eMedicine Specialties > Urology > Erectile Dysfunction, Premature Ejaculation, and Sexual Disorders

Premature Ejaculation: Differential Diagnoses & Workup

Author: Aaron Benson, MD, Staff Physician, Department of Surgery, Division of Urology, Southern Illinois University School of Medicine
Coauthor(s): Loren B Ost, MD, Associate Professor, Department of Surgery, Southern Illinois University School of Medicine; Urologist, SIU Physicians and Surgeons; Mark Jeffrey Noble, MD, Consulting Staff, Urologic Institute, Cleveland Clinic Foundation; Milton Lakin, MD, Head, Section of Medical Urology, Urological Institute, Cleveland Clinic
Contributor Information and Disclosures

Updated: May 5, 2009

Differential Diagnoses

Other Problems to Be Considered

  • Anorgasmia or severely delayed orgasm in the female partner: In this context, the term delayed is relative, as the average time to climax in females varies but averages 12-25 min according to many studies. Three hours needed to reach climax, for example, is well outside the norm. In extreme cases of delayed or difficult orgasm in the female partner, nearly all men would be considered to have premature ejaculation (rapid ejaculation). The partner's sexual response must be considered.
  • Adverse effect from a psychotropic drug: If the premature ejaculation started in association with commencement of a psychotropic drug but ceases when the drug is withdrawn, one should strongly consider that the two are related.
  • Pre-ejaculate: This may be confused as premature ejaculation. Pre-ejaculate is the lubricating fluids produced by Cowper glands and other glands during the excitement phase of sexual stimulation. A detailed sexual history should clarify this matter and should enable reassurance of the male as to what is actually happening.
  • Erectile dysfunction (ED): This may be a clinical symptom in some men who are actually experiencing premature ejaculation. Differentiating between the two problems is important.

Workup

Laboratory Studies

  • In males with premature ejaculation (rapid ejaculation) and no other medical problems, no specific conventional laboratory tests aid or affect treatment.
  • Checking a serum testosterone (free and total) level and prolactin level may be appropriate if premature ejaculation is observed in conjunction with an impotence problem.
  • If depression or other conditions coexist, laboratory studies specific to depression or to another medical or psychological problem are appropriate.
  • Some investigators are performing vibrational threshold testing on volunteer subjects; others are using nerve conduction times, somatosensory latency testing, or both. A few investigators are evaluating the hypothalamic-pituitary-gonadal axis, some are testing melatonin levels, and some are measuring levels of carbon monoxide and nitric oxide (mediators of male sexual function). However, all such determinations must be considered experimental at this time, and they have no applicability to current clinical practice.

More on Premature Ejaculation

Overview: Premature Ejaculation
Differential Diagnoses & Workup: Premature Ejaculation
Treatment & Medication: Premature Ejaculation
Follow-up: Premature Ejaculation
References
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References

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Further Reading

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Keywords

premature ejaculation, PE, primary premature ejaculation, secondary premature ejaculation, sexual dysfunction, ED, erectile dysfunction, rapid ejaculation, premature ejaculator, rapid ejaculator, performance anxiety, performance pressure, impotence, erection problem, rapid sexual release, primary PE, secondary PE, anorgasmia, lifelong premature ejaculation, acquired premature ejaculation

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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.

Medical Editor

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, 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

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
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: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

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, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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