Materiały źródłowe

• #1 The pathophysiology of delayed ejaculation – Chen – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/10617/11776

  Delayed ejaculation (DE) is probably least studied, and least understood of male sexual dysfunctions, with an estimated prevalence of 14% of the male population. […] Pathophysiology of DE is multifactorial and including psychosexual-behavioral and cultural factors, disruption of ejaculatory apparatus, central and peripheral neurotransmitters, hormonal or neurochemical ejaculatory control and psychosocial factors. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. […] The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE. […] The pathophysiological etiology of DE should be established thorough medical, psychosexual and psychosocial history. […] The etiology of DE is usually multidimensional, resulting from the mans biologic ejaculatory latency being affected by multiple organic biological, or psychogenic factors in varying combinations during his life.

• #2 The pathophysiology of delayed ejaculation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5002008/

  Delayed ejaculation (DE) is probably least studied, and least understood of male sexual dysfunctions, with an estimated prevalence of 14% of the male population. Pathophysiology of DE is multifactorial and including psychosexual-behavioral and cultural factors, disruption of ejaculatory apparatus, central and peripheral neurotransmitters, hormonal or neurochemical ejaculatory control and psychosocial factors. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE. […] The pathophysiological etiology of DE should be established thorough medical, psychosexual and psychosocial history. The etiology of DE is usually multidimensional, resulting from the mans biologic ejaculatory latency being affected by multiple organic biological, or psychogenic factors in varying combinations during his life.

• #3 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.17051

  Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. […] The literature suggests that the pathophysiology of DE/AE is multifactorial, including both organic and psychosocial factors. Despite the many publications on this condition, the exact pathogenesis is not yet known. […] Ejaculation involves emission, bladder neck closure, and expulsion (ejaculation proper). […] Many neurotransmitters such as serotonin, dopamine, and norepinephrine play roles in ejaculatory physiology. […] On one hand, it was argued that DE may be caused by psychosexual, psychosocial, or relationship problems. On the other hand, it has been argued that DE is caused by genetic, neurobiological, endocrine, anatomic, and infectious factors, or may be drug-induced.

• #4 DOAJ Logotype

  https://doaj.org/article/8e1013c6f74d40d4a727188cc7ad9589

  Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. […] The literature suggests that the pathophysiology of DE/AE is multifactorial, including both organic and psychosocial factors. Despite the many publications on this condition, the exact pathogenesis is not yet known.

• #5 Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5756804/

  Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. […] The literature suggests that the pathophysiology of DE/AE is multifactorial, including both organic and psychosocial factors. Despite the many publications on this condition, the exact pathogenesis is not yet known. […] Ejaculation involves emission, bladder neck closure, and expulsion (ejaculation proper). […] Many neurotransmitters such as serotonin, dopamine, and norepinephrine play roles in ejaculatory physiology. […] On one hand, it was argued that DE may be caused by psychosexual, psychosocial, or relationship problems. On the other hand, it has been argued that DE is caused by genetic, neurobiological, endocrine, anatomic, and infectious factors, or may be drug-induced.

• #6 The pathophysiology of delayed ejaculation – Chen – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/10617/11776

  Delayed ejaculation (DE) is probably least studied, and least understood of male sexual dysfunctions, with an estimated prevalence of 14% of the male population. […] Pathophysiology of DE is multifactorial and including psychosexual-behavioral and cultural factors, disruption of ejaculatory apparatus, central and peripheral neurotransmitters, hormonal or neurochemical ejaculatory control and psychosocial factors. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. […] The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE. […] The pathophysiological etiology of DE should be established thorough medical, psychosexual and psychosocial history. […] The etiology of DE is usually multidimensional, resulting from the mans biologic ejaculatory latency being affected by multiple organic biological, or psychogenic factors in varying combinations during his life.

• #7 The pathophysiology of delayed ejaculation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5002008/

  Delayed ejaculation (DE) is probably least studied, and least understood of male sexual dysfunctions, with an estimated prevalence of 14% of the male population. Pathophysiology of DE is multifactorial and including psychosexual-behavioral and cultural factors, disruption of ejaculatory apparatus, central and peripheral neurotransmitters, hormonal or neurochemical ejaculatory control and psychosocial factors. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE. […] The pathophysiological etiology of DE should be established thorough medical, psychosexual and psychosocial history. The etiology of DE is usually multidimensional, resulting from the mans biologic ejaculatory latency being affected by multiple organic biological, or psychogenic factors in varying combinations during his life.

• #8 The pathophysiology of delayed ejaculation – Chen – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/10617/11776

  Psychogenic and biogenic etiologies of DE usually are neither independent nor mutually exclusive, with both categories overlapping and including a combination of factors involving both etiological domains. […] The pathophysiology of DE in relation to congenital abnormalities is complex and is dependent upon anatomical variations of the pelvic floor and the physiological functioning of the organs located into the pelvic floor. […] Acquired or secondary DE is the result of an identifiable surgical procedure, a different medical condition or psychosexual changes. […] Ejaculatory duct damage may follow correction of an imperforate anus. […] The ability to ejaculate is severely impaired by spinal cord injury. […] Although hormonal regulation of all aspects of male reproduction is well established, the role of endocrine control on the ejaculatory process is still not completely clarified. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected.

• #9 The pathophysiology of delayed ejaculation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5002008/

  Psychogenic and biogenic etiologies of DE usually are neither independent nor mutually exclusive, with both categories overlapping and including a combination of factors involving both etiological domains. […] The pathophysiology of DE in relation to congenital abnormalities is complex and is dependent upon anatomical variations of the pelvic floor and the physiological functioning of the organs located into the pelvic floor. […] Acquired or secondary DE is the result of an identifiable surgical procedure, a different medical condition or psychosexual changes. It may affect ejaculation by a variety of ways, such as via disruption of the chemical or nervous control of ejaculation, or directly at the site of the ejaculatory organs themselves. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE.

• #10 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.17051

  These etiological factors organic and psychogenic etiologies are neither independent nor mutually exclusive and may well interact with each other, and their pathological effects may vary between individuals. […] An age-dependent increase in the prevalence of DE was reported in various studies. […] The significant heterogeneity in the occurrence and the presentation of SSRI-related sexual dysfunction may suggest underlying genetic factors. […] The neurological mechanisms that lead to DE/AE are damage to the sympathetic ganglia and/or injury of post-ganglionic sympathetic nerve fibers to the organs of emission, mainly as a result of a neuro-logic disease, trauma, or pelvic surgery. […] The list of organic causes possibly leading to DE/AE is extensive. […] Complaints of DE/AE in patients taking medications are not uncommon. Different medications may interfere with either central or peripheral control of ejaculation, potentially affecting the IELT.

• #11 Delayed Ejaculation: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/2184956-overview

  Male orgasm is defined as a subjective, perceptual-cognitive event of peak sexual pleasure that in normal conditions coincides with the moment of ejaculation. […] The presence of a normal sexual excitement phase is a prerequisite for male orgasmic disorder (MOD). […] Patients with MOD can achieve firm erections and have normal sexual intercourse with penetration. […] Urologic classifications are usually explicit in differentiating between failure to ejaculate and absence of orgasm. […] The succession of erection, ejaculation, and orgasm creates the impression that these events might have a common physiologic substrate. In reality, they are separate events. […] Normal ejaculation is a brief event consisting of two phases: emission and expulsion. […] The cerebral network modulating and controlling the final common output from all ejaculatory stimuli includes the posteromedial bed nucleus of the stria terminalis, the posterodorsal medial amygdaloid nucleus, the posterodorsal preoptic nucleus, and the parvicellular part of the subparafascicular thalamus.

• #12 Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5756804/

  These etiological factors organic and psychogenic etiologies are neither independent nor mutually exclusive and may well interact with each other, and their pathological effects may vary between individuals. […] The list of organic causes possibly leading to DE/AE is extensive and is outlined in Table 1, 2, 3. […] The neurological mechanisms that lead to DE/AE are damage to the sympathetic ganglia and/or injury of post-ganglionic sympathetic nerve fibers to the organs of emission, mainly as a result of a neuro-logic disease, trauma, or pelvic surgery. […] Complaints of DE/AE in patients taking medications are not uncommon. Different medications may interfere with either central or peripheral control of ejaculation, potentially affecting the IELT. […] The history is the key to the diagnosis. Treatment should be cause-specific.

• #13 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.17051

  These etiological factors organic and psychogenic etiologies are neither independent nor mutually exclusive and may well interact with each other, and their pathological effects may vary between individuals. […] An age-dependent increase in the prevalence of DE was reported in various studies. […] The significant heterogeneity in the occurrence and the presentation of SSRI-related sexual dysfunction may suggest underlying genetic factors. […] The neurological mechanisms that lead to DE/AE are damage to the sympathetic ganglia and/or injury of post-ganglionic sympathetic nerve fibers to the organs of emission, mainly as a result of a neuro-logic disease, trauma, or pelvic surgery. […] The list of organic causes possibly leading to DE/AE is extensive. […] Complaints of DE/AE in patients taking medications are not uncommon. Different medications may interfere with either central or peripheral control of ejaculation, potentially affecting the IELT.

• #14 The pathophysiology of delayed ejaculation – Chen – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/10617/11776

  Delayed ejaculation (DE) is probably least studied, and least understood of male sexual dysfunctions, with an estimated prevalence of 14% of the male population. […] Pathophysiology of DE is multifactorial and including psychosexual-behavioral and cultural factors, disruption of ejaculatory apparatus, central and peripheral neurotransmitters, hormonal or neurochemical ejaculatory control and psychosocial factors. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. […] The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE. […] The pathophysiological etiology of DE should be established thorough medical, psychosexual and psychosocial history. […] The etiology of DE is usually multidimensional, resulting from the mans biologic ejaculatory latency being affected by multiple organic biological, or psychogenic factors in varying combinations during his life.

• #15 The pathophysiology of delayed ejaculation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5002008/

  Psychogenic and biogenic etiologies of DE usually are neither independent nor mutually exclusive, with both categories overlapping and including a combination of factors involving both etiological domains. […] The pathophysiology of DE in relation to congenital abnormalities is complex and is dependent upon anatomical variations of the pelvic floor and the physiological functioning of the organs located into the pelvic floor. […] Acquired or secondary DE is the result of an identifiable surgical procedure, a different medical condition or psychosexual changes. It may affect ejaculation by a variety of ways, such as via disruption of the chemical or nervous control of ejaculation, or directly at the site of the ejaculatory organs themselves. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE.

