7. Patrick DL, Althof SE, Pryor JL, Rosen R, Rowland DL, Ho KF, et al. Premature ejaculation: an observational study of men and their partners. J Sex Med. May 2005;2(3):358-67. [Medline].

  8. Patrick DL, Rowland D, Rothman M. Interrelationships among measures of premature ejaculation: the central role of perceived control. J Sex Med. May 2007;4(3):780-8. [Medline].

  9. Verma KK, Khaitan BK, Singh OP. The frequency of sexual dysfunctions in patients attending a sex therapy clinic in north India. Arch Sex Behav. Jun 1998;27(3):309-14. [Medline].

  10. Giuliano F, Patrick DL, Porst H, La Pera G, Kokoszka A, Merchant S, et al. Premature ejaculation: results from a five-country European observational study. Eur Urol. May 2008;53(5):1048-57. [Medline].

  11. Frewen A, Rapee RM, Bowden P, Lagios K. Regional differences in men attending a sexual health clinic in Sydney for premature ejaculation. J Sex Med. Nov 2007;4(6):1733-8. [Medline].

  12. Mohee A, Eardley I. Medical therapy for premature ejaculation. Ther Adv Urol. Oct 2011;3(5):211-22. [Medline]. [Full Text].

  13. Masters WH, Johnson VE. Premature ejaculation. In: Human Sexual Inadequacy. Boston, Mass: Little Brown & Company; 1970:92-115.

  14. Choi HK, Jung GW, Moon KH, et al. Clinical study of SS-cream in patients with lifelong premature ejaculation. Urology. Feb 2000;55(2):257-61. [Medline].

  15. Xin ZC, Choi YD, Seong DH, Choi HK. Sensory evoked potential and effect of SS-cream in premature ejaculation. Yonsei Med J. Nov 1995;36(5):397-401. [Medline].

  16. Busato W, Galindo CC. Topical anaesthetic use for treating premature ejaculation: a double-blind, randomized, placebo-controlled study. BJU Int. May 2004;93(7):1018-21. [Medline].

  17. Henry R, Morales A. Topical lidocaine-prilocaine spray for the treatment of premature ejaculation: a proof of concept study. Int J Impot Res. Aug 2003;15(4):277-81. [Medline].

  18. Kilic S, Ergin, H, Baydinc YC. Venlafaxine extended release for the treatment of patients with premature ejaculation: a pilot, single-blind, placebo-controlled, fixed-dose crossover study on short-term administration of an antidepressant drug. Int J Androl. 2005;28:47. [Medline].

  19. Porst H. An overview of pharmacotherapy in premature ejaculation. J Sex Med. Oct 2011;8 Suppl 4:335-41. [Medline].

  20. Pryor JL, Althof SE, Steidle C, Rosen RC, Hellstrom WJ, Shabsigh R, et al. Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials. Lancet. Sep 9 2006;368(9539):929-37. [Medline].

  21. Safarinejad MR. Comparison of dapoxetine versus paroxetine in patients with premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. Clin Neuropharmacol. Sep-Oct 2006;29(5):243-52. [Medline].

  22. Safarinejad MR. Safety and efficacy of dapoxetine in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. Neuropsychopharmacology. May 2008;33(6):1259-65. [Medline].

  23. Giuliano F, Hellstrom WJ. The pharmacological treatment of premature ejaculation. BJU Int. Sep 2008;102(6):668-75. [Medline].

  24. Black K, Shea C, Dursun S, Kutcher S. Selective serotonin reuptake inhibitor discontinuation syndrome: proposed diagnostic criteria. J Psychiatry Neurosci. May 2000;25(3):255-61. [Medline].

  25. Colpi GM, Fanciullacci F, Aydos K, Grugnetti C. Effectiveness mechanism of chlomipramine by neurophysiological tests in subjects with true premature ejaculation. Andrologia. Jan-Feb 1991;23(1):45-7. [Medline].

  26. Girgis SM, El-Haggar S, El-Hermouzy S. A double-blind trial of clomipramine in premature ejaculation. Andrologia. Jul-Aug 1982;14(4):364-8. [Medline].

  27. Goodman RE. An assessment of clomipramine (Anafranil) in the treatment of premature ejaculation. J Int Med Res. 1980;8 Suppl 3:53-9. [Medline].

