ARTICULO DOS EP

INRTRODUCCION
TERAPIA CC LABRADOR
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TRATA'IENTO CO(NITI)O*CONDUCTUAL DE LAS DIS+UNCIONES
SE#UALES
+ra%"is"o ,a-ier La.rador/

A lo lar0o de las difere%tes 1po"as hist2ri"as3 a tra-1s de las di-ersas "4lt4ras3 la
h4&a%idad ha prete%dido &e5orar las t1"%i"as a&orosas persi04ie%do 4% fi% 6lti&o3
"o%se04ir 4% &aor pla"er satisfa""i2% se74al! De i04al &a%era3 desde la &8s re&ota
a%ti09edad3 ha "a4sado e%or&e i%ter1s la e7pli"a"i2% del "o&porta&ie%to se74al
a%2&alo3 as: "o&o los posi.les re&edios ;4e pod:a% e&plearse para s4 trata&ie%to! La
se74alidad las disf4%"io%es se74ales so% 4%a preo"4pa"i2% a%"estral de la
h4&a%idad!
E% los 6lti&os a<os ha% ha.ido "a&.ios dr8sti"os3 so"iales "4lt4rales3 ;4e otor0a%
espe"ial i&porta%"ia a la se74alidad= ha ha.ido separa"i2% e%tre se74alidad
reprod4""i2%3 lo ;4e ha s4p4esto "a&.ios e% las "ost4&.res! El te&a de la se74alidad
ha pasado de ser 4% te&a ta.6 a ser 4% te&a i%"l4ido de%tro de los pro.le&as de sal4d
.ie%estar so"ial! E% "o%se"4e%"ia3 el disfr4tar de la se74alidad se "o%sidera a"t4al&e%te
"o&o 4% o.5eti-o i&porta%te!
Los pro.le&as ;4e se prese%ta% e% el disfr4te de la se74alidad so% de.idos a &6ltiples
"a4sas> &odelos i%ade"4ados3 e7pe"tati-as3 presi2% so"ial!
Las ?disf4%"io%es se74ales@ p4ede% defi%irse "o&o 4% "o%54%to de pro.le&as de :%dole
di-ersa ;4e i&pide% o difi"4lta% a la perso%a disfr4tar de for&a satisfa"toria de la
se74alidad!
CONCEPCIONES ERRANEAS AL ACUDIR A TERAPIA SE#UAL
Co%"ep"i2% &4 red4"ida so.re el se7o la se74alidad> se7o B "oito
Las realiCa"io%es se74ales so% se<al de 17ito
Co%"ep"i2% estereotipada so.re los roles fe&e%i%o &as"4li%o Da"ti-o*
pasi-o3 dire"tor*se04idor!!!E
No da% i&porta%"ia a fa"tores sit4a"io%ales e% el desarrollo de la e7"ita"i2%
se74al Dl40ar3 &o&e%to3 i%terfere%"iasE
Patr2% de a"t4a"i2% ha.it4al "o%siste%te e% e-itar i%tera""io%es se74ales
D@sa.oteoF de la terapiaE!
Co%sidera% ;4e el o.5eti-o de 4%a terapia se74al es e%se<ar t1"%i"as se74ales!
/
GHa"e HII a<os el ho&.re ea"4la.a /H 2 /J "e%t:&etros "6.i"os de se&e%3 pero el
estr1s f:si"o3 ;4:&i"o so"ial ha he"ho ;4e la "a%tidad -aa dis&i%4e%do= a"t4al&e%te
el pro&edio es de tres a "i%"o "e%tr:&etros "6.i"os3 s4fi"ie%te para lo0rar 4% e&.araCoG!
'a4ri"io A;4i%o3 psi;4iatra se72lo0o
KEs la ea"4la"i2% pre"oC 4% pro.le&a serioL
'4"hos pa"ie%tes "o% EP %o tie%e% pro.le&as &1di"os de 0ra-edad! Si% e&.ar0o es
i&porta%te resol-er el pro.le&a de EP por dos raCo%es!
Pri&ero= es dif:"il de disfr4tar s4 -ida se74al e% ple%it4d si tie%e ea"4la"i2% pre"oC
p4es pasar8 la &aor parte del tie&po trata%do de retardar la ea"4la"i2%! As: a &e%4do
es s4 pare5a ;4ie% %o al"a%Ca la &87i&a satisfa""i2% se74al!
Se04%do3 la ea"4la"i2% pre"oC tie%de a ser 4% pro.le&a de por -ida a &e%os ;4e sea
tratada! De esta for&a 3 al04%as sesio%es se74ales p4ede% ser &8s prolo%0adas ;4e
otras3 pero el pro.le&a est8 sie&pre all: li&ita%do a la "o&pleta satisfa""i2% del a"to
se74al! Co%se"4e%te&e%te3 ha 4%a te%de%"ia a e-itar te%er rela"io%es se74ales otras
for&as de i%ti&idad! Este pro.le&a afe"ta sie&pre s4 rela"i2%3 s4 a4to"o%fia%Ca o s4
ha.ilidad para so"ialiCar
La ea"4la"i2% pre"oC es "o%siderada 4% pro.le&a desde ;4e se re"o%o"i2 la
i&porta%"ia del pla"er fe&e%i%o3 es el &oti-o &8s fre"4e%te de "o%s4lta
KSa.:as ;4e *se06% la teor:a e-ol4"io%ista* ha"e al04%os &iles de a<os 4% ea"4lador
pre"oC pod:a pres4&ir de s4perioridad a%te 4%o ;4e to&ara &8s tie&po para depositar
se&e% e% la -a0i%a de 4%a &45erL Dado ;4e la &45er pri&iti-a %o "o%o":a el pla"er
se74al el "oito represe%ta.a para ella &8s .ie% 4%a &olestia3 el ho&.re ;4e re;4er:a
%ada &8s 4%os se04%dos para ea"4lar pod:a e&.araCarla "o% &aor fa"ilidad! Los
ea"4ladores &8s "o%trolados e%fre%ta.a% la posi.le %e0a"i2% o h4ida de la &45er 3
;4iC8s3 la .4rla de al04%os testi0os
la &45er! Msta des"4.ri23 "o% el tra%s"4rrir del tie&po3 %o s2lo ;4e pod:a e7peri&e%tar
pla"er &edia%te la rela"i2% se74al3 si%o ;4e 1ste pod:a prolo%0arse 3 a &edida ;4e ha
ido li.er8%dose de ta.6es e i%hi.i"io%es ha de&a%dado 4% &e5or dese&pe<o de s4
"o&pa<ero
GLa a4toesti&a del ho&.re est8 e% 54e0o "ada -eC ;4e tie%e rela"io%es se74ales *di"e
'a4ri"io A;4i%o3 psi;4iatra se72lo0o*! Al e5er"er la se74alidad se po%e de &a%ifiesto
s4 &as"4li%idad perso%alidad3 sie%te 4%a 0ra% presi2% por;4e "4lt4ral&e%te se di"e
;4e 1l es el ser Ga"ti-oG e% la rela"i2% se74alG
'8s ;4e ser 4%a e7perie%"ia de pla"er f:si"o3 la rela"i2% se74al tie%e 0ra%des
i&pli"a"io%es psi"ol20i"as para los ho&.res3 ;4ie%es -alora% s4 &as"4li%idad se06% el
tie&po ;4e to&a la for&a "o&o se prod4"e ese refle5o fisiol20i"o lla&ado
ea"4la"i2%
EPIDE'IOLO(IA
Relia.le i%for&atio% o% the pre-ale%"e of lifelo%0a%d A*PE i% the 0e%eral &ale
pop4latio% isla"ki%0! Co%fo4%di%0 a""4rate pre-ale%"e esti*&ates are the
"o&peti%0 a%d -ari%0 defi%itio%s ofPE a%d the &a%%er i% whi"h pre-ale%"e data
were0athered Dpop4latio% .ased3 self*report3 or "li%i*"ia% .asedE! Lo"al a%d
re0io%al -ariatio%s sho4ld.e "o%sidered i% the "o%te7t of differe%t "4lt4ral3
H
reli0io4s3 a%d politi"al i%fl4e%"es! Additio%all3pre-ale%"e &a -ar a"ross
differe%t de&o0raph*i"s3 i%"l4di%0 0eo0raph3 eth%i"it3 a%d so"ial
stat4s [HN$!Based o% patie%t self*report3 PE is ro4ti%el"hara"teriCed as the &ost
"o&&o% &ale se74al"o&plai%t [HO$! Pre-ale%"e data deri-ed fro&patie%t self*
report will .e appre"ia.l hi0her tha% pre-ale%"e esti&ates .ased o% "li%i"ia%
dia0%osis4tiliCi%0 the &ore "o%ser-ati-e ISS' defi%itio%of PE! The followi%0
st4dies de&o%strate the-ari%0 pre-ale%"e esti&ates ra%0i%0 fro& PIQdow% to
PQ! Data fro& The (lo.al St4dof Se74al Attit4des a%d Beha-iors D(SSABE3 a%
i%ter%atio%al s4r-e i%-esti0ati%0 the attit4des3.eha-iors3 .eliefs3 a%d se74al
satisfa"tio% of HN3RII&e% a%d wo&e% a0ed JISOI ears3 reported the0lo.al
pre-ale%"e of PE D.ased o% s4.5e"t self*reportE to .e appro7i&atel PIQ a"ross
all a0e0ro4ps [HT3PI$! Per"eptio% of @%or&alF e5a"4latorlate%" -aried .
"o4%tr a%d differed whe%assessed either . the patie%t or their part%er [P/$!
A "ore li&itatio% of the (SSAB s4r-e ste&s fro&the fa"t that the o4%0est
parti"ipa%ts were a0edJI ears3 a% a0e whe% the i%"ide%"e of PE &i0ht
.e differe%t fro& o4%0er &e% [HO$! Co%trar tothe (SSAB st4d3 the Pre&at4re
E5a"4latio%Pre-ale%"e a%d Attit4de S4r-e fo4%d the pre-a*le%"e of PE a&o%0
&e% a0ed /OSNI to .e HH!NQ[PH$!
Table 1
La ea"4la"i2% pre"oC &ar"a los e%"4e%tros se74ales de la &itad de los fra%"eses! U%
est4dio de Opi%io%Ua dif4%dido por %4estros "o&pa<eros de Le H4ffPost re-ela ;4e
el RIQ de los ho&.res el JPQ de las &45eres fra%"esas D;4e ha% ha.lado so.re s4s
"o&pa<erosE ad&ite% s4frir ea"4la"i2% pre"oC!
LVi%"ide%"e de lV15a"4latio% pr1"o"e selo% les do%%1es r1"e%tes de la litt1rat4re serait de
HI W PIQ! CVest le pre&ier tro4.le se74el "heC lVho&&e de &oi%s de PI a%s! So%
i%"ide%"e reste relati-e&e%t sta.le a-e" lVX0e p4is;4Velle est de HHQ e%tre JI et JT a%s
et HPQ e%tre RI et RT a%s! YIQ des ho&&es so4haiteraie%t 15a"4ler pl4s tardi-e&e%t
E% el 8&.ito de las rela"io%es se74ales3 pare"e ;4e "4al;4ier tie&po pasado f4e peor3
por;4e la "ifra s4.e hasta el YTQ el YPQ respe"ti-a&e%te "4a%do se e-o"a% los
6lti&os /I a<os de -ida se74al! El tra.a5o3 realiCado e% i%ter%et por el la.oratorio
'e%ari%i D;4e "o&er"ialiCa 4% f8r&a"o para tratar el pro.le&aE3 se .asa e% 4%a &4estra
de NRI ho&.res NRI &45eres se74al&e%te a"ti-os!
La ea"4la"i2% pre"oC es el pro.le&a se74al &8s fre"4e%te e%tre la po.la"i2% &as"4li%a
fra%"esa3 por dela%te de la disf4%"i2% ere"til! E% Espa<a3 la Aso"ia"i2% Espa<ola para la
Sal4d Se74al re"i.e &8s "o%s4ltas e% s4 l:%ea de i%for&a"i2% DT/R ORO OHNE so.re la
disf4%"i2% ere"til ;4e so.re la ea"4la"i2% pre"oC! '8s ;4e a 4% refle5o de la realidad3
atri.4e% el &aor %6&ero de lla&adas al he"ho de ;4e @la disf4%"i2% es 4% te&a &8s
"o%o"ido3 ;4e a est8 e% la "alleF3 se06% ha e7pli"ado a El H4ffPost!
LA )ER(ZEN[A PERPET\A EL PROBLE'A
La ea"4la"i2% pre"oC -ie%e a"o&pa<ada3 ade&8s3 de efe"tos se"4%darios ;4e %o ha"e%
&8s ;4e e&peorar la sit4a"i2%> -er09e%Ca3 pro.le&as de a4toesti&a3 "4lpa3 te%sio%es e%
la rela"i2% de pare5a3 des"e%so del deseo se74al!
P
'e%os de 4% /RQ de los afe"tados ha a"4dido a 4% espe"ialista3 se06% el est4dio3 ta%
solo el RIQ se ha atre-ido a ha.lar del pro.le&a "o% s4 pare5a! Dos ter"ios de los
ea"4ladores pre"o"es re"o%o"e% ta&.i1%s ;4e %o sa.e% "2&o a.ordar s4 pro.le&a3
4% YNQ de ho&.res 54%to a 4% O/Q de &45eres "o%"er%idos %o ha% he"ho %i%06%
i%te%to de .4s"ar i%for&a"i2% para ata5arlo!
Los ;4e se atre-e% a ha.lar de s4 pro.le&a a .4s"ar ate%"i2% profesio%al des"4.re%
;4e %o est8% solos! ] so.re todo3 ;4e ha sol4"io%es "o&o preser-ati-os retarda%tes3 0el
a%est1si"o3 &edi"a&e%tos e5er"i"ios de reed4"a"i2%!
. ad&i%

'ETODOLO(IA
Trials were sear"hed i% "o&p4teriCed 0e%eral a%d spe"ialiCed data.ases3 s4"h as>
'EDLINE . P4.'ed D/TYY to HI/IE= Ps"IN+O D/TNJ to HI/IE= E'BASE D/TOI to
HI/IE= LILACS D/TOH to HI/IE= the Co"hra%e Ce%tral Re0ister of Co%trolled Trials
DCo"hra%e Li.rar3 HI/IE= a%d . "he"ki%0 .i.lio0raphies3 a%d "o%ta"ti%0
&a%4fa"t4rers a%d resear"hers!
Sele"tio% "riteria
Se .4s"aro% e%saos e% las .ases de datos ele"tr2%i"as 0e%erales espe"ialiCadas3
"o&o> 'EDLINE &edia%te P4.'ed D/TYY hasta HI/IE= Ps"IN+O D/TNJ hasta HI/IE=
E'BASE D/TOI hasta HI/IE= LILACS D/TOH hasta HI/IE= Re0istro Co"hra%e Ce%tral de
E%saos Co%trolados DCo"hra%e Ce%tral Re0ister of Co%trolled Trials3 CENTRALE
DCo"hra%e Li.rar3 HI/IE= &edia%te la re-isi2% de .i.lio0raf:as "o%ta"to "o%
fa.ri"a%tes e i%-esti0adores!
Criterios de sele""i2%
E%saos "o%trolados "o% asi0%a"i2% aleatoria o "4asialeatoria ;4e e-al4aro% las
i%ter-e%"io%es psi"oso"iales e% "o&para"i2% "o% i%ter-e%"io%es psi"oso"iales
difere%tes3 i%ter-e%"io%es far&a"ol20i"as3 lista de espera o %i%06% trata&ie%to para la
ea"4la"i2% pre"oC!
O.te%"i2% a%8lisis de los datos
Se o.t4-o i%for&a"i2% so.re pa"ie%tes3 i%ter-e%"io%es &edidas de res4ltado por al
&e%os dos re-isores i%depe%die%tes &edia%te 4% for&4lario est8%dar! La &edida de
res4ltado pri&aria para la "o&para"i2% de los efe"tos de las i%ter-e%"io%es
psi"oso"iales "o% la lista de espera los f8r&a"os est8%dar f4e la &e5or:a e% el tie&po
late%te de ea"4la"i2% i%tra-a0i%al Des de"ir3 el tie&po desde la pe%etra"i2% -a0i%al
hasta la ea"4la"i2%E! La &edida de res4ltado se"4%daria f4e el "a&.io e% los
"4estio%arios -alidados de ea"4la"i2% pre"oC!
Res4ltados pri%"ipales
E% 4% est4dio DDe Car4fel HIIYE3 la terapia "o%d4"t4al f4e si0%ifi"ati-a&e%te &e5or ;4e
la lista de espera para la d4ra"i2% del "oito DD' [difere%"ia de &edias$ JIN3TI
se04%dos= IC del TRQ> PIH3JH a R/P3POE la satisfa""i2% se74al de las pare5as DD'
^HY3/I= IC> ^RI3JO a ^/3NHE! La terapia "o%d4"t4al ta&.i1% f4e si0%ifi"ati-a&e%te
&e5or para 4%a terapia se7ol20i"a f4%"io%al %4e-a DD' J/H3II se04%dos= IC del TRQ>
J
PIR3OO a R/O3/HE3 el "a&.io "o% el tra%s"4rso del tie&po e% la per"ep"i2% s4.5eti-a de
la d4ra"i2% del "oito D&45eres> D' H3OO3 IC del TRQ> H3IY a P3NI= Ho&.res> D' H3RH3
IC del TRQ> /3YR a P3PTE la satisfa""i2% se74al de las pare5as DD' ^HR3/I= IC> ^JN3TR
a ^H3HRE -ers4s la lista de espera!
U% est4dio DLi HIIYE &ostr2 ;4e la "o&.i%a"i2% de "lorpro&aCi%a terapia "o%d4"t4al
f4e s4perior ;4e la "lorpro&aCi%a sola para el tie&po late%te de ea"4la"i2%
i%tra-a0i%al DD' /3//= IC del TRQ> I3OH a /3JIE3 la Selfrati%0 A%7iet S"ale DSASE
DEs"ala de a4toe-al4a"i2% de la a%siedadE DD' ^O3NH= IC del TRQ> ^//3IT a ^Y3PRE
para al04%as pre04%tas del Chi%ese I%de7 Pre&at4re E5a"4latio% DCIPEE D_%di"e "hi%o
de ea"4la"i2% pre"oCE D@a%siedad e% la a"ti-idad se74alF3 @satisfa""i2% de la pare5a
se74alF3 @satisfa""i2% se74al del pa"ie%teF3 @"o%trol del refle5o ea"4latorioF @late%"ia
ea"4latoriaFE D@A%8lisis /!HFE!
U% est4dio D]4a% HIIOE &ostr2 ;4e el "italopra& &e5or2 de for&a si0%ifi"ati-a el
tie&po late%te de ea"4la"i2% i%tra-a0i%al DCR ["o"ie%te de ries0os$ I3RH= IC del TRQ>
I3PJ a I3NOE el %6&ero de pare5as satisfe"has "o% s4 -ida se74al desp41s del
trata&ie%to DCR I3YI= IC del TRQ> I3PT a I3TPE -ers4s la terapia "o%d4"t4al!
E% el 6lti&o est4dio DA.delHa&id HII/E3 P/ pa"ie%tes re"i.iero% 4%o de "4atro
f8r&a"os ad&i%istrados se06% la %e"esidad de "ada pa"ie%te PR horas a%tes del "oito
pre-isto D"lo&ipra&i%a3 sertrali%a3 paro7eti%a3 silde%afilE3 o re"i.iero% i%str4""io%es
a"er"a del 4so de la t1"%i"a de @pa4sa"o&presi2%F! El est4dio "o%sisti2 e% "i%"o
per:odos de "4atro se&a%as de trata&ie%to3 separados por per:odos de la-ado Dwasho4tE
de dos se&a%as! La p4%t4a"i2% de a%siedad el tie&po late%te de ea"4la"i2% se
&idiero% a%tes del trata&ie%to3 desp41s de "ada trata&ie%to d4ra%te los per:odos de
la-ado! Las p4%t4a"io%es de satisfa""i2% se74al se &idiero% desp41s de "ada
trata&ie%to! Si% e&.ar0o3 los datos dispo%i.les del art:"4lo %o f4ero% s4fi"ie%tes para
i%"l4irlo la .ase de datos rela"io%ada %o est4-o dispo%i.le3 se06% el a4tor pri%"ipal!
