Premature Ejaculation

Definition

Premature ejaculation (PE) is a male sexual dysfunction characterized by ejaculation that always or nearly always occurs prior to or within about one minute of vaginal penetration (lifelong PE) or a clinically significant reduction in latency time (acquired PE), causing distress or interpersonal difficulty.

Epidemiology

• Most common male sexual dysfunction, affecting 20–30% of men worldwide
• Can occur at any age, more prevalent in younger men
• Divided into lifelong (primary) or acquired (secondary)
• Often underreported due to embarrassment

Etiology

• Primary (lifelong): genetic predisposition, neurobiological factors (serotonergic dysfunction, penile sensitivity)
• Secondary (acquired): erectile dysfunction, prostatitis, thyroid disorders, psychological stress, relationship issues
• Other contributing factors: performance anxiety, depression, certain medications, substance use

Pathophysiology

• Dysregulation of serotonin receptors (5-HT1A and 5-HT2C) affecting ejaculatory control
• Hypersensitivity of penile sensory nerves
• Neuroendocrine factors: abnormal oxytocin, dopamine, and nitric oxide signaling
• Psychogenic triggers: anxiety, relationship stress, negative sexual experiences