ICD-11HA03.0	MALE EARLY EJACULATION (PE) Male early ejaculation
ICD-10F52.4	Premature ejaculation
DSM-5-TRF52.4	Premature (Early) Ejaculation

1. Definition and nosology

Premature Ejaculation (PE; ICD-11: HA03.0 Male early ejaculation; DSM-5-TR: F52.4) — ejaculation occurring involuntarily within a short time, often before or within ~1 minute of penetration; loss of control and distress.

Subtypes: Lifelong (primary) — present from onset; Acquired (secondary) — developed later; Variable and Subjective — ISSM classification.

2. History

• Semans J.H. (1956) — ‘stop-start’ technique.
• Masters & Johnson (1970) — “squeeze” behavioral technique.
• ISSM (2014) — Althof S.E. international diagnostic and treatment guideline.
• 2009 — dapoxetine first approved drug for PE in the EU.

3. Epidemiology

• Prevalence in males 20–30% (self-reported); with strict ISSM criteria 4–5%.
• Age-related variability low; occurs in all age groups.
• Comorbidity: ED, anxiety, depression, relationship strain.

4. Aetiology and pathogenesis

• Neurobiological — serotonergic (5-HT2C, 5-HT1A balance); genetic component (lifelong).
• Psychological — performance anxiety, early sexual experience, relationship problems.
• Acquired — ED, prostatitis, hyperthyroidism, substance use.

5. Clinical features

• Intravaginal ejaculation latency time (IELT) short (lifelong ~1 min; acquired ≤ 3 min).
• Loss of control.
• Distress, avoidance, relationship tension.

6. Diagnosis

6.1 Unified diagnostic criteria (ISSM 2014 · DSM-5-TR)

A. Ejaculation always or almost always before or within ~1 minute of penetration (lifelong) or a clinically meaningful decrease in latency time to ≤ 3 minutes (acquired).

B. Inability to delay in all or almost all penetrations.

C. Negative personal consequences — distress, avoidance.

6.2 Source-specific clarifications

• ISSM (Althof S.E. et al. J Sex Med 2014).
• AUA and EAU guidelines.

6.3 Diagnostic algorithm

1. Clinical interview (sexual history, IELT, control, distress).
2. PEDT (Premature Ejaculation Diagnostic Tool) — 5-item.
3. Comorbid ED assessment (IIEF).
4. Endocrine and urologic (acquired form).

6.4 Differential diagnosis

7. Examination and assessment

• PEDT, IIEF.
• IELT (chronometry — when recommended).
• Endocrine and urologic (suspected acquired).

8. Treatment

8.1 General principles (ISSM 2014 · AUA · EAU)

1. Behavioral methods (first-line or combination):
   • Stop-start (Semans);
   • Squeeze technique (Masters & Johnson);
   • Pelvic floor exercises (Pastore A. RCT 2014).
2. Dapoxetine — short-acting SSRI; 30–60 mg 1–3 hours before intercourse; approved for PE in EU and many countries. Not approved for PE by US FDA.
3. SSRI off-label daily — paroxetine (10–40 mg) highest efficacy (Waldinger meta-analysis); sertraline, fluoxetine, citalopram alternatives; possible sexual side effects.
4. Topical anesthetics - lidocaine/prilocaine (EMLA, TEMPE/Fortacin spray) before penetration (cream 20–30 minutes, spray ~5 minutes); protection against partner transmission (condom or wipe).
5. Tramadol — in selected cases (addiction risk must be considered).
6. PDE5 inhibitor — only with comorbid ED.
7. Couple therapy and CBT — for performance anxiety.

8.2 Source-specific clarifications

• Althof S.E. et al. ISSM Guideline. J Sex Med 2014.
• Waldinger M.D. et al. SSRI meta-analysis.

Treatment methods

1. Dapoxetine — Short-acting SSRI; when needed; EU approval.
2. Topical Anaesthetic — Lidocaine/prilocaine (EMLA cream 20–30 min; Fortacin spray ~5 min prior).
3. SSRI Daily (off-label) — Paroxetine highest efficacy.
4. Start-Stop and Squeeze techniques — Behavioral methods; singly or in combination.
5. Pelvic Floor Exercises — Pastore RCT — IELT increase.

9. Prognosis

Dapoxetine and SSRIs increase IELT by 2–4 times; behavioral combination supports long-term effect.

10. Myths and misconceptions

Myth 1: “PE is only a psychological problem”

Evidence: Lifelong PE is associated with serotonergic neurobiology; the effects of dapoxetine and SSRIs confirm this.

Myth 2: “Dapoxetine is FDA-approved in the USA”

Evidence: Dapoxetine is not approved by the US FDA for PE; it is approved in the EU and many countries; in the US, it is treated off-label with daily SSRIs.

Myth 3: “Topical anesthetic is safe and has no effect on the partner”

Evidence: Condom or switch to wiping important for partner protection; otherwise partner may experience reduced sensation.

Myth 4: “Over-the-counter ‘PE enhancers’ are safe”

Evidence: FDA warnings — many “natural” products contain undeclared SSRIs or anesthetic components.

Myth 5: “Behavioral therapy is only an old method”

Evidence: ISSM recommends start-stop, squeeze, and pelvic floor exercises; effectiveness increases in combination with pharmacotherapy.

11. Sources

1. WHO. ICD-11. HA03.0 Male early ejaculation. 2024.
2. APA. DSM-5-TR. 2022.
3. Althof S.E. et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation. J Sex Med 2014;11(6):1392–1422.
4. Waldinger M.D. et al. Relevance of methodological design for the interpretation of efficacy of drug treatment of PE: a systematic review and meta-analysis. Int J Impot Res 2004;16(4):369–381.
5. Pastore A.L. et al. Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation: a novel therapeutic approach. Ther Adv Urol 2014;6(3):83–88.