The pathophysiology of lifelong premature ejaculation

Area of Science:

• Urology
• Andrology
• Neuroscience

Background:

• Lifelong premature ejaculation (PE) was historically viewed as solely persistent early ejaculation.
• Despite research, the mechanisms underlying PE remain incompletely understood.
• A new classification reveals lifelong PE differs significantly from acquired, subjective, and variable subtypes.

Purpose of the Study:

• To explore the complex phenotype and pathophysiology of lifelong PE.
• To challenge the long-held hypothesis of solely serotonergic dysfunction in lifelong PE.
• To emphasize the importance of objective measurement in lifelong PE research.

Main Methods:

• Review of current research on lifelong PE.
• Analysis of the new classification of PE subtypes.
• Discussion of neurobiological, genetic, and pharmacological factors.

Main Results:

• Lifelong PE presents a complex phenotype including premature erection and detumescence, indicative of a hyper/hypererotic state.
• The pathophysiology involves a complex interplay of central and peripheral serotonergic, dopaminergic, oxytocinergic, hormonal, genetic, and epigenetic factors.
• The hypothesis of solely serotonergic dysfunction is no longer tenable.

Conclusions:

• Lifelong PE is a disturbance in the timing of ejaculation, erection, detumescence, and arousal.
• Objective measurement using a stopwatch to record intravaginal ejaculation latency time (IELT) is crucial for accurate research.
• Maintaining the 1-minute cut-off for lifelong PE definition is essential for continued objective research.