Premature ejaculation

Specialty: Nephrology and urology.

• premature climax
• rapid ejaculation
• low ejaculatory latency time

Why it occurs

• Hypersensitivity of the glans penis or abnormalities of central serotonergic receptors (primary neurobiological causes)
• Performance anxiety or interpersonal psychological stress factors (anxiety that increases sympathetic tone and accelerates the ejaculatory reflex)
• Chronic prostatitis or active urethritis (pelvic and lower urinary tract inflammation alters the ejaculatory reflex arc causing early involuntary emission)
• Thyroid dysfunction (hyperthyroidism, where elevated thyroid hormones generally accelerate sympathetic responses)
• Prolonged periods of sexual abstinence (which lead to greater rapid initial arousal)

Initial workup

Application of validated scales and questionnaires such as the PEDT (Premature Ejaculation Diagnostic Tool) and recording of the intravaginal ejaculatory latency time (IELT); complete thyroid profile (TSH, free T4); Complete genitourinary physical examination including digital rectal examination to rule out chronic prostatitis if urinary symptoms or perineal pain coexist.

Standard management

• Dapoxetine — 30-60 mg orally administered 1 to 3 hours before sexual intercourse; ultra-short-acting selective serotonin reuptake inhibitor - SSRI - developed specifically for the on-demand treatment of premature ejaculation; contraindicated in hepatic failure, severe heart failure or concomitant use of MAOIs
• Paroxetine — 10-20 mg daily orally, chronic continuous daily use as an off-label indication, taking advantage of its side effect of delaying orgasm through central serotonergic modulation
• Lidocaine/Prilocaine cream or spray (apply locally to the glans 10 to 15 minutes before intercourse, wiping off excess or using a condom to prevent numbness for the partner and maintain the necessary stimulation).