British Special Interest Group Recommendations
The British Association for Sexual Health and HIV Special Interest Group for Sexual dysfunction examined the current guidelines and treatment mechanisms for premature ejaculation ( PE ). As a result, new guidelines were released to assist physicians in diagnosing the condition. Researchers may also use the guidelines in developing clinical trials to study premature ejaculation ( PE ).
Premature ejaculation ( PE ) continues to be the largest male sexual dysfunction reported by physicians in practice. In order to determine treatment options, the British Association for Sexual Health and HIV ( BASHH ) examined current research into the condition and issued guidelines to assist physicians. Researchers noted the dilemma of physicians who have patients reporting both short and long intravaginal ejaculation latency time ( IELT ), yet still complain of premature or rapid ejaculation.
BASHH examined the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ) definition of premature ejaculation ( PE ). This definition encompasses both lifelong and acquired premature ejaculation ( PE ) and also discusses several dimensions of the condition: lack of perceived control over ejaculation, personal distress, and personal satisfaction in sexual experiences. Since the underlying cause of premature ejaculation ( PE ) is often unclear, physicians need to rely on self-report and a complete sexual history in order to make a diagnosis determination.
Treatment options range from behavioral intervention such as the stop-start or squeeze technique to pharmacological interventions. Behavioral interventions have shown some success, yet require a great deal of dedication on the part of the male and his sexual partner in order to demonstrate effectiveness over time. Some men show progress through these techniques, yet the progress is difficult to sustain over time.
Pharmacological interventions include off-label antidepressant medications, such as selective serotonin reuptake inhibitors ( SSRIs ) like fluoxetine, paroxetine, sertraline, fluvoxamine, and citralopram which are not specifically approved for premature ejaculation ( PE ). A side effect of these medications is delayed ejaculation, although other sexual dysfunctions could develop over time that aggravates the condition. Once the medication is stopped, the therapeutic gains are lost.
Based on the review of current literature, BASHH made the following recommendations:
Premature ejaculation ( PE ) should be diagnosed after a thorough exam based on the DSM-IV criteria.
Patients with underlying erectile dysfunction should have this dysfunction treated in advance of any treatments for premature ejaculation ( PE )
Patients should understand the risks involved in current pharmacological interventions.
Patients should use SSRI medication on a daily basis and if successful, can switch to as-needed dosing. The lowest possible dose should be used in order to avoid unwanted sexual side effects.
Patients should have the option of using a multi-faceted treatment approach that encompasses both medical and behavioral components.
Patients should understand that there are no approved treatment medications specifically for premature ejaculation ( PE ), and medications that may be prescribed are done so strictly based on their ability to delay ejaculation as a side effect.
Richardson, Daniel, et. al. “Recommendations for the Management of Premature Ejaculation ( PE ): BASHH Special Interest Group for Sexual Dysfunction.”
International Journal of STD and Aids, 2006 (17), pp. 1-6.
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