Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
Clinical Psychosexology, Department of Dynamic and Clinical Psychology, University of Rome Sapienza, Rome, Italy.
Nat Rev Urol. 2021 Feb;18(2):115-127. doi: 10.1038/s41585-020-00417-1. Epub 2021 Jan 13.
Premature ejaculation (PE) and poor ejaculatory control are multidimensional sexual symptoms estimated to affect almost one-third of men, severely impairing the overall quality of life of patients and their partners. However, patients who do not completely fulfil the definition criteria for PE rarely receive a diagnosis or adequate treatment, with the risk of subsequent progression from initial, subclinical symptoms to clinically overt PE, frequently with other sexual comorbidities. Thus, the current definitions of PE warrant review, in order to consider and propose a new taxonomy encompassing other unaddressed, crucial clinical aspects of PE. These newly proposed criteria include the recommendation for a primary screening for erectile dysfunction (ED), as PE and ED can be comorbid in up to 50% of patients but have never before been considered as a unified clinical entity. In order to facilitate clinical practice and improve clinical management of men with PE and comorbid conditions, we propose and define the new taxonomic clinical entities of subclinical PE (SPE) and loss of control of erection and ejaculation (LCEE). Application of these diagnoses to men who meet the criteria for SPE and/or LCEE, but not the overt conditions, could improve access to treatment for these patients and reduce progression to the more serious clinical disorder.
早泄(PE)和射精控制不佳是多维的性症状,据估计影响了近三分之一的男性,严重损害了患者及其伴侣的整体生活质量。然而,不符合完全符合 PE 定义标准的患者很少得到诊断或充分治疗,他们存在从最初的亚临床症状进展为临床显性 PE 的风险,通常伴有其他性功能障碍。因此,目前的 PE 定义需要重新评估,以便考虑并提出一个新的分类法,涵盖 PE 尚未解决的其他关键临床方面。这些新提出的标准包括建议对勃起功能障碍(ED)进行初步筛查,因为 PE 和 ED 在多达 50%的患者中可能同时存在,但以前从未被视为一个统一的临床实体。为了促进临床实践和改善伴有合并症的男性的 PE 临床管理,我们提出并定义了亚临床 PE(SPE)和勃起及射精控制丧失(LCEE)的新分类临床实体。将这些诊断应用于符合 SPE 和/或 LCEE 标准但不符合显性条件的男性,可能会增加这些患者获得治疗的机会,并减少向更严重的临床障碍发展的风险。