Materiały źródłowe

• #1 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

  Ejaculatory disorders result from a disrupted mechanism of ejaculation emission, ejaculation or orgasm. […] The most common ejaculatory disorder is premature ejaculation but problems with ejaculation also include delayed ejaculation, anorgasmia, retrograde ejaculation, anejaculation and painful ejaculation. […] This article guides GPs on how to diagnose and treat these ejaculatory disorders, and when to refer to a specialist. […] GPs are typically the first point of contact for men with a disorder of ejaculation and they play a role in diagnosis, treatment and referral. […] GPs should also offer brief counselling and education as part of routine management. […] PE is a self-reported diagnosis and can be based on sexual history alone. But its useful to assess medical, psychological and physical factors to determine what is causing PE.

• #2 Disorders of Orgasm and Ejaculation in Men: Diagnosis & Treatments

  https://www.mhisc.ch/conditions-treatments/ejaculation-disorders-diagnosis-treatments

  Ejaculatory dysfunction is one of the most common male sexual disorders. The spectrum of ejaculatory dysfunction extends from Premature Ejaculation (PE), through Delayed Ejaculation (DE) to a complete inability to ejaculate (known as anejaculation), and includes retrograde ejaculation. […] Various epidemiological studies have shown that about 2030% of men have complaints of premature ejaculation. […] Acquired PE can often be traced to either neurobiogenic (endocrine, urologic, neurobiologic) or psychogenic factors, or in some instances, both. […] The prevalence of ejaculatory disorders is unclear. […] A number of pathophysiologies have been associated with ejaculatory problems. […] Delayed or absent ejaculation can be a lifelong or an acquired problem. […] Before considering a psychological/behavioral approach toward the treatment of DE, clinicians first need to exclude probable iatrogenic and pathophysiological causes.

• #3 Delayed ejaculation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/diagnosis-treatment/drc-20371363

  A physical exam and medical history might be all that are needed to suggest treatment for delayed ejaculation. But there might be a problem causing delayed ejaculation that needs treatment. Then you might need more tests, or you might need to see a specialist. […] Besides a physical exam of the penis and testicles, you might have: […] Blood tests. A blood sample sent to a lab can check for heart disease, diabetes, hormone levels and other health conditions. […] Urine tests, called urinalysis. Urine tests look for signs of diabetes, infection and other health conditions. […] For delayed ejaculation, some basic questions to ask include: […] What tests do I need? […] What treatments are there? Which one do you suggest for me? […] Your healthcare professional may ask: […] Do you have trouble ejaculating only now and then, or is it an ongoing problem?

• #4 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

  Ejaculatory disorders result from a disrupted mechanism of ejaculation emission, ejaculation or orgasm. […] The most common ejaculatory disorder is premature ejaculation but problems with ejaculation also include delayed ejaculation, anorgasmia, retrograde ejaculation, anejaculation and painful ejaculation. […] This article guides GPs on how to diagnose and treat these ejaculatory disorders, and when to refer to a specialist. […] GPs are typically the first point of contact for men with a disorder of ejaculation and they play a role in diagnosis, treatment and referral. […] GPs should also offer brief counselling and education as part of routine management. […] PE is a self-reported diagnosis and can be based on sexual history alone. But its useful to assess medical, psychological and physical factors to determine what is causing PE.

• #5 Delayed ejaculation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/diagnosis-treatment/drc-20371363

  Are you able to ejaculate during sexual intercourse? Or are you able to ejaculate only when your partner directly touches your penis or when you masturbate? […] Have you had changes in sexual desire or any other sexual problems? […] Have you had any other sexual problems, such as trouble getting or keeping an erection, called erectile dysfunction?

• #6 Ejaculatory Disorders: Pathophysiology and Management

  https://www.medscape.org/viewarticle/569396_4

  Diagnosis of PE in clinical practice is straightforward, as it is simply based on patient self-report, clinical history, sexual history and examination findings; however, primary and acquired PE must be differentiated, which are respectively defined as experience with the problem for as long as the man has been sexually active, and development of the condition after having had previous satisfying sexual relationships without problems. […] Obtaining a clinical history is crucial for identifying potential comorbidities, such as diabetes, neuropathies, traumas or urogenital infections, as well as previous surgery or drug consumption. […] Owing to the absence of validated tools for diagnosing PE, the American Urological Association guidelines recommend that the diagnosis of PE be based solely upon information gathered from taking a sexual history, such as questions concerning the frequency and duration of PE, the proportion of sexual attempts with PE, the patients relationships with specific partners, the frequency and nature of sexual activity, and the effects of PE on sexual activity and quality of life.

• #7 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

  Behavioural techniques and/or psychosexual counselling can be used as second-line treatments. […] Many men return to normal function following treatment for secondary PE. […] Behavioural techniques and/or counselling are the initial treatments. […] SSRIs, reducing penile sensation and/or PDE5 inhibitors are second-line treatments. […] For a general assessment, refer to a GP, endocrinologist or urologist who has an interest in sexual medicine. […] Delayed ejaculation occurs when an abnormal or excessive amount of stimulation is required to achieve orgasm with ejaculation. […] Anorgasmia is the inability to reach orgasm. […] Retrograde ejaculation occurs when semen passes backwards through the bladder neck into the bladder. […] Anejaculation is the complete absence of ejaculation, due to a failure of semen emission from the prostate and seminal ducts into the urethra. […] Painful ejaculation is an acquired condition where painful sensations are felt in the perineum or urethra and urethral meatus.

