【医脉通】2020+SIAMS临床指南:早泄的管理.pdf
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1、Vol.:(0123456789)1 3Journal of Endocrinological Investigation https:/doi.org/10.1007/s40618-020-01458-4CONSENSUS STATEMENTManagement ofpremature ejaculation:aclinical guideline fromtheItalian Society ofAndrology andSexual Medicine(SIAMS)A.Sansone1 A.Aversa2 G.Corona3 A.D.Fisher4 A.M.Isidori5 S.LaVig
2、nera6 E.Limoncin1 M.Maggi7 M.Merico8 E.A.Jannini1 Received:3 October 2020/Accepted:20 October 2020 Italian Society of Endocrinology(SIE)2020AbstractPremature ejaculation(PE)is the most prevalent male sexual dysfunction,and the most recently defined.PE is often mistak-enly considered a purely psychos
3、exological symptom by patients:the lacking awareness in regards to the pathophysiology and treatments often lead to resignation from the patients side,making PE the most underdiagnosed sexual complaint.However,an ever-growing body of evidence supporting several organic factors has been developed in
4、the last decades and several definitions have been suggested to encompass all defining features of PE.In the present document by the Italian Society of Andrology and Sexual Medicine(SIAMS),we propose 33 recommendations concerning the definition,pathophysiol-ogy,treatment and management of PE aimed t
5、o improve patient care.These evidence-based clinical guidelines provide the necessary up-to-date guidance in the context of PE secondary to organic and psychosexological conditions,such as prostate inflammation,endocrine disorders,and other sexual dysfunctions,and suggest how to associate pharmacoth
6、erapies and cognitive-behavioral therapy in a couple-centered approach.New therapeutic options,as well as combination and off-label treatments,are also described.IntroductionThe inclusion of premature ejaculation(PE)in the radar of science and medicine is relatively recent and still debated:the perc
7、eption that PE is a psychological or,at the best,sexological symptom,almost exclusively due to behavioral-relational derangements is indeed well-rooted 13.Patients and media are only partially aware of the solid body of evi-dence produced in the context of diagnosis,pathogenesis and treatment of PE.
8、Being one of the“youngest”topics for sexual medicine,many aspects of PE still need to be clarified on the basis of adequate evidence.The aim of this clinical guideline is to examine the current findings able to impact on the clinical management of the patient and the couple with PE.MethodsThe Italia
9、n Society of Andrology and Sexual Medicine(SIAMS),one of the leading national scientific societies in the related fields,commissioned an expert task force to pro-vide an updated guideline on PE.Following scrutiny and discussion of the best evidence from published literature *E.A.Jannini 1 Chair ofEn
10、docrinology andMedical Sexology(ENDOSEX),Department ofSystems Medicine,University ofRome Tor Vergata,via Montpellier 1,00133Rome,Italy2 Department ofExperimental andClinical Medicine,University ofCatanzaro Magna Graecia,Catanzaro,Italy3 Endocrinology Unit,Medical Department,Azienda-Usl,Maggiore-Bell
11、aria Hospital,Bologna,Italy4 Andrology,Womens Endocrinology andGender Incongruence Unit,Florence University Hospital,Florence,Italy5 Department ofExperimental Medicine,Sapienza University ofRome,Rome,Italy6 Department ofClinical andExperimental Medicine,University ofCatania,Catania,Italy7 Endocrinol
12、ogy Unit,Department ofExperimental,Clinical andBiomedical Sciences,University ofFlorence,Florence,Italy8 Department ofMedicine,Operative Unit ofAndrology andMedicine ofHuman Reproduction,University ofPadova,Padua,Italy Journal of Endocrinological Investigation1 3available in PubMed,the authors gener
13、ated a series of con-sensus recommendations according to the Grading of Rec-ommendations,Assessment,Development,and Evaluation(GRADE)system 4.The strength of recommendations and the quality of the evidence are expressed in four levels:denotes“very low-quality evidence”,“low quality”,“moderate qualit
14、y”and “high quality”.In addition,the number 1 denotes a strong rec-ommendation and is expressed with the phrase we recom-mend,whereas the number 2 denotes a weaker recom-mendation and it is expressed with the phrase we suggest.The strength also reflects the confidence that authors have that patients
15、 and couples with PE who receive recommended care will be better off.According to SIAMS rulings,these Guidelines have been prepared by a team of experts on the topic coordinated by the senior author and two members of the Guideline Com-mittee of the Society,then sent to the SIAMS Executive Committee
16、 and to the Directors of all SIAMS Excellence Centres for revisions and/or approval.Guidelines have then been announced by mail and published for two weeks on the Societys website,siams.info,so that all SIAMS Mem-bers could provide further comments and suggest additional minor revisions.Following th
17、is last step,the present manu-script has been submitted to the Journal of Endocrinological Investigation for the normal process of international peer reviewing.Definitions ofpremature ejaculationRecommendation#1.We recommend using the Interna-tional Society of Sexual Medicine(ISSM)PE definitions for
18、 experimental and scientific purposes(1).Recommendation#2.We suggest to define PE,for clini-cal purposes,as:(i)a persistent and recurrent subjective perception of loss of control over the mechanism of ejacu-lation in presence of proper erotic stimuli;(ii)a subjective,PE-related,distress induced in t
19、he patient and in the partner;(iii)a short intravaginal ejaculatory latency time(IELT),from penetration to ejaculation,subjectively perceived and partner-perceived IELT,(PIELT,and PPIELT,respectively)or objectively(stopwatch IELT,SIELT)measured as being lower than 180s.(1).Note that the order(i),(ii
20、),and(iii)here mentioned reflect the clinical importance of each aspect of the tridimensional definition of PE.Recommendation#3.We suggest that,in the real-life clinical practice,the same definition could be applied to other sexual stimuli,such as masturbation(MELT),or oral(OELT)and anal(AELT)interc
21、ourses,as well to non-het-erosexual settings 5(2).Recommendation#4.We suggest recording the Patients Reported Outcomes(PROs),as resulting from psychometric tests,and when possible,SIELT,PIELT,PPIELT,MELT,OELT,and AELT both during diagnosis and therapeutic follow-up(2).EvidenceThe current most widely
22、 used definitions are from the Inter-national Society of Sexual Medicine(ISSM 6),from the Diagnostic and Statistical Manual of Mental Disorders,in its fifth revision(DSM-5 7),and,more recently,from the 11th Revision of the International classification of diseases for mortality and morbidity statisti
23、cs(ICD-11)8.Table1 summarize the similarities and differences among the three definitions.In 2013,DSM defined PE as“a male sexual dysfunction characterized by a persistent or recurrent pattern of ejacu-lation occurring during partnered sexual activity within approximately 1min following vaginal pene
24、tration and before the individual wishes it.The symptoms must have been present for at least 6months and experienced on almost all(75100%)occasions of sexual activity(situational or generalized contexts).The symptoms cause clinically sig-nificant distress in the individual and the sexual dysfunction
25、 is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress and not attribut-able to substance/medication or another medical condition”7.More recently,the ISSM defined PE as a“male sexual dysfunction characterized by ejaculation that always or nearly a
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