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      An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE)

      review-article
      , PhD * , , MD , , MD, PhD , , MD § , , MD , , PhD, DSc ** , , MD, PhD †† , , MD ‡‡ , , MD, PhD §§ , , MD ¶¶ , , MD, PhD *** , , MD, PhD ††† , , MD, PhD ‡‡‡ , , MD §§§ , , PhD ¶¶¶ , , MD **** , , PhD †††† , , MD, PhD ‡‡‡‡ , , MD §§§§ , , MD ¶¶¶¶
      Sexual Medicine
      Blackwell Publishing Ltd
      Premature Ejaculation, Definition of PE, Diagnosis of PE, Etiology of PE, Pharmacotherapy of PE, Prevalence of PE, Psychotherapy of PE

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          Abstract

          Introduction

          In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts.

          Aim

          The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts.

          Method

          A comprehensive literature review was performed.

          Results

          This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients.

          Conclusion

          Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60–90.

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          Most cited references259

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          Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors.

          The Global Study of Sexual Attitudes and Behaviors (GSSAB) is an international survey of various aspects of sex and relationships among adults aged 40-80 y. An analysis of GSSAB data was performed to estimate the prevalence and correlates of sexual problems in 13,882 women and 13,618 men from 29 countries. The overall response rate was modest; however, the estimates of prevalence of sexual problems are comparable with published values. Several factors consistently elevated the likelihood of sexual problems. Age was an important correlate of lubrication difficulties among women and of several sexual problems, including a lack of interest in sex, the inability to reach orgasm, and erectile difficulties among men. We conclude that sexual difficulties are relatively common among mature adults throughout the world. Sexual problems tend to be more associated with physical health and aging among men than women.
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            The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking.

            This study evaluated the associated comorbidities and patient satisfaction with treatment options for premature ejaculation (PE), a common sexual dysfunction. A comprehensive, Internet-based survey (the PE Prevalence and Attitudes [PEPA] survey) was conducted among men ages 18-70 in the United States, Germany, and Italy (n=12,133). Men were classified as having PE based on self-report of low or absent control over ejaculation, resulting in distress for them or their sexual partner or both. The prevalence of PE was 22.7% (24.0% in the United States, 20.3% in Germany, and 20.0% in Italy) and did not vary significantly with age among men over age 24 yr. Men with PE were more likely to self-report other sexual dysfunctions (e.g., anorgasmia, low libido, erectile dysfunction) and psychological disturbances (e.g., depression, anxiety, excessive stress) than men without PE (p 70%) and most likely to have used (>50%) special positions during sex, interrupted stimulation, masturbation, and having intercourse more often than usual to manage their PE. Only 9.0% of men with PE reported having consulted a physician for the condition; 81.9% had to initiate the conversation about PE and 91.5% reported little or no improvement as a result of seeking treatment. PE is a highly prevalent sexual problem, with significant sexual and psychological comorbidities. Most men with PE do not seek assistance from their physician, and most of those who do are not satisfied with the results.
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              Development and validation of a premature ejaculation diagnostic tool.

              Diagnosis of premature ejaculation (PE) for clinical trial purposes has typically relied on intravaginal ejaculation latency time (IELT) for entry, but this parameter does not capture the multidimensional nature of PE. Therefore, the aim was to develop a brief, multidimensional, psychometrically validated instrument for diagnosing PE status. The questionnaire development involved three stages: (1) Five focus groups and six individual interviews were conducted to develop the content; (2) psychometric validation using three different groups of men; and (3) generation of a scoring system. For psychometric validation/scoring system development, data was collected from (1) men with PE based on clinician diagnosis, using DSM-IV-TR, who also had IELTs or =11 PE. The development and validation of this new PE diagnostic tool has resulted in a new, user-friendly, and brief self-report questionnaire for use in clinical trials to diagnose PE.
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                Author and article information

                Journal
                Sex Med
                Sex Med
                sm2
                Sexual Medicine
                Blackwell Publishing Ltd (Oxford, UK )
                2050-1161
                2050-1161
                June 2014
                22 May 2014
                : 2
                : 2
                : 60-90
                Affiliations
                [* ]Department of Psychiatry, Case Western Reserve University School of Medicine West Palm Beach, FL, USA
                []Australian Center for Sexual Health Sydney, NSW, Australia
                []Division of Pharmacology, Department of Pharmaceutical Sciences, Utrecht University Utrecht, The Netherlands
                [§ ]Department of Urology, Bagcilar Training & Research Hospital Istanbul, Merkez Mah, Turkey
                []Department of Urology, University of California at Davis CA, USA
                [** ]Department of Obstetrics and Gynecology, National University of Singapore Singapore, Singapore
                [†† ]Division of Urology, University of Buenos Aires Buenos Aires, Argentina
                [‡‡ ]St. Peter's Sexual Medicine, The London Clinic London, UK
                [§§ ]Neuro-Uro-Andrology, Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital Garches, France
                [¶¶ ]Department of Urology, Tulane University Health Sciences Center New Orleans, LA, USA
                [*** ]Department of Sexological Research, Psychiatric Center Copenhagen, Rigshospitalet Copenhagen, Denmark
                [††† ]Department of Urology, Instituto H. Ellis Sao Paulo, Brazil
                [‡‡‡ ]Erasmus MC-Daniel den Hoed Cancer Center Rotterdam, The Netherlands
                [§§§ ]School of Sexology, Department of Clinical, Applied and Biotechnological Sciences, University of L'Aquila L'Aquila, Italy
                [¶¶¶ ]School of Psychology, Deakin University Burwood, Vic., Australia
                [**** ]Albert Einstein College of Medicine, Department of Medicine, Montefiore Medical Center Bronx, NY, USA
                [†††† ]Graduate School, Valparaiso University Valparaiso, IN, USA
                [‡‡‡‡ ]Department of Psychiatry, Case Western Reserve University School of Medicine Cleveland, OH, USA
                [§§§§ ]Department of Urology, University of California San Francisco, CA, USA
                [¶¶¶¶ ]Clinica de Urologia e Andrologia Belo-Horizonte, Minas-Gerais, Brazil
                Author notes
                Corresponding Author: Stanley Althof, PhD, Center for Marital and Sexual Health of South Florida, Case Western Reserve University School of Medicine, 1515 N. Flagler Drive, Suite 540, West Palm Beach, FL 33401, USA. Tel: (561) 822-5454; Fax: (561) 822 5458; E-mail: stanley.althof@ 123456case.edu
                Article
                10.1002/sm2.28
                4184677
                25356302
                6aae92d6-0589-41f3-9796-88a838bddc22
                © 2014 The Authors. Sexual Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Sexual Medicine.

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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                premature ejaculation,definition of pe,diagnosis of pe,etiology of pe,pharmacotherapy of pe,prevalence of pe,psychotherapy of pe

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