• #16 Susten | 30 mg | Tablet | সাসটেন ৩০ মি.গ্রা. ট্যাবলেট | Square Pharmaceuticals PLC | Indications, Pharmacology, Dosage, Side Effects and more | MedEx

  https://medex.com.bd/brands/16408/susten-30-mg-tablet

  The mechanism of action of Dapoxetine in premature ejaculation is presumed to be linked to the inhibition of neuronal reuptake of serotonin and the subsequent potentiation of the neurotransmitter’s action at pre-and post synaptic receptors. […] Human ejaculation is primarily mediated by the sympathetic nervous system. The ejaculatory pathway originates from a spinal reflex centre, mediated by the brain stem, which is influenced initially by a number of nuclei in the brain (medial preoptic and paraventricular nuclei).

• #17 Delayed Ejaculation: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/2184956-overview

  Male orgasm is defined as a subjective, perceptual-cognitive event of peak sexual pleasure that in normal conditions coincides with the moment of ejaculation. […] The presence of a normal sexual excitement phase is a prerequisite for male orgasmic disorder (MOD). […] Patients with MOD can achieve firm erections and have normal sexual intercourse with penetration. […] Urologic classifications are usually explicit in differentiating between failure to ejaculate and absence of orgasm. […] The succession of erection, ejaculation, and orgasm creates the impression that these events might have a common physiologic substrate. In reality, they are separate events. […] Normal ejaculation is a brief event consisting of two phases: emission and expulsion. […] The cerebral network modulating and controlling the final common output from all ejaculatory stimuli includes the posteromedial bed nucleus of the stria terminalis, the posterodorsal medial amygdaloid nucleus, the posterodorsal preoptic nucleus, and the parvicellular part of the subparafascicular thalamus.

• #18 Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5756804/

  Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. […] The literature suggests that the pathophysiology of DE/AE is multifactorial, including both organic and psychosocial factors. Despite the many publications on this condition, the exact pathogenesis is not yet known. […] Ejaculation involves emission, bladder neck closure, and expulsion (ejaculation proper). […] Many neurotransmitters such as serotonin, dopamine, and norepinephrine play roles in ejaculatory physiology. […] On one hand, it was argued that DE may be caused by psychosexual, psychosocial, or relationship problems. On the other hand, it has been argued that DE is caused by genetic, neurobiological, endocrine, anatomic, and infectious factors, or may be drug-induced.

• #19 Delayed Ejaculation: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/2184956-overview

  It has been suggested that the ejaculatory reflex is primarily regulated by the central serotonergic and dopaminergic systems, […] Experimental evidence indicates that serotonin (5-HT), throughout brain descending pathways, exerts an inhibitory role on ejaculation. […] In view of the relation between the serotonergic receptors and their inhibitory and excitatory effects, it is likely that altered levels of 5-HT or altered 5-HT receptor sensitivity in the ejaculatory modulating centers of the central nervous system (CNS) contribute to the pathophysiologic mechanism behind ejaculatory disorders. […] The mechanism of orgasm is still the least well understood part of the sexual process. It probably involves central (cerebral) integration and response to sexual stimulation. […] Transient sympathoadrenal activation during sexual activity, reflected by increases in epinephrine and norepinephrine plasma levels, together with increased cardiovascular activity, has been reported to be associated with orgasm in males.

• #20 Delayed Ejaculation: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/2184956-overview

  It has been suggested that the ejaculatory reflex is primarily regulated by the central serotonergic and dopaminergic systems, […] Experimental evidence indicates that serotonin (5-HT), throughout brain descending pathways, exerts an inhibitory role on ejaculation. […] In view of the relation between the serotonergic receptors and their inhibitory and excitatory effects, it is likely that altered levels of 5-HT or altered 5-HT receptor sensitivity in the ejaculatory modulating centers of the central nervous system (CNS) contribute to the pathophysiologic mechanism behind ejaculatory disorders. […] The mechanism of orgasm is still the least well understood part of the sexual process. It probably involves central (cerebral) integration and response to sexual stimulation. […] Transient sympathoadrenal activation during sexual activity, reflected by increases in epinephrine and norepinephrine plasma levels, together with increased cardiovascular activity, has been reported to be associated with orgasm in males.

• #21 Serotonin’s Role in the Biology of Male Ejaculation

  https://www.verywellhealth.com/serotonin-s-role-in-the-biology-of-ejaculation-4156268

  Serotonin, a chemical in your brain, plays an important role in your sex life, including ejaculation. […] In humans, serotonin is the neurotransmitter most clearly associated with ejaculation. […] Using SSRI antidepressants long-term extends the time between erection and ejaculation. […] Studies in rats have also shown that where serotonin is located in the brain changes its effects. For example, if serotonin is injected into some parts of the rat brain, it causes delayed ejaculation. […] Similar to SSRIs, antipsychotics seem to extend the time between arousal and ejaculation.

• #22 Delayed Ejaculation: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/2184956-overview

  It has been suggested that the ejaculatory reflex is primarily regulated by the central serotonergic and dopaminergic systems, […] Experimental evidence indicates that serotonin (5-HT), throughout brain descending pathways, exerts an inhibitory role on ejaculation. […] In view of the relation between the serotonergic receptors and their inhibitory and excitatory effects, it is likely that altered levels of 5-HT or altered 5-HT receptor sensitivity in the ejaculatory modulating centers of the central nervous system (CNS) contribute to the pathophysiologic mechanism behind ejaculatory disorders. […] The mechanism of orgasm is still the least well understood part of the sexual process. It probably involves central (cerebral) integration and response to sexual stimulation. […] Transient sympathoadrenal activation during sexual activity, reflected by increases in epinephrine and norepinephrine plasma levels, together with increased cardiovascular activity, has been reported to be associated with orgasm in males.

• #23 Selective Serotonin Reuptake Inhibitors in Premature Ejaculation – EMJ

  https://www.emjreviews.com/urology/article/the-role-of-selective-serotonin-reuptake-inhibitors-in-premature-ejaculation/

  Premature ejaculation is a very common male sexual medical illness worldwide. Amongst several biological risk factors, the disturbance of central serotonin neurotransmission is one important cause. […] Disturbance of the central (spinal and supra-spinal) serotonergic neurotransmission is principally responsible for ejaculation. Presynaptic 5-HT1B and postsynaptic 5-HT2C receptor stimulation is thought to increase ejaculation latency time and 5-HT1A receptor stimulation is also known to play a role in ejaculation. […] Selective serotonin reuptake inhibitors (SSRI), such as paroxetine, fluoxetine, and sertraline, are used to treat depression and mental health disorders and can cause delayed or blocked ejaculation as a side effect in men. […] SSRI actively block presynaptic membrane 5-HT transporters and thus inhibit the 5-HT (serotonin) reuptake and breakdown; this results in availability of higher levels/activity of serotonin in the synaptic cleft. Increased synaptic availability of serotonin facilitates its binding to 5-HT receptors, leading to a delayed ejaculation.

• #24 Selective Serotonin Reuptake Inhibitors in Premature Ejaculation – EMJ

  https://www.emjreviews.com/urology/article/the-role-of-selective-serotonin-reuptake-inhibitors-in-premature-ejaculation/

  Premature ejaculation is a very common male sexual medical illness worldwide. Amongst several biological risk factors, the disturbance of central serotonin neurotransmission is one important cause. […] Disturbance of the central (spinal and supra-spinal) serotonergic neurotransmission is principally responsible for ejaculation. Presynaptic 5-HT1B and postsynaptic 5-HT2C receptor stimulation is thought to increase ejaculation latency time and 5-HT1A receptor stimulation is also known to play a role in ejaculation. […] Selective serotonin reuptake inhibitors (SSRI), such as paroxetine, fluoxetine, and sertraline, are used to treat depression and mental health disorders and can cause delayed or blocked ejaculation as a side effect in men. […] SSRI actively block presynaptic membrane 5-HT transporters and thus inhibit the 5-HT (serotonin) reuptake and breakdown; this results in availability of higher levels/activity of serotonin in the synaptic cleft. Increased synaptic availability of serotonin facilitates its binding to 5-HT receptors, leading to a delayed ejaculation.

• #25 Selective Serotonin Reuptake Inhibitors in Premature Ejaculation – EMJ

  https://www.emjreviews.com/urology/article/the-role-of-selective-serotonin-reuptake-inhibitors-in-premature-ejaculation/

  Premature ejaculation is a very common male sexual medical illness worldwide. Amongst several biological risk factors, the disturbance of central serotonin neurotransmission is one important cause. […] Disturbance of the central (spinal and supra-spinal) serotonergic neurotransmission is principally responsible for ejaculation. Presynaptic 5-HT1B and postsynaptic 5-HT2C receptor stimulation is thought to increase ejaculation latency time and 5-HT1A receptor stimulation is also known to play a role in ejaculation. […] Selective serotonin reuptake inhibitors (SSRI), such as paroxetine, fluoxetine, and sertraline, are used to treat depression and mental health disorders and can cause delayed or blocked ejaculation as a side effect in men. […] SSRI actively block presynaptic membrane 5-HT transporters and thus inhibit the 5-HT (serotonin) reuptake and breakdown; this results in availability of higher levels/activity of serotonin in the synaptic cleft. Increased synaptic availability of serotonin facilitates its binding to 5-HT receptors, leading to a delayed ejaculation.

• #26 Is Delayed Ejaculation A Problem – Mens Pharmacy Blog

  https://www.menspharmacy.co.uk/blog/erectile-dysfunction/delayed-ejaculation-problem/

  The mechanism of antidepressants-induced delayed ejaculation and delayed orgasm is thought to involve stimulation of postsynaptic 5-HT2A and 5-HT2C receptors by the increased synaptic levels of serotonin. Cyproheptadine acts as a 5-HT2A antagonist, being effective as an antiserotonergic agent. […] Delayed ejaculation can cause: problems with self-esteem in addition to feelings of inadequacy; failure; negativity; avoiding intimacy with others due to frustrations and fear of failure; decreased sexual pleasure; anxiety about sex; inability to conceive, or male infertility; low libido; stress and anxiety; conflicts in a relationship. […] Rowland et al. observed that men with delayed ejaculation show high levels of relationship distress, sexual dissatisfaction, and anxiety about their sexual performance and that they have significantly more general health issues than sexually functional men.

• #27 Delayed Ejaculation: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/2184956-overview

  It has been suggested that the ejaculatory reflex is primarily regulated by the central serotonergic and dopaminergic systems, […] Experimental evidence indicates that serotonin (5-HT), throughout brain descending pathways, exerts an inhibitory role on ejaculation. […] In view of the relation between the serotonergic receptors and their inhibitory and excitatory effects, it is likely that altered levels of 5-HT or altered 5-HT receptor sensitivity in the ejaculatory modulating centers of the central nervous system (CNS) contribute to the pathophysiologic mechanism behind ejaculatory disorders. […] The mechanism of orgasm is still the least well understood part of the sexual process. It probably involves central (cerebral) integration and response to sexual stimulation. […] Transient sympathoadrenal activation during sexual activity, reflected by increases in epinephrine and norepinephrine plasma levels, together with increased cardiovascular activity, has been reported to be associated with orgasm in males.

