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Redefining a sexual medicine paradigm: subclinical premature ejaculation as a new taxonomic entity

Nature Reviews Urology volume 18, pages 115–127 (2021)Cite this article

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Abstract

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.

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Fig. 1: Evolution of the PE scientific literature.
Fig. 2: Variation in parameters defining PE.
Fig. 3: Measuring a couple’s sexual health.
Fig. 4: Managing ejaculation disorders in clinical practice.
Fig. 5: The cycle of male sexual dysfunctions.

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Authors and Affiliations

  1. Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy

    Elena Colonnello, Giacomo Ciocca, Erika Limoncin, Andrea Sansone & Emmanuele A. Jannini

  2. Clinical Psychosexology, Department of Dynamic and Clinical Psychology, University of Rome Sapienza, Rome, Italy

    Giacomo Ciocca

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All authors researched data for the article, made a substantial contribution to the discussion of content, and wrote the manuscript. E.A.J. reviewed and edited the manuscript before submission.

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Correspondence to Emmanuele A. Jannini.

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Competing interests

E.A.J. has been a consultant and/or paid speaker for: Bayer, IBSA, Menarini, Lundbeck, Otsuka, Pfizer and Shionogi. E.L. and G.C. have been paid speakers for Shionogi. E.L. has also been a fellowship recipient from Pfizer. E.C. and A.S. declare no competing interests.

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Nature Reviews Urology thanks E. C. Serefoglu, D. Rowland and B. Olivier for their contribution to the peer review of this work.

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Colonnello, E., Ciocca, G., Limoncin, E. et al. Redefining a sexual medicine paradigm: subclinical premature ejaculation as a new taxonomic entity. Nat Rev Urol 18, 115–127 (2021). https://doi.org/10.1038/s41585-020-00417-1

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