title: An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE).
abstract: BACKGROUND
  In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts.
  
  
  OBJECTIVE
  The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts.
  
  
  METHODS
  A comprehensive literature review was performed.
  
  
  RESULTS
  This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients.
  
  
  CONCLUSIONS
  Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60-90.
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine West Palm Beach, FL, USA.
authors.forename: Stanley E
authors.initials: SE
authors.lastname: Althof
authors.affiliation: Australian Center for Sexual Health Sydney, NSW, Australia.
authors.forename: Chris G
authors.initials: CG
authors.lastname: McMahon
authors.affiliation: Division of Pharmacology, Department of Pharmaceutical Sciences, Utrecht University Utrecht, The Netherlands.
authors.forename: Marcel D
authors.initials: MD
authors.lastname: Waldinger
authors.affiliation: Department of Urology, Bagcilar Training & Research Hospital Istanbul, Merkez Mah, Turkey.
authors.forename: Ege Can
authors.initials: EC
authors.lastname: Serefoglu
authors.affiliation: Department of Urology, University of California at Davis CA, USA.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Shindel
authors.affiliation: Department of Obstetrics and Gynecology, National University of Singapore Singapore, Singapore.
authors.forename: P Ganesan
authors.initials: PG
authors.lastname: Adaikan
authors.affiliation: Division of Urology, University of Buenos Aires Buenos Aires, Argentina.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Becher
authors.affiliation: St. Peter's Sexual Medicine, The London Clinic London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Dean
authors.affiliation: Neuro-Uro-Andrology, Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital Garches, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Giuliano
authors.affiliation: Department of Urology, Tulane University Health Sciences Center New Orleans, LA, USA.
authors.forename: Wayne Jg
authors.initials: WJ
authors.lastname: Hellstrom
authors.affiliation: Department of Sexological Research, Psychiatric Center Copenhagen, Rigshospitalet Copenhagen, Denmark.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Giraldi
authors.affiliation: Department of Urology, Instituto H. Ellis Sao Paulo, Brazil.
authors.forename: Sidney
authors.initials: S
authors.lastname: Glina
authors.affiliation: Erasmus MC-Daniel den Hoed Cancer Center Rotterdam, The Netherlands.
authors.forename: Luca
authors.initials: L
authors.lastname: Incrocci
authors.affiliation: School of Sexology, Department of Clinical, Applied and Biotechnological Sciences, University of L'Aquila L'Aquila, Italy.
authors.forename: Emmanuele
authors.initials: E
authors.lastname: Jannini
authors.affiliation: School of Psychology, Deakin University Burwood, Vic., Australia.
authors.forename: Marita
authors.initials: M
authors.lastname: McCabe
authors.affiliation: Albert Einstein College of Medicine, Department of Medicine, Montefiore Medical Center Bronx, NY, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Parish
authors.affiliation: Graduate School, Valparaiso University Valparaiso, IN, USA.
authors.forename: David
authors.initials: D
authors.lastname: Rowland
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine Cleveland, OH, USA.
authors.forename: R Taylor
authors.initials: RT
authors.lastname: Segraves
authors.affiliation: Department of Urology, University of California San Francisco, CA, USA.
authors.forename: Ira
authors.initials: I
authors.lastname: Sharlip
authors.affiliation: Clinica de Urologia e Andrologia Belo-Horizonte, Minas-Gerais, Brazil.
authors.forename: Luiz Otavio
authors.initials: LO
authors.lastname: Torres
keywords: Definition of PE; Diagnosis of PE; Etiology of PE; Pharmacotherapy of PE; Premature Ejaculation; Prevalence of PE; Psychotherapy of PE