• #28 The pathophysiology of delayed ejaculation – Chen – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/10617/11776

  Psychogenic and biogenic etiologies of DE usually are neither independent nor mutually exclusive, with both categories overlapping and including a combination of factors involving both etiological domains. […] The pathophysiology of DE in relation to congenital abnormalities is complex and is dependent upon anatomical variations of the pelvic floor and the physiological functioning of the organs located into the pelvic floor. […] Acquired or secondary DE is the result of an identifiable surgical procedure, a different medical condition or psychosexual changes. […] Ejaculatory duct damage may follow correction of an imperforate anus. […] The ability to ejaculate is severely impaired by spinal cord injury. […] Although hormonal regulation of all aspects of male reproduction is well established, the role of endocrine control on the ejaculatory process is still not completely clarified. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected.

• #29 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-023-00692-7

  Delayed orgasm (DO) is defined as increased latency of orgasm despite adequate sexual stimulation and desire. […] Etiologies of DO/AO include medication-induced, psychogenic, endocrine, and genitopelvic dysesthesia. […] The most common etiologies include selective serotonin reuptake inhibitors (SSRI; 42%), psychogenic (28%), low testosterone (T; 21%), abnormal penile sensation (7%), and penile hyperstimulation (2%). […] Given the fundamental role of hormonal regulation in the physiology of orgasm, multiple endocrinopathies have been identified in patients with DO. […] Hyperprolactinemia also leads to DO as increased levels of prolactin (PRL) result in suppression of T production. […] Psychogenic DO results from feelings of fear, anxiety, hostility, relationship difficulties associated with sexual intercourse and encounters.

• #30 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-023-00692-7

  Delayed orgasm (DO) is defined as increased latency of orgasm despite adequate sexual stimulation and desire. […] Etiologies of DO/AO include medication-induced, psychogenic, endocrine, and genitopelvic dysesthesia. […] The most common etiologies include selective serotonin reuptake inhibitors (SSRI; 42%), psychogenic (28%), low testosterone (T; 21%), abnormal penile sensation (7%), and penile hyperstimulation (2%). […] Given the fundamental role of hormonal regulation in the physiology of orgasm, multiple endocrinopathies have been identified in patients with DO. […] Hyperprolactinemia also leads to DO as increased levels of prolactin (PRL) result in suppression of T production. […] Psychogenic DO results from feelings of fear, anxiety, hostility, relationship difficulties associated with sexual intercourse and encounters.

• #31 Delayed Ejaculation: Symptoms, Causes & Treatment | hims

  https://www.forhims.co.uk/conditions/delayed-ejaculation

  Some research shows that psychological stress may elevate a man’s prolactin levels, which can then lead to delayed ejaculation. […] Sometimes, delayed ejaculation is linked to a physical factor, like nerve damage or taking a certain type of medication. […] Potential physical causes of delayed ejaculation include: Insufficient sexual stimulation. One study found that men with delayed ejaculation had decreased sensitivity in the penile shaft. […] Use of certain medications. Some medications may affect your ability to orgasm and ejaculate. […] Damage to the pelvic nerves (those responsible for controlling the ability to orgasm and ejaculate) can cause delayed ejaculation. […] Conditions like low testosterone or hypothyroidism (underactive thyroid) could affect sexual performance and the ability to reach orgasm and ejaculate.

• #32 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.17051

  These etiological factors organic and psychogenic etiologies are neither independent nor mutually exclusive and may well interact with each other, and their pathological effects may vary between individuals. […] An age-dependent increase in the prevalence of DE was reported in various studies. […] The significant heterogeneity in the occurrence and the presentation of SSRI-related sexual dysfunction may suggest underlying genetic factors. […] The neurological mechanisms that lead to DE/AE are damage to the sympathetic ganglia and/or injury of post-ganglionic sympathetic nerve fibers to the organs of emission, mainly as a result of a neuro-logic disease, trauma, or pelvic surgery. […] The list of organic causes possibly leading to DE/AE is extensive. […] Complaints of DE/AE in patients taking medications are not uncommon. Different medications may interfere with either central or peripheral control of ejaculation, potentially affecting the IELT.

• #33 Delayed ejaculation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/symptoms-causes/syc-20371358

  Physical causes of delayed ejaculation include: Certain birth defects that affect the reproductive system. Injury to the pelvic nerves that control orgasm. Certain infections, such as a urinary tract infection. Prostate surgery, such as transurethral resection of the prostate or prostate removal. Neurological diseases, such as diabetic neuropathy, stroke or nerve damage to the spinal cord. Hormone-related conditions, such as low thyroid hormone level, called hypothyroidism, or low testosterone level, called hypogonadism. A condition in which the semen goes backward into the bladder rather than out of the penis, called retrograde ejaculation.

• #34 Delayed Ejaculation: Symptoms, Causes & Treatment | hims

  https://www.forhims.co.uk/conditions/delayed-ejaculation

  Some research shows that psychological stress may elevate a man’s prolactin levels, which can then lead to delayed ejaculation. […] Sometimes, delayed ejaculation is linked to a physical factor, like nerve damage or taking a certain type of medication. […] Potential physical causes of delayed ejaculation include: Insufficient sexual stimulation. One study found that men with delayed ejaculation had decreased sensitivity in the penile shaft. […] Use of certain medications. Some medications may affect your ability to orgasm and ejaculate. […] Damage to the pelvic nerves (those responsible for controlling the ability to orgasm and ejaculate) can cause delayed ejaculation. […] Conditions like low testosterone or hypothyroidism (underactive thyroid) could affect sexual performance and the ability to reach orgasm and ejaculate.

• #35 Delayed ejaculation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/symptoms-causes/syc-20371358

  Physical causes of delayed ejaculation include: Certain birth defects that affect the reproductive system. Injury to the pelvic nerves that control orgasm. Certain infections, such as a urinary tract infection. Prostate surgery, such as transurethral resection of the prostate or prostate removal. Neurological diseases, such as diabetic neuropathy, stroke or nerve damage to the spinal cord. Hormone-related conditions, such as low thyroid hormone level, called hypothyroidism, or low testosterone level, called hypogonadism. A condition in which the semen goes backward into the bladder rather than out of the penis, called retrograde ejaculation.

• #36 The pathophysiology of delayed ejaculation – Chen – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/10617/11776

  Psychogenic and biogenic etiologies of DE usually are neither independent nor mutually exclusive, with both categories overlapping and including a combination of factors involving both etiological domains. […] The pathophysiology of DE in relation to congenital abnormalities is complex and is dependent upon anatomical variations of the pelvic floor and the physiological functioning of the organs located into the pelvic floor. […] Acquired or secondary DE is the result of an identifiable surgical procedure, a different medical condition or psychosexual changes. […] Ejaculatory duct damage may follow correction of an imperforate anus. […] The ability to ejaculate is severely impaired by spinal cord injury. […] Although hormonal regulation of all aspects of male reproduction is well established, the role of endocrine control on the ejaculatory process is still not completely clarified. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected.

• #37 Ejaculation Problems: Too Fast, Too Slow or Not at All? » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/informationsessions/ejaculation-problems-too-fast-too-slow-or-not-at-all/

  Delayed ejaculation carries with it issues of inability to achieve orgasm and infertility. […] A common cause is pudendal neuropathy, caused by a crush to the perineum such as from bike riding with a narrow saddle. […] If the delayed ejaculation is situational is is probably psychologic; if it is generalized the problem is probably biologic.

• #38 The pathophysiology of delayed ejaculation – Chen – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/10617/11776

  Psychogenic and biogenic etiologies of DE usually are neither independent nor mutually exclusive, with both categories overlapping and including a combination of factors involving both etiological domains. […] The pathophysiology of DE in relation to congenital abnormalities is complex and is dependent upon anatomical variations of the pelvic floor and the physiological functioning of the organs located into the pelvic floor. […] Acquired or secondary DE is the result of an identifiable surgical procedure, a different medical condition or psychosexual changes. […] Ejaculatory duct damage may follow correction of an imperforate anus. […] The ability to ejaculate is severely impaired by spinal cord injury. […] Although hormonal regulation of all aspects of male reproduction is well established, the role of endocrine control on the ejaculatory process is still not completely clarified. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected.

• #39 The pathophysiology of delayed ejaculation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5002008/

  Psychogenic and biogenic etiologies of DE usually are neither independent nor mutually exclusive, with both categories overlapping and including a combination of factors involving both etiological domains. […] The pathophysiology of DE in relation to congenital abnormalities is complex and is dependent upon anatomical variations of the pelvic floor and the physiological functioning of the organs located into the pelvic floor. […] Acquired or secondary DE is the result of an identifiable surgical procedure, a different medical condition or psychosexual changes. It may affect ejaculation by a variety of ways, such as via disruption of the chemical or nervous control of ejaculation, or directly at the site of the ejaculatory organs themselves. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE.

• #40 The pathophysiology of delayed ejaculation – Chen – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/10617/11776

  Psychogenic and biogenic etiologies of DE usually are neither independent nor mutually exclusive, with both categories overlapping and including a combination of factors involving both etiological domains. […] The pathophysiology of DE in relation to congenital abnormalities is complex and is dependent upon anatomical variations of the pelvic floor and the physiological functioning of the organs located into the pelvic floor. […] Acquired or secondary DE is the result of an identifiable surgical procedure, a different medical condition or psychosexual changes. […] Ejaculatory duct damage may follow correction of an imperforate anus. […] The ability to ejaculate is severely impaired by spinal cord injury. […] Although hormonal regulation of all aspects of male reproduction is well established, the role of endocrine control on the ejaculatory process is still not completely clarified. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected.

• #41 Delayed ejaculation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/symptoms-causes/syc-20371358

  Physical causes of delayed ejaculation include: Certain birth defects that affect the reproductive system. Injury to the pelvic nerves that control orgasm. Certain infections, such as a urinary tract infection. Prostate surgery, such as transurethral resection of the prostate or prostate removal. Neurological diseases, such as diabetic neuropathy, stroke or nerve damage to the spinal cord. Hormone-related conditions, such as low thyroid hormone level, called hypothyroidism, or low testosterone level, called hypogonadism. A condition in which the semen goes backward into the bladder rather than out of the penis, called retrograde ejaculation.

• #42 Delayed Ejaculation: Causes, Symptoms, & Diagnosis

  https://www.healthline.com/health/delayed-ejaculation

  Delayed ejaculation (DE) occurs when a man needs more than 30 minutes of sexual stimulation to reach orgasm and ejaculate. […] DE has multiple causes, including anxiety, depression, neuropathy, and reactions to medications. […] There are many potential causes of DE, including psychological concerns, chronic health conditions, and reactions to medications. […] Psychological causes of DE can occur due to a traumatic experience. Cultural or religious taboos can give sex a negative connotation. Anxiety and depression can both suppress sexual desire, which may result in DE as well. […] Certain chemicals can affect the nerves involved in ejaculation. This can affect ejaculation with and without a partner. […] The physical causes of DE may include damage to the nerves in your spine or pelvis, certain prostate surgeries that cause nerve damage, heart disease that affects blood pressure to the pelvic region, infections, especially prostate or urinary infections, neuropathy or stroke, low thyroid hormone, low testosterone levels, and birth defects that impair the ejaculation process.

