Premature Ejaculation: Different Pathophysiologies and Etiologies Determine Its Treatment

@article{Waldinger2008PrematureED,
  title={Premature Ejaculation: Different Pathophysiologies and Etiologies Determine Its Treatment},
  author={Marcel D. Waldinger},
  journal={Journal of Sex \& Marital Therapy},
  year={2008},
  volume={34},
  pages={1 - 13}
}
  • M. Waldinger
  • Published 27 December 2007
  • Psychology, Medicine
  • Journal of Sex & Marital Therapy
Premature ejaculation (PE) is a frequent male sexual complaint. Its occurrence does not automatically imply the existence of a male sexual disorder. The current DSM definition of PE has a low-positive predictive value with a high associated risk for false-positive diagnoses of PE. A new classification in four well-defined PE syndromes has recently been proposed for the pending DSM-V. According to this new classification there are different pathophysiologies, etiologies, and treatments of PE… 
Recent advances in the classification, neurobiology and treatment of premature ejaculation.
  • M. Waldinger
  • Psychology, Medicine
    Advances in psychosomatic medicine
  • 2008
TLDR
A new classification of PE has been proposed for the pending DSM-V to distinguish four PE categories; lifelong PE, acquired PE, natural variable PE and premature-like ejaculatory dysfunction.
Premature Ejaculation: 2020 Update
TLDR
Although the pathophysiology of these four PE syndromes has not been completely elucidated yet, pharmacotherapy must be considered the treatment of choice for lifelong PE patients whereas treating the underlying pathology must be the initial goal for patients with acquired PE.
Redefining a sexual medicine paradigm: subclinical premature ejaculation as a new taxonomic entity
TLDR
Application of these diagnoses to men who meet the criteria for SPE and/or LCEE, but not the overt conditions, could improve access to treatment for these patients and reduce progression to the more serious clinical disorder.
Pathophysiology of premature ejaculation.
  • J. Buvat
  • Medicine
    The journal of sexual medicine
  • 2011
TLDR
Most of the proposed biological and psychological aetiologies of PE are not evidence-based and/or that attempts to confirm them have given conflicting results, and there are good data to support roles for genetic and psychological factors in lifelong PE.
Are premature ejaculation symptoms curable?
TLDR
Improved understanding of the types of PE and their various etiologies and pathophysiologies would improve the potential for cure, and the potential of a cure is improved.
Distribution and factors associated with four premature ejaculation syndromes in outpatients complaining of ejaculating prematurely.
TLDR
The prevalence of LPE was higher than that of other PE subtypes in an outpatient setting and several comorbidities were more common in patients with APE and PLED.
Evaluation of Premature Ejaculation
TLDR
The progress in PE research is discussed including evidence based evaluation methods and the classification of PE into four PE subtypes is relevant for pharmacotherapy and counseling of men with complaints of PE.
Complementary, Surgical, and Experimental Modalities for Management of Premature Ejaculation
TLDR
The majority of clinical research to date has focused on the condition now most clearly understood as lifelong PE, and there has been a recent movement towards subclassification of early ejaculation into four separate conditions.
New Concepts in the Diagnosis and Treatment of Premature Ejaculation
TLDR
Emerging medications and the ability to tailor treatments based on genetic information likely will change the paradigm of this disorder and how it will be treated by clinicians.
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References

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  • M. Waldinger
  • Psychology, Medicine
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TLDR
Patients suffering from premature ejaculation were subdivided into primary premature ejaculators (PPE)--those who suffered from PE since the beginning of their sexual lives--and secondary premature ejaculator (SPE)-- those who suffered after years of normal sexual functioning, and this classification appears to be helpful in formulating appropriate treatment plans.
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TLDR
On-demand selective serotonin reuptake inhibitor (SSRI) treatment will not lead to similarly impressive delays in ejaculation as has been observed with daily SSRI treatment, and the combination of an SSRI and any other compound that immediately and potently raises serotonin neurotransmission and/or use of oxytocin receptor antagonists may form the basis for the development of new on-demand and/ or daily drugs for the treatment of PE.
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TLDR
Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors is well tolerated and offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains.
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TLDR
The pause-squeeze technique remains the current treatment of choice for the disorder, however, this unitary treatment recommendation disguises a multidimensional disorder which has yet to evolve an operational definition, psychometrically sound assessment procedures, or clearly articulated etiology.
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TLDR
Shorter IELT was significantly associated with reduced ejaculatory control and sexual satisfaction and increased distress and interpersonal difficulty, indicating the need for additional PRO measures to characterize PE.
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TLDR
Basic and clinical psychopharmacological studies suggest that premature ejaculation is a not a psychological disturbance but a neurobiological phenomenon.
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TLDR
A number of salient differences in ejaculatory behavior, cognitive-affective patterns, and partner-related factors between PE patients and functional men could be delineated in this study, indicating that chronic rapid ejaculation is a serious disorder with a profound impact on the man’s life and his partnership.
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