Co%"l4sio%es de los a4tores
E% 0e%eral3 ha pr4e.as d1.iles e i%"o%siste%tes "o% respe"to a la efe"ti-idad de las
i%ter-e%"io%es psi"ol20i"as para el trata&ie%to de la ea"4la"i2% pre"oC! Tres de los
"4atro est4dios "o%trolados o% asi0%a"i2% aleatoria i%"l4idos de psi"oterapia para la
ea"4la"i2% pre"oC i%for&aro% la &edida de res4ltado pri&aria D&e5or:a e% el tie&po
late%te de ea"4la"i2% i%tra-a0i%alE3 la &aor:a t4-o 4% ta&a<o de &4estra pe;4e<o!
Los i%for&es i%i"iales de 17ito DTN3OQE de 'asters ,oh%so% %o p4diero% repli"arse!
U% est4dio e%"o%tr2 4%a &e5or:a si0%ifi"ati-a a partir del i%i"io e% la d4ra"i2% del "oito3
la satisfa""i2% se74al la f4%"i2% se74al "o% la terapia se7ol20i"a f4%"io%al %4e-a la
terapia "o%d4"t4al e% "o&para"i2% "o% la lista de espera! U% est4dio &ostr2 ;4e la
"o&.i%a"i2% de "lorpro&aCi%a terapia "o%d4"t4al f4e s4perior a la "lorpro&aCi%a
sola! A6% se %e"esita% e%saos "o% asi0%a"i2% aleatoria "o% &4estras de 0r4pos &8s
0ra%des para "o%fir&ar o ref4tar las pr4e.as a"t4ales dispo%i.les e% "4a%to a las
i%ter-e%"io%es psi"ol20i"as para el trata&ie%to de la ea"4la"i2% pre"oC!
Trad4""i2%
DE+INICION
R
There are &4ltiple defi%itio%s of PE DTa.le /E!The first "o%te&porar
&4lti-ariate e-ide%"e*.ased defi%itio% of lifelo%0 PE was de-eloped i%
HIIO . a pa%el of i%ter%atio%al e7perts3 "o%-e%ed. the I%ter%atio%al So"iet for
Se74al 'edi"i%eDISS'E3 who a0reed that the dia0%osti" "riteria%e"essar to
defi%e PE are ti&e fro& pe%etratio%to e5a"4latio%3 i%a.ilit to dela e5a"4latio%3
a%d%e0ati-e perso%al "o%se;4e%"es fro& PE! Thispa%el defi%ed lifelo%0 PE as a
&ale se74al dsf4%"*tio% "hara"teriCed . @! ! ! e5a"4latio% whi"halwas or%earl
alwas o""4rs prior to or withi%a.o4t o%e &i%4te of -a0i%al pe%etratio%3 the
i%a.ilit to dela e5a"4latio% o% all or %earl all-a0i%al pe%etratio%s3 a%d the
prese%"e of %e0ati-eperso%al "o%se;4e%"es3 s4"h as distress3 .other3fr4stratio%
a%d`or the a-oida%"e of se74al i%ti*&a"F [N$!This defi%itio% is s4pported .
e-ide%"e fro&se-eral "o%trolled "li%i"al trials that s400est thatOISTIQ of &e%
with lifelo%0 PE e5a"4late withi%YI se"o%ds a%d the re&ai%i%0 /ISHIQ withi%
H&i%4tes D+i04re /E [/N3/O$! This defi%itio% sho4ldfor& the .asis for the offi"ial
dia0%osis of lifelo%0 PE! It is li&ited to heterose74al &e% e%0a0i%0 i%
-a0i%al i%ter"o4rse as there are few st4dies a-ail*a.le o% PE resear"h i%
ho&ose74al &e% or d4ri%0other for&s of se74al e7pressio%! Preli&i%ar re"*
o&&e%datio%s of the A&eri"a% Ps"hiatri" Asso*"iatio%Vs DS'*) "o&&ittee
s400est a defi%itio%whi"h parallels the defi%itio% re"e%tl adopted .
the ISS' [/T$! The pa%el "o%"l4ded that thereis i%s4ffi"ie%t p4.lished e-ide%"e
to propose a%e-ide%"ed*.ased defi%itio% of a";4ired PE DA*PEE[N$! Howe-er3
re"e%t data s400est that &e% withA*PE ha-e si&ilar i%tra-a0i%al e5a"4latio%
late%"ti&es DIELTsE a%d report si&ilar le-els of e5a"4la*tor "o%trol a%d distress3
s400esti%0 the possi.ilitof also a si%0le 4%ifi%0 defi%itio% of PE [HI$!
Classifications of PE
I% /TJP3 S"hapiro proposed a disti%"tio% of PEi%to tpes A a%d B [H/$! 'e% with
tpe B ha-ealwas s4ffered fro& a -er rapid e5a"4latio% Dorshort late%"E3
whereas i% tpe A3 the rapid e5a"4*latio% de-elops later i% life a%d is ofte%
asso"iatedwith ere"tile dsf4%"tio% DEDE! I% /TOT3 thesetpes were3 respe"ti-el3
referred to as lifelo%0Dpri&arE a%d a";4ired Dse"o%darE PE [HH$! O-erthe ears3
other atte&pts ha-e .ee% &ade to ide%*tif -ario4s "lassifi"atio%s of PE3
i%"l4di%0 se-eralthat ha-e .ee% i%"orporated i%to PE defi%itio%s
SOP for Ejaculatory DysfunctionHIR, Se7 'ed HI/P=/I>HIJSHHTDe!0!3 0lo.al -s!
sit4atio%alE! I% HIIY3 Ualdi%0erproposed the e7iste%"e of fo4r PE s4.tpes3 with
differe%t patho0e%esis [HP3HJ$! S4pport for this%ew "lassifi"atio% is 0rad4all
de-elopi%0 [HR3HY$!
A male sexual dysfunction characterized by ejaculation which always or nearly always occurs rior
to or within 1 minute of !a"inal enetration# and the inability to delay ejaculation on all or nearly
all !a"inal enetrations# and ne"ati!e ersonal conse$uences# such as distress bother#
frustration# and%or the a!oidance of sexual intimacy&nternational Society of Sexual
'edicine# ())* +,-Persistent or recurrent ejaculation with minimal sexual stimulation# before# on# or
shortly afterenetration and before the erson wishes it. The condition must also cause mar/ed
distress orinterersonal difficulty and cannot be due exclusi!ely to the direct effects of a substance.
American Psychiatric Association.Dia"nostic and statistical manualof mental disorders# DS'0&10T2.
3th edition. 2e!ised# ())) +*-4or indi!iduals who meet the "eneral criteria for sexual dysfunction# the
inability to controlejaculation sufficiently for both artners to enjoy sexual interaction manifests as
either theoccurrence of ejaculation before or !ery soon after the be"innin" of intercourse 5if a time
limit isre$uired# before or within 16 seconds7 or the occurrence of ejaculation in the absence of
sufficient erection to ma/e intercourse ossible. The roblem is not the result of rolon"ed
Y
absence from sexual acti!ity.&nternational StatisticalClassification of Disease# 1)thEdition 5&CD01)7#
1883 +8-
The inability to control ejaculation for a 9sufficient: len"th of time before !a"inal enetration. &t does
not in!ol!e any imairment of fertility when intra!a"inal ejaculation occurs. Euroean Association of
;rolo"y.<uidelines on Disorders ofEjaculation# ())1 +1)-
Persistent or recurrent ejaculation with minimal stimulation before# on# or shortly after enetration
and before the erson wishes it# o!er which the sufferer has little or no !oluntary control# which
causes the sufferer and%or his artner bother or distress&nternational Consultation on
;rolo"ical Diseases# ())3 +11-Ejaculation that occurs sooner than desired# either before or shortly
after enetration# causin"distress to either one or both artnersAmerican ;rolo"ical Association
<uideline on the Pharmacolo"ic'ana"ement of PE# ())3 +1(-
The man does not ha!e !oluntary# conscious control# or the ability to choose in most encounters
when to ejaculate'etz and 'cCarthy# ())= +1=-
The 4oundation considers a man a remature ejaculator if he cannot control his ejaculatory
rocess for a sufficient len"th of time durin" intra!a"inal containment to satisfy his artner in at
least 6)> of their coital connections.'asters and ?ohnson# 18,) +13-'en with an &E@T of less than 1
minute 5belon"in" to the ).6 ercentile7 ha!e 9definite: PE# whilemen with &E@Ts between 1 and 1.6
minutes 5between ).6 and (.6 ercentile7 ha!e 9robable:PE 54i"ure 37. &n addition# an additional
"radin" of se!erity of PE should be defined in termsof associated sycholo"ical roblems. Thus# both
definite and robable PE need furthersycholo"ical subclassification in nonsymtomatic# mild#
moderate# and se!ere PE.Aaldin"er et al.# ())6 +16-PE is dia"nosed on the basis of the atholo"ical
&E@T# as measured by the stowatch method# witha feelin" of loss of !oluntary control and%or distress
or relational disturbances# as measured byP2O.?annini et al.# ())6 +1B-&E@TBintra!a"inal
ejaculationlatency timeC PE remature ejaculationC P2O atient0reorted outcome
HIY
'"'aho% et al! , Se7 'ed HI/P=/I>HIJSHHT PE i% "li%i"al pra"ti"e is fre;4e%tl a
self* reported "o&plai%t3 &aki%0 it diffi"4lt to appre"i*ate its real epide&iolo0!
I% additio%3 i% so&e&e%`"o4ples3 PE is dia0%osed o% the .asis ofdistress rather
tha% as a% o.5e"ti-e s&pto&!A%other pro.le& is the relati-e i%"o%sta%" of
thes&pto& i% &a% patie%ts! The real pre-ale%"e isdiffi"4lt to assess i%
"li%i"alpra"ti"e [HO$!
La ea"4la"i2% pre"oC es 4%a disf4%"i2% se74al ;4e prod4"e ;4e 4% ho&.re ea"4le
a%tes de lo deseado3 p4ede ser ape%as "o&e%Cado el a"to se74al3 al to"ar la -a0i%a o
i%"l4si-e a%tes de ;4e se prod4C"a la pe%etra"i2%!
El JIQ de los ho&.res s4fre de ea"4la"i2% pre"oC e% al06% &o&e%to de s4 -ida
Ea"4la"io% Pre"oC Lore%Co ,oa;4:% Este-a%eC * Li"! Na //Y*/RTO`/I
Defi%i"io%es de ea"4la"i2% pre"oC
La defi%i"i2% &1di"a de ea"4la"i2% pre"oC es la persiste%"ia de 4%a ea"4la"i2%
re"4rre%te ;4e se prod4"e "o% &:%i&a esti&4la"i2% se74al3 a%tes3 d4ra%te o "asi
i%&ediata&e%te desp41s de la pe%etra"i2% a%tes de ;4e la perso%a desee ;4e o"4rra!
E% t1r&i%os "o&4%es= ea"4la"i2% pre"oC se defi%e "o&o>
* La i%"apa"idad para "o%trolar la ea"4la"i2%!
* Ea"4lar a%tes de estar listo para ha"erlo o a%tes de ha.er satisfe"ho a s4 pare5a!
* Ea"4lar a%tes o po"os &i%4tos desp41s de la pe%etra"i2%!
LV15a"4latio% pr1"o"e %Vest pas 4%e a%o&alie! CVest 4% ph1%o&b%e phsiolo0i;4e do%t
so4ffre%t e%-iro% 4% ho&&e s4r trois ;4a%d il fait lVa&o4r
N
D4ra%t des a%%1es3 la d1fi%itio% de lV15a"4latio% pr1"o"e a repos1 s4r 4%e &es4re d4
te&ps o4 de &o4-e&e%ts! Le se7e se prati;4a%t e% 01%1ral W de473 "ertai%es d1fi%itio%s
o%t e%s4ite i%t10r1 la parte%aire! Po4r 'aster et ,oh%so%3 1tait 15a"4late4r pr1"o"e
lVho&&e ;4i 15a"4lait a-a%t ;4e sa fe&&e %Varri-e W lVor0as&e da%s RIQ des rapports
El refle5o ea"4latorio
El refle5o ea"4latorio es a;4el ;4e re04la la e7p4lsi2% del esper&a a tra-1s de las
"o%tra""io%es or0as&os se e%"4e%tra 4.i"ado e% el &6s"4lo PC!
KC2&o el &6s"4lo PC retie%e las ea"4la"io%esL
Este &6s"4lo3 "o&o todo &6s"4lo3 %e"esita ser fortale"ido o e%tre%ado para pote%"iar
s4 re%di&ie%to! E% el "aso del PC3 se trata de 4% &6s"4lo ese%"ial f4%da&e%tal ;4e
to&a 4% prota0o%is&o "asi pri%"ipal d4ra%te 4%a rela"i2% se74al! De ser %e"esario3 es
i&porta%te re&ediar "4al;4ier desorde% or08%i"o reside%te e% 1ste a ;4e el he"ho de
%o ha"erlo p4ede a"arrear%os serios pro.le&as e% %4estra -ida perso%al!
The Anatomy and Physiolo"y of the Ejaculatory 2esonse
The e5a"4lator refle7 "o&prises se%sor re"eptors a%d areas3 affere%t pathwas3
"ere.ral se%sor areas3 "ere.ral &otor "e%ters3 spi%al &otor "e%ters3 a%d effere%t
pathwas! Ne4ro"he&i"all3 this refle7 i%-ol-es a "o&ple7 i%terpla .etwee%
"e%tral seroto%er0i" a%d dopa&i%er0i" %e4ro%s3 HIJ
, Se7 'ed HI/P=/I>HIJSHHT c HI/H I%ter%atio%al So"iet for Se74al 'edi"i%e
with se"o%dar i%-ol-e&e%t of "holi%er0i"3 adre%* er0i"3 o7to"i%er0i"3 a%d
0a&&a a&i%o.4tri" a"id D(ABAE %e4ro%s! Based 4po% f4%"tio%al3 "e%tral3 a%d
peripheral &ediatio%3 the e5a"4lator pro"ess is tpi"all s4.* di-ided i%to three
phases> e&issio%3 e5e"tio% Dor pe%ile e7p4lsio%E3 a%d or0as&! E&issio% "o%sists
of "o%tra"tio%s of se&i%al -esi"les DS)sE a%d the prostate3 with e7p4lsio% of
sper& a%d se&i%al fl4id i%to the posterior 4rethra3 a%d is &ediated .
s&patheti" %er-es DT/I to LHE! E5e"tio% is &ediated . so&ati" %er-es DSHSSJE
a%d i%-ol-es p4lsatile "o%tra"tio%s of the .4l.o"a-er%os4s a%d pel-i" floor
&4s"les to0ether with rela7atio% of the e7ter%al 4ri%ar sphi%"ter! E5e"tio% also
i%-ol-es a s&patheti" spi%al "ord refle7 4po% whi"h there is li&ited -ol4%tar
"o%trol! The .ladder %e"k "loses to pre-e%t retro0rade flow= the .4l.o"a-er%os4s3
.4l.ospo%0ios4s3 a%d other pel-i" floor &4s"les "o%tra"t rhth&i"all3 a%d
the e7ter%al 4ri%ar sphi%"ter rela7es! I%ter&it* te%t "o%tra"tio% of the 4rethral
sphi%"ter pre-e%ts retro0rade flow i%to the pro7i&al 4rethra [/$!
Or0as& is the res4lt of "ere.ral pro"essi%0 of p4de%dal %er-e se%sor sti&4li
res4lti%0 fro& i%"reased press4re i% the posterior 4rethra3 se%sor sti&4li arisi%0
fro& the -er4&o%ta%4&3 a%d "o%tra"tio% of the 4rethral .4l. a%d a""essor
se74al or0a%s! 'a% %e4rotra%s&itters are i%-ol-ed i% the "o%trol of e5a"4latio%3
i%"l4di%0 dopa&i%e3 %orepi%ephri%e3 seroto%i%3 a"etl"holi%e3 o7to"i%3 (ABA3
a%d %itri" o7ide DNOE [H$! Of the &a% st4dies "o%d4"ted to i%-esti0ate the role
of the .rai% i% the de-elop&e%t a%d &ediatio% of se74al f4%"tio%i%03 dopa&i%e
a%d seroto%i% ha-e e&er0ed as esse%tial %e4ro"he&i"al fa"tors! Uhereas
dopa&i%e pro&otes se&i%al e&issio%` e5a"4latio% -ia DH re"eptors3 seroto%i% is
i%hi.i* tor! Seroto%er0i" %e4ro%s are widel distri.4ted i% the .rai% a%d spi%al
"ord a%d are predo&i*%a%tl fo4%d i% the .rai%ste&3 raphe %4"lei3a%d the
reti"4lar for&atio%! C4rre%tl3 &4ltipleseroto%i% DR*hdro7trpta&i%e [R*HT$E
O
re"ep*tors ha-e .ee% "hara"teriCed3 e!0!3 R*HT/a3R*HT/.3 R*HTHa3 R*HTH.3 et"!
[P$! Sti&4latio%of the R*HTHC re"eptor with R*HTHC a0o%istsres4lts i% dela of
e5a"4latio% i% &ale rats3whereas sti&4latio% of posts%apti" R*HT/A
re"eptors res4lts i% shorte%i%0 of e5a"4latio%late%" [J$3 leadi%0 to the hpothesis
that &e%with PE &a ha-e hpose%siti-it of R*HTHCa%d`or hperse%siti-it of
the R*HT/A re"eptor[R3Y$!
PE
CLASI+ICACION
Pre&at4re e5a"4latio% has .ee% s4."lassified i%to two for&s> a pri&ar Dlifelo%0E for&
that .e0i%s whe% a &ale first .e"o&es se74all a"ti-e a%d a se"o%dar Da";4iredE for&
'! D! Ualdi%0er a r1"e&&e%t propos1 de d1parta0er lV15a"4latio% pr1"o"e e% ;4atre
0ro4pes disti%"ts >N
LV15a"4latio% pr1"o"e pri&aire apparadt dbs les pre&iers rapports se74els3 elle est
pr1se%te W "ha;4e rapport3 a-e" des parte%aires diff1re%tes3 d4ra%t to4te la -ie! OIQ des
patie%ts o%t 4% IELT "o&pris e%tre PI et YI se" et HIQ e%tre 4%e et de47 &i%4tes!
LVori0i%e serait %e4ro.iolo0i;4e o4`et 01%1ti;4e! La pr1-ale%"e est fai.le! Les do%%1es
s"ie%tifi;4es po4r sa-oir si "e tpe dVEP est 041rissa.le &a%;4e%t e
LV15a"4latio% pr1"o"e se"o%daire o4 a";4ise apparadt s4.ite&e%t o4 pro0ressi-e&e%t
"heC 4% ho&&e ;4i 54s;4e*lW "o%trflait .ie% so% 15a"4latio%! Elle est asso"i1e W 4%
tro4.le 1re"tile3 W 4%e prostatite3 W 4% pro.lb&e ps"holo0i;4e o4 W 4% "o%flit de "o4ple!
Elle disparadt lors;4e le pro.lb&e asso"i1 est r10l1! La pr1-ale%"e est fai.le!
LV15a"4latio% pr1"o"e %at4relle apparadt de &a%ibre o""asio%%elle s4i-a%t les
"ir"o%sta%"es! Il %e sVa0it ;4e de -ariatio%s %or&ales d4 IELT! La pr1-ale%"e est 1le-1e!
