Understanding health care practitioners’ criteria regarding the decision to treat men with premature ejaculation

AI Summary

Practitioners adopt a patient centred approach, following the spirit of professional guidelines but not strictly applying specific diagnostic criteria for PE.
Most clinicians disregard ejaculatory latency thresholds; 61.6% ignore EL and only 13.6% use a one minute cutoff.
Bother, distress, and anxiety are routinely explored in depth, while professional identity, sexual health specialisation, and experience weakly influence diagnostic priorities.

Sex Med. 2026 May 20;14(4):qfag036. doi: 10.1093/sexmed/qfag036. eCollection 2026 Aug.

ABSTRACT

BACKGROUND: The extent to which health care practitioners (HCP) follow clinical practice guidelines (CPG) regarding diagnostic criteria can affect treatment outcomes, yet little is known about the factors HCPs take into consideration regarding their decision to treat men with symptoms of premature ejaculation (PE), a field where professional definitions vary considerably.

AIM: To describe HCP priorities regarding the use of PE diagnostic criteria in their decision-to-treat and, further, to assess whether HCP characteristics regarding specialization, professional identity, and experience impact decision-making priorities.

METHODS: A total of 228 professionally-trained medical and mental health specialists responded to online and in-person invitations to complete a survey regarding their criteria and approaches for deciding whether to treat men with complaints of PE. Included were items pertaining to professional identity and experience, along with analyses of 5 items focusing on the use of professional guidelines for diagnosing PE, the role of ejaculatory latency (EL), ejaculatory control, and bother/distress, the method of assessing bother/distress, and understanding the role of anxiety in the diagnostic process.

OUTCOME: HCPs’ priorities regarding diagnostic criteria for PE, including whether professional identity, specialization, and clinical experience might have affected their priorities.

RESULTS: Among the respondents, 42.5% identified with a mental health/therapy background; 57.5% with a medically-oriented background. Overall, 66.7% of HCPs used professional guidelines 70% of the time or more, with 33.3% using them half the time or less; 75% preferred either ISSM and DSM-5 guidelines. Furthermore, 61.6% indicated that the decision to treat did not consider EL at all, as long as other PE symptoms were present; and only 13.6% used a 1 min threshold. Bother/Distress and anxiety were explored in-depth by 81.5% and 78.5 of respondents, respectively. HCP characteristics regarding professional identity, specialization in sexual health, and clinical experience with PE had only weak effects on diagnostic strategies.

CLINICAL IMPLICATION: HCPs demonstrated a patient-centric rather than a criterion-centric approach regarding their decision to treat men with PE symptomology.

STRENGTHS AND LIMITATIONS: This study provided a rare in-depth view regarding the priorities of HCPs in their strategy for accepting patients for PE treatment. Limitations included a sample that was selective, not only due to the forums and networks from which they were drawn but also in terms of their Western geo-cultural origin.

CONCLUSION: Consistent with a patient-centric approach, HCPs dealing with men with PE generally follow the spirit of the professional diagnostic guidelines although not specific criteria within the guidelines.

PMID:42169980 | PMC:PMC13189166 | DOI:10.1093/sexmed/qfag036

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