Premature ejaculation

• Persistent or recurrent ejaculation within ∼ 1 minute of penetration and before the patient wishes to ejaculate
• PE is often situational and may not occur during masturbation, as the psychological pressure or performance anxiety is absent.
• Occurs in ≥ 75% of all sexual encounters

Psychosexual dysfunction

• Causes & risk factors
  • Prolonged illness: Patients may be hesitant or unsure how to initiate sexual activity.
  • Severe, acute illness: Patients may believe the illness can be caused or worsened by sexual activity. This is especially common in those with cardiovascular disease (eg, stroke, myocardial infarction), who are often concerned that sexual activity may strain the heart and lead to further cardiac events.
  • Surgical procedures: Patients may be embarrassed by their appearance (eg, surgical scar) or body odor (eg, incontinence, colostomy).
  • Loss of loved one: Patients may experience survivor guilt or feel fearful about the future.
• Features
  • Abrupt onset, clear precipitating event or stressor
  • Situational erectile dysfunction (normal nocturnal/nonsexual erections)
  • Impaired or premature orgasm
• Management
  • Cognitive-behavioral therapy
  • Couples/relational therapy