An Update of the International Society of Sexual Medicine’s Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE)
aldosterone
Stanley E. Althof, Ph.D1., Chris G. McMahon, M.D.2, Marcel D. Waldinger, M.D., Ph.D.3, Ege Can Serefoglu, M.D.4, Alan Shindel, M.D.5, Ganesh Adaikan Ph.D.6, Edgardo Becher, M.D.7, John Dean, M.D.8, Francois Giuliano, M.D., Ph.D.9, Wayne J.G. Hellstrom, M.D.10, Annamaria Giraldi, M.D., Ph.D.11, Sidney Glina, M.D., Ph.D.12, Luca Incrocci, M.D., Ph.D.13, Emmanuele Jannani, M.D.14, Marita McCabe, Ph.D.15, Sharon Parish, M.D.16, David Rowland, Ph.D.17, R Taylor Segraves, M.D., Ph.D.18, Ira Sharlip, M.D.19, Luiz Otavio Torres, M.D.20
1Department of Psychiatry, Ca Western Rerve University School of Medicine, West Palm Beach, FL, USA;
at one
2Australian Center for Sexual Health, Sydney, NSW, Australia; 3Department of Psychiatry and Neuroxology, HagaHospital Leyenburg, 4Bagcilar Training & Rearch Hospital, Department of Urology Merkez Mah, Istanbul, Turkey; 5The Hague, The Netherlands;5Department of Urology, University of California at Davis, CA, USA; 6National University of Singapore Department of Obstetrics and Gynecology, Singapore; 7Division of Urology, University of Buenos Aires. Buenos Aires, Argentina;
St. Peter’s Sexual Medicine, 8The London Clinic, London, UK; Neuro-Uro-Andrology, 9Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, Paris, FR; 10Department of Urology, Tulane University Health Sciences Center, New Orleans, LA, USA; 11Department of Sexological Rearch Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; 12Department of Urology, Instituto H. Ellis, Sao Paulo, Brazil;13Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands; 14Cour of Endocrinology and Medical Sexology, Department of Experimental Medicine, University of L’Aquila, L’Aquila, Italy; 15School of Psychology, Deakin University, Burwood, Vic., Australia; 16Albert Einstein College of Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA; 17Graduate School, Valparaiso University, Valparaiso, IN, USA;
18Department of Psychiatry, Ca Western Rerve University School of Medicine, Cleveland, OH, USA;
19Department of Urology, University of California, San Francisco, CA, USA; 20Clinica de Urologia e Andrologia, Belo-Horizonte, Minas-Gerais, Brazil
Introduction
In 2009, the International Society of Sexual Medicine (ISSM) convened a lect panel of experts to develop an evidence-bad t of guidelines for patients suffering from lifelong premature ejaculation (PE)1. That document reviewed definitions, etiology, impact on the patient and partner, asssment, and pharmacological, psychological and combined treatments. It concluded by recognizing the continually evolving nature of clinical rearch and recommended a subquent guideline review and revision every 4th year.
Consistent with that recommendation, the ISSM organized a 2nd multidisciplinary panel of experts in April, 2013 which met for 2 days in Bangalore, India. The committee members were lected to assure diversity of discipline, balance of opinion, knowledge, gender and geography. Twenty members consisting of 9 urologists, 3 psychiatrists, 3 psychologists, 1 family practice physician, 1 endocrinologist, 1 xual medicine physician, 1 radiation oncologist and 1 pharmacologist comprid the group. The Committee was chaired by Chris McMahon, M.D.
Prior to the meeting, the Committee members received a comprehensive literature review and were asked to critically asss the previous guidelines. Members were assigned specific topic for prentation and a writing committee was chon to craft this document. Quality of evidence and the strength of recommendation were graded using the Oxford Centre of Evidence-Bad Medicine syst
em2.
The meeting was supported by an unrestricted grant from Johnson and Johnson (Johnson and Johnson, New Brunswick New Jery), the manufacturer of dapoxetine. ISSM required complete independence from industry; there were no industry reprentatives at the meeting and there was no attempt by industry to influence the writing process at any time3. Members were required to declare in advance any conflicts of interests.
Definitions of Premature Ejaculation
Several definitions for PE exist, having been drafted by various professional organizations or professionals4-11(e Table 1). Most include the PE subtypes of lifelong and acquired (PE symptoms beginning after a period of normal ejaculatory function).