• #8 Delayed ejaculation

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20371342

  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. […] Treatment for delayed ejaculation depends on the cause. […] Your main healthcare professional is a good place to start when you have delayed ejaculation. See your healthcare professional if: Delayed ejaculation is an issue for you or your partner. […] A physical exam and medical history might be all that are needed to suggest treatment for delayed ejaculation. But there might be a problem causing delayed ejaculation that needs treatment. Then you might need more tests, or you might need to see a specialist. […] Delayed ejaculation treatment depends on the cause. Treatment might include taking medicine or making changes to medicines you take.

• #9 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

  GPs should assess general medical history and check more specifically for prescription and non-prescription medications. […] Psychological factors can contribute to ejaculatory disorders. […] GPs should perform the following: General examination, Penile and testicular examination, including a rectal examination if PE occurs with painful ejaculation, A neurological assessment of the genital area and lower limb. […] The underlying cause guides the management of PE. […] Treatment decision-making for PE should consider aetiology, patient needs and preferences, the impact of the disorder on the patient and his partner, and whether fertility is an issue. […] For primary PE, most men require ongoing treatment to maintain normal function. […] First-line treatments are SSRIs and reducing penile sensation.

• #10 Ejaculatory Dysfunction | Urology Associates | Denver Metro

  https://www.denverurology.com/mens-fertility-sexual-health/ejaculatory-dysfunction/

  Ejaculatory dysfunction is the inability of a man to efficiently ejaculate semen from the penis at the moment of sexual climax. […] Ejaculatory dysfunction is classified into four types: premature ejaculation, delayed ejaculation, retrograde ejaculation and anejaculation (no ejaculation). […] Ejaculation disorders, also called aspermia, can be caused by a problem at birth (primary) or by acquired dysfunctions (secondary) after birth (often much later in life), such as disease, injury and adverse drug reactions. […] Asserting a patient about his personal history is generally the first step a physician takes in diagnosing and evaluating ejaculatory dysfunctions. […] Elements of evaluation include: Physical exam of the genitalia and testicles for structural problems, Semen sample for evaluation of sperm presence and health, Post-ejaculate urine sample if no ejaculate was produced, Hormonal testing, Transrectal ultrasound (TRUS) to look for structural problems.

• #11 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. […] Treatment depends on the cause. […] You should talk to your doctor if you have delayed ejaculation and it is bothering you. […] How is the cause of delayed ejaculation diagnosed? […] Your doctor will ask about your symptoms and sexual history. They may do a physical examination. […] Your doctor may also recommend tests for some people, including: blood tests, urine tests, an ultrasound scan. […] You should talk to your doctor if you have delayed ejaculation and it is bothering you. […] Your doctor can: provide reassurance, assess you to identify the cause, recommend treatments. […] The treatment for delayed ejaculation depends on the cause. […] Your doctor will be able to give specific advice and treatment options. […] Your doctor may recommend medicines, depending on the cause of your delayed ejaculation. […] Delayed ejaculation might make it more difficult to conceive a baby. […] Talk with your doctor if you are worried about the effects of delayed ejaculation.

• #12 Delayed ejaculation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/diagnosis-treatment/drc-20371363

  A physical exam and medical history might be all that are needed to suggest treatment for delayed ejaculation. But there might be a problem causing delayed ejaculation that needs treatment. Then you might need more tests, or you might need to see a specialist. […] Besides a physical exam of the penis and testicles, you might have: […] Blood tests. A blood sample sent to a lab can check for heart disease, diabetes, hormone levels and other health conditions. […] Urine tests, called urinalysis. Urine tests look for signs of diabetes, infection and other health conditions. […] For delayed ejaculation, some basic questions to ask include: […] What tests do I need? […] What treatments are there? Which one do you suggest for me? […] Your healthcare professional may ask: […] Do you have trouble ejaculating only now and then, or is it an ongoing problem?

• #13 Retrograde ejaculation – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/retrograde-ejaculation/diagnosis-treatment/drc-20354896

  To diagnose retrograde ejaculation, your doctor may: […] Examine your urine for the presence of semen after you have an orgasm. This procedure is usually done at the doctor’s office. Your doctor will ask you to empty your bladder, masturbate to climax and then provide a urine sample for laboratory analysis. If a high volume of sperm is found in your urine, you have retrograde ejaculation. […] If your doctor suspects your dry orgasm is something other than retrograde ejaculation, you might need further tests or a referral to a specialist to find the cause. […] Retrograde ejaculation typically doesn’t require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause. […] If medication doesn’t allow you to ejaculate semen, you will likely need infertility procedures known as assisted reproductive technology to get your partner pregnant. […] Your doctor will want to determine whether your dry orgasms are retrograde ejaculation or linked to another problem that may need further evaluation.

• #14 Ejaculatory Dysfunction | Urology Associates | Denver Metro

  https://www.denverurology.com/mens-fertility-sexual-health/ejaculatory-dysfunction/

  Ejaculatory dysfunction is the inability of a man to efficiently ejaculate semen from the penis at the moment of sexual climax. […] Ejaculatory dysfunction is classified into four types: premature ejaculation, delayed ejaculation, retrograde ejaculation and anejaculation (no ejaculation). […] Ejaculation disorders, also called aspermia, can be caused by a problem at birth (primary) or by acquired dysfunctions (secondary) after birth (often much later in life), such as disease, injury and adverse drug reactions. […] Asserting a patient about his personal history is generally the first step a physician takes in diagnosing and evaluating ejaculatory dysfunctions. […] Elements of evaluation include: Physical exam of the genitalia and testicles for structural problems, Semen sample for evaluation of sperm presence and health, Post-ejaculate urine sample if no ejaculate was produced, Hormonal testing, Transrectal ultrasound (TRUS) to look for structural problems.

