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Premature ejaculation
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of premature ejaculation are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2025), the American Urological Association (AUA/SMSNA 2022), and the International Society for Sexual Medicine (ISSM 2014).
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Screening and diagnosis
Definitions: as per AUA/SMSNA 2022 guidelines, recognize the following definitions:
lifelong PE: poor ejaculatory control, associated bother, and ejaculation within about 2 minutes of initiation of penetrative sex presenting since sexual debut
acquired PE: consistently poor ejaculatory control, associated bother, and ejaculation latency markedly reduced from prior sexual experience during penetrative sex.
E
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Indications for screening
Diagnostic investigations
History and physical examination: as per EAU 2025 guidelines, elicit a medical and sexual history including assessment of intravaginal ejaculatory latency time (self-estimated), perceived control, distress and interpersonal difficulty due to the ejaculatory dysfunction for the diagnosis and classification of PE.
A
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Additional testing
Medical management
First-line therapy: as per EAU 2025 guidelines, offer either dapoxetine or the lidocaine/prilocaine spray as first-line therapy in patients with lifelong PE.
A
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Second-line therapy
PDE5 inhibitors
Management of comorbidities
Nonpharmacologic interventions
Behavioral and psychosexual therapy
As per EAU 2025 guidelines:
Offer behavioral, cognitive and/or couple therapy approaches in combination with pharmacotherapy in patients with PE. Discuss the use of mindfulness exercises.
B
Offer psychological/behavioral therapies in combination with pharmacotherapy in the management of acquired PE.
B
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Alternative therapies