• #43 Male sexual dysfunction: Clinical diagnosis and management strategies for common sexual problems

  https://www1.racgp.org.au/ajgp/2023/january-february/male-sexual-dysfunction

  Ejaculatory disorders can be divided into premature ejaculation, delayed ejaculation, anejaculation and retrograde ejaculation. […] Male hypogonadism, which is defined as a pathological disorder of the hypothalamic-pituitary-testicular axis and biochemical low total testosterone level, can be associated with cardiometabolic complications and ensuing erectile dysfunction, low libido, delayed ejaculation and anorgasmia. […] The best treatment approach for ejaculatory and orgasmic dysfunctions is a multimodal approach, with pharmacological, psychological and behavioural techniques used in combination. […] A mechanical device that provides penile vibratory stimulation has been shown to improve penile sensitivity and, in turn, assist with delayed ejaculation and orgasmic dysfunction. […] Testosterone therapy is effective to improve orgasm in patients with hypogonadism. […] Other off-label uses of medications such as bupropion, cyproheptadine or cabergoline have been shown in selected studies to treat delayed ejaculation and improve orgasm and sexual satisfaction, although further studies are warranted for their long-term efficacy and safety.

• #44 Male sexual dysfunction: Clinical diagnosis and management strategies for common sexual problems

  https://www1.racgp.org.au/ajgp/2023/january-february/male-sexual-dysfunction

  Ejaculatory disorders can be divided into premature ejaculation, delayed ejaculation, anejaculation and retrograde ejaculation. […] Male hypogonadism, which is defined as a pathological disorder of the hypothalamic-pituitary-testicular axis and biochemical low total testosterone level, can be associated with cardiometabolic complications and ensuing erectile dysfunction, low libido, delayed ejaculation and anorgasmia. […] The best treatment approach for ejaculatory and orgasmic dysfunctions is a multimodal approach, with pharmacological, psychological and behavioural techniques used in combination. […] A mechanical device that provides penile vibratory stimulation has been shown to improve penile sensitivity and, in turn, assist with delayed ejaculation and orgasmic dysfunction. […] Testosterone therapy is effective to improve orgasm in patients with hypogonadism. […] Other off-label uses of medications such as bupropion, cyproheptadine or cabergoline have been shown in selected studies to treat delayed ejaculation and improve orgasm and sexual satisfaction, although further studies are warranted for their long-term efficacy and safety.

• #45 The pathophysiology of delayed ejaculation – Chen – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/10617/11776

  Psychogenic and biogenic etiologies of DE usually are neither independent nor mutually exclusive, with both categories overlapping and including a combination of factors involving both etiological domains. […] The pathophysiology of DE in relation to congenital abnormalities is complex and is dependent upon anatomical variations of the pelvic floor and the physiological functioning of the organs located into the pelvic floor. […] Acquired or secondary DE is the result of an identifiable surgical procedure, a different medical condition or psychosexual changes. […] Ejaculatory duct damage may follow correction of an imperforate anus. […] The ability to ejaculate is severely impaired by spinal cord injury. […] Although hormonal regulation of all aspects of male reproduction is well established, the role of endocrine control on the ejaculatory process is still not completely clarified. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected.

• #46 The pathophysiology of delayed ejaculation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5002008/

  Psychogenic and biogenic etiologies of DE usually are neither independent nor mutually exclusive, with both categories overlapping and including a combination of factors involving both etiological domains. […] The pathophysiology of DE in relation to congenital abnormalities is complex and is dependent upon anatomical variations of the pelvic floor and the physiological functioning of the organs located into the pelvic floor. […] Acquired or secondary DE is the result of an identifiable surgical procedure, a different medical condition or psychosexual changes. It may affect ejaculation by a variety of ways, such as via disruption of the chemical or nervous control of ejaculation, or directly at the site of the ejaculatory organs themselves. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE.

• #47 The pathophysiology of delayed ejaculation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5002008/

  Psychogenic and biogenic etiologies of DE usually are neither independent nor mutually exclusive, with both categories overlapping and including a combination of factors involving both etiological domains. […] The pathophysiology of DE in relation to congenital abnormalities is complex and is dependent upon anatomical variations of the pelvic floor and the physiological functioning of the organs located into the pelvic floor. […] Acquired or secondary DE is the result of an identifiable surgical procedure, a different medical condition or psychosexual changes. It may affect ejaculation by a variety of ways, such as via disruption of the chemical or nervous control of ejaculation, or directly at the site of the ejaculatory organs themselves. […] The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE.

• #48 Delayed ejaculation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/symptoms-causes/syc-20371358

  Physical causes of delayed ejaculation include: Certain birth defects that affect the reproductive system. Injury to the pelvic nerves that control orgasm. Certain infections, such as a urinary tract infection. Prostate surgery, such as transurethral resection of the prostate or prostate removal. Neurological diseases, such as diabetic neuropathy, stroke or nerve damage to the spinal cord. Hormone-related conditions, such as low thyroid hormone level, called hypothyroidism, or low testosterone level, called hypogonadism. A condition in which the semen goes backward into the bladder rather than out of the penis, called retrograde ejaculation.

• #49 Delayed ejaculation – treatment, causes and diagnosis | healthdirect

  https://www.healthdirect.gov.au/delayed-ejaculation

  Delayed ejaculation is when you have trouble reaching orgasm and ejaculating. […] The causes of delayed ejaculation are different for everyone and can be complicated. […] Many different types of medicines can cause delayed ejaculation, including antidepressants, some strong pain-relief medicines, and some medicines for high blood pressure and heart disease. […] There can be physical reasons for delayed ejaculation, such as surgery or trauma to your pelvis or genitals, problems with your reproductive system, problems with your nerves or spinal cord, some hormonal conditions, chronic illnesses, such as diabetes or multiple sclerosis, and ageing. […] Mental health conditions and psychological factors can also be related to delayed ejaculation. These can include anxiety, depression, relationship issues, performance anxiety, fears of pregnancy or intimacy, and stress.

• #50 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-023-00692-7

  Hyperstimulation of the penis is another factor that has been identified to contribute to DO. […] Orgasmic dysfunction has been demonstrated among patients who undergo pelvic surgeries. […] There is no standardized treatment plan for DO. […] Treatment options include addressing underlying organic causes and sex therapy. […] Although the current evidence is not conclusive to support the routine use of PVS, the AUA guidelines state that PVS may be recommended for interested patients given the minimal risk. […] A variety of oral pharmacotherapies have been studied for DO/AO, however as noted above most of the evidence is derived from small cohorts with incomplete characterization of other confounding factors.

• #51 Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5756804/

  These etiological factors organic and psychogenic etiologies are neither independent nor mutually exclusive and may well interact with each other, and their pathological effects may vary between individuals. […] The list of organic causes possibly leading to DE/AE is extensive and is outlined in Table 1, 2, 3. […] The neurological mechanisms that lead to DE/AE are damage to the sympathetic ganglia and/or injury of post-ganglionic sympathetic nerve fibers to the organs of emission, mainly as a result of a neuro-logic disease, trauma, or pelvic surgery. […] Complaints of DE/AE in patients taking medications are not uncommon. Different medications may interfere with either central or peripheral control of ejaculation, potentially affecting the IELT. […] The history is the key to the diagnosis. Treatment should be cause-specific.

• #52 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.17051

  These etiological factors organic and psychogenic etiologies are neither independent nor mutually exclusive and may well interact with each other, and their pathological effects may vary between individuals. […] An age-dependent increase in the prevalence of DE was reported in various studies. […] The significant heterogeneity in the occurrence and the presentation of SSRI-related sexual dysfunction may suggest underlying genetic factors. […] The neurological mechanisms that lead to DE/AE are damage to the sympathetic ganglia and/or injury of post-ganglionic sympathetic nerve fibers to the organs of emission, mainly as a result of a neuro-logic disease, trauma, or pelvic surgery. […] The list of organic causes possibly leading to DE/AE is extensive. […] Complaints of DE/AE in patients taking medications are not uncommon. Different medications may interfere with either central or peripheral control of ejaculation, potentially affecting the IELT.

• #53 Is Delayed Ejaculation A Problem – Mens Pharmacy Blog

  https://www.menspharmacy.co.uk/blog/erectile-dysfunction/delayed-ejaculation-problem/

  Several classes of drugs are involved in the occurrence of delayed ejaculation. These drugs include antidepressants (like citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, amitriptyline, amoxapine, clomipramine, desipramine, duloxetine, mirtazapine, venlafaxine), anxiolytics (like alprazolam, chlordiazepoxide), neuroleptics, diuretics and certain anti-inflammatory drugs. Alcohol also can induce delayed ejaculation. […] According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), delayed ejaculation belongs to a group of sexual dysfunctions disorders typically characterized by a clinically significant inability to respond sexually or to experience sexual pleasure. The specific criteria of DSM-5 for delayed ejaculation include the following: In almost all or all (75-100%) sexual activity, the experience of either marked delay in ejaculation or marked infrequency or absence of ejaculation.

• #54 Is Delayed Ejaculation A Problem – Mens Pharmacy Blog

  https://www.menspharmacy.co.uk/blog/erectile-dysfunction/delayed-ejaculation-problem/

  Several classes of drugs are involved in the occurrence of delayed ejaculation. These drugs include antidepressants (like citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, amitriptyline, amoxapine, clomipramine, desipramine, duloxetine, mirtazapine, venlafaxine), anxiolytics (like alprazolam, chlordiazepoxide), neuroleptics, diuretics and certain anti-inflammatory drugs. Alcohol also can induce delayed ejaculation. […] According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), delayed ejaculation belongs to a group of sexual dysfunctions disorders typically characterized by a clinically significant inability to respond sexually or to experience sexual pleasure. The specific criteria of DSM-5 for delayed ejaculation include the following: In almost all or all (75-100%) sexual activity, the experience of either marked delay in ejaculation or marked infrequency or absence of ejaculation.

