• Erectile Dysfunction Guideline Update Panel. AUA guideline on the pharmacologic management of premature ejaculation. Linthicum (MD): American Urological Association, Inc.; 2004. 19 p. [30 references]

This is the current release of the guideline.

Premature ejaculation

Diagnosis
Treatment

Family Practice
Internal Medicine
Urology

Physicians

To provide appropriate recommendations for the diagnosis and treatment of premature ejaculation and concomitant erectile dysfunction

Male patients experiencing premature ejaculation with or without concomitant erectile dysfunction

Diagnosis

1. Detailed sexual history
2. Assessment of concomitant erectile dysfunction

Treatment

1. Patient education regarding treatment risks and benefits
2. Oral medications
   • Nonselective serotonin reuptake inhibitor
     • Clomipramine (Anafranil®)
   • Selective serotonin reuptake inhibitors
     • Fluoxetine (Prozac®, Sarafem®)
     • Paroxetine (Paxil®)
     • Sertraline (Zoloft®)

3. Topical anesthetic agents
   • Lidocaine/prilocaine cream (EMLA® cream)
4. Other pharmacologic therapies (discussed but not specifically recommended)
   • Intracorporal injection of a vasoactive agent (alprostadil)
   • Administration of sildenafil citrate
   • Adrenergic blockade

• Efficacy of pharmacologic treatment
• Treatment-associated side effects and adverse event rates
• Patient and partner satisfaction with treatment outcomes

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

Using the MEDLINE® database with Medical Subject Headings (MeSH) related to ejaculatory dysfunction, initial literature searches were performed limiting papers to reports of human studies published in English-language journals between 1966 and January 2001. Only a small number of articles provided outcomes data on premature ejaculation (PE). Additional studies were identified from references cited in these articles and from recommendations of individual Panel members. The MEDLINE search was last updated in October 2002. Even after the final literature search was completed, however, the Panel continued to scrutinize key references that were identified up until the peer review process.

51

Not stated

Not applicable

Systematic Review with Evidence Tables

Expert Consensus

The Panel’s recommendations were developed either solely by consensus or by consensus combined with a review of the available, though limited, evidence.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Peer Review

After this guideline was written, it was reviewed and approved by each member of the Panel and submitted for peer review by 57 physicians. Based on the results of peer assessment, revisions were made and the guideline was forwarded to the Panel again, to the Practice Guidelines Committee, and to the Board of Directors of the American Urological Association (AUA), all of which rendered approval.

Note from the National Guideline Clearinghouse: The recommendations without the associated supporting text have been excerpted from the guideline. For full context, please refer to the original guideline document.

Recommendation 1:

The diagnosis of premature ejaculation (PE) is based on sexual history alone. A detailed sexual history should be obtained from all patients with ejaculatory complaints. (Based on Panel consensus.)

Recommendation 2:

In patients with concomitant PE and erectile dysfunction (ED), the ED should be treated first. (Based on Panel consensus.)

Recommendation 3:

The risks and benefits of all treatment options should be discussed with the patient prior to any intervention. Patient and partner satisfaction is the primary target outcome for the treatment of PE. (Based on Panel consensus.)

Recommendation 4:

Premature ejaculation can be treated effectively with several serotonin reuptake inhibitors (SRIs) or with topical anesthetics. The optimal treatment choice should be based on both physician judgment and patient preference. (Based on Panel consensus and review of data.)

None provided

The type of supporting evidence is not specifically stated for each recommendation. The majority of the recommendations contained in the guideline are based on a consensus of expert opinion following review of the literature. In some cases, expert consensus is supplemented with a focused review of the limited data.

• Appropriate diagnosis and pharmacologic management of premature ejaculation and concomitant erectile dysfunction
• Decreased medication-associated side effects and adverse events
• Improved treatment outcomes and patient satisfaction

Topical anesthetics are contraindicated in patients who are either allergic themselves or have partners who are allergic to any component of the product.

• This guideline will address only pharmacologic therapies, as other therapies are not routinely prescribed by the target audience.
• This guideline does not preempt physician judgment in individual cases. Variations in patient subpopulations, physician experience, and available resources necessarily will influence choice of clinical strategy. Adherence to the recommendations presented in this document cannot assure a successful treatment outcome.
• Three major limitations were encountered in the evaluation of the evidence that precluded the ability to combine outcomes data and to perform study outcomes comparisons:
  • The lack of standardization in studying premature ejaculation (PE). Clinical trials employ a variety of definitions, entry criteria, physiological measurements, and psychometric instruments for evaluation.
  • The lack of agreement in quantifying the amount of stimulation that patients experienced. Time to ejaculation is a function of many factors, not the least of which is the nature of the stimulation. The same stimulus may be excessive for one man but elicit little excitement in another. Furthermore, the lack of a consistent stimulus (partner variables, nature of sexual activity, presence or absence of foreplay, preference for single or multiple stimuli) precludes a rigorous experimental design.
  • The lack of consistency and accuracy in measurements of time to ejaculation and other outcomes. The most common outcome parameter, time to ejaculation, is either recorded at the time or documented later by recall. These measurements lack accuracy but generally are useful when applied consistently within a single study. Application across multiple studies in a meta-analysis is problematic because any methodological differences will compromise the ability to make a valid comparison. Other common outcome measures concern patient and partner satisfaction. A variety of assessment tools are used, and there is no assurance of comparability between studies.

An implementation strategy was not provided.

Living with Illness

Effectiveness
Patient-centeredness

• Erectile Dysfunction Guideline Update Panel. AUA guideline on the pharmacologic management of premature ejaculation. Linthicum (MD): American Urological Association, Inc.; 2004. 19 p. [30 references]

Not applicable: The guideline was not adapted from another source.

2004

American Urological Association Education and Research, Inc. - Medical Specialty Society

American Urological Association, Inc. (AUA)

Erectile Dysfunction Guideline Update Panel

Panel Members: Drogo K. Montague, MD, Cochair; Jonathan Jarow, MD, Cochair; Gregory A. Broderick, MD; Roger R. Dmochowski, MD; Jeremy P.W. Heaton, MD; Tom F. Lue, MD; Ajay Nehra, MD; Ira D. Sharlip, MD

Consultants: Hanan S. Bell, PhD; Patrick M. Florer; Diann Glickman, PharmD

Not stated

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI on June 10, 2004. The information was verified by the guideline developer on August 4, 2004. This summary was updated by ECRI on May 31, 2006 following the U.S. Food and Drug Administration advisory on Paxil (paroxetine hydrochloride). This summary was updated by ECRI Institute on November 6, 2007, following the U.S. Food and Drug Administration advisory on Antidepressant drugs.

This NGC summary is based on the original guideline, which is copyrighted by the American Urological Association, Inc. (AUA).