• #15 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

  The International Classification of Diseases (ICD)-11 defines DE as an inability to achieve ejaculation or an excessive or increased latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. […] For both DO and AO, these patterns of orgasmic dysfunction have occurred episodically or persistently over a period of at least several months and is associated with clinically significant distress. […] Initial evaluation of a patient presenting with DO involves a thorough history and physical examination. This is the most important component of the patients evaluation. […] Hormonal evaluation serves as the basis for laboratory testing when evaluating a patient with DO. […] There is no standardized treatment plan for DO. Treatment plans are often multidisciplinary, involving urologists, primary care providers and mental health professionals to adequately address biopsychosocial factors.

• #16 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. […] Delayed ejaculation (DE) is a common medical condition. […] In rare cases, DE is a sign of a worsening health problem such as heart disease or diabetes. […] A physical examination and explanation of your symptoms are necessary to make an initial diagnosis. […] If a chronic health problem is suspected as the underlying cause, more testing may need to be done. […] These tests will look for infections, hormonal imbalances, and more. […] Testing the reaction of your penis to a vibrator may reveal if the problem is psychological or physical. […] Treatment will depend on the underlying cause. […] If you’ve had lifelong problems or you’ve never ejaculated, a urologist can determine if you have a structural birth defect.

• #17 Ejaculatory Dysfunction and Male Infertility — Male Infertility Guide

  https://www.maleinfertilityguide.com/ejaculatory-dysfunction

  Pain with ejaculation can have multiple possible causes, including: seminal vesicle inflammation, ejaculatory duct obstruction, seminal vesicle or prostate stones, prostatitis, urethritis, or epididymitis. […] The ejaculatory ducts carry fluid from the seminal vesicles and vas deferens into the urethra. When the ejaculatory ducts are completely blocked, the ejaculate is made up of only the fluid from the prostate. […] Retrograde ejaculation occurs when the bladder neck does not close completely, allowing semen to flow backward into the bladder during ejaculation. […] Anejaculation occurs when a man experiences the feelings of orgasm but no seminal fluid comes out, either antegrade (out the penis) or retrograde (into the bladder). […] Delayed ejaculation is used to describe the situation when a man has trouble reaching orgasm during sexual intercourse. […] Ejaculatory duct obstruction can be diagnosed through various methods, including transrectal ultrasound (TRUS) and seminal vesicle aspiration.

• #18 Ejaculatory Disorders: Pathophysiology and Management

  https://www.medscape.org/viewarticle/569396_4

  The major objective when diagnosing PE is to quantify the length of time between penetration and ejaculation, although a multidimensional assessment of patients affected with PE, including psychosocial involvement, is also needed. […] Neurophysiologic tests, such as pudendal nerve somatosensory evoked potentials, bulbocavernosus (BC) reflex and BC perineal motor evoked potentials, have been recently assessed for use in the investigation of the somatic sensory and motor function of the genital area in patients presenting with primary PE. […] Although no clear criteria exist, given that most sexually functional men ejaculate within about 3-8 min following intromission, men with latencies beyond 20-30 min and consequent distress or men who simply cease sexual activity due to exhaustion or irritation qualify for a diagnosis of delayed ejaculation.

• #19 Premature ejaculation – Wikipedia

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

  Premature ejaculation (PE) is a male sexual dysfunction that occurs when a male expels semen (and most likely experiences orgasm) soon after beginning sexual activity, and with minimal penile stimulation. […] The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines premature ejaculation as „A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the person wishes it,” with the additional requirements that the condition occurs for a duration longer than 6 months, causes clinically significant distress, and cannot be better explained by relationship distress, another mental disorder, or the use of medications. […] The 2007 ICD-10 defined PE as ejaculating without control, and within around 15 seconds.

• #20 Premature Ejaculation

  https://labs.la.utexas.edu/mestonlab/premature-ejaculation/

  Premature (early) ejaculation is defined in DSM-5 as a persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within about one minute following vaginal penetration and before the individual wishes it. […] In order to meet the diagnostic criteria, the problem must have persisted for at least six months, must be experienced on almost all or approximately all occasions of sexual activity, and must cause significant distress. […] The disorder may be specified by severity and can be categorized as lifelong, acquired, generalized, and situational. […] A medical doctor or clinical psychologist assesses for premature (early) ejaculation with an interview to determine ejaculation latency and discuss reactions to this problem. […] A thorough assessment of PE includes measuring three factors; length of time from penetration to ejaculation (ejaculation latency), subjective feelings of control over ejaculation, and personal and relational distress caused by the condition.

• #21 Diagnosis of Premature Ejaculation – ROC Clinic

  https://rocclinic.com/en/premature-ejaculation/diagnosis/

  The diagnosis of premature ejaculation is clinical and is reported by the patient. […] In the clinical history it is essential to explore the three axes that define premature ejaculation: low coitus time, lack of control over the moment of orgasm and negative interpersonal consequences. […] To define these parameters and as a measure of the problem – which will help us later to evaluate the treatment – we recommend using the parameters IELT (Intravaginal Coital Latency Time) and PEDT (Premature Ejaculation Diagnostic Tool). […] In men over 40 years of age it is highly recommended to use the IPSS (International Prostate Symptoms Score), a validated questionnaire that measures the presence and severity of urinary symptoms, to rule out that the cause of the problem is urinary. […] The strategy outlined above allows us to define the presence of premature ejaculation, its severity, its cause and its consequences on the sexual sphere. […] If, in addition to premature ejaculation, the patient has difficulty achieving or maintaining an erection, the physician may order blood tests to check your male hormone (testosterone) levels and other tests.