La pse4do*15a"4latio% pr1"o"e> lVho&&e a 4% IELT %or&al e%tre R et HR &i%4tes
&ais3 &al0r1 "ela3 se "roit 15a"4late4r pr1"o"e! La pr1-ale%"e est 1le-1e!
Selo% '! D! Ualdi%0er3 le "hiffre de HI W PIQ dVho&&es 15a"4late4rs pr1"o"es doit gtre
relati-is1 "ar les de47 pre&iers tpes dV15a"4latio% pr1"o"e o%t 4%e pr1-ale%"e .asse et
les de47 der%iers tpes 4%e pr1-ale%"e 1le-1e!

I'PACTO EN LA PARE,A
LVi&pa"t de lV15a"4latio% pr1"o"e s4r lVho&&e3 la fe&&e et le "o4ple pe4t gtre 0ra-e et
&e%er a4 di-or"e! Rappelo%s ;4e da%s les pas i%d4strialis1s o""ide%ta47 d4 Nord3 le
ta47 de di-or"e se sit4e e%tre PI et RIQ! E% S4isse3 W la fi% d4 ##e sib"le3 JPQ des
&aria0es se so%t ter&i%1s par 4% di-or"e! A47 Etat*U%is3 da%s HHQ des "as3 la "a4se d4
di-or"e est 4%e dsfo%"tio% se74elle
ETIOLO(IA
+ACTORES ETIOLO(ICOS DE LAS DIS+UNCIONES SE#UALES
/! +ACTORES PREDISPONENTES
I%ade"4ada i%for&a"i2% se74al D&itos se74alesE
Ed4"a"i2% &oral reli0iosa restri"ti-a
T
'odelos pater%os "o% rela"io%es pro.le&8ti"as o deterioradas
E7perie%"ias se74ales tra4&8ti"as d4ra%te la i%fa%"ia
I%se04ridad e% el propio 01%ero o rol psi"ose74al
Casti0o o des"alifi"a"i2% de "o%d4"tas se74ales
i%i"iales Despe"ial&e%te e% adoles"e%"iaE
E7pe"tati-as i%ade"4adas respe"to a la se74alidad
H! +ACTORES PRECIPITANTES
E7perie%"ias se74ales i%ade"4adas
Pro.le&as 0e%erales de rela"i2% de la pare5a
Co%d4"tas i%ade"4adas e% la i%tera""i2% se74al
Disf4%"i2% se74al e% el otro &ie&.ro de la pare5a!
Rea""i2% a trastor%o tra%sitorio o fallo espor8di"o a%terior
Co%di"io%a%tes psi"o*.iol20i"os de e&.araCo `o parto!
No adapta"i2% a los "a&.ios e% las resp4estas se74ales i%d4"idos por la edad
Trastor%os &8s 0e%erales ;4e p4eda% i%terferir "o% la a"ti-idad se74al
Ddepresi2%3 a%siedad3 al"oholis&o!!!E
Cir"4%sta%"ias ad-ersas fa&iliares3 so"iales3 la.orales!
P! +ACTORES DE 'ANTENI'IENTO
I%for&a"i2% se74al i%ade"4ada3 0e%eral o espe":fi"a de la disf4%"i2%!
Resp4esta de a%siedad o &iedo a%te la i%tera""i2% se74al!
A%ti"ipa"i2% de fallos o fra"asos3 e% 8&.ito se74al o perso%al!
Se%ti&ie%tos de "4lpa o respo%sa.ilidad por la disf4%"i2%!
Pro.le&as e% la rela"i2% de pare5a3 espe"ial&e%te de "o&4%i"a"i2% de
atra""i2%!
Otros trastor%os &8s 0e%erales3 "o&o depresi2%3 al"oholis&o3 a%ore7ia3 o
a%siedad!
/I
Histori"all3 atte&pts to e7plai% the etiolo0 of PE ha-e i%"l4ded a di-erse ra%0e
of .iolo0i"al a%d ps"holo0i"al theories! 'ost of these proposed etiolo0ies are
%ot e-ide%"e .ased a%d are spe"4la*ti-e at .est! The deter&i%a%ts of PE are
4%do4.t* edl "o&ple7 a%d &4lti-ariate3 with the etiolo0of lifelo%0 PE differe%t
fro& that of A*PE!O4r 4%dersta%di%0 of the %e4ro"he&i"al "e%tral"o%trol of
e5a"4latio% is at .est r4di&e%taraltho40h re"e%t i&a0i%0
a%dele"trophsiolo0i"al st4dies ha-e ide%tified i%"reased a%d de"reased
%e4ro%al a"ti-it i% se-eral .rai% areas d4ri%0aro4sal a%d e5a"4latio%
[H3PP$!Lifelo%0 PE!Ualdi%0er hpothesiCed that lifelo%0earl e5a"4latio% i%
h4&a%s &a .e e7plai%ed . either a hpose%siti-it of the R*HTHC a%d`or
hperse%siti-it of the R*HT/A re"eptor [R$!Re"e%t st4dies ha-e s400ested that i%
so&e &e%%e4ro.iolo0i"al a%d 0e%eti" -ariatio%s "o4ld "o%*tri.4te to the
pathophsiolo0 of lifelo%0 PE3as defi%ed . the ISS' "riteria3 a%d that
the"o%ditio% &a .e &ai%tai%ed a%d hei0hte%ed .ps"holo0i"al`e%-iro%&e%tal
fa"tors [PJSPY$!A*PE!A*PE &a .e d4e to DiE 4rolo0i"al dsf4%"*
tio%s3 for e7a&ple3 ED or prostatitis [PN$3 DiiEthroid dsf4%"tio% [PO$3 a%d DiiiE
ps"holo0i"al orrelatio%ship pro.le&s [PT3JI$! The a";4ired for&of PE &a .e
"4red . &edi"al a%d`or ps"holo0i*"al treat&e%t of the 4%derli%0 "a4se [PJ$!
PE a%d Ps"holo0i"al or Relatio%ship Pro.le&s!Ps*"holo0i"al theories i%"l4de
the effe"t of earle7perie%"e a%d se74al "o%ditio%i%03 a%7iet3 se74alte"h%i;4e3
the fre;4e%" of se74al a"ti-it3 a%dps"hod%a&i" e7pla%atio%s [J/3JH$!
A%7iet has .ee% reported as a "a4se of PE .&4ltiple a4thors a%d is e%tre%"hed
i% the folkloreof se74al &edi"i%e as the &ost likel "a4se ofPE despite s"a%t
e&piri"al resear"h e-ide%"e tos4pport a% "a4sal role [JP3JJ$! Se-eral a4thors
ha-e s400ested that a%7iet a"ti-ates the s&pa*theti" %er-o4s sste& a%d
red4"es the e5a"4lator
threshold as a res4lt of a% earlier e&issio% phase ofe5a"4latio% [JP3JJ$!
I%tra-a0i%al E5a"4lator Late%" Ti&e DIELTENo! of s4.5e"ts
4i"ure 1&ntra!a"inal ejaculation latency time measured with stowatch in 11) men with
lifelon" remature ejaculation# of
whom 8)> ejaculated within 1 minute after !a"inal enetration# includin" *)> within =)
seconds +1,-.
SOP for Ejaculatory Dysfunction
HIN
, Se7 'ed HI/P=/I>HIJSHHT
I*/I
/
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*HI
H/
*PI
P/*JI
J/*RI
R/*YI
Y/*
/R/*/
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/Y/*/NI
/N/*/OI
Hpoa"ti-e se74al desire &a lead to PE3 d4eto a% 4%"o%s"io4s
desiretoa..re-iate 4%wa%tedpe%etratio% [J/$! Si&ilarl3 di&i%ished se74al
desire "a% .e a "o%se;4e%"e of "hro%i" a%d fr4s*trati%0 PE [N$!
+e&ale se74al dsf4%"tio%s Ds4"h as a%or0as*&ia3 hpoa"ti-e se74al desire3
se74al a-ersio%3se74al aro4sal disorders3 a%d se74al pai% disorders3as -a0i%is&4s
[JR$E &a also .e related to A*PE!PE a%d Co&or.id ED!Re"e%t
datade&o%stratethat as &a% as half of s4.5e"ts with ED also e7pe*rie%"e PE
[HT3PH3JY$! S4.5e"ts with ED &a eitherre;4ire hi0her le-els of sti&4latio% to
a"hie-ea% ere"tio% or i%te%tio%all @r4shF i%ter"o4rse topre-e%t earl
det4&es"e%"e of a partial ere"tio%3res4lti%0 i% e5a"4latio% with a .rief late%"
//
[/Y$!This &a .e "o&po4%ded . the prese%"e ofhi0h le-els of perfor&a%"e
a%7iet related to theirED whi"h ser-es to o%l worse% their pre&at4rit!
Howe-er3 "a4tio% sho4ld .e e7er"ised i% the dia0*%osis of "o&or.id ED i% &e%
with PE as PP!PQ ofpote%t &e% with PE "o%f4se the a.ilit to &ai%tai%ere"tio%s
prior to e5a"4latio% a%d followi%0 e5a"4*latio%3 re"ord "o%tradi"tor respo%se`s
toso&e`all;4estio%s of the Se74al Health I%-e%tor for 'e%DSHI'E espe"iall
hP a%d hJ3 a%d re"ei-e a falsepositi-e SHI' dia0%osis of ED [JN$!
PE a%d Testostero%e!The role of testostero%e3 pro*la"ti%3 a%d other hor&o%es i%
&ale se74al .eha-iora%d the patho0e%esis of e5a"4lator dsf4%"tio%ha-e %ot
.ee% "o&pletel "larified! Testostero%e&a pla a fa"ilitator role i% the "o%trol
of e5a"4*latio% [JO$! It has .ee% also reported that &e% withlowest ;4artile
prola"ti% le-els are at i%"reased riskof &eta.oli" s%dro&e3 arterio0e%i" ED3 PE3
a%da%7iet s&pto&s [JT$!PE a%d Hperthroidis&!The &a5orit of patie%ts
with throid hor&o%e disorders e7perie%"e se74aldsf4%"tio%! St4dies s400est a
si0%ifi"a%t "orrela*tio% .etwee% PE a%d s4ppressed TSH -al4es
i% a sele"ted pop4latio% of a%drolo0i"al a%d se7o*lo0i"al patie%ts! The RIQ
pre-ale%"e of PE i% &e%with hperthroidis& fell to /RQ after treat&e%t
with throid hor&o%e %or&aliCatio% [J/3RI3R/$!Altho40h o""4lt throid disease
has .ee% reportedi% the elderl hospitaliCed pop4latio%3 it is 4%"o&*
&o% i% the pop4latio% who prese%t for treat&e%tof PE a%d ro4ti%e TSH s"ree%i%0
is %ot i%di"ated4%less "li%i"all i%di"ated [RH$!
PE a%d Prostate Disease!A"4te a%d "hro%i" lower4ro0e%ital i%fe"tio%3
prostatod%ia3 or "hro%i"pel-i" pai% s%dro&e DCPPSE is asso"iated withED3 PE3
a%d pai%f4l e5a"4latio% [J/3RP$! Se-eralst4dies report PE as the &ai% se74al
disorders&pto& i% &e% with "hro%i" prostatitis or CPPSwith a pre-ale%"e of
HYSNNQ [J/$!
Prostati" i%fla&&atio% a%d "hro%i" .a"terialprostatitis ha-e .ee% reported as
"o&&o% fi%di%0si% &e% with .oth lifelo%0 a%d A*PE [J/3RPSRR$!The
e7a"tpathophsiolo0 of the li%k .etwee%"hro%i" prostatitis3 ED3 a%d PE is
4%k%ow%! It has.ee% hpothesiCed that prostati" i%fla&&atio%&a res4lt
i%altered se%satio% a%d &od4latio% ofthe e5a"4lator refle7 .4t e-ide%"e is
Li"ki%0 [R/3RP3RY$! It has .ee% reported that a%ti.ioti"treat&e%t of
&i"ro.iolo0i"all "o%fir&ed .a"terialprostatitis i% &e% with A*PE res4lted i% a
H!Y*foldi%"rease i% IELT a%d i&pro-ed e5a"4lator "o%troli% OP!TQ of s4.5e"ts
[RN$!
Pl4s de PRQ des ho&&es so%t i%"apa.les de prolo%0er le4r e7"itatio% se74elle lors de la
p1%1tratio% a4*delW dV4%e &i%4te o4 de47! Cette diffi"4lt1 se74elle3 -1"4e par des
&illiers dGho&&es3 est s"ie%tifi;4e&e%t e7pli"a.le! Elle a po4r "a4se pre&ibre3 des
r1a"tio%s phsiolo0i;4es do%t des "o%tra"tio%s &4s"4laires ;4i fo%t pressio% s4r la
"o%0estio% sa%04i%e d4 p1%is e% 1re"tio%3 prod4ite%t selo% la post4re et la &a%ibre de
.o40er des ho&&es! Sa%s "o&pter "ertai%s &4s"les do%t ils %Go%t pas "o%s"ie%"e et ;4i
se "o%tra"te%t W le4r i%s4!!
/H
Penile Sensitivity in Patients with Primary Premature
Ejaculation

+ro& the Depart&e%t of Urolo03 ]o%sei U%i-ersit a%d Ewha Uo&a%s

U%i-ersit Colle0e of 'edi"i%e3 Seo4l3 iorea!
Abstract
Purpose
Ue i%-esti0ated pe%ile se%sor le-els i% patie%ts with pri&ar pre&at4re e5a"4latio% to
deter&i%e whether there is a% etiolo0i"al .asis for this "o%ditio%!
Materials and Methods
Pe%ile .iothesio&etr was perfor&ed i% /HI patie%ts with pri&ar pre&at4re
e5a"4latio% witho4t ere"tile dsf4%"tio% a%d %e4rolo0i"al defi"it3 a%d i% YY %or&al
pote%t &ale -ol4%teers! )i.rator thresholds were re"orded at the 0la%s pe%is3 pe%ile
shaft3 s"rot4& a%d i%de7 fi%0er 4si%0 a .iothesio&eter!
Results
O% the 0la%s pe%is a%d pe%ile shaft the -al4es i% patie%ts with pre&at4re e5a"4latio%
were si0%ifi"a%tl less tha% those i% %or&al pote%t &e% Dp less tha% I!II/E! I% %or&al
pote%t &e% a% a0e depe%de%" of .iothesio&etri" para&eters was %oted3 with a
si0%ifi"a%t i%"rease i% -i.rator threshold at the 0la%s pe%is a%d pe%ile shaft i% older
patie%ts! Howe-er3 i% patie%ts with pre&at4re e5a"4latio% there were "o%siste%tl
de"reased -al4es witho4t a0e depe%de%" at the 0la%s pe%is a%d pe%ile shaft Dp 0reater
tha% I!IRE!
Conclusions
Patie%ts with pri&ar pre&at4re e5a"4latio% ha-e pe%ile hperse%siti-it3 whi"h
pro-ides f4rther i&pli"atio%s for a% or0a%i" .asis of pre&at4re e5a"4latio%!
GE% la &aor:a de "asos e7iste 4%a &ala ed4"a"i2% se74al> %o h4.o 4% ho0ar .ie%
i%te0rado3 tal -eC el padre f4e al"oh2li"o o se -i-i2 4% desarrollo "o% a%siedad
e7a0erada se adoptaro% pr8"ti"as de a4toerotis&o i%ade"4adas3 "o&o esti&4larse
de ho&.res ;4e a"t6a% "o&o ea"4ladores pre"o"es e% 4%a rela"i2% e7tra&atri&o%ial3
lo "4al s4ele de.erse al estado de estr1s los se%ti&ie%tos de "4lpa 0e%erados por el
he"ho de sa.erse i%fieles! Al04%os &8s di"e% se%tirse fr4strados3 do&i%ados3 "astrados
o &a%ip4lados por s4 pare5a!
/P
El pro.le&a p4ede prese%tarse e% ho&.res de "4al;4ier edad3 pero es &8s fre"4e%te e%
;4ie%es s4pera% los JI e% ;4ie%es pade"e% hiperte%si2% arterial `o dia.etes
Les "o%"eptio%s s4r lV1tiolo0ie de lV15a"4latio% pr1"o"e o%t 1-ol41 "es "e%t der%ibres
a%%1es et pe4-e%t gtre r1parties e% ;4atre phases "hro%olo0i;4es >
la pre&ibre3 /OON*/T/N3 est "elle oj lV15a"4latio% pr1"o"e est re"o%%4e et apparadt
da%s la litt1rat4re &1di"ale3 "it1e e% /OON par (ross3 p4is e% /TI/ par irafft*E.i%0 =
la se"o%de ;4i sV1te%d de /T/N W /TRI3 est "elle oj elle est d1"rite "o&&e 4%e
%e4rose relati-e W 4% "o%flit i%"o%s"ie%t! D15W W lV1po;4e "ertai%s a4te4rs attire%t
lVatte%tio% s4r le fait ;4V4% pro.lb&e a%ato&i;4e "o&&e 4% frei% "o4rt3 -oire 4%e
hperse%si.ilit1 d4 0la%d3 po4rrait 5o4er 4% rfle =
la troisib&e ;4i sV1te%d de /TRI W /TTI est "elle oj 'aster et ,o%hso% "o%sidbre%t
;4e lV15a"4latio% pr1"o"e est se"o%daire W 4% pro.lb&e dVappre%tissa0e =
la ;4atrib&e ;4i a d1.4t1 e% /TTI est "elle oj lVo% 1-o;4e des pro.lb&es dVhper3
-oire dVhpose%si.ilit13 des r1"epte4rs "1r1.ra47 W la s1roto%i%e!
Cito%s e%"ore lVasso"iatio% re"o%%4e3 sa%s ;4e "ela soit "o%sid1r1 "o&&e des fa"te4rs
de ris;4e de lV15a"4latio% pr1"o"e3 a-e" lVa%7i1t13 la d1pressio% et la fai.le a"ti-it1
se74elle! U% lie% a 10ale&e%t 1t1 s4001r1 a-e" la prostatite "hro%i;4e et les tro4.les
1re"tiles!
U%e a4tre hpothbse .iolo0i;4e r1"e%te est "elle dV4%e a%o&alie de la lepti%e ;4i3 a4
%i-ea4 "1r1.ral3 est e% relatio% 1troite a-e" le sstb&e s1roto%i%er0i;4e > il e7iste 4%e
"orr1latio% positi-e e%tre les ta47 de lepti%e et le IELT!
El miedo, la inexperiencia, la falta de educacin y la abstinencia, entre las
causas ms destacadas.
El temor al embarazo es tambin motivo de que el hombre acorte el tiempo de
su relacin, sin que lo advierta.
LA ABSTINENCIA
U%a prolo%0ada a.sti%e%"ia se74al trae sie&pre "o%si0o 4%a 0ra% rapideC e% la
ea"4la"i2%! (e%eral&e%te e% las pare5as ;4e3 desp41s de &4"ho tie&po si% rela"i2%
se74al ha"e% el a&or3 el ho&.re lle0a &4 pro%to a la ea"4la"i2%! Por el "o%trario3 la
re04laridad fre"4e%"ia de la rela"i2% se74al trar "o%si0o 4% des"e%"so e% la i%te%sidad
rapideC de la e7"ita"i2%!
LA HIPERSENSIBILIDAD
Al04%os i%di-id4os est8% dotados de 4%a se%si.ilidad se74al e7tre&a! La e7"ita"i2% les
do&i%a pro%to3 el "o%trol %o les res4lta f8"il! E% estos "asos s4ele ser fre"4e%te el
;4e5arse de ea"4la"i2% r8pida3 i%"l4so repe%ti%a o &4 apres4rada!
