Premature ejaculation: A comprehensive urological review of current evidence-based management strategies

Abstract

Premature ejaculation (PE), acquired or lifelong, is a ubiquitous male sexual dysfunction with profound psychosexual morbidity. Accurate diagnosis requires integration of symptom timing, perceived ejaculatory control, partner perspective, and comorbidities, notably erectile dysfunction, alongside validated patient-reported outcomes; IELT, while a useful objective metric for severity grading, is insufficient as a standalone diagnostic criterion. Initial therapy is on-demand topical anesthetics and dapoxetine, with enhanced durability when combined with psychosexual therapy. Off-label SSRIs produce a modest but clinically meaningful delay in ejaculatory latency, limited by side effects and poor long-term adherence. PDE5 inhibitors demonstrate increasing efficacy particularly in combination with co-existing erectile dysfunction and combination treatment regimens optimize overall outcomes. No surgical intervention is currently endorsed by international guidelines, though frenulectomy may increase IELT in selected cases and selective dorsal neurectomy remains investigational. Device-based approaches including perineal transcutaneous electrical stimulation and pelvic floor rehabilitation show early promise in peer-reviewed trials, but remain investigational pending larger controlled studies. The literature was systematically searched across PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science (January 2005 to October 2025). Harmonized definitions, inclusive diagnostic criteria, and standardized outcome measures remain high priorities for future research.