Disorders of Ejaculation
Publication Date: June 1, 2020
Last Updated: March 14, 2022
Guideline Statements
Premature Ejaculation
Lifelong premature ejaculation is defined as poor ejaculatory control, associated bother, and ejaculation within about 2 minutes of initiation of penetrative sex that has been present since sexual debut. (Expert Opinion , )
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Acquired premature ejaculation is defined as consistently poor ejaculatory control, associated bother, and ejaculation latency that is markedly reduced from prior sexual experience during penetrative sex. (Expert Opinion , )
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Clinicians should assess medical, relationship, and sexual history and perform a focused physical exam to evaluate a patient with premature ejaculation. (Clinical Principle, )
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Clinicians may use validated instruments to assist in the diagnosis of premature ejaculation. (ConditionalC)
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Clinicians should not use additional testing for the evaluation of a patient with lifelong premature ejaculation. (ConditionalC)
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Clinicians may utilize additional testing, as clinically indicated, for the evaluation of the patient with acquired premature ejaculation. (ConditionalC)
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Clinicians should advise patients that ejaculatory latency is not affected by circumcision status. (ConditionalC)
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Clinicians should consider referring men with premature ejaculation to a mental health professional with expertise in sexual health. (ModerateC)
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Clinicians should recommend daily SSRIs; on demand clomipramine or dapoxetine (where available); and topical penile anaesthetics as first-line pharmacotherapies in the treatment of premature ejaculation. (StrongB)
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Clinicians may consider on-demand dosing of tramadol for the treatment premature ejaculation in men who have failed first-line pharmacotherapy. (ConditionalC)
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Clinicians may consider treating men with premature ejaculation who have failed first-line therapy with α1-adrenoreceptor antagonists. (Expert Opinion , )
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Clinicians should treat comorbid erectile dysfunction in patients with premature ejaculation according to the AUA Guidelines on Erectile Dysfunction. (Expert Opinion , )
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Clinicians should advise men with premature ejaculation that combining behavioral and pharmacological approaches may be more effective than either modality alone. (ModerateB)
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Clinicians should advise patients that there is insufficient evidence to support the use of alternative therapies in the treatment of premature ejaculation. (Expert Opinion , )
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Clinicians should inform patients that surgical management (including injection of bulking agents) for premature ejaculation should be considered experimental and only be used in the context of an ethical board-approved clinical trial. (Expert Opinion , )
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Clinicians should consider referring men diagnosed with lifelong or acquired delayed ejaculation to a mental health professional with expertise in sexual health. (Expert Opinion , )
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Delayed Ejaculation
Lifelong delayed ejaculation is defined as lifelong, consistent, bothersome inability to achieve ejaculation, or excessive latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. (Expert Opinion , )
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Acquired delayed ejaculation is defined as an acquired, consistent, bothersome inability to achieve ejaculation, or an increased latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. (Expert Opinion , )
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Clinicians should assess medical, relationship, and sexual history and perform a focused physical exam to evaluate a patient with delayed ejaculation. (Clinical Principle, )
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Clinicians may utilize additional testing as clinically indicated for the evaluation of delayed ejaculation. (ConditionalC)
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Clinicians should advise men with delayed ejaculation that modifying sexual positions or practices to increase arousal may be of benefit. (Expert Opinion , )
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Clinicians should suggest replacement, dose adjustment, or staged cessation of medications that may contribute to delayed ejaculation in men with delayed ejaculation. (Clinical Principle, )
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Clinicians should inform patients that there is insufficient evidence to assess the risk-benefit ratio of oral pharmacotherapy for the management of delayed ejaculation. (Expert Opinion , )
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Clinicians may offer treatment to normalize serum testosterone levels in patients with delayed ejaculation and testosterone deficiency. (Expert Opinion , )
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Clinicians should treat men who have delayed ejaculation and comorbid erectile dysfunction according to the AUA Guidelines on Erectile Dysfunction. (Expert Opinion , )
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Clinicians should counsel patients with delayed ejaculation that no currently available data indicate that invasive non-pharmacological strategies are of benefit. (Expert Opinion , )
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Recommendation Grading
Overview
Title
Disorders of Ejaculation
Authoring Organization
American Urological Association
Publication Month/Year
June 1, 2020
Last Updated Month/Year
September 3, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Male, Adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Psychologist, physician, nurse, nurse practitioner, physician assistant
Scope
Assessment and screening, Diagnosis, Management, Treatment
Diseases/Conditions (MeSH)
D061686 - Premature Ejaculation, D004542 - Ejaculation
Keywords
Premature Ejaculation, Ejaculation Disorders, Delayed ejaculation, emission, ejection, parasympathetic nervous system, Serum testosterone, Ejaculatio Praecox, Hematospermia, Retrograde ejaculation, Anorgasmia, Anejaculation, Post Orgasmic Illness Syndrome, Anhedonic Orgasm, Painful ejaculation
Source Citation
Shindel AW, Althof SE, Carrier S, Chou R, McMahon CG, Mulhall JP, Paduch DA, Pastuszak AW, Rowland D, Tapscott AH, Sharlip ID. Disorders of Ejaculation: An AUA/SMSNA Guideline. J Urol. 2022 Mar;207(3):504-512. doi: 10.1097/JU.0000000000002392. Epub 2021 Dec 28. PMID: 34961344.