LA EDUCACIN
E% otros "asos3 el h8.ito ad;4irido de 4%a pro%ta ea"4la"i2% p4ede ser la "a4sa de la
i%"apa"idad para prolo%0ar la ere""i2% si% ea"4lar! N4estra ed4"a"i2% %os ha for&ado
para rela"io%es se74ales r8pidad! No te%e%&os los o""ide%tales esa 0ra% -irt4d orie%tal
/J
;4e se lla&a ?to&arse todo el tie&po?! ] este trasfo%do pesa so.re &4"hos ho&.res!
EL !R"ASM!
Del &is&o &odo3 la prisa por disfr4tar ha dado a &4"hos la idea de ;4e lo &8s
i&porta%te e% la rela"i2% se74al es el or0as&o3 ;4e or0as&o ea"4la"i2% so% 4%a
&is&a "osa! Co%-ie%e disti%04ir las dos! Pero %or&al&e%te &4"hos ho&.res est8%
predisp4estos a ?a0ararse al pla"er "4l&i%a%te?3 %o para e% la otra "lase de pla"er! De
ah: s4 o.sesi2% por lle0ar a la ea"4la"i2%! ] de ah: la ea"4la"i2% r8pida!
LAS PR!ST#IUTAS
E% otros "asos3 lo ;4e e%"o%tra&os "o&o "a4sa est8 &8s .ie% aso"iado a "iertas
i%i"ia"io%es pr8"ti"as %o &4 a"o%se5a.les! Por e5e&plo3 el "aso del ;4e ha te%ido s4
pri&era rela"i2% "o% 4%a prostit4ta3 para ;4ie% lo pri%"ipal %o es el pla"er3 si%o el di%ero!
La prostit4ta &ide s4 tra.a5o "o% el relo5! ] &4"has -e"es s4 propia prisa ha i%fl4ido e%
;4e &4"hos ho&.res la ad;4iera% "o&o ha.it4al3 "o% el "o%si04ie%te per54i"io para la
pare5a!
LAS HURTADILLAS
Otra "lase de i%i"ia"io%es ;4e ha% sido "a4sa de h8.itos de ea"4la"i2% r8pida so% la
rela"io%es se74ales a h4rtadillas3 a es"o%didas3 e% ri%"o%es o portales o e% ser-i"ios
p6.li"os! Estas "ir"4%sta%"ias se 4%e% para "rear este pro.le&a desde las pri&eras
e7perie%"ias! Si desp41s %o se ha p4esto re&edio3 el kpro.le&a se &a%tie%e!
EL MIED!
El &iedo a ser des"4.ierto es otra de las ra:"es de la ea"4la"i2% pre"oC! Lo &is&o ;4e
"a4sa la i&pote%"ia! Esta3 por defe"to= a;41lla3 por e7"eso! Pero las dos p4ede% darse
a%te la opresi2% del &iedo s4 "orrespo%die%te preo"4pa"i2%!
LA URETRA
U%a "a4sa de ori0e% f:si"o es la i%fla&a"i2% de la 4retra Dpor herida o i%fe""i2%E3 ;4e se
%ota e% el a"to de la &i""i2% por la se%sa"i2% de "os;4illeo &olesto3 "o&o de res;4e&or!
Este he"ho p4ede pro-o"ar 4%a ea"4la"i2% a%tes de lo deseado!
LA PRSTATA
Del &is&o &odo las i%fla&a"io%es de la pr2stata3 pro"ede%te3 espe"ial&e%te e% los
52-e%es3 de al04%a i%fe""i2% o -ir4s e%trado por la 4retra! S4ele %otarse a tra-1s de 4%a
serie de s:%to&as3 "o&o so% 0a%as de ori%ar fre"4e%tes3 i%"l4so a -e"es 4%a ori%a 4%
ta%to &atiCada de "olor sa%04i%ole%to3 &e%or deseo se74al3 al04%as ere""io%es %o &4
&4 "o&pletas 3 "o&o res4ltado3 4%a ea"4la"i2% &8s r8pida! E% "4a%to a las perso%as
&aores3 la i%fe""i2% de la pr2stata3 por disti%tos &oti-os3 es "a4sa deter&i%a%te!
LA CIRCUNCISIN
/R
KEs la "ir"4%"isi2% "a4sa de la ea"4la"i2% r8pida o pre&at4raL Respe"to a este p4%to se
p4ede% o.te%er las &8s -ariadas opi%io%es! Co&o es sa.ido3 la "ir"4%"isi2% "o%siste e%
eli&i%ar el prep4"io o piel ;4e e%-4el-e el 0la%de del pe%e! El he"ho de ;4e el 0la%de
;4ede "o%ti%4a&e%te al des"4.ierto3 ha"e pe%sar e% ;4e la se%si.ilidad de lo %er-ios de
;4e est8 dotado el 0la%de dis&i%4a por la "ost4&.re de e%"o%trarse sie&pre
des"4.ierto! S4ele ad&itirse ;4e el ho&.re "ir"4%"idado tie%e li0era&e%te &e%os
se%si.ilidad
EL $RENILL!
Otra de las "a4sas de ori0e% f:si"o es el he"ho de te%er el fre%illo de&asiado "orto! Se
lla&a fre%illo al replie04e ;4e 4%e la piel del prep4"io "o% la .ase del pe%e3 por de.a5o
del 0la%de "er"a de la 4retra! Esta Co%a es espe"ial&e%te se%si.le! C4a%do el fre%illo es
de&asiado "orto3 la e7"ita"i2% es &4 apres4rada la ea"4la"i2% s4ele -e%ir &4
r8pida!
LA INERCIA
Otras "a4sas **las &8s de ori0e% psi"ol20i"o** so% la i%er"ia de "iertas perso%as3 s4
"ost4&.re a dedi"ar po"o tie&po a la rela"i2% se74al! Para &4"hos 4%a ?des"ar0a
fisiol20i"a? "o%stit4e lo pri%"ipal de la rela"i2% se74al! E% tales "asos3 %o es e7tra<o
;4e la ea"4la"i2% deseada lle04e "4a%to a%tes! Pero esto %o de5a de ser 4%a
defor&a"i2% por defi"ie%"ia ed4"ati-a!
LA REPRESIN
E% otros "asos la "a4sa es 4%a e%or&e represi2% se74al! La represi2% tie%e 4%a di%8&i"a
"o&ple5a3 pero ;4e sie&pre &a%tie%e "o%"e%trada la e%er0:a se74al de for&a ;4e3 e% el
&o&e%to propi"io3 la e%er0:a aflora! La ea"4la"i2% pre"oC es 4%a "aso &4 "o%"reto de
las tra.as a la realiCa"i2% se74al3 i&p4estas 0e%eral&e%te por %4estras "ost4&.res
"oa"ti-as represi-as!
LA MASTURBACIN
Se ha ha.lado a -e"es de la &ast4r.a"i2% "o&o "a4sa de la ea"4la"i2% pre"oC! Esto3
%or&al&e%te3 %o es "ierto! Lo ;4e s: p4ede s4"eder es ;4e "iertas for&as de pra"ti"ar la
&ast4r.a"i2% haa% "o%di"io%ado 4%as esti&4la"io%es la a4se%"ia de otras! E% tales
"asos3 la pr8"ti"a de esas esti&4la"io%es e% la rela"i2% se74al trae "o%si0o 4%a
e7"ita"i2% &8s r8pida! Pero %o es la &ast4r.a"i2% "o&o fe%2&e%o lo ;4e de.e ser
"o%siderado "a4sa!
EL PENE
La talla o &edida del pe%e ta&po"o es "a4sa de ea"4la"i2% pre"oC! Tal -eC ha.r:a ;4e
ha.lar de "iertos pro.le&as psi"ol20i"os s4.5eti-a&e%te "reados por 4% he"ho ;4e %o
tie%e% %ada de espe"ial! La "a4sa3 p4es3 se sit6a e% otro l40ar!
EL EMBARA%!
/Y
U% &oti-o &8s "o&6% es el &iedo al e&.araCo! Es "4rioso "o%statar "2&o e% &4"hos
"asos este &iedo prod4"e 4%a i&pote%"ia te&poral3 3 e% otros3 4%a predisposi"i2% a la
ea"4la"i2% r8pida! Psi"ol20i"a&e%te3 el ho&.re ;4e te&e 4% e&.araCo3 trata de ;4e la
rela"i2% se74al De% s4 fase de pe%etra"i2%E d4re el &e%or tie&po posi.le! Esto p4ede ser
i%"o%s"ie%te %o ser %i ad&itido %i te%ido "o&o tal!
LA E&CITACIN
Las "a4sas e% las ;4e parti"ipa dire"ta&e%te la &45er !!a4%;4e e% este pro.le&a %o
s4ele% ser "o%sideradas** so% i&porta%tes! La &45er &4 ardie%te o e7"ita%te p4ede
lle-ar al ho&.re a 4%a e7"ita"i2% &4"ho &8s r8pida! ] ta&.i1% a 4%a ea"4la"i2%
pre"oC!
L!S EST#MUL!S
E% otros "asos la &is&a &45er e% el e&pleo de 4%as esti&4la"io%es despropor"io%adas
p4ede pro-o"ar la ea"4la"i2%! Por e5e&plo3 sa.e&os ;4e ha Co%as &8s e7"ita.les ;4e
otras! ] "ari"ias &8s pro%tas a pro-o"ar la e7"ita"i2%! Si la &45er e&pieCa e% s4s
prel4dios por las "ari"ias &8s i%te%sas3 es &4 f8"il ;4e se prod4C"a la ea"4la"i2%
pre"oC!
DIA(NOSTICO
/E 'e% prese%ti%0 with self*reported PEsho4ld .e e-al4ated with a f4ll &edi"al`
se74al histor3 a fo"4sed phsi"al e7a&i%atio%3
i%-e%tor assess&e%t of ere"tile f4%"tio%3 a%da% i%-esti0atio%s s400ested .
these fi%di%0sDle-el PEPatie%ts e7pe"t "li%i"ia%s to i%;4ire a.o4ttheir se74al
health [RO$! Ofte% patie%ts are tooe&.arrassed3 sh3 a%d 4%"ertai% if se74al "o&*
plai%ts .elo%0 i% the health "are professio%alVsDHCPVsE offi"e [RT$! I%;4ir i%to
se74al health0i-es patie%tsV per&issio% to dis"4ss their se74al"o%"er%s a%d also
s"ree%s for asso"iated healthrisks De!0!3 "ardio-as"4lar risk a%d EDE! Ta.le H
lists re"o&&e%ded a%d optio%al ;4estio%s thatpatie%ts who "o&plai% of PE
sho4ld .e asked[//3YI$! The re"o&&e%ded ;4estio%s esta.lishthe dia0%osis a%d
dire"t treat&e%t "o%sidera*tio%s a%d the optio%al ;4estio%s 0ather detail for
i&ple&e%ti%0 treat&e%t! +i%all3 the "o&&itteere"o&&e%ds that the HCPs take a
&edi"al a%dps"hoso"ial histor!C4rre%t literat4re s400ests that the dia0%osis of
lifelo%0 PE is .ased p4rel o% the &edi"al historas there are %o predi"ti-e
phsi"al fi%di%0s or "o%*fir&ator i%-esti0atio%s [Y/$!a! As differe%tiatio% of
lifelo%0 a%d A*PE &a.e diffi"4lt i% either o4%0 &e% or &e% with %o%eor
fewpre-io4s se74al part%ers a%d`or li&itedse74al e7perie%"e3 a phsi"al
e7a&i%atio% ishi0hl desira.le a%d represe%ts a% opport4%it fors"ree%i%0 for
"ardio-as"4lar or 0e%der*spe"ifi"diseases! Howe-er3 i% &e% with A*PE3 a
phsi"ale7a&i%atio% is &a%dator i% a% effort to ide%tifHIO
'"'aho% et al!, Se7 'ed HI/P=/I>HIJSHHTthe etiolo0 of the PE a%d to alle-iate
its possi.le"a4se [YH$! The prese%"e of ED sho4ld .e e-al4*ated either .
&edi"al histor or with the assis*ta%"e of a -alidated i%str4&e%t! La.orator or
/N
i&a0i%0 i%-esti0atio%s are o""asio%all re;4ired.ased 4po% the patie%tVs &edi"al
histor! A di0italprostate e7a&i%atio%3 ro4ti%e i% a% a%drolo0i"alsetti%0 for all
&e% o-er JI3 is 4sef4l i% ide%tifi%0possi.le e-ide%"e of prostati" i%fla&&atio%
ori%fe"tio% [YP$!+i04re H is a flow "hart for the &a%a0e&e%t of
PE [J/$!HE Self*esti&atio% . the patie%t a%d part%erof e5a"4lator late%" sho4ld
.e 4sed to deter*&i%e IELT i% "li%i"al pra"ti"e Dle-el /EStopwat"h &eas4res of
IELT are widel 4sed i%"li%i"al trials a%d o.ser-atio%al st4dies of PE .4tha-e %ot
.ee% re"o&&e%ded for 4se i% ro4ti%e"li%i"al &a%a0e&e%t of PE! Despite the
pote%tialad-a%ta0e of o.5e"ti-e &eas4re&e%t3 stopwat"h&eas4res ha-e
thedisad-a%ta0e of .ei%0 i%tr4si-ea%d pote%tiall disr4pti-e of se74al pleas4re or
spo%ta%eit! 'ore re"e%tl3 st4dies ha-e i%di"atedthat patie%t or part%er self*
report of e5a"4latorlate%" "orrelates relati-el well with o.5e"ti-estopwat"h
late%" a%d &i0ht .e 4sef4l as a pro7&eas4re of IELT [YJSYN$! As patie%t self*
reportis the deter&i%i%0 fa"tor i% treat&e%t seeki%0a%d satisfa"tio%3 it
isre"o&&e%ded that self*esti&atio% . the patie%t a%d part%er of e5a"4la*
tor late%" is a""epted as the &ethod fordeter&i%i%0 IELT i% "li%i"al pra"ti"e!
PE Sta%dardiCed assess&e%t &eas4res s4"h as-alidated ;4estio%%aires a%d
patie%t*reportedo4t"o&e DPROE &eas4res "a% .e 4sed as a%ad54%"t to a f4ll
&edi"al`se74al histor a%dself*esti&atio% of e5a"4lator late%" i% thee-al4atio%
of &e% prese%ti%0 with self*reported PE Dle-el /E
These &eas4res are all relati-el %ew a%d werede-eloped pri&aril for 4se
asresear"h tools!So&e ha-e show% 0ood ps"ho&etri" propertiesa%d are
pote%tiall -al4a.le ad54%"ts for "li%i"als"ree%i%0 a%d assess&e%t!
Se-eral PE &eas4res ha-e .ee% des"ri.ed i% theliterat4re [YOSNJ$3 altho40h o%l
a s&all %4&.er
ha-e 4%der0o%e e7te%si-e ps"ho&etri" testi%0a%d -alidatio%! +i-e -alidated
;4estio%%aires ha-e.ee% de-eloped a%d p4.lished to date! C4rre%tl3there aretwo
;4estio%%aires that ha-e e7te%si-edata.ases a%d &eet &ost of the "riteria for test
de-elop&e%t a%d -alidatio%> The Pre&at4reE5a"4latio% Profile DPEPE a%d the
I%de7 of Pre&a*t4re E5a"4latio% DIPEE [YO3NI$! A third .rief dia0*%osti" &eas4re3
the PE dia0%osti" tool DPEDTE3has also .ee% de-eloped3 has a &odest data.ase3
a%d is a-aila.le for "li%i"al 4se [NH$! Two other&eas4res3 the Ara.i" a%d Chi%ese
PE h4estio%*%aires3 ha-e &i%i&al -alidatio% or "li%i"altrial data a-aila.le a%d
are %ot re"o&&e%ded for"li%i"al 4se!
PEP!
A fo4r*ite&3 self*report &eas4re of PE has.ee% de-eloped . Patri"k et al! [NI$!
The PEP"o%sists of si%0le*ite& "o%str4"ts of the followi%0>DiE per"ei-ed "o%trol
o-er e5a"4latio%= DiiE satisfa"*tio% with se74al i%ter"o4rse= DiiiE perso%al distress
related to e5a"4latio%= Di-E i%terperso%al diffi"4ltrelated to e5a"4latio%= a%d D-E
a% i%de7 or totals"ore! Ea"h of the fo4r i%di-id4al ite&s is assessed
o% a fi-e*poi%t s"ale3 whi"h are a-era0ed topro-ide a% i%de7 PE s"ore! The
&eas4re has .ee%Table (
2ecommended and otional $uestions to establish the dia"nosis of PE and direct treatment
+B)-2ecommended $uestions for dia"nosis Ahat is the time between enetration and ejaculation
5comin"7D Can you delay ejaculationD Do you feel bothered# annoyed# and%or frustrated by your PED
Otional $uestionsEDifferentiate lifelon" and ac$uired PE Ahen did you first exerience PED
/O
Fa!e you exerienced PE since your first sexual exerience on e!ery%almost e!ery attemt and with
e!ery artnerD Otional $uestionsEAssess erectile function &s your erection hard enou"h to
enetrateD Do you ha!e difficulty in maintainin" your erection until you ejaculate durin" intercourseD
Do you e!er rush intercourse to re!ent loss of your erectionD Otional $uestionsEAssess
relationshi imact Fow uset is your artner with your PED Does your artner a!oid sexual
intercourseD &s your PE affectin" your o!erall relationshiD Pre!ious treatment Fa!e you recei!ed
any treatment for you PE re!iouslyD
&mact on $uality of life Do you a!oid sexual intercourse because of embarrassmentD
Do you feel anxious# deressed# or embarrassed because of your PED
PE remature ejaculation
SOP for Ejaculatory Dysfunction HIT
, Se7 'ed HI/P=/I>HIJSHHT
III! E-al4atio% of the Patie%t Uith Pre&at4re E5a"4latio%
Pre&at4re e5a"4latio% is a self*reported dia0%osis! A se74al histor i% whi"h the patie%t
4ses la%04a0e that e7pli"itl "o&&4%i"ates the "ir"4&sta%"es of the "o%ditio% is the
f4%da&e%tal .asis of assess&e%t with ti&e to e5a"4latio% as the &ost i&porta%t feat4re!
The opi%io% of a part%er "a% pro-ide a si0%ifi"a%t "o%tri.4tio% to "li%i"ia%
4%dersta%di%0! A "o&plete des"riptio% is esse%tial i% disti%04ishi%0 PE fro& ED3 i!e!3
the i%a.ilit to attai% or &ai%tai% a% ere"tio%3 .e"a4se these "o%ditio%s fre;4e%tl
"oe7ist! 'oreo-er3 so&e &e% are 4%aware that loss of ere"tio% after e5a"4latio% is
%or&al= th4s3 the &a erro%eo4sl "o&plai% of ED whe% the a"t4al pro.le& is PE
Re"o&&e%datio% />
The dia0%osis of PE is .ased o% se74al histor alo%e! A detailed se74al histor sho4ld
.e o.tai%ed fro& all patie%ts with e5a"4lator "o&plai%ts!
[Based o% Pa%el "o%se%s4s!$
Uhe% o.tai%i%0 the patie%tGs histor3 se-eral i&porta%t se74al a%d ps"holo0i"al
"hara"teristi"s sho4ld .e assessed> fre;4e%" a%d d4ratio% of PE3 relatio%ship to spe"ifi"
part%ers3 o""4rre%"e with all or so&e atte&pts3 de0ree of sti&4l4s res4lti%0 i% PE3
%at4re a%d fre;4e%" of se74al a"ti-it Dforepla3 &ast4r.atio%3 i%ter"o4rse3 4se of
-is4al "l4es3 et"!E3 i&pa"t of PE o% se74al a"ti-it3 tpes a%d ;4alit of perso%al
relatio%ships a%d ;4alit of life3 a00ra-ati%0 or alle-iati%0 fa"tors3 a%d relatio%ship to
dr40 4se or a.4se! La.orator or phsiolo0i"al testi%0 is %ot re;4ired 4%less the histor
a%d a phsi"al e7a&i%atio% re-eal i%di"atio%s .eo%d 4%"o&pli"ated PE!