  28. Haensel SM, Rowland DL, Kallan KT. Clomipramine and sexual function in men with premature ejaculation and controls. J Urol. Oct 1996;156(4):1310-5. [Medline].

  29. Kim SC, Seo KK. Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: a double-blind, placebo controlled study. J Urol. Feb 1998;159(2):425-7. [Medline].

  30. Berkovitch M, Keresteci AG, Koren G. Efficacy of prilocaine-lidocaine cream in the treatment of premature ejaculation. J Urol. Oct 1995;154(4):1360-1. [Medline].

  31. Abdel-Hamid IA. Phosphodiesterase 5 inhibitors in rapid ejaculation: potential use and possible mechanisms of action. Drugs. 2004;64(1):13-26. [Medline].

  32. Mattos RM, Marmo Lucon A, Srougi M. Tadalafil and fluoxetine in premature ejaculation: prospective, randomized, double-blind, placebo-controlled study. Urol Int. 2008;80(2):162-5. [Medline].

  33. Chen J, Keren-Paz G, Bar-Yosef Y, Matzkin H. The role of phosphodiesterase type 5 inhibitors in the management of premature ejaculation: a critical analysis of basic science and clinical data. Eur Urol. Nov 2007;52(5):1331-9. [Medline].

  34. Blier P, Bergeron R, de Montigny C. Selective activation of postsynaptic 5-HT1A receptors induces rapid antidepressant response. Neuropsychopharmacology. May 1997;16(5):333-8. [Medline].

  35. [Best Evidence] Safarinejad MR. Once-daily high-dose pindolol for paroxetine-refractory premature ejaculation: a double-blind, placebo-controlled and randomized study. J Clin Psychopharmacol. Feb 2008;28(1):39-44. [Medline].

  36. Safarinejad MR, Hosseini SY. Safety and efficacy of tramadol in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. J Clin Psychopharmacol. Feb 2006;26(1):27-31. [Medline].

  37. Salem EA, Wilson SK, Bissada NK, Delk JR, Hellstrom WJ, Cleves MA. Tramadol HCL has promise in on-demand use to treat premature ejaculation. J Sex Med. Jan 2008;5(1):188-93. [Medline].

  38. Assalian P. Guidelines for the pharmacotherapy of premature ejaculation. World J Urol. Jun 2005;23(2):127-9. [Medline].

  39. Balon R. Antidepressants in the treatment of premature ejaculation. J Sex Marital Ther. 1996;22(2):85-96. [Medline].

  40. Blier P, Bergeron R. Effectiveness of pindolol with selected antidepressant drugs in the treatment of major depression. J Clin Psychopharmacol. 1995;15:217-22.

  41. Brown AJ. Ciprofloxacin as cure of premature ejaculation. J Sex Marital Ther. Oct-Dec 2000;26(4):351-2. [Medline].

  42. Carson C, Glasser D, Laumann E. Prevalence and correlates of premature ejaculation among men aged 40 years and older: a United States nationwide population-based study. Program and abstracts from the American Urological Association 98th Annual Meeting; April 26-May 1, 2003, Chicago, I. Abstracts of the American Urological Association 98th Annual Meeting; April 26-M.

  43. Cavallini G. Alpha-1 blockade pharmacotherapy in primitive psychogenic premature ejaculation resistant to psychotherapy. Eur Urol. 1995;28(2):126-30. [Medline].

  44. Chen J, Mabjeesh NJ, Matzkin H, Greenstein A. Efficacy of sildenafil as adjuvant therapy to selective serotonin reuptake inhibitor in alleviating premature ejaculation. Urology. Jan 2003;61(1):197-200. [Medline].

  45. Choi HK, Xin ZC, Choi YD, et al. Safety and efficacy study with various doses of SS-cream in patients with premature ejaculation in a double-blind, randomized, placebo controlled clinical study. Int J Impot Res. Oct 1999;11(5):261-4. [Medline].

  46. Clayton DO, Shen WW. Psychotropic drug-induced sexual function disorders: diagnosis, incidence and management. Drug Saf. Oct 1998;19(4):299-312. [Medline].

  47. Cohen PG. The association of premature ejaculation and hypogonadotropic hypogonadism. J Sex Marital Ther. Fall 1997;23(3):208-11. [Medline].