• #22 EAU Guidelines on Sexual and Reproductive Health – Uroweb

  https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/disorders-of-ejaculation

  A significant proportion of men with ED also experience PE. High levels of performance anxiety related to ED may worsen PE, with a risk of misdiagnosing PE instead of the underlying ED. […] Although it has been suggested as an objective diagnostic criterion and treatment outcome measure, the use of IELT alone is not sufficient to define PE, as there is significant overlap between men with and without PE. […] In everyday clinical practice, self-estimated IELT is sufficient. Self-estimated and stopwatch-measured IELT are interchangeable and correctly assign PE status with 80% sensitivity and 80% specificity. […] A comprehensive medical history and a thorough physical examination can serve as valuable tools for clinicians in identifying the underlying medical factors contributing to PE.

• #23 Advantages and limitations of current premature ejaculation assessment and diagnostic methods: a review – Wei – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/34305/html

  Currently, the index of premature ejaculation (IPE), the premature ejaculation diagnostic tool (PEDT), and the premature ejaculation profile (PEP) are the questionnaires that are applied most frequently in a clinical setting and that meet most of the criteria for test development and validation. […] The IPE questionnaire has been shown to correlate well with the IELT and have good known-groups validity and test-retest reliability. […] In determining the presence or absence of PE, Symonds et al. developed the PEDT questionnaire in 2007 and made this task valid and straightforward. […] The PEP is a 4-item PE assessment tool, developed and validated by Patrick et al. in 2009, that measures all domains of ejaculatory function as defined by the DSM-IV-TR: control over ejaculation, satisfaction with sexual intercourse, interpersonal difficulties, and distress related to ejaculation.

• #24 The correlation between premature ejaculation and a high incidence of erectile dysfunction and its research progress: a narrative review – Min – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/130356/html

  Premature ejaculation (PE) and erectile dysfunction (ED) are common sexual dysfunction symptoms in men. The diagnosis of PE is mainly based on the patients sexual and medical history. The Chinese Index of Premature Ejaculation (CIPE), Premature Ejaculation Diagnostic Tool (PEDT), Index of Premature Ejaculation (IPE), Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD), International Index of Erectile Function (IIEF), Premature Ejaculation Profile (PEP), and other scales are ideal tools for PE diagnosis. IIEF, Female Sexual Function Index (FSFI), Golombok-Rust Inventory of Sexual Satisfaction (GRISS), Sexual Life Quality Questionnaire (SLQQ), Arizona Sexual Experience Scale (ASEX), Structure Interview on Erectile Dysfunction (SIEDY), and other scales are ideal tools for ED diagnosis.

• #25 Validation of Three Early Ejaculation Diagnostic Tools: A Composite Measure Is Accurate and More Adequate for Diagnosis by Updated Diagnostic Criteria | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0077676

  However, clinician-based diagnoses have been criticized for being imprecise. […] There are a number of questionnaires available for EE diagnosis, of which we shall focus on three recently published ones here (see Supporting Information): the Premature Ejaculation Diagnostic Tool (PEDT), the Premature Ejaculation Profile (PEP), and finally, Multiple Indicators of Premature Ejaculation (MIPE), the latter a modified version of an unpublished questionnaire developed by Grenier and Byers. […] The purpose of the present study was to: 1. Validate these three questionnaires using responses from both EE patients and population controls to compare their validity; and 2. Investigate whether a more valid measure of EE could be created by selecting variables from all three questionnaires (i.e. variables that best differentiated between patients and controls). […] In conclusion, three commonly used diagnostic tools for EE were shown to have good reliability and validity. A composite measure can be derived from these tools to form a new, valid tool which is adequate considering proposed changes to diagnostic criteria.

• #26 Diagnosis of Premature Ejaculation – ROC Clinic

  https://rocclinic.com/en/premature-ejaculation/diagnosis/

  The diagnosis of premature ejaculation is clinical and is reported by the patient. […] In the clinical history it is essential to explore the three axes that define premature ejaculation: low coitus time, lack of control over the moment of orgasm and negative interpersonal consequences. […] To define these parameters and as a measure of the problem – which will help us later to evaluate the treatment – we recommend using the parameters IELT (Intravaginal Coital Latency Time) and PEDT (Premature Ejaculation Diagnostic Tool). […] In men over 40 years of age it is highly recommended to use the IPSS (International Prostate Symptoms Score), a validated questionnaire that measures the presence and severity of urinary symptoms, to rule out that the cause of the problem is urinary. […] The strategy outlined above allows us to define the presence of premature ejaculation, its severity, its cause and its consequences on the sexual sphere. […] If, in addition to premature ejaculation, the patient has difficulty achieving or maintaining an erection, the physician may order blood tests to check your male hormone (testosterone) levels and other tests.

• #27 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. […] There is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. […] Unfortunately, there is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. Treatment should be cause-specific. […] The literature suggests that the pathophysiology of DE/AE is multifactorial, including both organic and psychosocial factors that are neither independent nor mutually exclusive. Despite the many publications on this condition, the exact pathogenesis is not yet known. […] A number of approaches can be employed for infertile men, including collection of nocturnal emissions, vigorous prostatic massage, prostatic urethra catheterization, PVS, rectal probe EEJ, sperm retrieval from either the vas deferens or the epididymis, or testicular sperm extraction.