Re"o&&e%datio% H>
I% patie%ts with "o%"o&ita%t PE a%d ED3 the ED sho4ld .e treated first!
[Based o% Pa%el "o%se%s4s!$
A%other priorit of assess&e%t sho4ld .e deter&i%i%0 whether ED is a "o%"4rre%t
pro.le&! 'a% patie%ts with ED de-elop se"o%dar PE3 perhaps d4e to either the %eed
for i%te%se sti&4latio% to attai% a%d &ai%tai% a% ere"tio% or d4e to the a%7iet asso"iated
/T
with diffi"4lt i% attai%i%0 a%d &ai%tai%i%0 a% ere"tio%! Pre&at4re e5a"4latio% &a
i&pro-e i% patie%ts whe% "o%"o&ita%t ED is effe"ti-el treated!
TRATA'IENTO
KC2&o ha0o los e5er"i"ios de ie0elL
La idea pri%"ipal "o%siste e% tra.a5ar los &4s"4los ;4e "o%for&a% la Co%a 0e%ital "o% el
o.5eto de ?ed4"ar? al &4s"4lo p4.o"o""i0eo &edia%te la apli"a"i2% de t1"%i"as
e5er"i"ios /II Q %at4rales desarrollados espe"ifi"a&e%te para eli&i%ar la p1rdida del
"o%trol so.re el refle5o ea"4latorio!
Ha -arias &a%eras de realiCar los e5er"i"ios de ie0el3 pero se re"o&ie%da a"4dir a 4%a
i%stit4"i2% seria respo%sa.le a fi% de a.ordar 4% trata&ie%to .a5o estas dire"tri"es
e-itar lesio%es "o%traprod4"e%tes para el or0a%is&o!
Reco'endaci(n
"rado de
reco'endaci(n
Si e7iste DE3 i%fe""i2% de tra"to 0e%ito4ri%ario 4 otra disf4%"i2%
se74al3 ha ;4e tratar pri&ero 1stas!
B
La terapia "o%d4"t4al p4ede ser .e%efi"iosa para la EP3 pero
re;4iere &4"ho tie&po3 la "ola.ora"i2% de la pare5a es dif:"il de
lle-ar a "a.o!
C
El trata&ie%to far&a"ol20i"o es la .ase del trata&ie%to de la EP
pri&aria!
A
El trata&ie%to diario "o% 4% ISRS es el trata&ie%to de pri&era
ele""i2% e% la EP!
A
La dapo7eti%a es 4% ISRS de "orta a""i2%3 apro.ado e% E4ropa
para el trata&ie%to a de&a%da de la EP!
A
El trata&ie%to a%est1si"o t2pi"o es 4%a alter%ati-a a los ISRS! A
La re"4rre%"ia es pro.a.le desp41s del "ese del trata&ie%to! A
La terapia "o%d4"t4al p4ede &e5orar la re"a:da e% el trata&ie%to
far&a"ol20i"o!
C
'ETA ANALISIS Ta TOPICO
Topical Anesthetic Agents for Premature Ejaculation: A
Systematic Review and Meta-analysis

3
HI
Depart&e%t of Urolo03 Uest Chi%a Hospital3 Si"h4a% U%i-ersit3 Che%0d43
Chi%a
http>``d7!doi!or0`/I!/I/Y`5!4rolo0!HI/H!/H!IHO3 How to Cite or Li%k Usi%0 DOI
Per&issio%s l Repri%ts
!b)ecti*e
To e-al4ate the effi"a" a%d safet of topi"al a%estheti" a0e%ts for patie%ts with
pre&at4re e5a"4latio% DPEE!
Methods
Eli0i.le ra%do&iCed "o%trolled trials DRCTsE were ide%tified fro& ele"tro%i" data.ases
DCo"hra%e Ce%tral Re0ister of Co%trolled Trials3 'edli%e3 a%d E'BASEE witho4t
la%04a0e restri"tio%s! The data.ase sear"h3 ;4alit assess&e%t3 a%d data e7tra"tio% were
perfor&ed i%depe%de%tl . H re-iewers! The &ai% o4t"o&e for the effi"a" of topi"al
a%estheti" a0e%ts was i%tra-a0i%al e5a"4lator late%" ti&e DIELTE! Effi"a" a%d safet
were e7plored 4si%0 Re-iew 'a%a0er3 -ersio% R!/!I DCo"hra%e Colla.oratio%3 O7ford3
UiE!
Results
Ei0ht trials &et the i%"l4sio% "riteria! O4r pooled a%alsis showed that IELT i% the
topi"al a%estheti" a0e%t 0ro4p was si0%ifi"a%tl i&pro-ed "o&pared to the pla"e.o
0ro4p Dra%do&*effe"t &odel= &ea% differe%"e ['D$ R!OH3 TRQ "o%fide%"e i%ter-al [CI$
P!RI*O!/J3 P m!IIII/E! A""ordi%0 to the s4.0ro4p a%alsis3 a si0%ifi"a%t i&pro-e&e%t
was o.tai%ed i% the do&ai%s of e5a"4lator "o%trol3 se74al satisfa"tio%3 a%d distress i%
the I%de7 of Pre&at4re E5a"4latio% DIPEE ;4estio%%aire Dra%do&*effe"t &odel3 'D J!RP3
TRQ CI P!IR*Y!I/3 P m!IIII/E! I% ter&s of ad-erse e-e%ts DAEsE3 the pooli%0 o4t"o&e
showed that the o-erall i%"ide%"e of AEs was si0%ifi"a%tl hi0her i% the topi"al
a%estheti" a0e%t 0ro4p tha% i% the pla"e.o 0ro4p Dra%do&*effe"t &odel3 relati-e risk
[RR$ J!HO3 TRQ CI /!YP*//!HJ3 P B !IIPE! Howe-er3 %earl all of the AEs were &ild a%d
tra%sie%t!
Conclusion
Topi"al a%estheti" a0e%ts ha-e .ee% show% to .e effe"ti-e a%d well tolerated for patie%ts
with pri&ar PE3 pro-idi%0 a si0%ifi"a%t i&pro-e&e%t i% IELT with a hi0her i%"ide%"e
of AEs that were %ot lo%0*lasti%0 or se-ere! Hi0h*;4alit RCTs are %e"essar to "o%fir&
the effi"a" a%d safet of topi"al a%estheti"s for PE!
I)! Treat&e%t of Pre&at4re E5a"4latio%
H/
Re"o&&e%datio% P>
The risks a%d .e%efits of all treat&e%t optio%s sho4ld .e dis"4ssed with the patie%t prior
to a% i%ter-e%tio%! Patie%t a%d part%er satisfa"tio% is the pri&ar tar0et o4t"o&e for the
treat&e%t of PE!
[Based o% Pa%el "o%se%s4s!$
As o4tli%ed a.o-e3 the treat&e%ts for PE ra%0e fro& ps"holo0i"al a%d .eha-ioral
therapies to phar&a"olo0i" therapies! Uhile phar&a"olo0i" therapies are the fo"4s of
this 04ideli%e3 other tpes of i%ter-e%tio%s &a .e "o%sidered! The patie%t plas a
"e%tral role i% deter&i%i%0 the %eed for treat&e%t! The patie%t a%d possi.l his part%er
"a% .e reass4red that PE is a "o&&o% a%d treata.le disorder! I%for&atio% o% the risks
a%d .e%efits of all therape4ti" optio%s sho4ld .e prese%ted to the patie%t Da%d part%erE so
that a% ed4"ated treat&e%t "hoi"e &a .e &ade . the patie%t i% "o%s4ltatio% with the
phsi"ia%! Pre&at4re e5a"4latio% is %ot a life*threate%i%0 "o%ditio%= therefore3 safet
sho4ld .e a pri&ar "o%sideratio%! So&e treat&e%ts3 s4"h as %e4re"to& a%d pe%ile
prosthesis i&pla%tatio%3 ha-e risks that far o4twei0h their .e%efits! I% additio%3 %o%e of
the &edi"al therapies "4rre%tl e&ploed i% the &a%a0e&e%t of PE ha-e .ee% appro-ed
. the U!S! +ood a%d Dr40 Ad&i%istratio% D+DAE for this spe"ifi" i%di"atio%! Th4s3
doses a%d dosi%0 re0i&e%s fre;4e%tl de-iate fro& that e&ploed for +DA*appro-ed
i%di"atio%s3 a%d this differe%"e sho4ld .e "o%sidered i% the risk*-ers4s*.e%efit
assess&e%t of phar&a"olo0i" therap!
Effi"a" of Proposed Treat&e%ts
The prepo%dera%"e of e-ide%"e to0ether with Pa%el "o%se%s4s stro%0l s400est that
patie%ts "a% .e%efit fro& the 4se of se-eral oral or topi"al &edi"atio%s! At the dosa0es
4sed i% the &a%a0e&e%t of PE3 these treat&e%ts ha-e .ee% show% to ha-e safet profiles
that 0e%erall are appropriate to s4pport their 4se!
Re"o&&e%datio% J>
Pre&at4re e5a"4latio% "a% .e treated effe"ti-el with se-eral seroto%i% re4ptake
i%hi.itors DSRIsE or with topi"al a%estheti"s! The opti&al treat&e%t "hoi"e sho4ld .e
.ased o% .oth phsi"ia% 54d0&e%t a%d patie%t prefere%"e!
[Based o% Pa%el "o%se%s4s a%d re-iew of data!$
Oral 'edi"atio% S A%tidepressa%ts
Se-eral a%tidepressa%ts k%ow% to "a4se a%or0as&ia a%d delaed e5a"4latio% ha-e .ee%
e-al4ated i% the &a%a0e&e%t of PE! These a%tidepressa%ts i%"l4de SRIs3 the &a5orit of
whi"h are sele"ti-e DSSRIsE n fl4o7eti%e3 paro7eti%e3 a%d sertrali%e S a%d the tri""li"
a%tidepressa%t "lo&ipra&i%e DTa.le /E! The SRIs ha-e .ee% s4""essf4ll 4tiliCed i% the
&a%a0e&e%t of PE! As a 0ro4p3 i% "li%i"al trials3 the SRIs ha-e pro-ided si0%ifi"a%t
.e%efit o-er pla"e.o! St4dies ha-e s400ested that %efaCodo%e3 "italopra&3 a%d
fl4-o7a&i%e are i%effe"ti-e for the treat&e%t of PE a%d &a .e &ore s4ita.le tha% other
SSRIs for treat&e%t of depressio% i% &e% %ot wa%ti%0 e5a"4lator i&pair&e%t!
HH
Ta.le /! 'edi"al therap optio%s for the treat&e%t of pre&at4re e5a"4latio%o
Oral Therapies Trade Na&esp Re"o&&e%ded Dose qr
No%sele"ti-e seroto%i% re4ptake i%hi.itor
Clo&ipra&i%e A%afra%ils
HR to RI &0`da or
HR &0 J to HJ h pre*i%ter"o4rse
Sele"ti-e seroto%i% re4ptake i%hi.itors
+l4o7eti%e ProCa"s3 Sarafe&s R to HI &0`da
Paro7eti%e Pa7ils /I3 HI3 JI &0`da
or
HI &0 P to J h pre*i%ter"o4rse
Sertrali%e [olofts HR to HII &0`da or
RI &0 J to O h pre*i%ter"o4rse
Topi"al Therapies
Lido"ai%e`prilo"ai%e "rea& E'LAs Crea& Lido"ai%e H!RQ`prilo"ai%e H!RQ
HI to PI &i%4tes pre*i%ter"o4rse
oThis list does %ot refle"t order of "hoi"e or effi"a"!
pTrade %a&es listed &a %ot .e all*i%"l4si-e!
q Peak plas&a "o%"e%tratio%s o""4r H to O ho4rs DhE postdose a%d half*li-es ra%0e fro&
/ to P das!
rTitrate doses fro& low to hi0h .ased o% respo%se!
Dosi%0
)ario4s doses a%d dosi%0 re0i&e%s of the SRIs ha-e .ee% e-al4ated i% effi"a" a%d
safet st4dies of PE! So&e st4dies ha-e e&ploed "o%ti%4o4s dail dosi%0 while others
4se a sit4atio%al dosi%0 re0i&e% where. the &edi"atio% is o%l take% prior to se74al
a"ti-it! Differe%t sit4atio%al dosi%0 re0i&e%s also ha-e .ee% assessed3 -ari%0 ti&i%0
of the dose prior to se74al a"ti-it to the ti&e of peak plas&a "o%"e%tratio%s of the
pres"ri.ed a0e%t! The li&ited data o% sit4atio%al dosi%0 s400est that this re0i&e% &a
.e of 4se to so&e &e% .e"a4se of the theoreti"al ad-a%ta0e that less of the dr40 will .e
4sed! I% 0e%eral3 tho40h3 these SRIs ha-e .ee% desi0%ed for "o%ti%4o4s 4sa0e3 a%d their
.e%efits i% the treat&e%t of depressio% are .etter esta.lished after a period of "o%siste%t
dr40 ad&i%istratio%! Co%-ersel3 "o%ti%4o4s ad&i%istratio% &a foster a pro.le& with
patie%t "o&plia%"e!
Uhether "o%ti%4o4s or sit4atio%al dosi%0 is &ore effe"ti-e i% the &a%a0e&e%t of PE is
4%"lear! The opti&al i%ter-al for sit4atio%al dosi%0 .efore i%ter"o4rse has %ot .ee%
esta.lished a%d the o%set of a"tio% of these SRIs for this i%di"atio% is 4%k%ow%!
Howe-er3 all Pa%el &e&.ers 4tiliCe a sit4atio%al dosi%0 re0i&e% i% their pra"ti"es3 a%d
so&e i%itiate therap with dail dosi%0 Dloadi%0 periodE! The "hoi"e of re0i&e% ofte% is
.ased 4po% the fre;4e%" of se74al a"ti-it . the patie%t!
D4ratio% of Therap
HP
Therap for PE &ost likel will .e %eeded o% a "o%ti%4i%0 .asis! There is %o "lear
"o%se%s4s as to whether SRIs will effe"t a% e-e%t4al "4re of PE3 allowi%0 for
dis"o%ti%4atio% of the &edi"atio%3 or whether SRIs will .e re;4ired for life! The Pa%el
&e&.ersG e7perie%"e is that PE 4s4all ret4r%s 4po% dis"o%ti%4i%0 therap!
Dosi%0 of Spe"ifi" Seroto%i% Re4ptake I%hi.itors
Doses of fl4o7eti%e ra%0i%0 fro& R to HI &0`da Dsee Ta.le /E are reported to .e &ore
effe"ti-e i% delai%0 e5a"4latio% a%d e%ha%"i%0 patie%t`part%er satisfa"tio% tha% pla"e.o!
A re0i&e% i% whi"h the dose is i%"reased after / week Dto JI &0`da or to YI &0`daE
also has .ee% 4sed with s4""ess! //3 /H I% additio%3 there is e-ide%"e that a "li%i"all
.e%efi"ial effe"t &a .e o.ser-ed at dail doses as low as R &0!/P
Both dail ad&i%istratio% of paro7eti%e at /I3 HI a%d JI &0`da a%d episodi"
ad&i%istratio% at HI &0 P to J ho4rs prior to i%ter"o4rse Dsee Ta.le /E ha-e .ee% show%
to i%"rease e5a"4lator late%"!/J3 /R3 /Y D4e to the li&ited %4&.er of patie%ts
e-al4ated i% these trials3 the .e%efit of i%"reasi%0 the dose to JI &0`da has %ot .ee%
esta.lished! The &a5orit of e-ide%"e shows effe"ti-e%ess with HI &0 dail dosi%03 th4s
s4pporti%0 a 0e%eral s400estio% that this dose of paro7eti%e pro-ides the 0reatest .e%efit
i% re&ediati%0 PE!
Sertrali%e3 either 0i-e% i% dail doses of HR3 RI3 /II or HII &0 or sit4atio%all i% doses
of RI &0 at R p!&! DJ to O ho4rs .efore i%ter"o4rseE Dsee Ta.le /E3 has .ee% show% to
i%"rease e5a"4lator late%"!/N Hi0her doses &a i%"rease effi"a"3 .4t lo0i" s400ests
that hi0her doses &a .e asso"iated with i%"reased fre;4e%" of ED a%d de"reased
li.ido! St4dies to date3 tho40h3 ha-e .ee% too s&all to s4.sta%tiate this "o%"l4sio% a.o4t
dose*related side effe"ts!
Clo&ipra&i%e3 a tri""li" a%tidepressa%t with SRI effe"ts3 has i&pro-ed e5a"4lator
late%" a%d other &eas4res of PE whe% pres"ri.ed at doses of HR a%d RI &0`da or HR
&0 J to HJ ho4rs prior to i%ter"o4rse Dsee Ta.le /E! Ad-erse e-e%t rates a%d the
.e%efi"ial effe"ts of "lo&ipra&i%e appear to .e dose*related!/O
Ad-erse Effe"ts
Altho40h the ad-erse effe"ts of the SRIs ha-e .ee% well des"ri.ed i% the &a%a0e&e%t
of "li%i"al depressio%3 the followi%0 fa"ts sho4ld .e "o%sidered whe% wei0hi%0 the risks
of pres"ri.i%0 these a0e%ts for the patie%t with PE>
+irst3 &e% .ei%0 treated for PE ofte% are differe%t fro& those .ei%0 treated for
depressio%3 a%d the ad-erse effe"ts of these &edi"atio%s ha-e %ot .ee% well assessed i%
setti%0s other tha% depressio%! Howe-er3 fro& e-ide%"e 0athered to date3 it appears that
the ad-erse e-e%t profiles of the SRIs reported i% the treat&e%t of PE are si&ilar to
those reported i% patie%ts .ei%0 treated for depressio%! The tpe a%d rate of o""4rre%"e
of side effe"ts appear to .e a""epta.le to &ost patie%ts a%d tpi"all i%"l4de %a4sea3 dr
&o4th3 drowsi%ess3 a%d red4"ed li.ido Dsee Appe%di"es / a%d HE! Isolated "ases of &ore
serio4s "o&pli"atio%s3 s4"h as &a%ia/T a%d withdrawal s&pto&s3 a%d pote%tial dr40
i%tera"tio%s also ha-e .ee% asso"iated with the 4se of SRIs! Phar&a"od%a&i" dr40
i%tera"tio%s res4lti%0 i% a ?seroto%er0i" s%dro&e? "hara"teriCed i% &ild "ases .
HJ
heada"he3 %a4sea3 sweati%03 a%d diCCi%ess a%d i% se-ere "ases . hperther&ia3 ri0idit3
deliri4&3 a%d "o&a ha-e .ee% reported rarel with "o%"o&ita%t 4se of &o%oa&i%e
o7idase i%hi.itors3 lithi4&3 s4&atripta% a%d trptopha%! Phar&a"oki%eti" i%tera"tio%s
res4lti%0 i% alteratio%s i% dr40 .lood le-els ha-e .ee% reported with the "o%"o&ita%t
ad&i%istratio% of a0e%ts that3 like the SRIs3 also are &eta.oliCed . the "to"hro&e
PJRI isoe%C&e sste& or are .o4%d to plas&a protei%s! Cli%i"all si0%ifi"a%t
phar&a"oki%eti" i%tera"tio%s &a rarel o""4r with the 4se of a%ti"o%-4lsa%ts3
.e%CodiaCepi%es3 "i&etidi%e3 tri""li" a%tidepressa%ts3 a%tips"hoti" a0e%ts3
tol.4ta&ide3 a%tiarrhth&i"s3 a%d warfari% espe"iall i% the elderl patie%t!
