Evaluation of Premature Ejaculation 1. The committee believes that there is insufficient evidence for screening or patient detection of premature ejaculation, either in the general population or in a specific population, but recommends screening for patients with erectile dysfunction (ED). 2. Clinicians are recommended to use a series of screening questions and to ask about history of previous medication use and psychosocial profile. 3. Because patient self-report is a determinant of treatment seeking and satisfaction, self-evaluation of ejaculatory latency by patients and their partners is recommended when premature ejaculation occurs, and this should be routinely performed in the clinic. 4, The premature ejaculation summary (PEP) and premature ejaculation index (IPE) questionnaires are the better available premature ejaculation questionnaire measures and are particularly suitable for monitoring treatment response. 5. For lifelong premature ejaculation, a physical examination is recommended for most patients. 6. For acquired premature ejaculation, purposeful correlation testing must be performed to assess underlying or associated disorders such as ED, thyroid disease, and prostatitis. Treatment 1. Strong evidence suggests that dapoxetine is safe and effective when given as needed, whether for acquired or lifelong premature ejaculation, and dapoxetine is available in some countries. 2. There is strong evidence that off-label use of daily doses of selective 5-hydroxytryptamine reuptake inhibitors (SSRIs), such as paroxetine, sertraline, citalopram, fluoxetine, and serotonin-containing tricyclic chlorpromazine, is safe and effective; in addition, on-demand administration of chlorpromazine, paroxetine, and sertraline for acquired or lifelong premature ejaculation is also safe and effective. 3. There is better evidence that off-label use of local anesthetic drugs given as needed is safe and effective for the treatment of lifelong premature ejaculation. 4. Although some evidence suggests that off-label on-demand or daily dose administration of phosphodiesterase 5 inhibitors (PDE5is) is safe and effective in men with normal erectile function who have lifelong premature ejaculation. However, the use of PDE5is not recommended for men with lifelong premature ejaculation with normal erectile function and further evidence-based studies are needed. 5. Tramadol may be an effective option for premature ejaculation treatment, but given its addictive nature and side effects, it should only be considered when other treatments fail. Tramadol should not be used in combination with an SSRI due to the risk of serotonin syndrome and potential fatalities. Further controlled studies are still needed to evaluate the effectiveness and safety of tramadol for the treatment of premature ejaculation. 6, A small amount of evidence suggests that psychological or behavioral interventions are effective. 7. When men with acquired premature ejaculation have a clear sudden psychological cause or lifelong event and the individual or partner can be treated or successfully treated with pharmacological interventions, a combination of pharmacological and psychological/behavioral treatment may be very useful. Similarly, in men with premature ejaculation with ED, combined treatment may be beneficial for the psychosocial aspects of sexual dysfunction. 8. There is reliable evidence to support the use of ED medications for the treatment of premature ejaculation with ED. Combined use of premature ejaculation medication and ED medication for premature ejaculation with ED is not recommended (evidence level IIIc). 9. Selective dorsal penile nerve excision or enlargement of the glans with hyaluronic acid may result in permanent loss of sexual function and is not recommended for the treatment of premature ejaculation.