The major criticisms of the extant definitions included their failure to be evidence-bad, lack of specific operational criteria, excessive vagueness, and reliance on the subjective judgment of the diagnostician12. Nonetheless, three common constructs underlie most definitions of PE: 1) a short ejaculatory latency; 2) a perceived lack of control or inability to delay ejaculation; both related to the broader construct of perceived lf-efficacy; and 3) distress and interpersonal difficulty to the individu
al and/or partner (related to the ejaculatory dysfunction)12.
Table 1–Definitions of Premature Ejaculation Established through Connsus Committees and/or Professional Organizations
Definition Source
A male xual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within one minute of vaginal penetration, either prent from the first xual experience or following a new bothersome change in ejaculatory latency, and the inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal conquences, such as distress bother, frustration and/or the avoidance of xual intimacy International Society of Sexual Medicine, 2013
ui设计培训机构好A. Persistent or recurrent pattern of ejaculation occurring during partnered
xual activity within approximately 1 minute following vaginal penetration and
before the individual wishes it ( Note: Although the diagnosis of premature
(early) ejaculation may be applied to individuals engaged in non-vaginal xual
activities, specific duration criteria have not been established for the
activities)
B.The symptom in Criterion A must have been prent for at least 6 months
and must be experienced on almost all or all ( approximately 75%-100%)
occasions of xual activity ( in identified situational contexts or, if generalized,
in all contexts)
C. The symptom in Criteria A caus clinically significant distress in the
individual.
D.The xual dysfunction is not better explained by a nonxual mental
disorder or as a conquence of vere relationship distress or other significant
stressors and is not attributable to the effects of a substance/medication or
another medical disorder.
DSM – 5, 2013
Persistent or recurrent ejaculation with minimal xual stimulation, before, on
or shortly after penetration and before the person wishes it. The condition
must also cau marked distress or interpersonal difficulty and cannot be due
exclusively to the direct effects of a substance
DSM-IV-TR, 2000
For individuals who meet the general criteria for xual dysfunction, the inability to control ejaculation sufficiently for both partners to enjoy xual interaction, manifest as either the occurrence of ejaculation before or very soon after the beginning of intercour (if a time limit is required, before or within 15 conds) or the occurrence of ejaculation in the abnce of sufficient erection to make intercour possible. The problem is not the result of prolonged abnce from xual activity International Statistical Classification of Dia, 10th Edition, 1994
minosThe inability to control ejaculation for a “sufficient” length of time before vaginal penetration. It does not involve any impairment of fertility, when intravaginal ejaculation occurs European Association of Urology. Guidelines on Disorders of Ejaculation, 2001
商务英语专业描述
Persistent or recurrent ejaculation with minimal stimulation before, on, or shortly after penetration, and before the person wishes it, over which the sufferer has little or no voluntary control, which caus the sufferer and/or his partner bother or distress International Consultation on Urological Dias, 2004
园林设计培训Ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners American Urological Association Guideline on the Pharmacologic Management of Premature Ejaculation, 2004
Becau of the discontent with the existing PE definitions, as well as pressure from regulatory agencies concerning the inadequacy of the definitions, the ISSM convened in 2007 and again in 2013 a meeting of experts to develop a definition grounded in clearly definable scientific criteria12. After carefully reviewing the literature, the Committee propod that PE is,
日本重启商业捕鲸“ … a male xual dysfunction characterized by
–ejaculation which always or nearly always occurs prior to
or within about one minute of vaginal penetration from
the first xual experience (lifelong premature
ejaculation), OR, a clinically significant reduction in latency
time, often to about 3 minutes or less (acquired premature
ejaculation), and
–the inability to delay ejaculation on all or nearly all
vaginal penetrations, and
–negative personal conquences, such as distress,
bother, frustration and/or the avoidance of xual intimacyessay
(LOE 1a)
The definition applies to both lifelong and acquired PE but is limited to intravaginal xual activity, as correlations between coital, oral x and masturbatory latencies are not consistently high. In addition, it does not define PE when men have x with men. The Committee concluded that there was insufficient information available to extend the definition to the other situations or groups.(LOE 5d)置换反应
li anThe DSM-513definition of premature (early) ejaculation, published in 2013, is consistent with the ISSM definition and includes the approximately 1 minute Intravaginal Ejaculatory Latency Time (IELT) criteria as well as the inclusion of distress. It also asks the clinician to specify the subtypes of lifelong and acquired, generalized or situational as well as the verity of the dysfunction.