Se"o%d3 doses that are effe"ti-e i% the treat&e%t of PE 4s4all are lower tha% those
re"o&&e%ded i% the treat&e%t of depressio%3 s400esti%0 that the fre;4e%" a%d se-erit
of ad-erse e-e%ts also "o4ld .e less!
Third3 .e"a4se two dr40 ad&i%istratio% re0i&e%s3 "o%ti%4o4s dail dosi%0 a%d
sit4atio%al dosi%03 are e&ploed i% the treat&e%t of PE3 ad-erse e-e%t profiles &a
differ a&o%0 patie%ts depe%di%0 o% the re0i&e% pres"ri.ed!
The e7perie%"e with SRIs3 as refle"ted i% the e-ide%"e ta.les3 a%d the fa&iliarit of
Pa%el &e&.ers to date with these &edi"atio%s i% this "li%i"al setti%0 s400est that the
le-el of ad-erse effe"ts is a""epta.le for the .e%efit deri-ed i% the patie%t with PE!
Topi"al A%estheti" A0e%ts
Topi"al a%estheti" a0e%ts &a .e applied to the pe%is prior to i%ter"o4rse to dela
e5a"4latio%! After topi"al appli"atio%3 these a0e%ts ha-e .ee% 4sed either with or witho4t
a "o%do&! The "o%do& &a .e re&o-ed prior to se74al i%ter"o4rse a%d the pe%is
washed "lea% of a% resid4al a"ti-e "o&po4%d! Lido"ai%e`prilo"ai%e "rea& DH!R 0E
applied for HI to PI &i%4tes prior to i%ter"o4rse Dsee Ta.le /E has .ee% show% to
i%"rease late%" ti&e! No si0%ifi"a%t side effe"ts ha-e .ee% %oted! Prolo%0ed
appli"atio% of topi"al a%estheti" DPI to JR &i%4tesE has .ee% reported to res4lt i% loss of
ere"tio% d4e to %4&.%ess of the pe%is i% a si0%ifi"a%t per"e%ta0e of &e%!HI The
red4"tio% of pe%ile se%satio% &a li&it the a""epta.ilit of this &ethod of treat&e%t!
Diff4sio% of resid4al topi"al a%estheti" o% the pe%is i%to the -a0i%al wall also &a res4lt
i% %4&.%ess i% the part%er!H/ Topi"al a%estheti"s are "o%trai%di"ated i% patie%ts who are
either aller0i" the&sel-es or ha-e part%ers who are aller0i" to a% "o&po%e%t of the
prod4"t!
Other Phar&a"olo0i" Therapies
Other phar&a"olo0i" therapies ha-e .ee% des"ri.ed i% the treat&e%t of PE i% patie%ts
witho4t ED! I%tra"orporal i%5e"tio% of a -asoa"ti-e a0e%t3 s4"h as alprostadil3 a%d the
ad&i%istratio% of silde%afil "itrate3 therapies effe"ti-e i% the &a%a0e&e%t of ED3 ha-e
.ee% fo4%d to i%"rease late%" i% patie%ts with PE i% a few s&all st4dies!HH3 HP A re"e%t
st4d of OI &e% witho4t "o%"o&ita%t ED fo4%d that the ad&i%istratio% of a "o&.i%atio%
of silde%afil "itrate a%d paro7eti%e o% a sit4atio%al .asis e%ha%"ed the effi"a" of
paro7eti%e alo%e3 altho40h there was a% i%"rease i% the fre;4e%" of the side effe"ts of
heada"he a%d fl4shi%0!HJ U%derli%0 these i%ter-e%tio%s is the hpothesis that
phar&a"olo0i" &ai%te%a%"e of a ri0id ere"tio% red4"es the patie%tGs %eed to r4sh to
or0as&!
HR
Be"a4se e5a"4latio% i%-ol-es the s&patheti" %er-o4s sste&3 adre%er0i" .lo"kade has
.ee% proposed as a treat&e%t for delai%0 or i%hi.iti%0 e5a"4latio%! O%e "li%i"al trial did
show &odest effi"a" with alf4Cosi% a%d teraCosi%!HR Phe%o7.e%Ca&i%e a%d
propra%olol also ha-e .ee% st4died3 .4t the Pa%el did %ot .elie-e the e-ide%"e was
s4ffi"ie%t to s4pport a re"o&&e%datio% for their 4seHY3 HN3 HO
)! +4t4re Resear"h
Defi"ie%"ies a%d i%"o%siste%"ies i% the desi0% of a%d la"k of reporti%0 sta%dards for
"li%i"al st4dies o% PE ha-e hi%dered atte&pts to ide%tif .est pra"ti"es! +4t4re resear"h
efforts 4si%0 well*pla%%ed a%d well*e7e"4ted ra%do&iCed3 "o%trolled trials are %eeded
to>
Deter&i%e e5a"4latio% late%" ti&e i% the 0e%eral pop4latio%=
De-elop a "o%se%s4s o% the defi%itio% of PE=
De-elop sta%dardiCed3 -alidated i%str4&e%ts to &eas4re o4t"o&es Di!e!3
patie%t`part%er satisfa"tio% a%d .other3 e5a"4lator late%"E=
Deter&i%e &ore pre"isel the effi"a" a%d risks of dr40 therapies=
Deter&i%e ideal dosi%0 re0i&e%s for SRIs Di!e!3 dail -ers4s sit4atio%al dosi%0
re0i&e%s a%d whether loadi%0 is %e"essar prior to sit4atio%al dosi%0E=
Deter&i%e the opti&al treat&e%t d4ratio% a%d how or whether to dis"o%ti%4e therap=
Deter&i%e the lo%0*ter& a""epta.ilit of therape4ti" a0e%ts to patie%ts=
Deter&i%e the effi"a" of "o&.i%i%0 phar&a"olo0i" a%d .eha-ioral approa"hes to
therap= a%d
Ide%tif the a0e*spe"ifi" pre-ale%"e of PE!
Other a4thorsHT3 PI ha-e &ade re"o&&e%datio%s for reporti%0 res4lts i% this field that
sho4ld .e "o%sidered . i%-esti0ators st4di%0 PE!
)I! Co%"l4sio%s
'a%a0e&e%t of pre&at4re e5a"4latio% S a "o&pariso% of treat&e%t o4t"o&e i% patie%ts
with a%d witho4t ere"tile dsf4%"tio%
Si%0 5oo Chia
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DOI> /I!/IJY`5!/PYR*HYIR!HIIH!IIPYO!7
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I%ter%atio%al ,o4r%al of A%drolo0
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iewords>
ere"tile dsf4%"tio%=
pre&at4re e5a"4latio%=
sele"ti-e seroto%i% re*4ptake i%hi.itors=
se74al satisfa"tio%
S4&&ar
This st4d e-al4ated the pro.le& of pre&at4re e5a"4latio% DPEE i% patie%ts treated for
ere"tile dsf4%"tio%! The ai& was to "o&pare the effi"a" of sele"ti-e seroto%i%
re4ptake i%hi.itors DSSRIsE i% the &a%a0e&e%t of pri&ar PE a%d PE asso"iated with
silde%efil treat&e%t! Ei0ht*se-e% patie%ts with PE see% o-er a period of /N &o%ths
were re"r4ited i%to this prospe"ti-e st4d! The were "ate0oriCed i%to two 0ro4ps>
pri&ar PE D(PIE a%d PE i% silde%efil*treated patie%ts D(PIIE! All patie%ts re"r4ited i%to
(PII had ere"tile dsf4%"tio% DEDE that was s4""essf4ll treated with silde%efil "itrate
for at least a ear! Both 0ro4ps of patie%ts were 0i-e% sertrali%e RI &0 J h .efore
e7pe"ted ti&e of se7! The &i%i&4& follow*4p was Y &o%ths! The e5a"4latio% late%"
.efore a%d after treat&e%t of the two 0ro4ps were "o&pared! The se74al satisfa"tio%
s"ores of the patie%ts i% the two 0ro4ps were also so40ht a%d a%alsed! Twe%t*ei0ht
per"e%t of patie%ts with ED who were s4""essf4ll treated with silde%efil de-eloped PE!
S4.5e"ts i% 0ro4p (PI were o4%0er a%d ha-e less "o&or.id fa"tors tha% those i% 0ro4p
(PII! There was %o si0%ifi"a%t differe%"e i% the &ea% e5a"4latio% late%" for .oth
0ro4ps DJY -s! PJ!Y se" for (PI a%d (PII3 respe"ti-elE! Howe-er3 there was hi0hl
si0%ifi"a%t differe%"e i% the e5a"4latio% late%" .etwee% the two 0ro4ps after treat&e%t
HN
with sertrali%e for Y &o%ths DHJN!H -s! ///!Y se" for (PI a%d (PII3 respe"ti-elE! There
was also si0%ifi"a%t differe%"e i% the se74al satisfa"tio% s"ore for 0ro4p (PI post*
treat&e%t3 .4t %ot for (PII! No si0%ifi"a%t side*effe"t of sertrali%e was reported fro&
patie%ts i% .oth 0ro4ps! S4""essf4l treat&e%t of ED "o4ld %ot ass4re se74al satisfa"tio%!
At least a ;4arter of silde%efil treated ED patie%ts &i0ht de-elop PE whi"h wo4ld
"o%ti%4e to fr4strate these patie%ts se74all! Uhile sele"ti-e seroto%i% re*4ptake
i%hi.itors DSSRIsE was effe"ti-e i% the &a%a0e&e%t of pri&ar PE3 the were %ot as
effe"ti-e i% patie%ts with silde%efil "orre"ted ED
Para a"larar e7pli"ar todo este e%tresi5o3 la do"tora 'olero al4de al &odelo
GLVappro"he se7o"orporelleV3 4% &odelo de desarrollo se74al f4%"io%al3 "reado por el
profesor ,ea% Des5ardi%s desarrollado e% la U%i-ersidad de h4e.e"! Des5ardi%s
"o%"ept4aliC2 este &odelo para ;4e p4diera ser 4tiliCado e% terapia por los profesio%ales
de se7olo0:a3 a ;4e a4da a los pa"ie%tes a desarrollar fortale"er la di&e%si2% er2ti"a
de la se74alidad para s4perar &e5or las difi"4ltades se74ales! Aspe"to f4%da&e%tal de
%4estra se74alidad desarrollo
Topical Anesthetic A+ents ,or Pre'ature E)aculation-
A S.ste'atic Re*ie/ and Meta0anal.sis1
Pu C, an! ", "iu ", uan #, $ei %, #an P.
Urolo+.1 2345 $eb 2311 6Epub ahead o, print7
C!NCLUSI!N-
Topi"al a%estheti" a0e%ts ha-e .ee% show% to .e effe"ti-e a%d well tolerated for patie%ts
with pri&ar PE3 pro-idi%0 a si0%ifi"a%t i&pro-e&e%t i% IELT with a hi0her i%"ide%"e
of AEs that were %ot lo%0*lasti%0 or se-ere! Hi0h*;4alit RCTs are %e"essar to "o%fir&
the effi"a" a%d safet of topi"al a%estheti"s for PE!
Recent iterature in Se!ual Medicine " Andrology
Septe'ber 2342 0 Publication o, the Month
Selecti*e resection o, dorsal ner*es o, penis ,or
pre'ature e)aculation
Zhang GX, Yu LP, Bai WJ, Wang XF.
Source
Depart&e%t of Urolo03 Peki%0 U%i-ersit PeopleGs Hospital3 Bei5i%03 Chi%a!
Int 8 Androl1 2342 Au+ 421 6Epub ahead o, print
C!NCLUSI!N
HO
Re0ardi%0 the res4lts ielded i% that st4d with a.o4t P!R fold &ea% i%"rease of the
IELT after rese"tio% of dorsal %er-e .ra%"hes these are %ot .etter tha% those p4.lished
either with Dapo7eti%e o% de&a%d treat&e%t or dail dosi%0 of SSRIs i% off*la.el 4se
i%di"ati%0 that s4r0er is %ot at all s4perior to dr40*treat&e%t! I wo4ld like to sa here
-er "lear that this ki%d of treat&e%t of PE sho4ld %ot o%l .e "o%sidered e7peri&e%tal
.4t sho4ld .e a.sol4tel re5e"ted to .e "o%sidered as a% alter%ati-e therape4ti" re0i&e%
for PE e-e% i% so*"alled e7"eptio%al "ases!
E,,icac. and sa,et. o, Tra'adol ,or Pre'ature
E)aculation- A S.ste'atic Re*ie/ and Meta0
anal.sis
Wu T, Yue X, Duan X, Luo D, Cheng Y, Tian Y, Wang K.
Source
Depart&e%t of Urolo03 Uest Chi%a Hospital3 Si"h4a% U%i-ersit3 Che%0d43 Chi%a!
Urolo+.1 2342 Sep9:3;5<-=4:02>1 Epub 2342 8ul 2=1
C!NCLUSI!N- I% this di-erse pop4latio%3 tra&adol is a% effe"ti-e a%d safet
phar&a"olo0i" therap for pre&at4re e5a"4latio%
Erectile d.s,unction and pre'ature e)aculation-
underl.in+ causes and a*ailable treat'ents
,AN I/3 HI/I
Erectile and e)aculator. disorders co'prise the 'ost pre*alent se?ual disorders in
'en@ /ith erectile d.s,unction ;ED< pri'aril. a,,ectin+ a+in+ 'en /ho ha*e
coe?istin+ 'orbidities such as cardio*ascular disease and diabetes 'ellitus1
Pre'ature e)aculation ;PE< can a,,ect 'en o, all a+es and is not t.picall.
associated /ith underl.in+ or+anic disorders but is belie*ed to be associated /ith
i'balances in serotonin neurotrans'ission1 The a*ailabilit. o, oral
phosphodiesterase inhibitors has re*olutioniAed the 'ana+e'ent o, ED@ replacin+
less0desirable older products associated /ith 'ore side e,,ects1 Althou+h 'an.
e,,icacious treat'ent options are currentl. a*ailable and reco''ended ,or the
'ana+e'ent o, PE@ se*eral challen+es re'ain in brin+in+ the ,irst desirable@ sa,e@
and e,,ecti*e $DA0appro*ed dru+ to the US 'arBet1 This re*ie/ e?a'ines the
underl.in+ causes associated /ith ED and PE and e*aluates currentl. a*ailable
treat'ent options and those under in*esti+ation1 ;Formulary1 23439>C-4D02D1<
HT
TECNICA CC
La eyaculacin precoz, es considerada como una de las disfunciones
sexuales ms frecuente que afecta la respuesta sexual masculina.
Disfuncin que va desde manifestaciones puntuales, hasta un
verdadero trastorno de etiologa multifactorial en el cual la ansiedad
juega un papel fundamental. l o!jetivo terap"utico !sico, consiste
principalmente en el aprendizaje progresivo del control voluntario del
reflejo de eyaculacin, mediante identificacin y modulacin de las
sensaciones que preceden al orgasmo, eliminando asimismo las
conductas inhi!itorias y la ansiedad que !loquea la percepcin de
dichas sensaciones. l entrenamiento normalmente se lleva en
presencia y cola!oracin de la pareja sexual. Desde una perspectiva
cognitivo#conductual, $%odelo de &arro!les y 'anz(, la intervencin
terap"utica en se estructura en torno a los siguientes niveles)
*rimer nivel
sta!lecimiento de relacin terap"utica y de las metas de
tratamiento
'egundo nivel
+nformacin y educacin sexual.
%odificacin de posi!les actitudes negativas hacia la sexualidad.
ntrenamiento en ha!ilidades de comunicacin y sociales.
,ercer nivel
ntrenamiento en ha!ilidades sexuales especficas.
*rimer nivel.
,ras la devolucin de la informacin o!tenida mediante el anlisis
funcional del pro!lema, el esta!lecimiento de una !uena relacin
terap"utica $empata y confianza(, tan necesaria en estos casos, se
esta!lecen conjuntamente con la pareja las metas a conseguir en la
terapia. n este sentido, se pone mayor "nfasis en las condiciones
necesarias $motivacin y cola!oracin( para adquirir nuevos recursos
que pueden contri!uir a mejorar, no solo la disfuncin sexual que
padece el varn $yaculacin precoz( sino la vida sexual de la pareja
en s.
PI
'egundo nivel.
+nformacin y educacin sexual.
+nformacin a la pareja so!re la naturaleza del pro!lema, su carcter
psicolgico, los distintos factores responsa!les en la adquisicin y
mantenimiento del mismo, as como la conducta pro!lema en sus
distintas manifestaciones $motoras, cognitivas y fisiolgicas( y sus
consecuencias. xplicar el papel de las actitudes, creencias, de la
ansiedad, de forma comprensi!le para el paciente, recalcando los
resultados del anlisis funcional. *oniendo mayor "nfasis en la
responsa!ilidad de am!os miem!ros de la pareja en la resolucin del
pro!lema. -esulta .til dar una explicacin anatmica y fisiolgica
elemental so!re la respuesta sexual femenina y masculina, so!re el
fenmeno de la eyaculacin y las causas que impiden su control
voluntario. *ara mejorar la asimilacin de la informacin el uso de
materiales ilustrativos $diapositivas, di!ujos u otros materiales
audiovisuales.( suele ser de gran utilidad .n caso de recomendar
alg.n material audiovisual auxiliar para casa, normalmente se
aconseja a la pareja verlo conjuntamente para mejorar y fomentar la
comunicacin a la vez de recoger informacin.
%odificacin de actitudes.
'i es necesario, se procede a modificar las actitudes negativas
presentes en la pareja, mitos sexuales, detectando las ideas falsas y
poniendo al da las actitudes contraproducentes, mediante las
t"cnicas pertinentes $de!ate, reconstruccin cognitiva, etc.( se
desmontan los crculos viciosos. La modificacin de las creencias
errneas, es en s misma una fuente de cam!ios de actitudes y de
conductas. /o hay que olvidar que el rgano sexual esencial es el
cere!ro. n este sentido se le ayuda a la pareja a identificar y
modificar las actitudes o pensamientos errneos asociados tanto con
el pro!lema, $soy responsa!le de la satisfaccin sexual de mi
pareja.., toda interaccin sexual de!e terminar en coito0, la
excitacin sexual masculina es incontrola!le0,soy incapaz de
controlar mi eyaculacin0, voy a decepcionar a mi pareja incluso si
me afirma lo contrario0( , como los asociados con la terapia o la
realizacin de las tareas para casa $su naturaleza y consecuencias(
dificultndolas e impidiendo as, la consecucin de las metas
terap"uticas.
ntrenamientos en ha!ilidades sociales y de comunicacin.
P/
l o!jetivo de esta fase, es la mejora de la comunicacin entre la
pareja $ver!al, fsica o corporal(. 1 trav"s de las t"cnicas disponi!les
$ntrenamiento en ha!ilidades sociales, 1sertividad, xpresin de
sentimientos, 1prender a dar 2feed!ac34 positivo durante la actividad
sexual o fuera de ella, etc.(. *ara mejorar la comunicacin fsica, se
fomenta el concepto de 2sexo no exigente4 en la pareja, mediante
t"cnicas como la focalizacin sensorial $experimentar sensaciones
sensuales y sexuales sin o!sesionarse o preocuparse por el resultado
o meta(. %ejorar la comunicacin tanto ver!al como fsica en la
pareja, permite a la misma explorar conjuntamente su sexualidad
$conductas, deseos, motivaciones y actitudes...etc.( para gozar de
una armona sexual plena.
,ercer nivel.
