Die Ejaculatio praecox in der urologischen Praxis

Zusammenfassung

Auch in der allgemein-urologischen Praxis ist die Ejaculatio praecox (EP) eine häufige männliche Sexualbeschwerde oder -störung. Die Häufigkeit in den einzelnen Praxen ist sehr unterschiedlich. In größeren Studien ist die Prävalenz stark von der geltenden Definition abhängig und bewegt sich zwischen 3% und 25%. Subjektiv ist die Unfähigkeit, die Ejakulation zu verzögern und der daraus resultierende Leidensdruck für den Patienten und dessen Partner relevant. Als objektivierbare Hilfsgröße dient die intravaginale Latenzzeit (IELT). In der täglichen Routinepraxis ist dieser objektive Parameter jedoch nicht praktikabel. Klinisch haben sich 2 Fragebögen durchgesetzt: Premaure Ejaculation Profile und Index of Premature Ejaculation. Studien konnten zeigen, dass die Selbsteinschätzung von Patienten relativ gut mit der objektiven, mittels Stoppuhr gemessenen IELT, korreliert. Pharmakologisch werden neben topischen Anästhetika vor allem selektive Serotonin-Wiederaufnahmehemmer (SSRI) und das seit 2009 in Deutschland zugelassene Medikament Dapoxetin eingesetzt. In Anwendung (täglich oder on-demand) und vor allem Wirkung (x-fache Verlängerung der IELT) unterscheiden sich die Medikamente stark. Dieser Artikel beschäftigt sich mit der für die tägliche Arbeit relevanten Definition der EP, der Prävalenz, Ätiologie und Neurophysiologie und auch mit der klinischen Vorgehensweise. Die verschiedenen pharmakologischen Therapiemöglichkeiten werden unter Berücksichtigung der Leitlinie der International Society for Sexual Medicine diskutiert.

Abstract

Premature ejaculation is a frequent male sexual complaint or sexual disturbance found in urological practices and outpatient units. The frequency in the individual practices varies considerably. In large studies the prevalence is strongly dependent on the definition and ranges between 3% and 25%. Subjectively, the inability to delay ejaculation and the distress resulting from it, is relevant for the patient and his partner. Intravaginal ejaculation latency time (IELT) is used as an objective parameter. Nevertheless, in the everyday routine practice this objective parameter is not practical. Clinically 2 questionnaires have asserted themselves (Premature Ejaculation Profile and Index of Premature Ejaculation). Studies have shown that the self-assessment of patients correlates relatively well with the objective IELT measured by means of a stopwatch. Beside topical anaesthetics and elective serotonin reuptake inhibitors (SSRI), especially Dapexetine which has been approved in Germany since 2009, are treatment options. These drugs differ particularly in their use (daily or on-demand) and their effectiveness (measured by x-fold increase of IELT). This article deals with the clinical approach to EP. Beside the definition, prevalence, aetiology and neurophysiology of EP, the different pharmacological therapies as well as the guidelines of the International Society for Sexual Medicine are discussed.

Schlüsselwörter

Ejaculatio praecox - Definition - Diagnostik - Therapie - SSRI - Dapoxetin

Key words

premature ejaculation - definition - diagnosis - therapy - SSRI - dapoxetin

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