• #55 Is Delayed Ejaculation A Problem – Mens Pharmacy Blog

  https://www.menspharmacy.co.uk/blog/erectile-dysfunction/delayed-ejaculation-problem/

  Several classes of drugs are involved in the occurrence of delayed ejaculation. These drugs include antidepressants (like citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, amitriptyline, amoxapine, clomipramine, desipramine, duloxetine, mirtazapine, venlafaxine), anxiolytics (like alprazolam, chlordiazepoxide), neuroleptics, diuretics and certain anti-inflammatory drugs. Alcohol also can induce delayed ejaculation. […] According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), delayed ejaculation belongs to a group of sexual dysfunctions disorders typically characterized by a clinically significant inability to respond sexually or to experience sexual pleasure. The specific criteria of DSM-5 for delayed ejaculation include the following: In almost all or all (75-100%) sexual activity, the experience of either marked delay in ejaculation or marked infrequency or absence of ejaculation.

• #56 Is Delayed Ejaculation A Problem – Mens Pharmacy Blog

  https://www.menspharmacy.co.uk/blog/erectile-dysfunction/delayed-ejaculation-problem/

  Several classes of drugs are involved in the occurrence of delayed ejaculation. These drugs include antidepressants (like citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, amitriptyline, amoxapine, clomipramine, desipramine, duloxetine, mirtazapine, venlafaxine), anxiolytics (like alprazolam, chlordiazepoxide), neuroleptics, diuretics and certain anti-inflammatory drugs. Alcohol also can induce delayed ejaculation. […] According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), delayed ejaculation belongs to a group of sexual dysfunctions disorders typically characterized by a clinically significant inability to respond sexually or to experience sexual pleasure. The specific criteria of DSM-5 for delayed ejaculation include the following: In almost all or all (75-100%) sexual activity, the experience of either marked delay in ejaculation or marked infrequency or absence of ejaculation.

• #57 Delayed ejaculation – Wikipedia

  https://en.wikipedia.org/wiki/Delayed_ejaculation

  Delayed ejaculation (DE) is a man’s inability or persistent difficulty in achieving orgasm, despite typical sexual desire and sexual stimulation. […] Delayed ejaculation is closely related to anorgasmia. […] The etiologies of delayed ejaculation can be age-related, organic, psychological, or pharmacological. […] Primary lifelong DEs are poorly understood and rarely explained by few congenital anatomic causes. […] Delayed ejaculation is a possible side effect of alcohol and certain medications, including antipsychotics, antidepressants including selective serotonin reuptake inhibitors (SSRIs), opiates such as morphine or oxycodone, many benzodiazepines such as Valium or Xanax, and certain antihypertensives including thiazide diuretics, alpha-adrenergic blockers and ganglion blockers.

• #58 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-023-00692-7

  Delayed orgasm (DO) is defined as increased latency of orgasm despite adequate sexual stimulation and desire. […] Etiologies of DO/AO include medication-induced, psychogenic, endocrine, and genitopelvic dysesthesia. […] The most common etiologies include selective serotonin reuptake inhibitors (SSRI; 42%), psychogenic (28%), low testosterone (T; 21%), abnormal penile sensation (7%), and penile hyperstimulation (2%). […] Given the fundamental role of hormonal regulation in the physiology of orgasm, multiple endocrinopathies have been identified in patients with DO. […] Hyperprolactinemia also leads to DO as increased levels of prolactin (PRL) result in suppression of T production. […] Psychogenic DO results from feelings of fear, anxiety, hostility, relationship difficulties associated with sexual intercourse and encounters.

• #59 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.17051

  These etiological factors organic and psychogenic etiologies are neither independent nor mutually exclusive and may well interact with each other, and their pathological effects may vary between individuals. […] An age-dependent increase in the prevalence of DE was reported in various studies. […] The significant heterogeneity in the occurrence and the presentation of SSRI-related sexual dysfunction may suggest underlying genetic factors. […] The neurological mechanisms that lead to DE/AE are damage to the sympathetic ganglia and/or injury of post-ganglionic sympathetic nerve fibers to the organs of emission, mainly as a result of a neuro-logic disease, trauma, or pelvic surgery. […] The list of organic causes possibly leading to DE/AE is extensive. […] Complaints of DE/AE in patients taking medications are not uncommon. Different medications may interfere with either central or peripheral control of ejaculation, potentially affecting the IELT.

• #60 Serotonin’s Role in the Biology of Male Ejaculation

  https://www.verywellhealth.com/serotonin-s-role-in-the-biology-of-ejaculation-4156268

  Serotonin, a chemical in your brain, plays an important role in your sex life, including ejaculation. […] In humans, serotonin is the neurotransmitter most clearly associated with ejaculation. […] Using SSRI antidepressants long-term extends the time between erection and ejaculation. […] Studies in rats have also shown that where serotonin is located in the brain changes its effects. For example, if serotonin is injected into some parts of the rat brain, it causes delayed ejaculation. […] Similar to SSRIs, antipsychotics seem to extend the time between arousal and ejaculation.

• #61 Serotonin’s Role in the Biology of Male Ejaculation

  https://www.verywellhealth.com/serotonin-s-role-in-the-biology-of-ejaculation-4156268

  Serotonin, a chemical in your brain, plays an important role in your sex life, including ejaculation. […] In humans, serotonin is the neurotransmitter most clearly associated with ejaculation. […] Using SSRI antidepressants long-term extends the time between erection and ejaculation. […] Studies in rats have also shown that where serotonin is located in the brain changes its effects. For example, if serotonin is injected into some parts of the rat brain, it causes delayed ejaculation. […] Similar to SSRIs, antipsychotics seem to extend the time between arousal and ejaculation.

• #62 Ejaculatory and Orgasmic Disorders | UCSF Department of Urology

  https://urology.ucsf.edu/patient-care/adult-non-cancer/male-sexual-and-reproductive-health/ejaculatory-orgasmic-disorders

  Delayed Ejaculation (DE) can be thought of as the opposite of PE. It is defined as difficulty or inability to reach sexual climax after a period of desired sexual stimulation. This condition is poorly understood; it is more common in older men but can occur in men of any age. It may be related to changes in serum testosterone levels, declines in penile sensitivity, secondary to issues of decreased erection responses and/or libido, or other relationship causes. Anti-depressants, particularly those of the SSRI class, are commonly associated with delayed or absent orgasmic responses. […] Some experts have theorized that delayed ejaculation may be the result of conditioning of their sexual responses; this theory is based on the observation that some men (typically young) may be able to reach climax during masturbation but have trouble when engaging in sex with a partner. While interesting, it may also be hypothesized that these younger men simply need more intense sexual stimulation. The true cause of delayed ejaculation in such cases is difficult to determine.

• #63 Serotonin’s Role in the Biology of Male Ejaculation

  https://www.verywellhealth.com/serotonin-s-role-in-the-biology-of-ejaculation-4156268

  Serotonin, a chemical in your brain, plays an important role in your sex life, including ejaculation. […] In humans, serotonin is the neurotransmitter most clearly associated with ejaculation. […] Using SSRI antidepressants long-term extends the time between erection and ejaculation. […] Studies in rats have also shown that where serotonin is located in the brain changes its effects. For example, if serotonin is injected into some parts of the rat brain, it causes delayed ejaculation. […] Similar to SSRIs, antipsychotics seem to extend the time between arousal and ejaculation.

• #64 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1088855

  Multiple proposed psychogenic factors may contribute to the pathogenesis of DE. […] Any congenital abnormality, medical disease, surgical procedure, or drug that interferes with either central control of ejaculation or the peripheral control that includes sympathetic nerve supply to the vas deferens, bladder neck, prostate or seminal vesicles, as well as the somatic efferent nerve supply to the pelvic floor, can result in DE/AE and anorgasmia. […] An age-dependent increase in the prevalence of DE was reported in various studies. […] DE is marked by etiological complexity (it is multifactorial and many cases are idiopathic), and a range of severity from DE to AE. […] According to this ejaculation distribution theory, lifelong DE, as well as PE, is considered to be part of a normal biological variability in IELT. […] The list of organic causes possibly leading to DE/AE is extensive and is outlined in Table 1, 2, 3. […] The history is the key to the diagnosis of DE/AE. […] Treatment should be cause-specific. […] A rigid treatment plan is not suitable for all patients.

• #65 Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5756804/

  Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. […] The literature suggests that the pathophysiology of DE/AE is multifactorial, including both organic and psychosocial factors. Despite the many publications on this condition, the exact pathogenesis is not yet known. […] Ejaculation involves emission, bladder neck closure, and expulsion (ejaculation proper). […] Many neurotransmitters such as serotonin, dopamine, and norepinephrine play roles in ejaculatory physiology. […] On one hand, it was argued that DE may be caused by psychosexual, psychosocial, or relationship problems. On the other hand, it has been argued that DE is caused by genetic, neurobiological, endocrine, anatomic, and infectious factors, or may be drug-induced.

• #66 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.17051

  Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. […] The literature suggests that the pathophysiology of DE/AE is multifactorial, including both organic and psychosocial factors. Despite the many publications on this condition, the exact pathogenesis is not yet known. […] Ejaculation involves emission, bladder neck closure, and expulsion (ejaculation proper). […] Many neurotransmitters such as serotonin, dopamine, and norepinephrine play roles in ejaculatory physiology. […] On one hand, it was argued that DE may be caused by psychosexual, psychosocial, or relationship problems. On the other hand, it has been argued that DE is caused by genetic, neurobiological, endocrine, anatomic, and infectious factors, or may be drug-induced.

• #67 Delayed ejaculation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/symptoms-causes/syc-20371358

  Delayed ejaculation is a condition in which it takes a long period of sexual arousal to reach climax and release semen from the penis, called ejaculate. Some people with delayed ejaculation can’t ejaculate at all. […] Possible causes of delayed ejaculation include certain ongoing health conditions, surgeries and medicines. Treatment for delayed ejaculation depends on the cause. […] Some medicines, certain ongoing health conditions and surgeries can cause delayed ejaculation. Other causes include substance misuse or a mental health concern, such as depression, anxiety or stress. Often, it’s due to a mix of physical and psychological concerns. […] Psychological causes of delayed ejaculation include: Depression, anxiety or other mental health conditions. Relationship problems due to stress, not communicating well or other concerns. Anxiety about performance. Poor body image. Cultural or religious taboos. Differences between the reality of sex with a partner and sexual fantasies.

• #68 Delayed ejaculation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/symptoms-causes/syc-20371358

  Delayed ejaculation is a condition in which it takes a long period of sexual arousal to reach climax and release semen from the penis, called ejaculate. Some people with delayed ejaculation can’t ejaculate at all. […] Possible causes of delayed ejaculation include certain ongoing health conditions, surgeries and medicines. Treatment for delayed ejaculation depends on the cause. […] Some medicines, certain ongoing health conditions and surgeries can cause delayed ejaculation. Other causes include substance misuse or a mental health concern, such as depression, anxiety or stress. Often, it’s due to a mix of physical and psychological concerns. […] Psychological causes of delayed ejaculation include: Depression, anxiety or other mental health conditions. Relationship problems due to stress, not communicating well or other concerns. Anxiety about performance. Poor body image. Cultural or religious taboos. Differences between the reality of sex with a partner and sexual fantasies.

