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

Premature Ejaculation: Follow-up

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

Follow-up

Further Outpatient Care

  • Outpatient care can be scheduled as appropriate for the clinical circumstances.

Inpatient & Outpatient Medications

  • Premature ejaculation (rapid ejaculation) is a nonurgent problem that is treated best in an outpatient setting. Medication can be part of the treatment, and adjustments to medication may be necessary based on patient response. (See Treatment and Medication).

Deterrence/Prevention

  • Future research might indicate whether the incidence of premature ejaculation in young men can be decreased by better sex education during adolescence. Early successful treatment of erectile dysfunction (ED) possibly prevents secondary premature ejaculation in older men.

Complications

  • Severe premature ejaculation can cause stress within a marriage or other relationship, which might contribute to conflicts and separation or divorce in some cases.
  • Conception is also difficult in cases of premature ejaculation before vaginal intromission.

Prognosis

  • Masters and Johnson claim that the great majority of men with premature ejaculation (>85%) can be treated successfully with the squeeze-pause technique alone. In most cases, they claim success is achieved within 3 months of the start of therapy.
  • Although Masters and Johnson reported good results with the squeeze technique, clinical experience varies widely and some authors have observed much poorer success.11
  • With a combination of methods, including selective serotonin reuptake inhibitor (SSRI)–type medications, achieving improvement or cure in most cases should be possible, provided that the couple (not just the man) is committed to working on this problem together.
  • Numerous published reports also indicate that counseling and medical therapy can help achieve success rates as high as 85%, certainly equal to that reported originally by Masters and Johnson.
  • The problem with all treatments for premature ejaculation is that the relapse rate is 20-50%, depending on the study; thus, the durability of the response can be questionable. Some males may need to make a long-term commitment to periodically repeating the behavioral techniques (long-standing habits can be difficult to modify). Some who succeed with medical therapy (ie, SSRIs) might need to use the medication for the rest of their lives, just as some people with depression need life-long medication to avoid repeated bouts of depression or many with high blood pressure need life-long antihypertensives to control their blood pressure. The precise long-term failure rates are not well established and depend on the duration of follow-up for a particular cohort of patients.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Because premature ejaculation (rapid ejaculation) is not a medically dangerous condition, a failure to diagnose or to treat this condition successfully usually does not result in medicolegal problems.
  • Before the availability of several nonsurgical methods for treating erectile dysfunction (ED), a patient mistakenly diagnosed with ED might have undergone a penile prosthesis implantation that would have yielded unsatisfactory results for the patient because of the incorrect initial diagnosis. Even in this scenario, the patient would climax prematurely, but he would still be able to engage in sexual intercourse because his erection would remain adequate because of the presence of the penile implant. Currently, penile implants are placed much more rarely, and with the use of nonsurgical treatments for ED, any permanent harm resulting from diagnosing ED rather than premature ejaculation is unlikely.
 


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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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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