Anteportal ejaculation is the term applied to men who ejaculate prior to vaginal penetration and is considered the most vere form of PE. Such men or couples typically prent when they are having difficulty conceiving children. It is estimated that between 5% and 20% of men with lifelong PE suffer from anteportal PE14.
The committee recognized that some men who lf-diagno PE and prent for treatment fail to fulfill the ISSM criteria for PE. Waldinger has propod two additional “subtypes” of men who are dis
tresd about their ejaculatory function but do not meet the diagnostic criterion for PE. He designated them as Variable PE (VPE) and Subjective PE (SPE)10, 15. The subtypes should be considered provisional; however, we believe the categories may help health care professionals (HCPs) address the concerns of men who do not qualify for the diagnosis of PE but are eking help. VPE is characterized by short ejaculatory latency which occurs irregularly and inconsistently with some subjective n of diminished control of ejaculation. This subtype is not considered a xual dysfunction but rather a normal variation in xual performance. SPE is characterized by one or more of the following: 1) subjective perception of consistent or inconsistent short IELT; 2)
preoccupation with an imagined short ejaculatory latency or lack of control over the timing of ejaculation; 3) actual IELT in the normal range or even of longer duration (i.e. an ejaculation that occurs after 5 minutes); 4) ability to control ejaculation (i.e. to withhold ejaculation at the moment of imminent ejaculation) that may be diminished or lacking and; 5) the preoccupation that is not better accounted for by another mental disorder. (LOE 5d)
Epidemiology
Premature ejaculation has been recognized as a syndrome for well over 100 years16. Despite this lo
ng history, the prevalence of the condition remains unclear. This ambiguity derives in large part from the difficulty defining what constitutes clinically relevant PE. Vague definitions without specific operational criteria, different modes of sampling, and non-standardized data acquisition have led to tremendous variability in estimated prevalence1, 12, 17-19. The nsitive nature of PE further hampers the reliability of epidemiologic studies; the small fraction of the male population willing to answer questions concerning their xual lives may not be reprentative of the larger population of men20, 21. And, some men with genuinely rapid ejaculation times may be reluctant to report this complaint due to worry about social stigmatization22. Converly, healthy individuals may report PE becau of the incentives provided by rearchers, the belief that they will benefit from participation in a survey22, or a misunderstanding of what is typical with respect to ejaculatory latency in real world xual encounters8. Aside from difficulties with definitions and sampling, there is marked variability in distress related to early ejaculation between individual men and across cultures8. It is likely that some men may report early ejaculation when asked a single item question on an epidemiological survey while not experiencing bother sufficient to justify medical attention. Bad on the abnce of distress such men would not meet the current criteria for PE12, 23.
Peer-reviewed studies on the prevalence of PE published prior to March 2013 are summarized in Ta
ble 224-51. Most of the studies utilized the DSM-IV-TR definition and characterized PE as the “most common male xual dysfunction”, with a prevalence rate of 20-30%20-22. As the DSM-IV-TR definition lacks objective diagnostic criteria, the high prevalence of PE reported in many of the surveys is a source of ongoing debate37, 43, 46-51. It is, however, unlikely that the PE prevalence is as high as 20-30% bad on the
relatively low number of men who prent for treatment of PE21, 41, 45.
In two online surveys, one of Arabic-speaking men in the Middle East, the cond of US men, 82.6% and 78% of participants respectively reported some degree of PE28,34. This high rate of PE is best accounted for by the inclusion of men with VPE or SPE. In the Middle Eastern study only 15.3% of men reported that they “always” ejaculated before they wished while 46% and 21% described themlves as “sometimes” or “mostly” ejaculating before they wished. In the US study, the 78% of men acknowledging some degree of PE decread to 14.4% when combining the “always’ or “mostly” group.
In two five nation (Turkey, USA, UK, Netherlands, and Spain) studies of IELT in men from the general population, the median IELT was 5.4 minutes (range, 0.55–44.1 minutes) and 6.0 minutes (r
ange 0.1-52.7 minutes), respectively8, 44. In the samples 2.5% of men had an IELT of less than one minute and 6% of less than two minutes PE1, 8, 44. The percentages are not necessarily equivalent to the prevalence of lifelong PE
