Workup for Premature Ejaculation
The workup for premature ejaculation is based entirely on a comprehensive sexual and medical history with focused physical examination—routine laboratory testing and physiological studies are not indicated unless specific findings from history or exam suggest an underlying condition. 1
Essential History Components
The diagnosis of PE is fundamentally a self-reported diagnosis requiring detailed sexual history that explicitly documents the following key elements 1:
- Ejaculatory latency time (self-estimated intravaginal ejaculatory latency time is appropriate for clinical practice; stopwatch measurement is only required for research trials) 1
- Perceived control over ejaculation 1
- Personal distress and interpersonal difficulty caused by the ejaculatory dysfunction 1
- Classification: Distinguish between lifelong PE (present since sexual debut, typically <2 minutes) versus acquired PE (markedly reduced latency from prior experience, either <2-3 minutes or ≥50% reduction from baseline) 1
- Pattern: Determine if PE is situational (with specific partners) or consistent (all attempts) 1
Additional Critical History Elements
- Frequency and duration of PE 1
- Relationship to specific partners and occurrence with all or some attempts 1
- Nature and frequency of sexual activity (foreplay, masturbation, intercourse, use of visual stimuli) 1
- Impact on quality of life and personal relationships 1
- Aggravating or alleviating factors 1
- Drug use or abuse 1
- Psychological assessment: Screen for anxiety, depression, bipolar disorder, or significant psychiatric problems over the past 6-12 months 1
Physical Examination
Include a focused physical examination to identify anatomical abnormalities that may be associated with PE or other sexual dysfunctions, particularly erectile dysfunction 1. While physical examination rarely changes management in uncomplicated PE, it is reassuring to patients and may identify issues requiring consideration 1.
Critical Differential: Erectile Dysfunction
It is crucial to differentiate PE from erectile dysfunction (ED), as ED patients frequently develop secondary PE from anxiety about maintaining erections 1. Some men erroneously complain of ED when the actual problem is PE, being unaware that loss of erection after ejaculation is normal 1. If concomitant PE and ED exist, treat the ED first—PE often improves when ED is effectively managed 1, 2, 3.
Laboratory and Physiological Testing
Do not perform routine laboratory or physiological tests 1. These should be directed only by specific findings from history or physical examination 1. Laboratory testing is not required unless the history and physical examination reveal indications beyond uncomplicated PE 1.
While high serum testosterone, hyperthyroidism, elevated glucose/HbA1c, and inflammatory cells in urine or prostatic secretions may be associated with PE, routine testing for these is not recommended in the absence of clinical suspicion 1.
Patient-Reported Outcomes
Consider using validated patient-reported questionnaires as an adjunct to diagnosis or as an "ice breaker" to facilitate conversation about ejaculatory issues, though they are not required to make the diagnosis 1.
Partner Input
The opinion of a partner can provide significant contribution to clinician understanding and should be incorporated when possible 1.
Common Pitfalls to Avoid
- Do not rely solely on IELT as the diagnostic criterion—control, distress, and interpersonal difficulty are equally important 1
- Do not order unnecessary laboratory tests in straightforward cases of PE 1
- Do not miss coexisting ED, which requires treatment before addressing PE 1, 2, 3
- Do not forget to assess psychological factors including depression, anxiety, decreased self-esteem, and relationship conflict, which are associated with PE 2