  48. Cohen PG, Holbrook JM. Effects of fenfluramine on ejaculatory function, luteinizing hormone and testosterone levels in men with hypogonadotropic hypogonadism and premature ejaculation. Int Clin Psychopharmacol. Mar 1999;14(2):91-4. [Medline].

  49. Cooper AJ, Cernovsky ZZ, Colussi K. Some clinical and psychometric characteristics of primary and secondary premature ejaculators. J Sex Marital Ther. Winter 1993;19(4):276-88. [Medline].

  50. Dunn KM, Croft PR, Hackett GI. Association of sexual problems with social, psychological, and physical problems in men and women: a cross sectional population survey. J Epidemiol Community Health. Mar 1999;53(3):144-8. [Medline].

  51. Eledjam JJ, Viel E, Bassoul B, Bruelle P. [Non-analgesic effects of opioids]. Cah Anesthesiol. 1991;39(2):111-4. [Medline].

  52. Epperly TD, Moore KE. Health issues in men: part I: Common genitourinary disorders. Am Fam Physician. Jun 15 2000;61(12):3657-64. [Medline].

  53. Fanciullacci F, Colpi GM, Beretta G, Zanollo A. Cortical evoked potentials in subjects with true premature ejaculation. Andrologia. Jul-Aug 1988;20(4):326-30. [Medline].

  54. Fein RL. Intracavernous medication for treatment of premature ejaculation. Urology. Apr 1990;35(4):301-3. [Medline].

  55. Godpodinoff ML. Premature ejaculation: clinical subgroups and etiology. J Sex Marital Ther. Summer 1989;15(2):130-4. [Medline].

  56. Goldmeier D, Keane FE, Carter P, et al. Prevalence of sexual dysfunction in heterosexual patients attending a central London genitourinary medicine clinic. Int J STD AIDS. May 1997;8(5):303-6. [Medline].

  57. Hellstrom WJG. Premature Ejaculation: Out of the Dark Ages and Into the 21st Century. Urology Times, Supplement. 2005;33:1-20.

  58. Homonnai ZT, Shilon M, Paz GF. Phenoxybenzamine--an effective male contraceptive pill. Contraception. May 1984;29(5):479-91. [Medline].

  59. Hsieh JT, Chang HC, Law HS, et al. In vivo evaluation of serotonergic agents and alpha-adrenergic blockers on premature ejaculation by inhibiting the seminal vesicle pressure response to electrical nerve stimulation. Br J Urol. Aug 1998;82(2):237-40. [Medline].

  60. Hurwitz MB. Sexual dysfunction associated with infertility. A comparison of sexual function during the fertile and the non-fertile phase of the menstrual cycle. S Afr Med J. Jul 15 1989;76(2):58-61. [Medline].

  61. Kara H, Aydin S, Yucel M, et al. The efficacy of fluoxetine in the treatment of premature ejaculation: a double-blind placebo controlled study. J Urol. Nov 1996;156(5):1631-2. [Medline].

  62. Kim JJ, Kwak TI, Jeon BG, et al. Effects of glans penis augmentation using hyaluronic acid gel for premature ejaculation. Int J Impot Res. Dec 2004;16(6):547-51. [Medline].

  63. Kim SW, Paick JS. Short-term analysis of the effects of as needed use of sertraline at 5 PM for the treatment of premature ejaculation. Urology. Sep 1999;54(3):544-7. [Medline].

  64. Korenman SG. New insights into erectile dysfunction: a practical approach. Am J Med. Aug 1998;105(2):135-44. [Medline].

  65. Kuhr CS, Heiman J, Cardenas D, et al. Premature emission after spinal cord injury. J Urol. Feb 1995;153(2):429-31. [Medline].

  66. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. Feb 10 1999;281(6):537-44. [Medline].

  67. Laumann EO, Paik A, Rosen RC. The epidemiology of erectile dysfunction: results from the National Health and Social Life Survey. Int J Impot Res. Sep 1999;11 Suppl 1:S60-4. [Medline].

  68. Levine SB. Premature ejaculation: some thoughts about its pathogenesis. J Sex Marital Ther. Summer 1975;1(4):326-34. [Medline].

  69. McMahon CG. Treatment of premature ejaculation with sertraline hydrochloride. Int J Impot Res. Sep 1998;10(3):181-4; discussion 185. [Medline].

