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ejaculation started in association with the commencement of psychotropic pharmacotherapy but ceased when the drug was withdrawn, one should strongly consider a relationship between the two events.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]

Workup

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Author

Samuel G Deem, DO Faculty, Department of Urology, Charleston Area Medical Center

Samuel G Deem, DO is a member of the following medical societies: American College of Surgeons, American Osteopathic Association, American Urological Association, Endourological Society, Society of Urologic Oncology, American Society of Clinical Oncology, American College of Osteopathic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Kevin P Brown, DO Resident Physician, Department of Urology, Charleston Area Medical Center

Kevin P Brown, DO is a member of the following medical societies: American Osteopathic Association, American Urological Association

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Urology, Department 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 Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

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. 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

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.

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.

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.

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

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