• #28 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. Anorgasmia (AO) is characterized as the absence of orgasm. […] Given the multifactorial complex nature of this disorder, a thorough history and physical examination represent the most critical components of patient evaluation in the clinical setting. […] There remains a paucity of standardized treatments for men with ejaculatory and/or orgasmic dysfunction. […] In this review, we specifically focus on summarizing the current knowledge regarding the epidemiology, pathophysiology, diagnosis, and treatment of DO/AO. […] The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) states that distressing difficulties with orgasm in men would be considered under delayed ejaculation, which is defined as a marked delay in ejaculation or a marked infrequency of absence of ejaculation on 75-100% of all occasions of partnered sexual activity without the individual desiring delay, persisting for at least 6 months, and causing significant distress to the individual.

• #29 :: 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. […] There is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. […] A careful clinical history and appropriate physical examination should focus on all related symptoms and signs. […] The evaluation may involve determining whether DE is lifelong or acquired and global or situational. […] Men with DE/AE have demonstrated high levels of relationship distress, sexual dissatisfaction, anxiety about their sexual performance, and lower frequencies of coital activity than sexually functional men. […] The history is the key to the diagnosis of DE/AE. Evaluation begins by exclusion of retrograde ejaculation, absence of puberty, genital tract obstruction, anorgasmia, and other sexual dysfunctions that may be misdiagnosed as DE/AE, such as erectile dysfunction, a subtly decreased libido, ejaculatory pain, the partner’s sexual dysfunction, sexual orientation conflicts, or paraphilic inclinations/interests.

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

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

  Your physician can determine if a medication is the cause. […] 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. […] The same is true when the underlying cause is a medication. […] DE can cause problems with self-esteem in addition to feelings of inadequacy, failure, and negativity. […] Other complications may include decreased sexual pleasure, anxiety about sex, inability to conceive, or male infertility, low libido, stress and anxiety. […] Treatment or counseling can help resolve these issues. […] There are many possible causes of DE. […] Regardless of the cause, treatments are available.

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

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

  Unfortunately, there is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. Treatment should be cause-specific. […] There are many approaches to treatment planning, including various psychological interventions, pharmacotherapy, and specific treatments for infertile men. […] A rigid treatment plan is not suitable for all patients.

• #32 Ejaculation problems

  https://www.nhs.uk/conditions/ejaculation-problems/

  Ejaculation problems are common sexual problems in men. If you have a persistent problem with ejaculation, visit your GP, who will discuss the problem with you and may examine you or refer you to a specialist. […] Premature ejaculation is a common ejaculation problem. It’s where the male ejaculates sooner than he or his partner wishes during sexual arousal. […] Delayed ejaculation (male orgasmic disorder) is classed as either experiencing a significant delay before ejaculation or being unable to ejaculate at all, even though the man wants to and his erection is normal. […] Retrograde ejaculation is a rarer type of ejaculation problem. It happens when semen travels backwards into the bladder instead of through the urethra (the tube that urine passes through).

• #33 Retrograde Ejaculation – Harvard Health

  https://www.health.harvard.edu/a_to_z/retrograde-ejaculation-a-to-z

  Ejaculation is the ejection of semen out of the urethra (passageway inside the penis) when a man has an orgasm. […] Retrograde ejaculation is when the semen travels backwards into the bladder. […] Retrograde ejaculation has several possible causes, including: Damage from surgery to the muscles of the bladder, or to the nerves that control these muscles. […] Retrograde ejaculation does not interfere with a man’s ability to have an erection or to achieve orgasm, but it can cause infertility because the sperm cannot reach the woman’s uterus. Retrograde ejaculation is responsible for about 1% of all cases of male infertility in the United States. […] In most cases, the diagnosis will be made by a primary care doctor or a urologist, a doctor who specializes in male reproductive disorders and urinary tract problems. The doctor will ask questions about your medical history, previous surgery, sexual history and current medications. These questions will be followed by a thorough physical examination. The diagnosis usually can be confirmed if many sperm are found in a urine sample after ejaculation.

• #34 Retrograde ejaculation – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/retrograde-ejaculation/diagnosis-treatment/drc-20354896

  To diagnose retrograde ejaculation, your doctor may: […] Examine your urine for the presence of semen after you have an orgasm. This procedure is usually done at the doctor’s office. Your doctor will ask you to empty your bladder, masturbate to climax and then provide a urine sample for laboratory analysis. If a high volume of sperm is found in your urine, you have retrograde ejaculation. […] If your doctor suspects your dry orgasm is something other than retrograde ejaculation, you might need further tests or a referral to a specialist to find the cause. […] Retrograde ejaculation typically doesn’t require treatment unless it interferes with fertility. In such cases, treatment depends on the underlying cause. […] If medication doesn’t allow you to ejaculate semen, you will likely need infertility procedures known as assisted reproductive technology to get your partner pregnant. […] Your doctor will want to determine whether your dry orgasms are retrograde ejaculation or linked to another problem that may need further evaluation.

• #35 Retrograde Ejaculation – Men’s Health Issues – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/men-s-health-issues/sexual-function-and-dysfunction-in-men/retrograde-ejaculation

  Retrograde ejaculation is a condition in which semen is ejaculated backward into the bladder rather than out through the penis. […] A doctor makes the diagnosis of retrograde ejaculation by finding a large amount of sperm in a urine sample taken shortly after orgasm. […] Men usually need no treatment unless infertility is a concern. About one-third of men with retrograde ejaculation improve after treatment with medications that close the bladder neck (such as pseudoephedrine or imipramine). However, men who use these medications should be alert and periodically checked by their doctor for increases in heart rate and blood pressure. Use of these medications is limited to men seeking fertility. […] If infertility requires treatment and medications do not help, doctors can sometimes collect a man’s sperm for insemination.

