Premature Ejaculation Differential Diagnoses

Updated: May 19, 2023
  • Author: Samuel G Deem, DO; Chief Editor: Edward David Kim, MD, FACS  more...
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Diagnostic Considerations

Several other conditions must be considered in making a diagnosis of premature (early) ejaculation.

One such condition is severely delayed orgasm in the female partner. The term “delayed” is relative in this context; the average time to climax in females varies but averages 12-25 minutes, according to many studies, and 3 hours, for example, would be well outside the norm. In extreme cases of delayed or difficult orgasm in the female partner, almost any male would be considered to have premature ejaculation. The partner’s sexual response must always be taken into account.

Another such condition is an adverse effect from a psychotropic drug. If the premature ejaculation started in association with the commencement of psychotropic pharmacotherapy but ceased when the drug was withdrawn, one should strongly consider a relationship between the two events.

In addition, preejaculate may be mistaken for premature ejaculation. Preejaculate is the lubricating fluid produced by Cowper glands and other glands during the excitement phase of sexual stimulation. A detailed sexual history should clarify this matter and enable the clinician to reassure the male as to what is actually happening.

Erectile dysfunction may be associated with premature ejaculation, and it may be difficult or impossible to establish which condition developed first. [20] For lifelong premature ejaculation, associations with certain anxiety disorders have been noted. For acquired premature ejaculation, associations with drug withdrawal, thyroid disease, and prostatitis have been found. [19]

A study of men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) found that the odds ratio (OR) for premature ejaculation significantly increased with the severity of pelvic pain, from 1.269 in men with mild prostatitis-like symptoms to 2.134 in men with moderate to severe symptoms. These authors suggested routine screening for CP/CPPS in men with premature ejaculation and for premature ejaculation in men with CP/CPPS. [21]