Premature Ejaculation 

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

Background

Premature ejaculation (PE; also known as rapid ejaculation) is the most common type of sexual dysfunction in men younger than 40 years. Most professionals who treat premature ejaculation define this condition as the occurrence of ejaculation prior to the wishes of both sexual partners. This broad definition thus avoids specifying a precise duration for sexual relations and reaching a climax, which is variable and depends on many factors specific to the individuals engaging in intimate relations. An occasional instance of premature ejaculation might not be cause for concern, but, if the problem occurs with more than 50% of attempted sexual relations, a dysfunctional pattern usually exists for which treatment may be appropriate.

To clarify, a male may reach climax after 8 minutes of sexual intercourse, but this is not premature ejaculation if his partner regularly climaxes in 5 minutes and both are satisfied with the timing. Another male might delay his ejaculation for a maximum of 20 minutes, yet he may consider this premature if his partner, even with foreplay, requires 35 minutes of stimulation before reaching climax. If intercourse is the method of sexual stimulation for the second example and the male climaxes after 20 minutes of intercourse and then loses his erection, satisfying his partner (at least with intercourse), who needs 35 minutes to climax, is impossible.

Because many females are unable to reach climax at all with vaginal intercourse (no matter how prolonged), this situation may actually represent delayed orgasm in the female partner rather than premature ejaculation in the male; the problem can be either or both, depending on the point of view. This highlights the importance of obtaining a thorough sexual history from the patient (and preferably from the couple).

The criteria for premature ejaculation stated in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revision (DSM-IV-TR) is as follows: (1) persistent and recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration before the person wishes it; (2) marked distress or interpersonal difficulty; and (3) not exclusively due to direct effects.

The human sexual response can be divided into 3 phases: desire (libido), excitement (arousal), and orgasm. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) classifies sexual disorders into 4 categories: (1) primary, (2) general medical condition–related, (3) substance-induced, and (4) not otherwise specified. Each of the 4 DSM-IV categories has disorders in all 3 sexual phases.[1]

Premature ejaculation may be primary or secondary. Primary premature ejaculation applies to individuals who have had the condition since they became capable of functioning sexually (ie, postpuberty). Secondary premature ejaculation means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control, and, for unknown reasons, he began experiencing premature ejaculation later in life. Secondary premature ejaculation does not relate to a general medical disorder and is usually not related to substance inducement, although, rarely, hyperexcitability might relate to a psychotropic drug and resolves when the drug is withdrawn. Premature ejaculation fits best into the category of "not otherwise specified" because the cause is unknown, although psychological factors are suggested in most cases.

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Pathophysiology

Premature ejaculation is believed to be a psychological problem and does not represent any known organic disease involving the male reproductive tract or any known lesions in the brain or nervous system. The organ systems directly affected by premature ejaculation include the male reproductive tract (ie, penis, prostate, seminal vesicles, testicles, and their appendages), the portions of the central and peripheral nervous system controlling the male reproductive tract, and the reproductive organ systems of the sexual partner (for the purpose of this discussion, the partner is assumed to be female) that may not be stimulated sufficiently to achieve orgasm.[2]

If the premature ejaculation occurs so early that it happens before commencement of sexual intercourse and the couple is attempting pregnancy, then pregnancy is impossible to achieve unless artificial insemination is used. Perhaps the most affected organ system is the psyche of the partners. Both partners are likely to be dissatisfied emotionally and physically by this problem.

From an evolutionary perspective, logic may dictate that males who can ejaculate rapidly would be more likely to succeed in fertilizing a female than males who require prolonged stimulation to reach climax. The genes of a male who ejaculates rapidly (but not so rapidly that ejaculation occurs before intromission) would be more likely to be passed on to succeeding generations. In a primitive sense, a male who could not complete the fertilization process quickly might be pushed away or killed by a competing male because of his obvious vulnerability during intercourse.

Premature ejaculation has historically been considered a psychological disorder. One theory is that males are conditioned by societal pressures to reach climax quickly because of fear of discovery when masturbating as teenagers or during early sexual experiences "in the back seat of the car" or with a prostitute. This pattern of rapid attainment of sexual release is difficult to change in marital or long-term relationships. The fact that female arousal and orgasm require more time than male arousal is being increasingly recognized, and this may result in increased recognition and definition of premature ejaculation as a problem.