• #36 Ejaculatory Dysfunction | Urology Associates | Denver Metro

  https://www.denverurology.com/mens-fertility-sexual-health/ejaculatory-dysfunction/

  Retrograde ejaculation can cause infertility but not any other problems. Doctors most often diagnose it through physical exams and ordering tests of a post-ejaculation urine sample that may show semen in the urine. […] The most common treatment for anejaculation is psychological counseling to address underlying causes and sexual therapy.

• #37 Anejaculation: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/23371-anejaculation

  Anejaculation means no ejaculation. When orgasm occurs but semen isn’t released from your penis, it’s called anejaculation. Anejaculation is a type of male sexual dysfunction that can affect one’s ability to enjoy sex. It can also lead to male infertility. Most people who have anejaculation still make sperm. But infertility can happen because they can’t ejaculate the semen that carries sperm. The primary sign of anejaculation is the lack of ejaculate (fluid) during orgasm. Your healthcare provider will review your symptoms and medical history and perform a physical examination. If you’re able to orgasm, your provider may order a urine test (urinalysis) to take place immediately after you climax. No sperm (azoospermia) in a urine sample after an orgasm may indicate anejaculation. If there are sperm in your urine sample, you may have a different type of sexual dysfunction called retrograde ejaculation. Anejaculation doesn’t cause any long-term problems. Some people don’t seek or want treatment. Treatment (when desired) depends on the underlying cause. Psychotherapy (talk therapy), sex therapy and anti-anxiety medications can ease anxiety and stress that cause situational anejaculation. Anejaculation makes it more difficult to conceive a child, but it’s not impossible. A urologist or reproductive medicine specialist can use different methods to retrieve sperm from your testicles. You should call your healthcare provider if you experience anejaculation that affects your ability to enjoy sex or get or maintain an erection.

• #38 Inability to Ejaculate – Men’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/men-s-health-issues/sexual-function-and-dysfunction-in-men/inability-to-ejaculate

  Inability to ejaculate (anejaculation) is usually caused by inability to reach orgasm (anorgasmia). It usually occurs as part of erectile dysfunction. […] A doctor bases the diagnosis of anejaculation on the man’s symptoms, results of an examination, and, if orgasm is possible, a urine test. Absence of sperm in a urine sample obtained after an orgasm indicates anejaculation, whereas presence of many sperm indicates retrograde ejaculation. […] Treatment of anejaculation depends on the cause and may include stopping any medications that may be causing the problem, engaging in psychotherapy, or helping trigger ejaculation using oral medications such as pseudoephedrine and/or imipramine.

• #39 Anejaculation: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/23371-anejaculation

  Anejaculation means no ejaculation. When orgasm occurs but semen isn’t released from your penis, it’s called anejaculation. Anejaculation is a type of male sexual dysfunction that can affect one’s ability to enjoy sex. It can also lead to male infertility. Most people who have anejaculation still make sperm. But infertility can happen because they can’t ejaculate the semen that carries sperm. The primary sign of anejaculation is the lack of ejaculate (fluid) during orgasm. Your healthcare provider will review your symptoms and medical history and perform a physical examination. If you’re able to orgasm, your provider may order a urine test (urinalysis) to take place immediately after you climax. No sperm (azoospermia) in a urine sample after an orgasm may indicate anejaculation. If there are sperm in your urine sample, you may have a different type of sexual dysfunction called retrograde ejaculation. Anejaculation doesn’t cause any long-term problems. Some people don’t seek or want treatment. Treatment (when desired) depends on the underlying cause. Psychotherapy (talk therapy), sex therapy and anti-anxiety medications can ease anxiety and stress that cause situational anejaculation. Anejaculation makes it more difficult to conceive a child, but it’s not impossible. A urologist or reproductive medicine specialist can use different methods to retrieve sperm from your testicles. You should call your healthcare provider if you experience anejaculation that affects your ability to enjoy sex or get or maintain an erection.

• #40 Ejaculatory Dysfunction and Male Infertility — Male Infertility Guide

  https://www.maleinfertilityguide.com/ejaculatory-dysfunction

  Several types of problems may occur with ejaculation: ejaculatory duct obstruction, retrograde ejaculation, retarded ejaculation, anejaculation, congenital anorgasmia, and painful ejaculation. Each will be discussed below. […] Men who have azoospermia, low volume, and acidic, fructose-negative ejaculate despite having a normal FSH and normal testicular volume (indicative of likely normal sperm production) are likely not passing any fluid from the seminal vesicles and vas deferens into the urethra. […] The diagnosis of retrograde ejaculation is made with a post-ejaculatory urinalysis (PEU). A PEU is performed by having the man provide a urine sample into a separate cup right after giving a semen analysis specimen. […] Evaluation of patients with anejaculation should include checking a hormone profile as well as a review of their medications. A good medical and surgical history can also look for other risk factors, including diabetes or other neurologic problems, as well as previous surgical procedures in the abdomen or pelvis which may have impacted nearby nerves.

• #41 The correlation between premature ejaculation and a high incidence of erectile dysfunction and its research progress: a narrative review – Min – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/130356/html

  The Global Study of Sexual Attitudes and Behaviors (GSSAB), an international survey of various aspects of sex and relationships among adults aged 4080 years in 29 countries around the world, revealed significant correlations between PE and ED in the regions that studied sex. Chin et al. conducted a cross-sectional observational study on the coexistence of PE and ED. The prevalence of ED among 483 participants in the PE group was 30.2%, the prevalence of lifelong PE among 1,893 participants in the ED group was 4.1%, and the prevalence of acquired PE was 18.0%. In addition, Corona et al. reported that the prevalence of ED in men with PE (31.9%) was higher than that in men without PE (11.8%), confirming the high prevalence of both PE and ED, indicating that both sexual symptoms are susceptible to each other.