• #69 Delayed ejaculation – Wikipedia

  https://en.wikipedia.org/wiki/Delayed_ejaculation

  Psychological and lifestyle factors have been discussed as potential contributors, including insufficient sleep, distraction due to worry, distraction from the environment, anxiety about pleasing their partner and anxiety about relationship problems. […] According to the DSM-5-TR, „Delayed ejaculation is associated with highly frequent masturbation, use of masturbation techniques not easily duplicated by a partner, and marked disparities between sexual fantasies during masturbation and the reality of sex with a partner.” […] Diagnosis and management of DE warrant one of the most comprehensive medical evaluation in sexual health assessment that includes a full medical and sexual history performed along with a detailed physical examination. […] Techniques geared towards reduction of anxiety are important skills that can help overcome performance anxiety, as this can often interrupt the natural erectile function through orgasmic progression. […] There is as yet no reliable medication for all cases of delayed ejaculation.

• #70 Delayed ejaculation – Wikipedia

  https://en.wikipedia.org/wiki/Delayed_ejaculation

  Psychological and lifestyle factors have been discussed as potential contributors, including insufficient sleep, distraction due to worry, distraction from the environment, anxiety about pleasing their partner and anxiety about relationship problems. […] According to the DSM-5-TR, „Delayed ejaculation is associated with highly frequent masturbation, use of masturbation techniques not easily duplicated by a partner, and marked disparities between sexual fantasies during masturbation and the reality of sex with a partner.” […] Diagnosis and management of DE warrant one of the most comprehensive medical evaluation in sexual health assessment that includes a full medical and sexual history performed along with a detailed physical examination. […] Techniques geared towards reduction of anxiety are important skills that can help overcome performance anxiety, as this can often interrupt the natural erectile function through orgasmic progression. […] There is as yet no reliable medication for all cases of delayed ejaculation.

• #71 Delayed Ejaculation Causes, Diagnosis, Treatment, and Coping

  https://www.verywellhealth.com/delayed-ejaculation-3300047

  Stress has a cause-and-effect relationship with DE. Not only can stress contribute to DE, but the inability to achieve orgasm can build upon these negative emotions, making orgasm all the more impossible. […] Delayed ejaculation is a frustrating condition for both you and your partner. Overcoming DE can take time and require commitment from both of you as a team. […] Delayed ejaculation is type of male sexual dysfunction that causes difficulty reaching orgasm. It can have a number of causes, including medical conditions like heart disease and diabetes, hormonal problems, and medication side effects. […] Delayed ejaculation treatment depends on the underlying cause. Certain medications can help, and therapy may also be useful.

• #72 Premature Ejaculation | PPT

  https://www.slideshare.net/slideshow/premature-ejaculation-49647084/49647084

  Genetic factors play a significant role in the pathophysiology of PE. […] Short IELT values in men with PE d/t diminished synaptic 5-HT neurotransmission d/t an increase in the function of 5-HTT related to genetic polymorphisms of the protein. […] Sympathetic nervous system, activated by anxiety, may result in an earlier emission phase of ejaculation and subsequently reduced ejaculatory threshold. It is suggested that men with PE have a hyperexcitable ejaculatory reflex, resulting in faster emission and/or expulsion. […] The role of hormones in the genesis of PE is not completely understood. […] Chronic prostatitis is more prevalent among men with a diagnosis of PE. After 1 month of antibiotic treatment, most of treated patients show a significant increase in their IELT. Mechanism behind link between chronic prostatitis and PE and the mean by which antibiotic treatment improved IELT are unclear.

• #73 Delayed Ejaculation: Causes, Symptoms, & Diagnosis

  https://www.healthline.com/health/delayed-ejaculation

  Delayed ejaculation (DE) occurs when a man needs more than 30 minutes of sexual stimulation to reach orgasm and ejaculate. […] DE has multiple causes, including anxiety, depression, neuropathy, and reactions to medications. […] There are many potential causes of DE, including psychological concerns, chronic health conditions, and reactions to medications. […] Psychological causes of DE can occur due to a traumatic experience. Cultural or religious taboos can give sex a negative connotation. Anxiety and depression can both suppress sexual desire, which may result in DE as well. […] Certain chemicals can affect the nerves involved in ejaculation. This can affect ejaculation with and without a partner. […] The physical causes of DE may include damage to the nerves in your spine or pelvis, certain prostate surgeries that cause nerve damage, heart disease that affects blood pressure to the pelvic region, infections, especially prostate or urinary infections, neuropathy or stroke, low thyroid hormone, low testosterone levels, and birth defects that impair the ejaculation process.

• #74 Delayed ejaculation: Causes, treatment, and outlook

  https://www.medicalnewstoday.com/articles/284679

  Certain types of masturbatory behavior may play a role in developing delayed ejaculation. […] The specialist observed that most men with delayed ejaculation reported no problems reaching an orgasm or ejaculating via masturbation. […] Delayed ejaculation is diagnosed when a person is concerned about a marked delay or infrequency of achieving ejaculation during most sexual encounters over a period of 6 months or more, and when other problems have been ruled out. […] Treatment for delayed ejaculation depends on the cause. For instance, if SSRIs are the issue, a doctor may prescribe an alternative drug. […] Psychologists recognize that there is no single intervention that works for all people. They know that the key to successful treatment is to identify the source of the problem and to use appropriate, targeted therapy to deal with the psychological factors that trigger or contribute to the problem.

• #75 Delayed ejaculation: Causes, treatment, and outlook

  https://www.medicalnewstoday.com/articles/284679

  Certain types of masturbatory behavior may play a role in developing delayed ejaculation. […] The specialist observed that most men with delayed ejaculation reported no problems reaching an orgasm or ejaculating via masturbation. […] Delayed ejaculation is diagnosed when a person is concerned about a marked delay or infrequency of achieving ejaculation during most sexual encounters over a period of 6 months or more, and when other problems have been ruled out. […] Treatment for delayed ejaculation depends on the cause. For instance, if SSRIs are the issue, a doctor may prescribe an alternative drug. […] Psychologists recognize that there is no single intervention that works for all people. They know that the key to successful treatment is to identify the source of the problem and to use appropriate, targeted therapy to deal with the psychological factors that trigger or contribute to the problem.

• #76 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-023-00692-7

  Hyperstimulation of the penis is another factor that has been identified to contribute to DO. […] Orgasmic dysfunction has been demonstrated among patients who undergo pelvic surgeries. […] There is no standardized treatment plan for DO. […] Treatment options include addressing underlying organic causes and sex therapy. […] Although the current evidence is not conclusive to support the routine use of PVS, the AUA guidelines state that PVS may be recommended for interested patients given the minimal risk. […] A variety of oral pharmacotherapies have been studied for DO/AO, however as noted above most of the evidence is derived from small cohorts with incomplete characterization of other confounding factors.

• #77 Overcoming Ejaculation Problems: Delayed, Premature, and Retrograde Ejaculation

  https://www.webmd.com/men/features/overcoming-ejaculation-problems

  You may also have a hand in your delayed ejaculation problem. By adopting a masturbation technique that involves intense pressure, friction and speed, some men train themselves to respond to a level of stimulation no partner could duplicate — at least not without coaching, which the man usually is reluctant to provide. […] Michael A. Perelman, PhD, a sex and marital therapist in New York, says he sometimes recommends a masturbation moratorium for men delayed orgasm. This does more than stop the practices that may be contributing to the problem. It also allows a build-up of sexual desire, which provides „a mechanism for reducing the threshold of arousal necessary for orgasm,” Perelman says. […] But while masturbation can cause delayed ejaculation, it can also aid in the cure. If a guy won’t agree to keep his hands off, Perelman will urge him at least to alter his masturbation style — to switch hands, for example — in order to break old habits. The problem is that your tried-and-true, quick-and-dirty masturbation style is probably terrible practice for sex with another person.

• #78 Why Delayed Ejaculation Is More Common Than Folks Realize | Psychology Today

  https://www.psychologytoday.com/us/blog/sexual-tipping-point/201812/why-delayed-ejaculation-is-more-common-than-folks-realize

  Idiosyncratic masturbation patterns (techniques not easily duplicated by the partner during sexual acts) are a frequent cause of DE. […] The best model to understand human sexual response integrates rather than isolates all the biomedical, psychosocial and cultural factors. […] With no FDA drug approved for DE, urologists may find it difficult to treat, but help learning to alter thoughts and behavior can bring success. […] Delayed ejaculation is the least understood of the male sexual dysfunctions. […] DE is typically defined as a marked delay in ejaculation and/or infrequency or absence of ejaculation. […] Ejaculatory difficulty may occur in all situations (generalized) or be limited to certain experiences (situational). […] Delayed ejaculation is best understood as an endpoint response that represents the interaction of biological, medical, psychological, social, and cultural factors.

• #79 The GP Guide: How to diagnose and treat ejaculatory disorders | Healthy Male

  https://healthymale.org.au/health-article/gp-guide-how-diagnose-and-treat-ejaculatory-disorders

  Delayed ejaculation occurs when an abnormal or excessive amount of stimulation is required to achieve orgasm with ejaculation. It often occurs with concomitant illness and is also associated with ageing. […] Delayed ejaculation can have a psychosexual cause, for example, if there is an idiosyncratic masturbatory style. […] Aetiological treatment: managing the underlying condition or concomitant illness e.g. androgen deficiency. […] Medication modification: consider an alternative agent or a drug holiday from causal agent. […] Psychosexual counselling.

• #80 Delayed Ejaculation: Symptoms, Causes & Treatment | hims

  https://www.forhims.co.uk/blog/delayed-ejaculation-causes-treatment

  Delayed ejaculation is a medical condition that makes it difficult or impossible to orgasm and ejaculate. Or, in certain cases, reaching ejaculation may require an extended period of sexual stimulation. […] Numerous factors can play a role in delayed ejaculation causes, from psychological issues to health problems or even the use of certain medications. Sometimes, there are multiple causes. […] In many instances, delayed ejaculation is caused by a psychological factor, like depression or sexual performance anxiety. […] Sometimes, delayed ejaculation is linked to a physical factor, like nerve damage or taking a certain type of medication. […] Damage to the pelvic nerves (those responsible for controlling the ability to orgasm and ejaculate) can cause delayed ejaculation. […] Delayed ejaculation can happen to men of all ages, but studies show it’s more common in older men.

• #81 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.17051

  These etiological factors organic and psychogenic etiologies are neither independent nor mutually exclusive and may well interact with each other, and their pathological effects may vary between individuals. […] An age-dependent increase in the prevalence of DE was reported in various studies. […] The significant heterogeneity in the occurrence and the presentation of SSRI-related sexual dysfunction may suggest underlying genetic factors. […] The neurological mechanisms that lead to DE/AE are damage to the sympathetic ganglia and/or injury of post-ganglionic sympathetic nerve fibers to the organs of emission, mainly as a result of a neuro-logic disease, trauma, or pelvic surgery. […] The list of organic causes possibly leading to DE/AE is extensive. […] Complaints of DE/AE in patients taking medications are not uncommon. Different medications may interfere with either central or peripheral control of ejaculation, potentially affecting the IELT.

