Guideline sources The following summarized guidelines for the evaluation and management of delayed ejaculation (DE) are prepared by our editorial team based on guidelines from the American Urological Association (AUA/SMSNA 2022). 1 Guidelines 1. Screening and diagnosis Definitions: Recognize that lifelong DE is defined as lifelong, consistent, bothersome inability to achieve ejaculation, or excessive latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. E Recognize that acquired DE is defined as an acquired, consistent, bothersome inability to achieve ejaculation, or an increased latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. E 2. Diagnostic investigations Initial assessment: Elicit a medical, relationship, and sexual history and perform a focused physical examination for the evaluation of patients with DE. B https://web.pathway.md/diseases/rec6I6QVeDF2MvvpN 1/2 6/29/23, 10:06 PM Delayed ejaculation Pathway Consider obtaining additional testing as clinically indicated for the evaluation of patients with DE. C 3. Medical management Modification in precipitating medications: consider offering replacement, dose adjustment, or staged cessation of medications likely to contribute to DE in patients with DE. C Management of erectile dysfunction: treat patients with DE and comorbid erectile dysfunction according to the erectile dysfunction guidelines. E Management of testosterone deficiency: consider offering treatment to normalize serum testosterone levels in patients with DE and testosterone deficiency. E Specific therapies: insufficient evidence to recommend oral pharmacotherapy or invasive nonpharmacological strategies for the management of patients with DE. I 4. Patient education General counseling: consider advising patients with DE to modify sexual positions or practices to increase arousal. E 5. Follow-up and surveillance Indications for referral: consider referring patients with lifelong or acquired DE to a mental health professional with expertise in sexual health. E References 1. Alan W Shindel, Stanley E Althof, Serge Carrier et al. Disorders of Ejaculation: An AUA/SMSNA Guideline. J Urol. 2022 Mar;207 3 504 512. Open https://web.pathway.md/diseases/rec6I6QVeDF2MvvpN 2/2