• #42 The correlation between premature ejaculation and a high incidence of erectile dysfunction and its research progress: a narrative review – Min – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/130356/html

  The International Society for Sexual Medicine (ISSM) and the European Association of Urology believe that every man with PE should be adequately screened for ED and treated first whenever it presents. Because ED and PE can coexist in the same patient within the entity of LCEE, both symptoms should be investigated and treated appropriately. […] A combination of multiple treatments may still be the most effective way to treat such complex sexual symptoms, with drug intervention or combination therapy being more effective than nondrug intervention. According to research, combined therapy can significantly improve patients ejaculation control and EF.

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

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

  Clinicians should assess medical, relationship, and sexual history and perform a focused physical exam to evaluate a patient with premature ejaculation. […] Clinicians may utilize additional testing as clinically indicated for the evaluation of delayed ejaculation. […] Clinicians should consider referring men diagnosed with lifelong or acquired delayed ejaculation to a mental health professional with expertise in sexual health. […] Ejaculatory dysfunction is increasingly common with age, which is itself associated with declining serum T levels. […] Clinicians should treat men who have delayed ejaculation and comorbid erectile dysfunction according to the AUA Guidelines on Erectile Dysfunction.

• #44 The correlation between premature ejaculation and a high incidence of erectile dysfunction and its research progress: a narrative review – Min – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/130356/html

  Some scholars have proposed the hypothesis of a vicious cycle between PE and ED. PE patients may try to reduce their sexual arousal to delay ejaculation or attempt to control ejaculation through rapid erection, which may lead to ED; early erection subsidence after ejaculation in some PE patients may cause symptoms of ED. People with ED may require intense stimulation to achieve and maintain an erection. To complete sexual intercourse during a normal erection, ED patients may speed up the ejaculation process, which may lead to PE. In addition, psychosocial factors related to PE or ED affect both, and PE can lead to unsatisfactory sexual relationships, increase sexual stress and anxiety, and affect erectile function. […] The co-occurrence and relative independence of PE and ED means that PE and ED may be caused by different causes and have a certain degree of independence. The two can coexist but are not necessarily directly responsible for each other, meaning that improving PE will not necessarily automatically improve ED.

• #45 Advantages and limitations of current premature ejaculation assessment and diagnostic methods: a review – Wei – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/34305/html

  The initial assessment of patients includes a medical history, physical examination, questionnaires, and other diagnostic tools. Overall, these assessment methods were less subjective. Thus, it would be essential to develop a quantitative and systematic measuring scheme to establish an objective approach for the diagnosis of PE, which could be used in the treatment of this condition. […] To date, several measures have been applied for the evaluation of PE. These methods include history enquiry/physical examination, patients-reported outcome (PRO)-questionnaires, IELT evaluations, penile biothesiometry, and penile electrophysiological test. […] Since it is difficult to determine whether a man has PE based on the patient history and physical examination, there is an apparent need for a valid and reliable screening instrument for PE.

• #46 The correlation between premature ejaculation and a high incidence of erectile dysfunction and its research progress: a narrative review – Min – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/130356/html

  Premature ejaculation (PE) and erectile dysfunction (ED) are common sexual dysfunction symptoms in men. The diagnosis of PE is mainly based on the patients sexual and medical history. The Chinese Index of Premature Ejaculation (CIPE), Premature Ejaculation Diagnostic Tool (PEDT), Index of Premature Ejaculation (IPE), Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD), International Index of Erectile Function (IIEF), Premature Ejaculation Profile (PEP), and other scales are ideal tools for PE diagnosis. IIEF, Female Sexual Function Index (FSFI), Golombok-Rust Inventory of Sexual Satisfaction (GRISS), Sexual Life Quality Questionnaire (SLQQ), Arizona Sexual Experience Scale (ASEX), Structure Interview on Erectile Dysfunction (SIEDY), and other scales are ideal tools for ED diagnosis.

• #47 Validation of Three Early Ejaculation Diagnostic Tools: A Composite Measure Is Accurate and More Adequate for Diagnosis by Updated Diagnostic Criteria | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0077676

  To validate three early ejaculation diagnostic tools, and propose a new tool for diagnosis in line with proposed changes to diagnostic criteria. Significant changes to diagnostic criteria are expected in the near future. Available screening tools do not necessarily reflect proposed changes. […] All instruments had very good precision (Areas under the Curve ranging from .93-.98). A new five-item instrument (named CHecklist for Early Ejaculation Symptoms CHEES) consisting of high-performance variables selected from the three instruments had validity (Nagelkerke R2 range .51-.79 for backwards/forwards logistic regression) equal to or slightly better than any individual instrument (i.e., had slightly higher validity statistics, but these differences did not achieve statistical significance). Importantly, however, this instrument was more in line with proposed changes to diagnostic criteria.

• #48 Delayed Ejaculation: Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/22125-delayed-ejaculation

  If you have delayed ejaculation, you or your partner may find sexual intercourse frustrating instead of pleasurable because of the time it takes you to ejaculate. The first step is to talk to a provider and get a physical exam. Treatment may include therapy or changes to your medications. […] A healthcare provider will ask you questions about your medical history, sexual habits and ejaculation patterns. […] A provider may perform a physical examination and order tests to help identify or rule out other conditions. […] A healthcare provider may offer several different delayed ejaculation treatments. […] A healthcare provider will explain what you should expect. […] Talk to a healthcare provider when you first notice an inability to ejaculate, especially if its frustrating or troubling for you or your partner. They can help you determine the cause and prescribe the proper treatment.