  70. McMahon CG, Touma K. Treatment of premature ejaculation with paroxetine hydrochloride. Int J Impot Res. Oct 1999;11(5):241-245; discussion 246. [Medline].

  71. Metz ME, Pryor JL, Nesvacil LJ, et al. Premature ejaculation: a psychophysiological review. J Sex Marital Ther. Spring 1997;23(1):3-23. [Medline].

  72. Montague DK, Jarow J, Broderick GA, et al. AUA guideline on the pharmacologic management of premature ejaculation. J Urol. Jul 2004;172(1):290-4. [Medline].

  73. Nathan SG. The epidemiology of the DSM-III psychosexual dysfunctions. J Sex Marital Ther. Winter 1986;12(4):267-81. [Medline].

  74. Paick JS, Jeong H, Park MS. Penile sensitivity in men with premature ejaculation. Int J Impot Res. Dec 1998;10(4):247-50. [Medline].

  75. Pirke KM, Kockott G, Aldenhoff J, et al. Pituitary gonadal system function in patients with erectile impotence and premature ejaculation. Arch Sex Behav. Jan 1979;8(1):41-8. [Medline].

  76. Read S, King M, Watson J. Sexual dysfunction in primary medical care: prevalence, characteristics and detection by the general practitioner. J Public Health Med. Dec 1997;19(4):387-91. [Medline].

  77. Rosen RC. Prevalence and risk factors of sexual dysfunction in men and women. Curr Psychiatry Rep. Jun 2000;2(3):189-95. [Medline].

  78. Rowland DL, Haensel SM, Blom JH, Slob AK. Penile sensitivity in men with premature ejaculation and erectile dysfunction. J Sex Marital Ther. Fall 1993;19(3):189-97. [Medline].

  79. Safarinejad MR, Hosseini SY. Safety and efficacy of citalopram in the treatment of premature ejaculation: a double-blind placebo-controlled, fixed dose, randomized study. Int J Impot Res. Mar-Apr 2006;18(2):164-9. [Medline].

  80. Salonia A, Maga T, Colombo R, et al. A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation. J Urol. Dec 2002;168(6):2486-9. [Medline].

  81. Seftel AD, Althof SE. Rapid ejaculation. In: Sexual Dysfunction in Medicine. Vol 2. 2000:10-3.

  82. Spector IP, Carey MP. Incidence and prevalence of the sexual dysfunctions: a critical review of the empirical literature. Arch Sex Behav. Aug 1990;19(4):389-408. [Medline].

  83. Symonds T, Roblin D, Hart K, Althof S. How does premature ejaculation impact a man s life?. J Sex Marital Ther. Oct-Dec 2003;29(5):361-70. [Medline].

  84. Ventegodt S. [Sexuality and quality of life. Results from the quality of life-study of 4,626 Danes aged 31-33 years born at Rigshospitalet 1959-1961]. Ugeskr Laeger. Jul 22 1996;158(30):4299-304. [Medline].

  85. Virag R, Beck-Ardilly L. [Nosology, epidemiology, clinical quantification of erectile dysfunctions]. Rev Med Interne. 1997;18 Suppl 1:10s-13s. [Medline].

  86. Waldinger MD. Lifelong premature ejaculation: from authority-based to evidence-based medicine. BJU Int. 2005;95:191. [Medline].

  87. Waldinger MD. Premature ejaculation: state of the art. Urol Clin North Am. Nov 2007;34(4):591-9, vii-viii. [Medline].

  88. Waldinger MD, Olivier B. Utility of selective serotonin reuptake inhibitors in premature ejaculation. Curr Opin Investig Drugs. 2004;5:743. [Medline].

  89. Wiederholt I. [Treatment of premature ejaculation with an antiandrogen]. Psychiatr Prax. Aug 1977;4(3):176-80. [Medline].

  90. Xin ZC, Choi YD, Rha KH, Choi HK. Somatosensory evoked potentials in patients with primary premature ejaculation. J Urol. Aug 1997;158(2):451-5. [Medline].

  91. Xin ZC, Chung WS, Choi YD, et al. Penile sensitivity in patients with primary premature ejaculation. J Urol. Sep 1996;156(3):979-81. [Medline].

 
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