目标：在穿透之前或之后不久射精的男性，没有控制感，经历与这种情况有关的痛苦的人可能会被诊断为早泄（PE），而难以达到性高潮的男性可能会被诊断为射精延迟（DE）。许多临床医生的经验表明，这些问题并不罕见，可能会给患者带来相当大的尴尬和不满。临床医生在管理PE和DE中的作用是进行适当的调查，提供教育，并提供合理且基于可靠科学数据的可用治疗方法。
方法：用于告知本指南的系统评价是由西北太平洋循证实践中心的方法学团队进行的。研究馆员在OvidMEDLINE（1946年至2019年3月1日）中进行了搜索，Cochrane中央对照试验登记册（至2019年1月）和Cochrane系统评价数据库（至2019年3月1日）。更新搜索于2019年9月5日进行。数据库搜索产生了1,851篇潜在相关文章。在对摘要和标题进行双重审查之后，选择223篇系统综述和个别研究进行全文双重综述，8项系统评价和59项单独研究被确定为符合纳入标准,并被纳入评价.
结果：几个心理健康，行为，PE和DE都存在药物治疗选择；然而，这些药物治疗方案均未获得美国食品和药物管理局的批准,它们在PE和DE治疗中的使用被认为是标签外的.
结论：射精时间的紊乱会严重阻碍男性及其伴侣的性享受。小组建议，共同决策是射精障碍管理的基础；性伴侣参与决策，如果可能,可以优化结果。
OBJECTIVE: Men who ejaculate before or shortly after penetration, without a sense of control, and who experience distress related to this condition may be diagnosed with premature ejaculation (PE), while men who experience difficulty achieving sexual climax may be diagnosed with delayed ejaculation (DE). The experience of many clinicians suggest that these problems are not rare and can be a source of considerable embarrassment and dissatisfaction for patients. The role of the clinician in managing PE and DE is to conduct appropriate investigation, to provide education, and to offer available treatments that are rational and based on sound scientific data.
METHODS: The systematic review utilized to inform this
guideline was conducted by a methodology team at the Pacific Northwest Evidence-based Practice Center. A research librarian conducted searches in Ovid MEDLINE (1946 to March 1, 2019), the Cochrane Central Register of Controlled Trials (through January 2019) and the Cochrane Database of Systematic Reviews (through March 1, 2019). An update search was conducted on September 5, 2019. Database searches resulted in 1,851 potentially relevant articles. After dual review of abstracts and titles, 223 systematic reviews and individual studies were selected for full-text dual review, and 8 systematic reviews and 59 individual studies were determined to meet inclusion criteria and were included in the review.
RESULTS: Several psychological health, behavioral, and pharmacotherapy options exist for both PE and DE; however, none of these pharmacotherapy options have achieved approval from the United States Food and Drug Administration and their use in the treatment of PE and DE is considered off-label.
CONCLUSIONS: Disturbances of the timing of ejaculation can pose a substantial impediment to sexual enjoyment for men and their partners. The Panel recommends shared decision-making as fundamental in the management of disorders of ejaculation; involvement of sexual partner(s) in decision making, when possible, may allow for optimization of outcomes.
