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Sex Med. 2014 Jun;2(2):60-90. doi: 10.1002/sm2.28.

An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE).

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Department of Psychiatry, Case Western Reserve University School of Medicine West Palm Beach, FL, USA.
Australian Center for Sexual Health Sydney, NSW, Australia.
Division of Pharmacology, Department of Pharmaceutical Sciences, Utrecht University Utrecht, The Netherlands.
Department of Urology, Bagcilar Training & Research Hospital Istanbul, Merkez Mah, Turkey.
Department of Urology, University of California at Davis CA, USA.
Department of Obstetrics and Gynecology, National University of Singapore Singapore, Singapore.
Division of Urology, University of Buenos Aires Buenos Aires, Argentina.
St. Peter's Sexual Medicine, The London Clinic London, UK.
Neuro-Uro-Andrology, Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital Garches, France.
Department of Urology, Tulane University Health Sciences Center New Orleans, LA, USA.
Department of Sexological Research, Psychiatric Center Copenhagen, Rigshospitalet Copenhagen, Denmark.
Department of Urology, Instituto H. Ellis Sao Paulo, Brazil.
Erasmus MC-Daniel den Hoed Cancer Center Rotterdam, The Netherlands.
School of Sexology, Department of Clinical, Applied and Biotechnological Sciences, University of L'Aquila L'Aquila, Italy.
School of Psychology, Deakin University Burwood, Vic., Australia.
Albert Einstein College of Medicine, Department of Medicine, Montefiore Medical Center Bronx, NY, USA.
Graduate School, Valparaiso University Valparaiso, IN, USA.
Department of Psychiatry, Case Western Reserve University School of Medicine Cleveland, OH, USA.
Department of Urology, University of California San Francisco, CA, USA.
Clinica de Urologia e Andrologia Belo-Horizonte, Minas-Gerais, Brazil.



In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts.


The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts.


A comprehensive literature review was performed.


This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients.


Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60-90.


Definition of PE; Diagnosis of PE; Etiology of PE; Pharmacotherapy of PE; Premature Ejaculation; Prevalence of PE; Psychotherapy of PE

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