• #82 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1088855

  Multiple proposed psychogenic factors may contribute to the pathogenesis of DE. […] Any congenital abnormality, medical disease, surgical procedure, or drug that interferes with either central control of ejaculation or the peripheral control that includes sympathetic nerve supply to the vas deferens, bladder neck, prostate or seminal vesicles, as well as the somatic efferent nerve supply to the pelvic floor, can result in DE/AE and anorgasmia. […] An age-dependent increase in the prevalence of DE was reported in various studies. […] DE is marked by etiological complexity (it is multifactorial and many cases are idiopathic), and a range of severity from DE to AE. […] According to this ejaculation distribution theory, lifelong DE, as well as PE, is considered to be part of a normal biological variability in IELT. […] The list of organic causes possibly leading to DE/AE is extensive and is outlined in Table 1, 2, 3. […] The history is the key to the diagnosis of DE/AE. […] Treatment should be cause-specific. […] A rigid treatment plan is not suitable for all patients.

• #83 What Is Delayed Ejaculation – Klarity Health Library

  https://my.klarity.health/what-is-delayed-ejaculation/

  Delayed ejaculation is when an assigned male at birth (AMAB) ; straight, gay, bisexual or pansexual, faces either a too-long time prior to orgasm and ejaculation or an inability to achieve ejaculation, despite the AMAB desire to and his/their erection being normal. […] This problem, which can wreck a sex life, is just as significant as premature ejaculation or erectile dysfunction. […] However, many of them are able to cause infertility such as delayed ejaculation. […] Psychological factors: many of them can also cause premature ejaculation, for instance, relationship problems, depression, or anxiety. Here are some theories about its mechanism. […] Ageing: is a directly affecting mechanism that leads to sexual climax. […] There are a variety of mental or physical causes that contribute to delayed ejaculation;

• #84 Delayed Ejaculation DSM-5 302.74 (N53.11)

  https://www.theravive.com/therapedia/delayed-ejaculation-dsm–5-302.74-(n53.11)

  The DSM-5 notes that normal age related changes in men include loss of genital sensitivity and decline of testosterone, which can be causal in delayed ejaculation. […] According to the DSM-5, The aging process as noted above, will inevitably produce predictable sexual changes, including delay of ejaculation, or ejaculatory failure. An IMS (Ideosyncratic Masturbation Style) may cause ejaculatory delay or failure, as sexual expectations may not be met when a partner is present. Men may also fear impregnating a woman, which will produce psychic tension and inhibit ejaculation. There is a growing body of evidence which suggests excessive exposure to pornography may reduce sexual desire, impair arousal, and otherwise produce sexual dysfunction though a stimuli overexposure and desensitization process.

• #85 Overcoming Ejaculation Problems: Delayed, Premature, and Retrograde Ejaculation

  https://www.webmd.com/men/features/overcoming-ejaculation-problems

  Delayed ejaculation affects a much smaller number of men — as few as 3%, according to some estimates. It’s one of the most poorly understood ejaculation problems. Some men cannot reach orgasm at all, at least not with a partner. […] There are lots of different reasons for delayed ejaculation. Some medicines — like antidepressants — can cause it. For many men, it happens due to age. As we grow older, the nerve endings in the penis become less sensitive, says Barbara Keesling, PhD, author of All Night Long: How to Make Love to a Man Over 50, and a professor of human sexuality at the California State University, Fullerton. […] When the reflexes slow down, it takes longer, Keesling says. „Another thing that happens with age is that your erection ability goes down too, so it becomes more difficult to ejaculate without a full erection.”

• #86 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1088855

  Multiple proposed psychogenic factors may contribute to the pathogenesis of DE. […] Any congenital abnormality, medical disease, surgical procedure, or drug that interferes with either central control of ejaculation or the peripheral control that includes sympathetic nerve supply to the vas deferens, bladder neck, prostate or seminal vesicles, as well as the somatic efferent nerve supply to the pelvic floor, can result in DE/AE and anorgasmia. […] An age-dependent increase in the prevalence of DE was reported in various studies. […] DE is marked by etiological complexity (it is multifactorial and many cases are idiopathic), and a range of severity from DE to AE. […] According to this ejaculation distribution theory, lifelong DE, as well as PE, is considered to be part of a normal biological variability in IELT. […] The list of organic causes possibly leading to DE/AE is extensive and is outlined in Table 1, 2, 3. […] The history is the key to the diagnosis of DE/AE. […] Treatment should be cause-specific. […] A rigid treatment plan is not suitable for all patients.

• #87 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1088855

  Multiple proposed psychogenic factors may contribute to the pathogenesis of DE. […] Any congenital abnormality, medical disease, surgical procedure, or drug that interferes with either central control of ejaculation or the peripheral control that includes sympathetic nerve supply to the vas deferens, bladder neck, prostate or seminal vesicles, as well as the somatic efferent nerve supply to the pelvic floor, can result in DE/AE and anorgasmia. […] An age-dependent increase in the prevalence of DE was reported in various studies. […] DE is marked by etiological complexity (it is multifactorial and many cases are idiopathic), and a range of severity from DE to AE. […] According to this ejaculation distribution theory, lifelong DE, as well as PE, is considered to be part of a normal biological variability in IELT. […] The list of organic causes possibly leading to DE/AE is extensive and is outlined in Table 1, 2, 3. […] The history is the key to the diagnosis of DE/AE. […] Treatment should be cause-specific. […] A rigid treatment plan is not suitable for all patients.

• #88 What Is Delayed Ejaculation – Klarity Health Library

  https://my.klarity.health/what-is-delayed-ejaculation/

  Some antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). […] Delayed ejaculation (impaired ejaculation/retarded ejaculation) is when a AMAB experiences difficulties in ejaculation and orgasm, which are not limited to vaginal sexual intercourse but also occur during masturbation or manual, oral, vaginal, or anal stimulation by the partner. […] Therefore, the issue is not when a male takes longer than others to ejaculate, but when he/they experiences negative consequences as a result. […] In the Diagnostic and Statistical Manual of Mental Disorders (DSM), fifth edition, the definition of delayed ejaculation (retarded ejaculation) requires 1 of 2 symptoms: either a marked delay in or a marked infrequency or absence of ejaculation on 75% to 100% (more than 3 out of 4) of occasions for at least 6 months of partnered sexual activity without the individual desiring delay and causing significant distress to the individual.

• #89 Delayed Ejaculation DSM-5 302.74 (N53.11)

  https://www.theravive.com/therapedia/delayed-ejaculation-dsm–5-302.74-(n53.11)

  The DSM-5 notes comorbidity with major depressive disorder. […] The DSM -5 does not provide specific treatment options. Treatment recommendations will vary depending on the underlying cause. If illicit drug or excessive alcohol use is identified as causal, then group or individual counseling for chemical abuse and dependency is indicated. Depression and anxiety can be addressed through CBT (Cognitive Behavioral Therapy) if a mood or anxiety disorder is causal. Couples counseling may be indicated to enhance communication and resolve tensions and conflicts if this is a contributing or complicating factor. Given the consistent descriptions in the literature on the weight of intrapsychic, conflicts and repressed desires, psychodynamic therapy may be indicated to resolve these conflicts. […] Delayed ejaculation may complicate efforts at conception, and create frustration with sexual activity, avoidance, and resultant relationship difficulties. The DSM -5 notes a number of medical conditions that can precipitate delayed ejaculation, such as traumatic surgical injury to the groin or genitals, multiple sclerosis, or diabetes.

• #90 Delayed Ejaculation – Tower Urology

  https://www.towerurology.com/mens-health/delayed-ejaculation/

  Delayed ejaculation can be caused by chronic medical problems, certain medications or surgery. It may also have psychological causes. In some instances, it is a combination of both physical and psychological causes. […] Physical causes include nervous system pathology, such as strokes and mul. stroke), injury to the back or spine, endocrine disease (i.e. diabetes), prostate disease or surgery and heart surgery. Certain types of medication may also cause delayed ejaculation. These medications can include antidepressants, antipsychotics and antihypertensives. Delayed ejaculation may also occur with excessive alcohol use or recreational drug use. […] Psychological causes of delayed ejaculation include relationship problems, anxiety, depression and other mental health problems, fatigue, performance anxiety, conditioning caused by a history of unusual masturbating and cultural or religious issues. […] Other risk factors for delayed ejaculation include older age and erectile dysfunction.

• #91 Premature ejaculation: A clinical review for the general physician

  https://www.racgp.org.au/afp/2015/october/premature-ejaculation-a-clinical-review-for-the-ge

  Psychological components often contribute to acquired premature ejaculation. However, it is likely that a complex interplay between neurophysiological factors predominantly influence premature ejaculation. In particular, genetic predisposition for impairment of inhibitory serotonergic pathways that regulate ejaculation, modulated by 5-HT2c, 5-HT1a, 5-HT1b receptors and synaptic serotonin transporters has been reported for lifelong premature ejaculation. […] Other conditions, such as chronic prostatitis and hyperthyroidism, may also be associated with acquired premature ejaculation. […] Erectile dysfunction and premature ejaculation frequently co-exist, as men with erectile dysfunction might try to ejaculate early, before loss of erection. Thus, detection of comorbid erectile dysfunction is crucial in guiding therapeutic implementation.

• #92 Delayed Ejaculation: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/2184956-overview

  Male orgasm is defined as a subjective, perceptual-cognitive event of peak sexual pleasure that in normal conditions coincides with the moment of ejaculation. […] The presence of a normal sexual excitement phase is a prerequisite for male orgasmic disorder (MOD). […] Patients with MOD can achieve firm erections and have normal sexual intercourse with penetration. […] Urologic classifications are usually explicit in differentiating between failure to ejaculate and absence of orgasm. […] The succession of erection, ejaculation, and orgasm creates the impression that these events might have a common physiologic substrate. In reality, they are separate events. […] Normal ejaculation is a brief event consisting of two phases: emission and expulsion. […] The cerebral network modulating and controlling the final common output from all ejaculatory stimuli includes the posteromedial bed nucleus of the stria terminalis, the posterodorsal medial amygdaloid nucleus, the posterodorsal preoptic nucleus, and the parvicellular part of the subparafascicular thalamus.

