Ejaculatory disorders: pathophysiology and management

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Ejaculatory dysfunction (EjD) is one of the most common male sexual disorders, yet EjD is still frequently misdiagnosed or overlooked as a result of numerous patient and physician barriers. The wide spectrum of EjD ranges from premature or rapid ejaculation, through delayed ejaculation, to a complete inability to ejaculate—otherwise known as anejaculation—and includes retrograde ejaculation and painful ejaculation. Conventional algorithms for managing ejaculatory disorders are based either on an organic or psychogenic etiology, with the latter more traditionally considered the main cause. This paper reviews physiopathological, diagnostic and therapeutic aspects of ejaculation disorders, with a particular focus on the most prevalent disorder, premature ejaculation.

Key Points

  • Ejaculatory dysfunction is one of the most common male sexual disorders, but is still frequently misdiagnosed

  • The most common ejaculatory dysfunction is premature ejaculation (PE), which affects 5–40% of sexually active men

  • Ejaculation involves cerebral sensory areas, motor centers and several spinal nuclei that are tightly interconnected

  • Diagnosis of PE in clinical practice is straightforward, as it is simply based on patient self report, clinical history, sexual history and examination findings

  • The major objective when diagnosing PE is to quantify the length of time between penetration and ejaculation, although a multidimensional assessment of patients affected with PE, including psychosocial involvement, is also needed

  • Selective serotonin reuptake inhibitors and topical anesthetic creams can provide good efficacy for treating PE, even if a clear understanding of the etiology of lifelong PE is lacking

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Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Correspondence to Vincenzo Mirone.

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