Premature ejaculation diagnosis

An accurate diagnosis based on careful analysis of the various potential biological or psychosocial factors in ejaculatory dysfunction can generally be achieved by taking a meticulous medical and sexual history, followed by a proper physical examination. When PE is suspected, the most important facets of the sexual history are estimated intravaginal latency prior to ejaculation, duration and origin of the problem, any difficulty achieving or maintaining erection, degree of desire, frequency of rapid ejaculation, and its effect on the man and the couple. Questions about quality and duration of erections, ejaculatory control, frequency of intercourse, history of prostatitis or thyroid disease, and pain in either partner during or after sex are also helpful. Additional questions should address both partners' degree of sexual satisfaction and level of distress as well as their desire to correct the problem. It behooves the physician to make all of these inquiries tactfully, but also very thoroughly.

For the sake of effective treatment, it is extremely important to differentiate between PE and ED, as the two conditions may occur together, or the patient himself may mix them up. Some men with PE, for example, erroneously consider their loss of erection after rapid ejaculation to represent ED. The physician must question the patient carefully to determine whether ejaculation or the sensation of ejaculation occurs before the loss of erection, which would support the diagnosis of PE.

Unfortunately, about 90% of men who experience ejaculatory disturbance refuse to volunteer any information about it, unless a physician specifically quizzes them; even then, most are not receptive to any investigation or therapy for it. The causes of this voluntary omission include the associated stigma, embarrassment, shyness, and reluctance to discuss intimate problems. False beliefs about PE range from the notion that it is only temporary and corrects itself spontaneously to the idea that all cases are psychological and that no treatment is successful. Some affected men disregard their partners' sexual needs; others argue that, because their partners do not complain, or can reach orgasm themselves within a few minutes, there is nothing of concern.

The physical exam should focus on signs of chronic illness and endocrine dysfunction, secondary sexual characteristics, neurologic assessment, and palpation of the testicles and penis for abnormalities. Checking the chest for gynecomastia (breast enlargement), the urethra for urethritis, and the prostate for infection are also important for discovering possible etiologic factors.