Disorders of Ejaculation

Patient Guideline Summary

Publication Date: June 1, 2020

Objective

Objective

This patient summary means to summarize key recommendations from the American Urological Association (AUA) and Sexual Medicine Society of North America (SMSNA) for disorders of ejaculation. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • The timing of ejaculation can vary significantly. Either a short time or a long time can be a problem if it interferes with sexual enjoyment.
  • We will use the abbreviations PE for premature ejaculation and DE for delayed ejaculation.
  • The cause of both conditions is usually psychological. Nevertheless, physical causes should be sought in the same way as your annual check-up.
  • Erectile dysfunction (ED) can contribute to an ejaculation problem and requires separate management.
  • Some of the more common physical causes include hormone imbalances, diabetes, medications, and infections.
  • Circumcision does not affect ejaculatory function.
  • This patient summary focuses on the psychological management of PE and DE.

Diagnosis

Diagnosis

  • Since your general health affects your sexual function, both a physical and a psychological evaluation are recommended.
  • Somewhere between one and two minutes from penetration to ejaculation is the loose benchmark for normal, but the determining factor is sexual satisfaction.
  • You may be asked to fill out a questionnaire dealing with your sexual relationships and other psychological issues, both current and past, that can affect it.
  • Adult-onset dysfunction is more likely to be due to physical causes than lifelong dysfunction. Therefore, more attention to physical factors will be paid if a sexual function has changed.
  • You may be tested for hormone imbalances, diabetes, and infections.
  • A list of all the medications you are taking should be available.

Treatment

Treatment

  • If no physical causes are identified, you will probably be referred to a mental health professional for treatment.
  • ED, if present, should be treated at the same time.
  • Changing sexual positions and practices may be discussed.
  • Medications suspected of contributing to dysfunction may need to be changed, if possible.
  • There are oral medications useful for PE and possibly useful for DE.
  • Topical anesthetics like lidocaine are moderately effective.
  • Surgery and injections are not currently supported by available evidence.

Abbreviations

  • AUA: American Urologic Association
  • DE: Delayed Ejaculation
  • ED: Erectile Dysfunction
  • PE: Premature Ejaculation
  • SMSNA: Sexual Medicine Society Of North America

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.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.