• #93 Delayed Ejaculation: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/2184956-overview

  Male orgasm is defined as a subjective, perceptual-cognitive event of peak sexual pleasure that in normal conditions coincides with the moment of ejaculation. […] The presence of a normal sexual excitement phase is a prerequisite for male orgasmic disorder (MOD). […] Patients with MOD can achieve firm erections and have normal sexual intercourse with penetration. […] Urologic classifications are usually explicit in differentiating between failure to ejaculate and absence of orgasm. […] The succession of erection, ejaculation, and orgasm creates the impression that these events might have a common physiologic substrate. In reality, they are separate events. […] Normal ejaculation is a brief event consisting of two phases: emission and expulsion. […] The cerebral network modulating and controlling the final common output from all ejaculatory stimuli includes the posteromedial bed nucleus of the stria terminalis, the posterodorsal medial amygdaloid nucleus, the posterodorsal preoptic nucleus, and the parvicellular part of the subparafascicular thalamus.

• #94 Delayed ejaculation – Wikipedia

  https://en.wikipedia.org/wiki/Delayed_ejaculation

  Delayed ejaculation (DE) is a man’s inability or persistent difficulty in achieving orgasm, despite typical sexual desire and sexual stimulation. […] Delayed ejaculation is closely related to anorgasmia. […] The etiologies of delayed ejaculation can be age-related, organic, psychological, or pharmacological. […] Primary lifelong DEs are poorly understood and rarely explained by few congenital anatomic causes. […] Delayed ejaculation is a possible side effect of alcohol and certain medications, including antipsychotics, antidepressants including selective serotonin reuptake inhibitors (SSRIs), opiates such as morphine or oxycodone, many benzodiazepines such as Valium or Xanax, and certain antihypertensives including thiazide diuretics, alpha-adrenergic blockers and ganglion blockers.

• #95 Ejaculation Problems: Too Fast, Too Slow or Not at All? » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/informationsessions/ejaculation-problems-too-fast-too-slow-or-not-at-all/

  Delayed ejaculation carries with it issues of inability to achieve orgasm and infertility. […] A common cause is pudendal neuropathy, caused by a crush to the perineum such as from bike riding with a narrow saddle. […] If the delayed ejaculation is situational is is probably psychologic; if it is generalized the problem is probably biologic.

• #96 Delayed Ejaculation: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/2184956-overview

  Male orgasm is defined as a subjective, perceptual-cognitive event of peak sexual pleasure that in normal conditions coincides with the moment of ejaculation. […] The presence of a normal sexual excitement phase is a prerequisite for male orgasmic disorder (MOD). […] Patients with MOD can achieve firm erections and have normal sexual intercourse with penetration. […] Urologic classifications are usually explicit in differentiating between failure to ejaculate and absence of orgasm. […] The succession of erection, ejaculation, and orgasm creates the impression that these events might have a common physiologic substrate. In reality, they are separate events. […] Normal ejaculation is a brief event consisting of two phases: emission and expulsion. […] The cerebral network modulating and controlling the final common output from all ejaculatory stimuli includes the posteromedial bed nucleus of the stria terminalis, the posterodorsal medial amygdaloid nucleus, the posterodorsal preoptic nucleus, and the parvicellular part of the subparafascicular thalamus.

• #97 Delayed Ejaculation: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/2184956-overview

  It has been suggested that the ejaculatory reflex is primarily regulated by the central serotonergic and dopaminergic systems, […] Experimental evidence indicates that serotonin (5-HT), throughout brain descending pathways, exerts an inhibitory role on ejaculation. […] In view of the relation between the serotonergic receptors and their inhibitory and excitatory effects, it is likely that altered levels of 5-HT or altered 5-HT receptor sensitivity in the ejaculatory modulating centers of the central nervous system (CNS) contribute to the pathophysiologic mechanism behind ejaculatory disorders. […] The mechanism of orgasm is still the least well understood part of the sexual process. It probably involves central (cerebral) integration and response to sexual stimulation. […] Transient sympathoadrenal activation during sexual activity, reflected by increases in epinephrine and norepinephrine plasma levels, together with increased cardiovascular activity, has been reported to be associated with orgasm in males.

• #98 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-023-00692-7

  Delayed orgasm (DO) is defined as increased latency of orgasm despite adequate sexual stimulation and desire. […] Etiologies of DO/AO include medication-induced, psychogenic, endocrine, and genitopelvic dysesthesia. […] The most common etiologies include selective serotonin reuptake inhibitors (SSRI; 42%), psychogenic (28%), low testosterone (T; 21%), abnormal penile sensation (7%), and penile hyperstimulation (2%). […] Given the fundamental role of hormonal regulation in the physiology of orgasm, multiple endocrinopathies have been identified in patients with DO. […] Hyperprolactinemia also leads to DO as increased levels of prolactin (PRL) result in suppression of T production. […] Psychogenic DO results from feelings of fear, anxiety, hostility, relationship difficulties associated with sexual intercourse and encounters.

• #99 Ejaculation Problems: Too Fast, Too Slow or Not at All? » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/informationsessions/ejaculation-problems-too-fast-too-slow-or-not-at-all/

  The psychological definition of delayed ejaculation refers to the inability to have an ejaculation during sexual intercourse. […] Problems of delayed ejaculation tend to be somewhat rare and not well understood by psychologists and sex therapists. […] In many cases, the man himself may tend to delay treatment or to minimize the distress of the situation. […] In spite of the lack of information regarding delayed ejaculation, the most successful approach, for sex therapists, is to engage both members of the couple into addressing the problem. […] Ejaculatory problems can have a devastating affect on self-esteem. […] For some men, there may be additional psychological issues that underlie an ejaculatory dysfunction. […] Traditional behavioral sex therapy for delayed ejaculation is as follows: the man begins by masturbating, then starts intercourse when he is almost ready to ejaculate; the procedure continues with the man beginning intercourse earlier and earlier.

• #100 Delayed ejaculation – treatment, causes and diagnosis | healthdirect

  https://www.healthdirect.gov.au/delayed-ejaculation

  The treatment for delayed ejaculation depends on the cause. […] Your doctor may recommend medicines, depending on the cause of your delayed ejaculation. […] Delayed ejaculation can’t be prevented if the cause is physical, such as nerve damage. […] Delayed ejaculation might make it more difficult to conceive a baby. […] Delayed ejaculation might also increase stress, lead to anxiety or depression, contribute to low self-esteem, and lead to relationship issues.

• #101 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation

  Lifelong delayed ejaculation is defined as lifelong, consistent, bothersome inability to achieve ejaculation, or excessive latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. (Expert Opinion) […] Acquired delayed ejaculation 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. (Expert Opinion) […] DE is arguably the least studied, least reported and least understood male sexual dysfunction. DE is of particular concern when procreation is desired. Regardless of the desire for procreation, the impact of failure to achieve orgasm is significant in that it typically results in a lack of sexual fulfilment for both the man and his partner.

• #102 Delayed ejaculation – treatment, causes and diagnosis | healthdirect

  https://www.healthdirect.gov.au/delayed-ejaculation

  The treatment for delayed ejaculation depends on the cause. […] Your doctor may recommend medicines, depending on the cause of your delayed ejaculation. […] Delayed ejaculation can’t be prevented if the cause is physical, such as nerve damage. […] Delayed ejaculation might make it more difficult to conceive a baby. […] Delayed ejaculation might also increase stress, lead to anxiety or depression, contribute to low self-esteem, and lead to relationship issues.

• #103 Ejaculation Problems: Too Fast, Too Slow or Not at All? » Sexual Medicine » BUMC

  https://www.bumc.bu.edu/sexualmedicine/informationsessions/ejaculation-problems-too-fast-too-slow-or-not-at-all/

  The psychological definition of delayed ejaculation refers to the inability to have an ejaculation during sexual intercourse. […] Problems of delayed ejaculation tend to be somewhat rare and not well understood by psychologists and sex therapists. […] In many cases, the man himself may tend to delay treatment or to minimize the distress of the situation. […] In spite of the lack of information regarding delayed ejaculation, the most successful approach, for sex therapists, is to engage both members of the couple into addressing the problem. […] Ejaculatory problems can have a devastating affect on self-esteem. […] For some men, there may be additional psychological issues that underlie an ejaculatory dysfunction. […] Traditional behavioral sex therapy for delayed ejaculation is as follows: the man begins by masturbating, then starts intercourse when he is almost ready to ejaculate; the procedure continues with the man beginning intercourse earlier and earlier.

• #104 Is Delayed Ejaculation A Problem – Mens Pharmacy Blog

  https://www.menspharmacy.co.uk/blog/erectile-dysfunction/delayed-ejaculation-problem/

  The mechanism of antidepressants-induced delayed ejaculation and delayed orgasm is thought to involve stimulation of postsynaptic 5-HT2A and 5-HT2C receptors by the increased synaptic levels of serotonin. Cyproheptadine acts as a 5-HT2A antagonist, being effective as an antiserotonergic agent. […] Delayed ejaculation can cause: problems with self-esteem in addition to feelings of inadequacy; failure; negativity; avoiding intimacy with others due to frustrations and fear of failure; decreased sexual pleasure; anxiety about sex; inability to conceive, or male infertility; low libido; stress and anxiety; conflicts in a relationship. […] Rowland et al. observed that men with delayed ejaculation show high levels of relationship distress, sexual dissatisfaction, and anxiety about their sexual performance and that they have significantly more general health issues than sexually functional men.

• #105 Is Delayed Ejaculation A Problem – Mens Pharmacy Blog

  https://www.menspharmacy.co.uk/blog/erectile-dysfunction/delayed-ejaculation-problem/

  The mechanism of antidepressants-induced delayed ejaculation and delayed orgasm is thought to involve stimulation of postsynaptic 5-HT2A and 5-HT2C receptors by the increased synaptic levels of serotonin. Cyproheptadine acts as a 5-HT2A antagonist, being effective as an antiserotonergic agent. […] Delayed ejaculation can cause: problems with self-esteem in addition to feelings of inadequacy; failure; negativity; avoiding intimacy with others due to frustrations and fear of failure; decreased sexual pleasure; anxiety about sex; inability to conceive, or male infertility; low libido; stress and anxiety; conflicts in a relationship. […] Rowland et al. observed that men with delayed ejaculation show high levels of relationship distress, sexual dissatisfaction, and anxiety about their sexual performance and that they have significantly more general health issues than sexually functional men.

• #106 Delayed Ejaculation: Causes, Symptoms, & Diagnosis

  https://www.healthline.com/health/delayed-ejaculation

  A temporary ejaculation problem can cause anxiety and depression. This can lead to recurrence, even when the underlying physical cause has been resolved. […] Treatment will depend on the underlying cause. […] Low Testosterone can contribute to DE and low testosterone supplements could help fix your DE issue. […] Psychological counseling can help treat depression, anxiety, and fears that trigger or perpetuate DE. […] DE can generally be resolved by treating the mental or physical causes. Identifying and seeking treatment for DE sometimes exposes an underlying medical condition. Once this is treated, DE often resolves.

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