What should be the focus of history in suspected lifelong premature ejaculation (PE)?

Updated: Jan 15, 2019
  • Author: Samuel G Deem, DO; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

The history should include questions about the following:

  • Early sexual experiences – Did the patient experience a traumatic sexual episode as a child or teenager (eg, discovery by a parent during masturbation, with subsequent feelings of guilt and perhaps threatened or actual punishment)?

  • Family relationships during childhood and adolescence – How did the patient relate to his mother, father, brother(s), sister(s)? Does the family have a history of incest or sexual assault? Males can be sexually assaulted by other males and, in rare instances, by females, including siblings

  • Peer relationships – Did the patient have other male friends or any female friends? How does he regard himself in comparison with peers (eg, inferior, superior, more athletic, frailer, more intelligent, or less intelligent)?

  • Work or school – Does the patient have any difficulties with work (or school, if still a student)?

  • General attitude toward sex – Does the patient regard sex as dirty? What is his sexual preference, fantasy, and arousal pattern? Did the patient have a strict religious upbringing? If so, what was he taught about sex?

  • Marital versus nonmarital context – If the premature ejaculation began with an initial nonmarital relationship, does he feel guilt about this? If the first coital experience was within a marital relationship that involved premature ejaculation from the start, was there premarital noncoital sexual play between the partners?

  • Sexual attitude and response of the female partner – If the female partner is having a problem (eg, dyspareunia), it could relate to the male’s problem or may have preceded it

  • Nonsexual aspects of the current relationship – Does the couple fight, or are they going through a power struggle?

  • Involvement of the sexual partner – If the patient’s sexual partner is not present for this interview, why not? Is the partner failing to support the man or blaming him?

Clues from these and similar questions usually point toward causative factors that may be specifically addressed with therapy.


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