The Practice Guidelines Committee o...

The Practice Guidelines Committee of the American Urological Association (AUA) has released a of the present day guideline on the treatment of premature ejaculation. "Premature Ejaculation: Guideline onward the Pharmacologic Management of Premature Ejaculation" is available online at http:// www.auanet.org/timssnet/products/ guidelines/pme.cfm.

The guideline does not explicitly rate the solidity of evidence for recommendations, yet it is based on consensus opinion.

While contemplate findings vary considerably, most epidemiologic studies allude to that premature ejaculation may be the principally common male sexual disorder, occurring in 21 percent of men ages 18 to 59 in the United States. There are sum of two units forms of premature ejaculation: a primary (lifelong) form that begins when a male first becomes sexually active, and a secondary (acquired) form.

Premature ejaculation is a self-reported diagnosis. A sexual history in which the patient uses language that explicitly communicates the circumstances of the condition is the fundamental basis of assessment, with time to ejaculation as the chiefly important feature. The opinion of a partner can provide a significant contribution to diagnosis. A entire description is essential in distinguishing premature ejaculation from erectile dysfunction because these conditions repeatedly coexist. Moreover, some men are unaware that los of erection after ejaculation is normal; thus, they may erroneously complain of erectile dysfunction when the actual question at issue is premature ejaculation. In patients with concomitant premature ejaculation and erectile dysfunction, the erectile dysfunction should be treated first.

Premature ejaculation can be treated with psychotherapy and behavioral therapy. This guideline is the first to address pharmacologic treatment. Although not approved by way of the U.S. Food and remedy Administration (FDA) for this indication, oral anti-depressants and topical anesthetic agents have been shown to delay ejaculation in men with premature ejaculation and have minimal side powers when used for this object (see accompanying table). Dosages and dosing regimens for premature ejaculation repeatedly deviate from those used for FDA-approved indications, and this difference should be considered in the risk-versus-benefit assessment of pharmacologic therapy. Treatment with specific oral anti-depressants known to cause anorgasmia and delayed ejaculation should be started at the lowest possible dosage that is compatible with a reasonable chance of success

Topical anesthetic agents may be applied to the penis before intercourse to delay ejaculation. After topical application, these agents have been used with and without a condom. lengthened application of topical anesthetic (30 to 45 minutes) has been reported in a significant percentage of men to spring in loss of erection because of numbnes of the penis. Diffusion of residual topical anesthetic in succession the penis into the vaginal wall also may come in numbness in the partner.

The choice of additional therapy is based upon the patient and partner reports of efficacy, side meanings and acceptance of the therapy as well as forward a regular review of alternative approaches. Support and education of the patient and, when possible, the partner are an integral part of therapy for premature ejaculation.

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group