When should I refer a patient with premature ejaculation to a specialist for further evaluation?

Refer a patient with premature ejaculation to a specialist for further evaluation if:

• There is a suspected underlying psychogenic or relationship cause that cannot be managed in primary care, warranting psychosexual or mental health specialist input.
• There is a complex or severe mental health condition contributing to symptoms that requires specialist management.
• Initial management in primary care has failed, and specialist assessment is needed to explore other treatment options or underlying causes.

Currently, UK guidelines do not provide explicit referral criteria for premature ejaculation specifically, but by analogy with erectile dysfunction management, referral is appropriate when psychological factors are suspected or when primary care management is insufficient.

Specialist referral may involve urology, sexual health, or psychosexual services depending on the suspected cause.

Offer initial management and assessment in primary care before referral.

Note: The provided UK guideline excerpts do not explicitly address premature ejaculation referral criteria; however, principles from erectile dysfunction guidelines and psychosexual referral recommendations can be applied.