Premature ejaculation: assessed properly, treated to the pattern.

早漏（PE) is reaching climax sooner than desired during sexual activity, on a persistent basis, causing distress to one or both partners. The AUA/SMSNA Guideline defines lifelong (primary) PE using two criteria: ejaculation within about 2 minutes of initiation of penetrative sex and the perceived inability to delay it.⁵

PEは男性から報告される最も一般的な性的懸念です。約3人に1人が人生のどこかでPEを経験し、約20〜30%が持続的な症状を抱えています。¹ これほど一般的であるにもかかわらず、治療を求めるのはごく一部に過ぎません。その理由の一部は恥ずかしさであり、また効果的な治療法が存在することを知らない人が多いためです。

PEは以下の4つのタイプに分類されます： lifelong (primary) PE, present from first sexual experiences, acquired (secondary) PE, which develops after a period of normal control, 変動型 PE (irregular occurrence in otherwise normal-functioning men), and 主観型 PE (perceived PE in men with objectively normal ejaculation time). The type matters, because treatment approaches differ.

The distinction that changes management most is primary versus secondary. Primary (lifelong) PE has been present since a man became sexually active and is more biologically driven, so treatment is directed at ejaculatory control itself: behavioural techniques, topical anaesthetics and on-demand dapoxetine. Secondary (acquired) PE represents a change from previously normal control, and usually has an identifiable medical or psychological cause. In secondary PE the first step is to find and treat that cause.⁵

PEは非常に治療可能な疾患です。ほとんどの患者は、特に行動療法と薬物療法を組み合わせたエビデンスに基づく治療により、有意義な改善を実感しています。

PEには生物学的要因と心理学的要因の両方が関与しており、ほとんどの症例でその両方が組み合わさっています。主要な要因を理解することが、治療方針の決定につながります。

セロトニン作動性の違い are the strongest biological contributor to lifelong (primary) PE. Lower serotonin signalling in specific brain regions reduces the threshold for ejaculation. This is why SSRI such as on-demand dapoxetine, which raise serotonin signalling, are used for PE.

陰茎の過敏症 can contribute to lifelong (primary) PE, because heightened sensory feedback triggers ejaculation more readily. Topical anaesthetics directly address this mechanism.

不安や心理的要因 are the strongest contributors to acquired (secondary) PE. Performance anxiety, relationship stress, depression, and life pressure all reduce ejaculatory control. The pattern is often "fast → anxious → faster" - a self-reinforcing cycle that responds well to combined behavioural and pharmacological treatment.

併発 erectile dysfunction is present in a meaningful proportion of patients with acquired (secondary) PE. Treating ED often improves the PE, and treating one without the other can worsen the other. Clinical evaluation always considers both.

ホルモン因子 ～を含む testosterone deficiency and thyroid dysfunction can contribute. Hyperthyroidism in particular is associated with PE, so thyroid function is included in evaluation where indicated.⁶

前立腺炎症（prostatitis) is associated with acquired (secondary) PE in some patients. Where pelvic discomfort or urinary symptoms accompany PE, prostatic evaluation is part of the workup.

薬物使用 一部の娯楽用薬物や過度のアルコール摂取は、射精制御に影響を与える可能性があります。すべての診察において服薬状況の確認が行われます。

General health factors matter too, so comprehensive health screening is part of the men's sexual health workup, particularly for acquired (secondary) PE in patients over 40.

来院前 Your personal health concierge shares a brief intake form covering symptom history, type of PE (primary or secondary), sexual history including partner context, current medications, and any co-occurring concerns. The intake helps focus consultation time on assessment rather than data collection.

診察中 The consultation lasts 30-45 minutes. Our medical team takes a focused history covering symptom pattern, onset, situational variability, partner perspective if helpful, and screening for co-occurring conditions (ED, anxiety, depression, prostatic symptoms). Physical examination is brief and usually limited to general assessment unless other concerns emerge.

Investigations are not usually needed for straightforward primary PE. Where secondary PE or co-occurring concerns are present, bloodwork may be added (testosterone, thyroid function, prolactin, glucose). Urinalysis if prostatic symptoms.

診察後 最初の診察で治療の選択肢を話し合い、通常はすぐに初期治療を開始します。フォローアップは4週間後（反応評価）、12週間後（調整）、その後は必要に応じて長期的に行われます。行動療法はフォローアップを通じて強化されます。

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