Some have questioned whether premature ejaculation is purely psychological. A number of investigators have found differences in nerve conduction/latency times and hormonal differences in men who experience premature ejaculation compared with individuals who do not. The theory is that some men have hyperexcitability or oversensitivity of their genitalia, thus preventing down-regulation of their sympathetic pathways and delay of orgasm. Recently, a certain group of nerves in the lumbar spinal cord has been identified as the possible generator of ejaculation. This nerve site is thought to be linked to excitatory and inhibitory dopamine pathways in the brain, which play significant roles in sexual behavior. This knowledge, while continuing to be researched, is providing the foundation for possible development of medications specifically targeting delay of ejaculation.[3]

Other questions have been raised regarding possible biochemical factors in premature ejaculation. Testosterone is thought to play a role in the ejaculatory reflex. Higher testosterone (free and total) levels have been demonstrated in men with premature ejaculation than in men without premature ejaculation.[4]

Research published in a Chinese andrology journal showed that semen from men with premature ejaculation contained significantly less acid phosphatase and alpha-glucosidase than did the semen of controls.[5] These researchers concluded that these biochemical parameters may reflect dysfunction of the prostate and epididymis, possibly contributing to premature ejaculation; however, these have yet to be supported by subsequent studies.

In other biochemical parameters, many men with premature ejaculation have been shown to have low serum levels of prolactin.[6] However, in this same study of prolactin in men with sexual dysfunction, men in the lowest quartile of serum prolactin levels who had premature ejaculation also demonstrated associated metabolic syndrome, erectile dysfunction, and anxiety. In other words, while biochemical markers such as prolactin may contribute to premature ejaculation, organic and psychological associations (ie, anxiety) suggest that biochemical parameters play only a partial role in premature ejaculation. Further research is needed.

While other factors may play roles of unknown significance, psychological factors have been found to contribute greatly to premature ejaculation beyond merely the time to ejaculation. While patients with premature ejaculation show significantly lower intravaginal ejaculatory latency time (IELT), the IELT in those who fit the DSM-IV-TR criteria for premature ejaculation overlaps with the IELT in patients who do not fit the criteria.[7] However, while a shorter IELT has been the measure of premature ejaculation in many studies, the perception of ejaculation control has been shown to mediate patient and/or partner satisfaction with sexual intercourse and ejaculation-related distress.[8] While premature ejaculation is most likely not a purely psychological disorder, such associations demonstrate a significant psychological role in the disorder.

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Epidemiology

Frequency

United States

An estimated 30%-70% of American males experience premature ejaculation. The National Health and Social Life Survey (NHSLS) indicates a prevalence of 30%, which is fairly steady through all adult age categories. (In contrast, erectile dysfunction [ED] rises in prevalence with increasing age). However, various surveys have shown that many men do not report premature ejaculation to their physician, possibly because of embarrassment or a feeling that no treatment is available for the problem. Some men might not even perceive premature ejaculation as a medical problem. Such survey data suggest that the percentage of men who experience premature ejaculation at some point in their lives is almost certainly more than the 30% reported in the NHSLS.

International

Estimates of premature ejaculation in European countries and India mirror the prevalence in the United States.[9] The prevalence in other parts of Asia, Africa, Australia, and elsewhere is unknown.

Mortality/Morbidity

No known direct morbidity or mortality results from premature ejaculation. Indirectly, premature ejaculation may alter self-esteem, may cause marital dysfunction, and may be a factor in depression, with its obvious consequences.

Race

Although no reproducible data exist on major differences between racial groups with respect to the incidence or prevalence of premature ejaculation, a few recent surveys suggest that some racial variation may exist with respect to this condition. A telephone survey by Carson et al (2003) found in interviews of 1320 men without ED that 21% of non-Hispanic African Americans reported premature ejaculation, while 29% of Hispanics and 16% of non-Hispanic whites reported the condition. An analysis by Laumann et al (1999) of the NHSLS found that premature ejaculation was more prevalent among African American men (34%) and white men (29%) than among Hispanic men (27%).[10]

In a small study of a sexual health clinic in Australia, 59% of premature ejaculation diagnoses were in men of Asian or Middle Eastern descent, while 41% were of Western or European birth.[11] However, drawing firm conclusions from these data is difficult in view of the small number of such studies and lack of suitable controls.

Sex

Premature ejaculation is a condition that only affects males.

Age

Premature ejaculation can occur at virtually any age in an adult man's life. As a reported condition, it is most common in younger men (aged 18-30 y) but may also occur in conjunction with secondary impotence in men aged 45-65 years.

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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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