*rograma de ha!ilidades sexuales especficas.
o -educcin de la ansiedad.
n el enunciado mismo de 2eyaculacin precoz4 se encuentra uno de
los pilares del tratamiento que es la reduccin de la ansiedad de
ejecucin que presentan la mayora de los pacientes durante sus
actividades sexuales. 'eg.n el nivel de ansiedad y las caractersticas
del caso se pueden utilizar indirectamente distintos procedimientos
$relajacin, desensi!ilizacin en imaginacin o en vivo...( o
directamente mediante el uso de otras t"cnicas especficas que
contri!uyen a reducir la ansiedad asociada a la eyaculacin precoz
como) La focalizacin sensorial5 l desarrollo de fantasas sexuales5
,"cnicas de 2parada y arranque4 y 2t"cnica de compresin4.
o ,"cnicas especficas.
&omo ha!ilidades sexuales especificas para la eyaculacin precoz, se
utilizan principalmente la t"cnica de 2parada y arranque4 de 6ames
'emans $789:( o la t"cnica de 2compresin vacilar4 de %aster y
6ohnson $78;<( en com!inacin con la focalizacin sensorial y otros
aspectos educativos.
l mecanismo de accin de estos procedimientos, pueden implicar
elementos de contra#condicionamiento, de ha!ituacin o incremento
PH
de los um!rales o latencia de la eyaculacin sensoriales tras su
reiterada estimulacin. 1 parte de los efectos que pueden tener en la
reduccin de ansiedad, en general se entrena al paciente, con la
ayuda de su pareja, a modular su nivel de excitacin, a trav"s de la
siguiente secuencia)
%antenimiento de la ereccin sin eyaculacin a trav"s de la
estimulacin por parte de la pareja, ense=ndole a focalizar su
atencin so!re las sensaciones antecedentes de la eyaculacin.
n esta fase se procede a la estimulacin de zonas genitales por la
pareja, pero sin coito, utilizando las t"cnicas de 2parada y arranque 2
y 2compresin4. n am!as, la pareja comienza con el juego ertico
$sin coito( tan pronto que se haya logrado la ereccin, el paciente
de!e acostarse en posicin supina mientras la pareja lo mastur!a.
&entrndose .nicamente en las sensaciones previas a la eyaculacin,
o!servando cmo crece la excitacin...
&uando el paciente perci!a que la eyaculacin esta prxima,
mediante un gesto le pide a su pareja que pare la estimulacin y
apriete la parte inferior del glande hasta que desaparezca la
inminencia de la eyaculacin. &uando la excitacin haya disminuido
hasta un nivel controla!le, la pareja de!e comenzar a estimularle de
nuevo. /o es recomenda!le esperar ms de >< segundos entre
estimulacin y otra, ya que el o!jetivo es que la excitacin disminuya
un poco, hasta niveles maneja!les sin que se pierda la ereccin. l
proceso se reanuda una media de cuatro veces permitiendo la
eyaculacin en la .ltima.
1 lo largo del ejercicio el paciente de!e dejarse llevar por sus
sensaciones, sin controlar nada, solo centrarse en el placer e indicar a
su pareja que cese la estimulacin cuando perci!a las sensaciones
previas a la eyaculacin.
&oito sin exigencia para permitir que la expresin sexual fluya
li!remente, sin condicionarla a metas, fines etc.
n esta fase el paciente gua la mano de su pareja para adaptar la
estimulacin al ritmo deseado, o!teniendo as la firmeza, rapidez y
profundidad deseada y experimentando las sensaciones previas a la
eyaculacin. l proceso parada?arranque y apretn se repite unas
cuatro veces, permitiendo la eyaculacin extravaginal en la .ltima.
&uando el paciente sea capaz de identificar las sensaciones previas a
la eyaculacin, se repite el proceso, pero esta vez con lu!ricacin del
PP
pene con vasilina, simulando la lu!ricacin vaginal. La fase suele
precisar entre tres a seis sesiones con eyaculacin extravaginal.
&oito normalizado.
*ostura, mujer encima del hom!re en postura supina con las manos
en las caderas de su pareja, marcando el ritmo de caderas. 'e utiliza
la t"cnica de parada y arranque y cuando el paciente perci!e las
sensaciones previas a la eyaculacin pide a su pareja que pare los
movimientos coitales, que retire el pene de la vagina y apriete el
glande entre el dedo ndice y el pulgar hasta que desaparezca el
reflejo de eyacular. ,ras unos segundos se reanuda el ejercicio, cuatro
veces permitiendo la eyaculacin en la .ltima de ellas. @na vez
alcanzado el control se repite el mismo procedimiento pero esta vez,
sin retirar el pene de la vagina. &onservando la pareja la misma
postura, el paciente puede realizar inicialmente movimientos coitales
suaves para ir aumentando la intensidad de los mismos
sucesivamente, permitiendo la eyaculacin en el cuarto ensayo.
*osteriormente se puede repetir los mismo pero adoptando la pareja
una posicin lateral, en cuyo caso se repite lo mismo pero intentando
controlar la eyaculacin reduciendo la intensidad de los movimientos
coitales, pero sin necesidad de detenerlos como antes. 1l ser la
posicin del 2misionero4 la menos indicada para la eyaculacin
precoz, se deja para el final.
&uando el paciente logra ejercer control so!re su eyaculacin en sus
relaciones sexuales normales, antes de dar el tratamiento por
finalizado, previamente se prepara a la pareja para la prevencin de
recadas y la generalizacin de lo aprendido. n este sentido y con la
finalidad de mantener los resultados se le recomienda a la pareja
repetir el ejercicio de parada?arranque una vez por semana.
%ohammed 6amil l Aahi
*siclogo?*sicoterapeuta
BIBLIO(RA+IA
N! Carso% C3 (4%% i! Pre&at4re e5a"4latio%> defi%itio% a%d pre-ale%"e! &nt ' &mpot (es!
HIIY=/O Ds4ppl /E>R*/P!
PJ
The Asso"iatio% .etwee% )ari"o"ele3 Pre&at4re E5a"4latio% a%d Prostatitis S&pto&s>
Possi.le 'e"ha%is&s
+ra%"es"o Lotti 'D/
Iss4e
The ,o4r%al of Se74al 'edi"i%e
The ,o4r%al of Se74al 'edi"i%e
)ol4&e Y3 Iss4e /I3 pa0es HONOSHOON3 O"to.er HIIT
Co%"l4sio%s! I% "o%"l4sio%3 si0%s a%d s&pto&s of prostatitis are &ore "o&&o% i%
-ari"o"ele patie%ts3 who &ore ofte% "o&plai% of pre&at4re e5a"4latio%! Lotti +3 Coro%a
(3 'a%"i%i '3 Bia0i%i C3 Colpi ('3 I%%o"e%ti SD3 +ili&.erti E3 (a""i '3 ira4sC C3
SforCa A3 +orti (3 'a%%4""i E3 a%d 'a00i '! The asso"iatio% .etwee% -ari"o"ele3
pre&at4re e5a"4latio% a%d prostatitis s&pto&s> Possi.le &e"ha%is&s! , Se7 'ed
HIIT=Y>HONOSHOON
Ta EP HI/H
Treatment of premature ejaculation

a
Di-isio% of A%drolo0 a%d +e&ale Urolo03 Depart&e%t of Urolo0 a%d
S4r0er3 Cha%0 (4%0 'e&orial Hospital*Li%ko43 Tao4a%3 Taiwa%

.
Colle0e of 'edi"i%e3 Cha%0 (4%0 U%i-ersit3 Tao4a%3 Taiwa%
http>``d7!doi!or0`/I!/I/Y`5!4rols!HI/P!I/!IIJ3 How to Cite or Li%k Usi%0 DOI
Abstract
Pre&at4re e5a"4latio% DPEE is the &ost "o&&o% &ale se74al disorder3 a%d it &a ha-e a
profo4%d %e0ati-e i&pa"t o% a &a% a%d his part%erGs li-es! Differe%t or0a%iCatio%s a%d
so"ieties ha-e %o "o%se%s4s o% the defi%itio% a%d "lassifi"atio%s of PE! Howe-er3 &ost
or0a%iCatio%s a%d so"ieties i%"l4de i% their defi%itio%s the i%tra-a0i%al e5a"4latio%
late%" ti&e DIELTE3 the "o%trol of e5a"4latio%3 a%d the distress or i&pa"t of
i%terperso%al diffi"4lties! E-al4atio% pro"ed4res ha-e .ee% sta%dardiCed i% "li%i"al
st4dies . the de-elop&e%t of a% o.5e"ti-e &eas4re&e%t of IELT D4si%0 a stopwat"hE
a%d . the i%trod4"tio% of patie%t*reported o4t"o&e DPROE ;4estio%%aires o%
e5a"4latio% "o%trol a%d se74al satisfa"tio%! The ide%tifi"atio% of fo4r differe%t patter%s
of PEnlifelo%03 a";4ired3 %or&al -aria%t3 a%d pre&at4re*like e5a"4lator dsf4%"tio%n
is "riti"al .e"a4se of differe%t 4%derli%0 patho0e%eses a%d "o%se;4e%tl differe%t
&a%a0e&e%t approa"hes! The opti&al treat&e%t for PE sho4ld .e i%di-id4aliCed3 .ased
o% a patie%tGs s&pto&s3 e7pe"tatio%s3 a%d 4%derli%0 -aria%t "a4ses! 'ost lifelo%0 PE
patie%ts %eed phar&a"otherap Dpossi.l i% "o&.i%atio% with ps"hose74al "o4%seli%0E
PR
as a first*li%e treat&e%t .e"a4se of the 4%derli%0 %e4ro.iolo0i"al etiolo0 a%d the
i&pa"t of PE o% the "o4pleGs relatio%ship! The &a%a0e&e%t of a";4ired PE is
etiolo0i"all spe"ifi" a%d &a i%"l4de phar&a"otherap for ere"tile f4%"tio%
&a%a0e&e%t i% &e% with "o&or.id ere"tile dsf4%"tio% DEDE! 'e% with %at4ral
-aria.le PE "o&plai% of earl e5a"4latio% i% sit4atio%al or "oi%"ide%tal "o%ditio%s= the
e5a"4latio% is i%"o%siste%t a%d o""4rs irre04larl! Ps"hoed4"atio% a%d reass4ra%"e are
i%di"ated for &e% with this tpe of PE! Ps"hotherap or se7 "o4%seli%0 is the first
"hoi"e of treat&e%t for &e% with pre&at4re*like e5a"4lator dsf4%"tio%! All
phar&a"otherapies s4"h as lo%0*ter& sele"ti-e seroto%i% re4ptake i%hi.itors DSSRIsE or
o%*de&a%d topi"al a%estheti"s are off*la.el i%di"atio%s3 The .e%efits of
phar&a"otherap toward i&pro-i%0 e5a"4latio% ti&es sho4ld .e wei0hed a0ai%st their
safet profiles! The de-elop&e%t of the short*a"ti%0 sele"ti-e seroto%i% re4ptake
i%hi.itor DSSRIE dapo7eti%e hdro"hloride DPI &0 a%d YI &0E for oral o%*de&a%d 4se
ope%ed a %ew era of PE treat&e%t! Other pote%tial phar&a"otherapies s4"h as tra&adol3
lido"ai%e`prilo"ai%e spra3 a%d phosphodiesterase i%hi.itors are still 4%der de-elop&e%t!
Their safet a%d effi"a" profiles sho4ld .e f4rther e-al4ated a%d s4pported .
additio%al "li%i"al st4dies!
Ee./ords
dapo7eti%e=
pre&at4re e5a"4latio%=
seroto%i%=
SSRI
There are %o fi04res or ta.les for this do"4&e%t!

There are H C'E ;4estio%s .ased o% this arti"le!

Correspo%di%0 a4thor! Depart&e%t of Urolo03 Cha%0 (4%0 'e&orial Hospital*
Li%ko43 R +4*Shi%0 Street3 (4isha%3 Tao4a% PPPPP3 Taiwa%!
#ntracavernous medication for treatmentof premature
ejaculation
'!D! Ri"hard L! +ei%
Di-isio% of Urolo03 North 'ia&i 'edi"al Ce%ter3 North 'ia&i +lorida3 USA
PY
Abstract
Si7tee% &e% "o&plai%ed of pre&at4re e5a"4latio% d4ri%0 a fi-e*&o%th period .etwee%
'a /TON3 a%d O"to.er /TON! Ei0ht patie%ts e%tered this st4d 4si%0 i%tra"a-er%o4s
-asoa"ti-e dr40s as treat&e%t for their pro.le&! The patie%ts3 a0es twe%t*fo4r thro40h
fift*ei0ht Da-era0e JH earsE3 were all phsi"all health a%d taki%0 %o &edi"atio%s!
+i-e patie%ts had %or&al fi%di%0s o% %o"t4r%al t4&es"e%"e &o%itor3 while P patie%ts did
%ot 4se the &o%itor! A &i7t4re of phe%tola&i%e &eslate3 /!I &0`&L3 a%d papa-eri%e
hdro"hloride3 PI &0`&L3 was 4sed! The re;4ired was fro& I!/I &L to I!JI &L! All O
patie%ts respo%ded s4""essf4ll to this treat&e%t Three patie%t stated the were "4red
a%d stopped the treat&e%t! The other R patie%ts "o%ti%4ed 4si%0 the &edi"atio% "atio%
after fo4rtee% &o%ths! The dr40*i%d4"ed ere"tio% lasted .etwee% two a%d fo4r fo4rs
despite e e5a"4latio% There ha-e .ee% %o side effe"ts thro40h April /TOO! All patie%ts
report satisfa"tio% with the res4lts of this treat&e%t! The st4d showed that
i%tra"a-er%o4s &edi"atio% therap "a% .e s4""essf4l i% the treat&e%t of pre&at4re
e5a"4latio%
L3APROCHE SE#OCORPORALE
LVappro"he se7o"orporelle se .ase s4r les lois d4 "orps 4%i-erselle&e%t re"o%%4es3 soit
lV4tilisatio% de lVespa"e3 lVi%te%sit1 &4s"4laire et le rth&e3 propres W to4tes a"ti-it1s
"orporelles "o&&e la da%se3 les arts &artia473 le sport3 et"! Cette appro"he a po4r .4t
dVa&1liorer la ;4alit1 de lVe7"itatio% se74elle s4r le pla% phsiolo0i;4e3 e% te%a%t
"o&pte d4 plaisir et de la 5o4issa%"e ;4i de-raie%t lVa""o&pa0%er! O% sait ;4e le plaisir
et la 5o4issa%"e so%t des do%%1es ;4alitati-es et s4.5e"ti-es3 "Vest*W*dire per"epti-es et
1&otio%%elles! Bas1e s4r 4% "o%"ept de vsa%t1 se74ellew3 lVappro"he se7o"orporelle
1-al4e les pro.l1&ati;4es se74elles ta%t a4 pla% de la fo%"tio% e7"itatoire ;4e de la
fo%"tio% de plaisir! La pre&ibre se rapporte a47 r1a"tio%s phsiolo0i;4es de lVe7"itatio%
se74elle et la de47ib&e3 a47 fa"te4rs ps"ho*1&otio%%els3 e47*&g&es for&1s de
pl4sie4rs 1l1&e%ts! Ces de47 fo%"tio%s3 a4ssi i&porta%tes lV4%e ;4e lVa4tre3 so%t e%
"o%ti%4elle i%tera"tio% et i%fl4e%"e%t la ;4alit1 de lVe7"itatio% ai%si ;4e "elle d4 plaisir!
CVest do%" W partir de "ette 0rille ;4e se fait 4% dia0%osti" e% th1rapie se7o"orporelle!
To4tefois3 "ette appro"he "o%siste 10ale&e%t e% lVappre%tissa0e de "ertai%es ha.ilet1s
se7o"orporelles3 lors;4e %1"essaire3 "e ;4i re%d "ette appro"he 4%i;4e et i%%o-atri"e! De
faxo% 01%1rale3 "es ha.ilet1s per&ette%t W 4% i%di-id4 dVappre%dre W diff4ser so%
e7"itatio%3 W la "a%aliser3 W la 01rer ai%si ;4VW effe"t4er 4% lX"her*prise3 afi% de l4i
per&ettre de sVa.a%do%%er da%s 4% or0as&e p4issa%t!
Cette appro"he est do%" to4t i%di;41e "heC les ho&&es 15a"4late4rs pr1"o"es o4
rapides3 do%t la diffi"4lt1 W prolo%0er lVe7"itatio% se74elle relb-e 01%1rale&e%t des
r1a"tio%s phsiolo0i;4es se &a%ifesta%t da%s le4r "orps lors;4Vils so%t e7"it1s! Noto%s
;4e la diff1re%"e e%tre vpr1"o"ew et vrapidew se sit4e da%s la d4r1e! No4s diso%s
vpr1"o"ew lors;4V4% ho&&e %e pe4t &ai%te%ir so% e7"itatio% "oytale pl4s dV4%e &i%4te3
et vrapidew lors;4Vil pe4t la &ai%te%ir e%-iro% de47 &i%4tes! La pl4part des ho&&es
;4i "o%s4lte%t po4r "e pro.lb&e so%t 10ale&e%t affe"t1s s4r le pla% 1&otio%%el!
PN
To4tefois3 "Vest da-a%ta0e le4r diffi"4lt1 W 01rer le4r e7"itatio% ;4i s4s"ite e% e47 des
&alaises 1&otio%%els3 parfois trbs i&porta%ts3 pl4tft ;4e lVi%-erse! Les ho&&es ;4i
15a"4le%t &al0r1 e473 aprbs ;4el;4es -a*et*-ie%t3 appr1he%de%t 01%1rale&e%t la
p1%1tratio%3 -1"4e a-e" 4%e a%7i1t1 0ra%dissa%te! U% ho&&e pe4t do%" gtre a4 so&&et
de lVe7"itatio% phsiolo0i;4e3 to4t e% 1ta%t a4 so&&et de so% d1plaisir 1&otio%%el!
CVest sa%s "o&pter le se%ti&e%t de fai.le esti&e de soi*&g&e d1-elopp1 W la s4ite
dV1"he"s r1p1t1s!
Certai%s ho&&es se vpr1o""4pe%tw telle&e%t des r1a"tio%s de le4r parte%aire3 ;4Vils e%
o4.lie%t de vsVo""4perw dVe47*&g&es! Pri-1s d4 "o%ta"t a-e" le4r propre "orps3 ils so%t
e%-ahis par lVe7"itatio%3 sa%s po4-oir i%ter-e%ir W te&ps! Po4r traiter effi"a"e&e%t
lV15a"4latio% pr1"o"e et rapide3 lVappro"he se7o"orporelle se .ase s4r la "o&pr1he%sio%
de "e ;4i ad-ie%t da%s le "orps dV4% ho&&e e7"it1 se74elle&e%t3 soit la "o%0estio%
sa%04i%e d4 r1fle7e 1re"tile dV4%e part3 et la pressio% e7er"1e par "ertai%es r1a"tio%s
&4s"4laires s4r "ette "o%0estio%3 dVa4tre part! Ce ;4i fa-orise3 "heC les ho&&es
fa"ile&e%t e7"ita.les3 le d1"le%"he&e%t i%-olo%taire des spas&es 15a"4latoires! Ces
r1a"tio%s &4s"4laires so%t des "o%tra"tio%s pro-o;41es parti"4libre&e%t par la post4re
et les &o4-e&e%ts dV4% ho&&e lors de la p1%1tratio%3 &ais a4ssi par la "o%tra"tio%
r1fle7e et so4-e%t i%"o%s"ie%te des &4s"les is"hio*"a-er%e47 et .4l.o*"a-er%e47!
A4 "o4rs dV4%e 1-al4atio% se7olo0i;4e3 "ertai%es ;4estio%s sp1"ifi;4es sVi&pose%t! E%
a*t*il to45o4rs 1t1 ai%si3 o4 se4le&e%t a-e" 4%e parte%aire e% parti"4lier L )it*il 4%e
e7"itatio% pl4s i%te%se a-e" "ette parte%aire L ] a*t*il de lVa%7i1t1 lors;4Vil fait
lVa&o4r L Pe4t*il gtre "aress1 &a%4elle&e%t o4 orale&e%t sa%s pro.lb&e L Est*il
"apa.le de saisir so% poi%t de v%o%*reto4rw lors;4Vil est se4l L A*t*il to45o4rs re"her"h1
4% so4la0e&e%t rapide lors;4Vil se &ast4r.ait o4 "her"hait*il3 sa%s s4""bs3 W prolo%0er
so% e7"itatio% L La "o&pr1he%sio% d4 lie% e7ista%t e%tre les "o%tra"tio%s &4s"4laires et
les ris;4es de d1"le%"he&e%t des spas&es 15a"4latoires est esse%tielle! E% si&4la%t les
&o4-e&e%ts de la p1%1tratio%3 lVho&&e pe4t fa"ile&e%t pre%dre "o%s"ie%"e des
te%sio%s e7er"1es s4r la "o%0estio% sa%04i%e d4 p1%is lors dV4%e relatio% se74elle! Ta%t
;4V4% ho&&e "o%ser-era ses &g&es -ieilles ha.it4des3 il perp1t4era le pro.lb&e ;4Vil
d1plore!
Les ha.ilet1s ;4V4% ho&&e a4ra W d1-elopper po4r par-e%ir W 4% s4&&4& dVe7"itatio%
et de plaisir "o%sistero%t do%" W l4i appre%dre W .o40er a-e" 4% &i%i&4& de te%sio%s
&4s"4laires! La respiratio% a.do&i%ale fait partie des appre%tissa0es li1s a47
relX"he&e%ts &4s"4laires! Noto%s e%tre a4tres les vha.ilet1s de .asew et les vha.ilet1s
i%t10r1esw! Les pre&ibres "o%siste%t e% lVappre%tissa0e de la do4.le .as"4le r1fle7e3
ta%dis ;4e les ha.ilet1s i%t10r1es per&ette%t de faire "e &o4-e&e%t de -a*et*-ie%t a-e"
4% &i%i&4& de te%sio%s &4s"4laires! La %otio% de rth&e fait 10ale&e%t partie des
ha.ilet1s i%t10r1es! La do4.le .as"4le r1fle7e est 4% &o4-e&e%t de .as"4le d4 .assi%
ai%si ;4e d4 ha4t d4 "orps3 i%"l4a%t le re%-erse&e%t de la tgte -ers lVarribre! Po4r e%
fa"iliter lVe71"4tio% de &a%ibre "o%s"ie%te3 4% se7oth1rape4te for&1 W lVappro"he
se7o"orporelle e%sei0%era dVa.ord "o&&e%t .as"4ler le .assi% da%s pl4sie4rs positio%s >
W ;4atre pattes po4r fa"iliter la positio% d4 &issio%%aire = de.o4t po4r fa"iliter la
positio% derribre 4%e parte%aire = s4r le dos = s4r le "ft1! Aprbs 4%e se&ai%e de "et
appre%tissa0e3 le se7oth1rape4te e%sei0%era "o&&e%t e71"4ter la .as"4le d4 ha4t d4
"orps3 ai%si ;4e la re%-erse de la tgte! P4is3 "o&&e%t asso"ier "es de47 .as"4les!
PO
La &a5orit1 des ho&&es pe4-e%t3 e% de47 W ;4atre s1a%"es3 e71"4ter les ha.ilet1s de
.ase! LVappre%tissa0e des ha.ilet1s i%t10r1es sVa5o4te se4le&e%t lors;4e "es ho&&es
possbde%t les ha.ilet1s de .ase! Ils pe4-e%t alors pre%dre "o%s"ie%"e de la diff1re%"e
e%tre 4% 1tat de te%sio% et 4% 1tat de relX"he&e%t &4s"4laire! Ils appre%%e%t ai%si W faire
la do4.le .as"4le r1fle7e to4t e% relX"ha%t les &4s"les vW ris;4ew3 soit les &4s"les
fessiers3 "e47 des 5a&.es3 les is"hi"a-er%e47 et les .4l.o*"a-er%e473 ai%si ;4e le
sphi%"ter a%al!
Le rfle de la respiratio% est trbs i&porta%t! No4s disti%04ero%s de47 tpes de
respiratio%! To4t dVa.ord3 la respiratio% a.do&i%ale3 ;4i "o%siste W re&plir le .as d4
-e%tre "o&&e 4% .allo%! CVest 4%e v.o41e de sa4-eta0ew! Cette si&ple respiratio% a
po4r effet de relX"her les &4s"les d4 .as d4 -e%tre sit41s prbs des Co%es 01%itales!
Pl4sie4rs ho&&es so%t s4rpris de resse%tir 4% 1%or&e "ha%0e&e%t da%s la d4r1e de
le4rs relatio%s se74elles3 &g&e aprbs 4%e se4le re%"o%tre3 0rX"e W "ette &a%ibre de
respirer et de se d1te%dre! Cette respiratio% a dVa.ord po4r .4t de pre%dre 4%e pa4se3 et
&g&e pl4sie4rs3 lors;4e "es ho&&es fo%t se4ls lVappre%tissa0e de le4r poi%t de v%o%*
reto4rw!
E%s4ite3 la respiratio% a71e s4r lVe7piratio% profo%de! E% effet3 "Vest pri%"ipale&e%t la
&a%ibre dVe7pirer ;4i per&et W 4% 15a"4late4r pr1"o"e o4 rapide de "o%ti%4er W .o40er3
to4t e% relX"ha%t a4 &a7i&4& les &4s"les d15W &e%tio%%1s! To4tefois3 la respiratio%
v.o41e de sa4-eta0ew l4i sera to45o4rs 4tile3 -oire &g&e %1"essaire3 W "ertai%s
&o&e%ts! Lors;4e %o4s e7piro%s trbs profo%d1&e%t3 %os &4s"les a.do&i%a47 se
v"o&pri&e%tw3 "e ;4i a po4r effet de per&ettre W %otre .assi% dVa-a%"er -ers lVa-a%t3
sa%s lVi%ter-e%tio% de %os &4s"les fessiers! LVe7piratio% e% profo%de4r 5o4e do%" 4%
rfle pri&ordial da%s lVe71"4tio% de la do4.le .as"4le r1fle7e! Elle per&et %o%
se4le&e%t a4 .assi% dVa-a%"er de l4i*&g&e3 &ais a4ssi W la .as"4le d4 ha4t d4 "orps de
se faire sa%s effort3 ai%si ;4VW la tgte de se re%-erser a4to&ati;4e&e%t! No4s le
"o%stato%s pl4s fa"ile&e%t lors;4e %o4s3 ho&&es o4 fe&&es3 so&&es s4r le dos3 les
5a&.es repli1es o4 allo%01es!
h4a%t a4 rth&e3 il re-gt 10ale&e%t 4%e 0ra%de i&porta%"e po4r 01rer lVe7"itatio%
se74elle3 p4is;4V4% rth&e trbs rapide d1"le%"he les a4to&atis&es de la d1"har0e3
s4rto4t "heC les ho&&es fa"ile&e%t e7"ita.les! Il sVa0ira do%" po4r "es ho&&es de
prati;4er la do4.le .as"4le r1fle7e W di-ers rth&es3 e% les adapta%t W le4r de0r1
dVe7"itatio%3 sa%s o4.lier le relX"he&e%t &4s"4laire!
Ai%si3 aprbs lVi%t10ratio% de le4rs ha.ilet1s se7o"orporelles3 .ie% des ho&&es
15a"4late4rs pr1"o"es et rapides par-ie%%e%t W d1"ider d4 &o&e%t de le4r d1"har0e
15a"4latoire et o.tie%%e%t ai%si le &a7i&4& de plaisir et de satisfa"tio% da%s la phase
dVe7"itatio%! CVest le 5e4 de lVi%tera"tio% ;4i se &a%ifeste! La se7oth1rapie est ter&i%1e
lors;4V4% ho&&e est "apa.le de 01rer so% e7"itatio% et ;4Vil sVe% dit satisfait! De faxo%
01%1rale3 les "o&&e%taires de le4r parte%aire reflbte%t 10ale&e%t "ette satisfa"tio%! U%e
der%ibre s1a%"e a lie4 trois se&ai%es pl4s tard3 afi% de sVass4rer de la "o%solidatio%
positi-e de la th1rapie! Des patie%ts o%t fo4r%i la pre4-e ;4e le4r "apa"it1 W 01rer le4r
e7"itatio% 1tait d4ra.le lors;4Vils re-e%aie%t3 aprbs pl4sie4rs a%%1es3 po4r 4%e a4tre
raiso%! Il est to4tefois arri-1 ;4e dVa4tres patie%ts aie%t W d1plorer 4%e pl4s 0ra%de
diffi"4lt1 W &adtriser le4r e7"itatio%! Aprbs 1-al4atio%3 il sVa-1rait ;4Vils a-aie%t repris
le4rs v-ieilles ha.it4desw! Da%s "es "as3 ;4el;4es s1a%"es s4ffise%t po4r les re&ettre s4r
le .o% "he&i% de la -ol4pt1! E% r1s4&13 les pressio%s &4s"4laires e7er"1es s4r la
PT
"o%0estio% sa%04i%e d4 p1%is so%t e% lie% dire"t a-e" les ris;4es de d1"le%"her les
spas&es 15a"4latoires! CVest po4r;4oi lVappro"he se7o"orporelle3 ;4i e% tie%t "o&pte3 a
a4ta%t de s4""bs a4prbs des 15a"4late4rs pr1"o"es et rapides!
Aprbs a-oir trait1 a-e" s4""bs pl4s de /RII ho&&es3 dep4is 4%e -i%0tai%e dVa%%1es3
%o4s po4-o%s affir&er ;4e "ette appro"he3 to4t e% 1ta%t .rb-e3 est effi"a"e et d4ra.le!
Aprbs e%-iro% si7 W di7 re%"o%tres3 la pl4part appre%%e%t W 01rer le4r e7"itatio% et
"ertai%s par-ie%%e%t &g&e W la prolo%0er a4*delW dV4%e ;4i%Cai%e de &i%4tes! No%
se4le&e%t par-ie%%e%t*ils W prolo%0er le4r e7"itatio% de faxo% si0%ifi"ati-e3 &ais ils
d1"o4-re%t le plaisir et la 5o4issa%"e ;4i lVa""o&pa0%e%t!
Co%"l4sio%
E5a"4latio% pr1"o"e > traite&e%t phar&a"olo0i;4e o4 se7olo0i;4e L DV4% poi%t de -4e
s"ie%tifi;4e3 le traite&e%t phar&a"olo0i;4e a fait de &a%ibre i%dis"4ta.le la pre4-e de
so% effi"a"it1 W "o4rt ter&e! Cepe%da%t3 ses effets se"o%daires %e so%t pas %10li0ea.les
et so% effi"a"it1 W lo%0 ter&e reste i%"o%%4e! Il est i&possi.le a45o4rdVh4i dVaffir&er
;4Vil 041rit lV15a"4latio% pr1"o"e!
LVappro"he se7o"orporelle est effi"a"e selo% ses partisa%s! +or"e est to4tefois de
"o%stater3 et "Vest &alhe4re4se&e%t le "as po4r la pl4part des traite&e%ts se7olo0i;4es3
;4e les 1t4des pro4-a%t "ette effi"a"it1 fo%t "r4elle&e%t d1fa4t! Le re"o4rs W la
se7olo0ie %e sVappli;4e pas W to4t 15a"4late4r pr1"o"e! Il fa4t e% effet gtre prgt W
"o%s4lter 4% se7olo04e3 W se re&ettre e% ;4estio%3 W i%-estir d4 te&ps3 de lV1%er0ie et
parfois de lVar0e%t! E%fi%3 il -a4t &ie47 parta0er so% lit a-e" 4%e parte%aire
"o&pr1he%si-e3 patie%te et W lVesprit o4-ert! Ces "o%ditio%s opti&ales %e se re%"o%tre%t
pas "heC to4t 4% "ha"4%! CVest la raiso% po4r la ;4elle les ISRS3 et %ota&&e%t3 la
dapo71ti%e o%t 4% .el a-e%ir de-a%t e473 "e"i dVa4ta%t pl4s3 ;4Va4 "o%traire des
se7olo04es3 les &oe%s fi%a%"iers po4r faire le4r pro&otio% %e -o%t pas &a%;4er! Le
v&ar"h1w est lW e HIQ W PIQ des ho&&es so4ffre%t dV15a"4latio% pr1"o"e etz YIQ
so4haite%t 15a"4ler pl4s tardi-e&e%t e
I&pli"atio%s prati;4es
Ta PSICOLO( EP
Sao Pa4lo 'edi"al ,o4r%al
Pri%t -ersio% ISSN /R/Y*P/OI
Sao Pa4lo 'ed! ,! -ol!/PI %o!H S{o Pa4lo HI/H
http>``d7!doi!or0`/I!/RTI`S/R/Y*P/OIHI/HIIIHIII/P
COCHRANE HI(HLI(HTS
Ps"hoso"ial i%ter-e%tio%s for pre&at4re e5a"4latio%
Ta&ara 'el%ik= Sta%le Althof= |l-aro Na0i. Atallah= 'aria Ed4arda dos Sa%tos P40a=
Sid%e (li%a= Ra"hel Riera
ABSTRACT
BACi(ROUND> Pre&at4re e5a"4latio% DPEE is a -er "o&&o% se74al dsf4%"tio%
a&o%0 patie%ts3 a%d with -ari%0 pre-ale%"e esti&ates ra%0i%0 fro& PQ to HIQ!
Altho40h ps"holo0i"al iss4es are prese%t i% &ost patie%ts with pre&at4re PE3 as a
JI
"a4se or as a "o%se;4e%"e3 resear"h o% the effe"ts of ps"holo0i"al approa"hes for PE
has i% 0e%eral %ot .ee% "o%trolled or ra%do&ised a%d is la"ki%0 i% lo%0*ter& follow 4p!
OB,ECTI)E> To assess the effi"a" of ps"hoso"ial i%ter-e%tio%s for PE!
CRITERIA +OR CONSIDERIN( STUDIES +OR THIS RE)IEU> Trials were
sear"hed i% "o&p4teriCed 0e%eral a%d spe"ialiCed data.ases3 s4"h as> 'EDLINE .
P4.'ed D/TYY to HI/IE= Ps"IN+O D/TNJ to HI/IE= E'BASE D/TOI to HI/IE= LILACS
D/TOH to HI/IE= the Co"hra%e Ce%tral Re0ister of Co%trolled Trials DCo"hra%e Li.rar3
HI/IE= a%d . "he"ki%0 .i.lio0raphies3 a%d "o%ta"ti%0 &a%4fa"t4rers a%d resear"hers!
SELECTION CRITERIA> Ra%do&ised or ;4asi*ra%do&ised "o%trolled trials e-al4ati%0
ps"hoso"ial i%ter-e%tio%s "o&pared with differe%t ps"hoso"ial i%ter-e%tio%s3
phar&a"olo0i"al i%ter-e%tio%s3 waiti%0 list3 or %o treat&e%t for PE!
DATA COLLECTION AND ANAL]SIS> I%for&atio% o% patie%ts3 i%ter-e%tio%s3 a%d
o4t"o&es was e7tra"ted . at least two i%depe%de%t re-iewers 4si%0 a sta%dard for&!
The pri&ar o4t"o&e &eas4re for "o&pari%0 the effe"ts of ps"hoso"ial i%ter-e%tio%s
to waiti%0 list a%d sta%dard &edi"atio%s was i&pro-e&e%t i% IELT Di!e!3 ti&e fro&
-a0i%al pe%etratio% to e5a"4latio%E! The se"o%dar o4t"o&e was "ha%0e i% -alidated PE
;4estio%%aires!
'AIN RESULTS> I% o%e st4d .eha-ioral therap DBTE was si0%ifi"a%tl .etter tha%
waiti%0 list for d4ratio% of i%ter"o4rse D'D D&ea% differe%"eE JIN!TI se"o%ds3 TRQ CI
PIH!JH to R/P!POE3 a%d "o4plesG se74al satisfa"tio% D'D *HY!/I3 CI *RI!JO to */!NHE! BT
was also si0%ifi"a%tl .etter for a %ew f4%"tio%al*se7olo0i"al treat&e%t D+SE D'D
J/H!II se"o%ds3 TRQ CI PIR!OO to R/O!/HE3 "ha%0e o-er ti&e i% s4.5e"ti-e per"eptio% of
d4ratio% of i%ter"o4rse DUo&e%> 'D H!OO3 TRQ CI H!IY to P!NI= 'e%> 'D H!RH3 CI
/!YR to P!PTE a%d "o4plesG se74al satisfa"tio% D'D *HR!/I3 TRQ CI *JN!TR to *H!HRE3
-ers4s waiti%0 list!
AUTHORSG CONCLUSIONS> O-erall3 there is weak a%d i%"o%siste%t e-ide%"e
re0ardi%0 the effe"ti-e%ess of ps"holo0i"al i%ter-e%tio%s for the treat&e%t of pre&at4re
e5a"4latio%! Three of the fo4r i%"l4ded ra%do&ised "o%trolled st4dies of ps"hotherap
for PE reported o4r pri&ar o4t"o&e DI&pro-e&e%t i% IELTE3 a%d the &a5orit ha-e a
s&all sa&ple siCe! The earl s4""ess reports DTN!OQE of 'asters a%d ,oh%so% "o4ld %ot
.e repli"ated! O%e st4d fo4%d a si0%ifi"a%t i&pro-e&e%t fro& .aseli%e i% the d4ratio%
of i%ter"o4rse3 se74al satisfa"tio% a%d se74al f4%"tio% with a %ew f4%"tio%al*se7olo0i"al
treat&e%t a%d .eha-ior therap "o&pared to waiti%0 list! O%e st4d showed that the
"o&.i%atio% of "hlorpro&aCi%e a%d BT was s4perior to "hlorpro&aCi%e alo%e!
Ra%do&ised trials with lar0er 0ro4p sa&ples are still %eeded to f4rther "o%fir& or de%
the "4rre%t a-aila.le e-ide%"e for ps"holo0i"al i%ter-e%tio%s for treati%0 PE!
This is the a.stra"t of a Co"hra%e Re-iew p4.lished i% the Co"hra%e Data.ase of
Sste&ati" Re-iews DCDSRE HI//3 Iss4e IO3 DOI> /I!/IIH`/JYR/ORO!CDIIO/TR!p4.O
Dwww!the"o"hra%eli.rar!"o&E! +or f4ll "itatio% a%d a4thorsG details3 see refere%"e /!
+or Lati% A&eri"a a%d the Cari..ea%3 the f4ll te7t is freel a-aila.le fro&>
http>``o%li%eli.rar!wile!"o&`doi`/I!/IIH`/JYR/ORO!CDIIO/TR!p4.H`a.stra"t
=5sessio%idBRDRJBE/BCBRCIPEO++TOEPB/YIAROIOO!dIPtI/

RE+ERENCE
/! 'el%ik T3 Althof S3 Atallah AN3 et al! Ps"hoso"ial i%ter-e%tio%s for pre&at4re
e5a"4latio%! Co"hra%e Data.ase Sst Re-! HI//=DOE>CDIIO/TR!
J/
/! Rowla%d DL! Ps"holo0i"al i&pa"t of pre&at4re e5a"4latio% a%d .arriers to its
re"o0%itio% a%d treat&e%t! C4rr 'ed Res Opi%! HI//=HNDOE>/RIT*/O! [ Li%ks $
H! '"'aho% C(3 Althof S3 Ualdi%0er 'D3 et al! A% e-ide%"e*.ased de}%itio% of
lifelo%0 pre&at4re e5a"4latio%> report of the I%ter%atio%al So"iet for Se74al 'edi"i%e
Ad Ho" Co&&ittee for the De}%itio% of Pre&at4re E5a"4latio%! B,U I%t!
HIIO=/IHDPE>PPO*RI! [ Li%ks
JH