• #49 Ejaculation Problems: Retrograde Ejaculation, Inhibited Ejaculation Symptoms and Home Treatment

  https://www.webmd.com/sexual-conditions/mens-sexual-problems

  To diagnose a man’s sexual problem, the doctor likely will begin with a thorough history of symptoms. […] They may order other tests to rule out any medical problems that may be contributing to the dysfunction. […] Several tests can be used to evaluate the causes and extent of male sexual problems. […] Many cases of male sexual dysfunction can be corrected by treating the underlying physical or psychological problems. […] Medications, such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra), may help improve sexual function in men by increasing blood flow to the penis. […] Promescent is a drug used to treat premature ejaculation. […] The success of treatment for sexual problems depends on the underlying cause. […] The outlook is good for dysfunction that is related to a treatable or reversible physical condition. […] If you consistently experience sexual function problems, see your doctor for evaluation and treatment.

• #50 Delayed ejaculation // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/delayed-ejaculation

  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. […] Treatment for delayed ejaculation depends on the cause. […] Your main healthcare professional is a good place to start when you have delayed ejaculation. See your healthcare professional if: Delayed ejaculation is an issue for you or your partner. […] A physical exam and medical history might be all that are needed to suggest treatment for delayed ejaculation. But there might be a problem causing delayed ejaculation that needs treatment. Then you might need more tests, or you might need to see a specialist. […] Delayed ejaculation treatment depends on the cause. Treatment might include taking medicine or making changes to medicines you take. It might involve psychological counseling or addressing alcohol or illicit drug use.

• #51 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

  Behavioural techniques and/or psychosexual counselling can be used as second-line treatments. […] Many men return to normal function following treatment for secondary PE. […] Behavioural techniques and/or counselling are the initial treatments. […] SSRIs, reducing penile sensation and/or PDE5 inhibitors are second-line treatments. […] For a general assessment, refer to a GP, endocrinologist or urologist who has an interest in sexual medicine. […] Delayed ejaculation occurs when an abnormal or excessive amount of stimulation is required to achieve orgasm with ejaculation. […] Anorgasmia is the inability to reach orgasm. […] Retrograde ejaculation occurs when semen passes backwards through the bladder neck into the bladder. […] Anejaculation is the complete absence of ejaculation, due to a failure of semen emission from the prostate and seminal ducts into the urethra. […] Painful ejaculation is an acquired condition where painful sensations are felt in the perineum or urethra and urethral meatus.

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

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

  If the cause is believed to be psychological (and no other reasonable explanation can be found), the healthcare provider may refer you to a psychologist or sex therapist trained in treating sexual dysfunction. […] If a disease, medical condition, or surgical complication is believed to be the cause, various lab tests, imaging studies, and diagnostic procedures may be performed to support or rule out the suspicion.

• #53 Delayed Ejaculation: Informed Diagnosis and Treatment | Psychology Today

  https://www.psychologytoday.com/us/blog/sexual-tipping-point/201812/delayed-ejaculation-informed-diagnosis-and-treatment

  Men with DE find it difficult or impossible to ejaculate and/or experience orgasm. DE is a failure to ejaculate during masturbation and/or partner manual, oral, coital, or anal stimulation. Diagnosis of DE requires distress about the symptom(s), adequate sexual stimulation, and a conscious desire to achieve orgasm. […] It is frequently useful for a physician (usually a urologist) to conduct a physical examination and medical history to help identify any Physical factors contributing to DE. […] A physician will know that any procedure or disease that disrupts the nervous systems path to the genitals (spinal cord injury, multiple sclerosis, pelvic-region surgery, severe diabetes, alcoholism, etc. all have the potential to interfere with ejaculation and orgasm. […] Additionally, DE is one of many ejaculation problems that can be confused with each other, and/or can occur together. The doctor will differentiate anejaculation (no cum), painful ejaculation, and retrograde ejaculation (during the climax, the semen goes in the wrong direction back into the bladder), decreased volume/force/sensation of ejaculation, and the very rare post-orgasmic illness syndrome. DE is distinct from erectile dysfunction (ED), the condition where a man is unable to attain or maintain an erection rigid enough for sexual activity). DE is also different from the normal refractory period, the length of time after an ejaculation during which men are physically incapable of having a repeat ejaculation. DE is also different from anorgasmia (inability to experience orgasm or sexual climax).

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

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

  Male sexual dysfunction (MSD) can affect males of all ages. […] Each of these male sexual problems can be difficult to treat, and some males may have more than one form of sexual dysfunction. […] Comprehensive clinical history-taking, tailored physical examination and relevant laboratory testing can provide relevant clues for MSD diagnosis. […] Ejaculatory disorders can be divided into premature ejaculation, delayed ejaculation, anejaculation and retrograde ejaculation. […] Premature ejaculation is defined as the inability to control or delay ejaculation, resulting in psychosexual distress. […] In contrast to anejaculation, where ejaculation is absent during orgasm, retrograde ejaculation occurs when semen enters the bladder instead of being released into the penis during orgasm.

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

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

  Orgasmic dysfunction is the diminished intensity of an orgasm or an inability to achieve orgasm during sexual stimulation and can coexist with ejaculatory disorders. […] Patient history remains an integral part of evaluating patients presenting with MSD given that these dysfunctions represent self-reported conditions and many lack confirmatory diagnostic tests. […] It is important to ascertain the exact MSD, potential causative (contributing) factors and relevant modifiable factors. […] Initial evaluation is recommended with blood tests for cardiometabolic factors such as fasting glucose, glycated haemoglobin, lipid profile and hormone profile, in fasting state and collected in the early morning. […] Management strategies are listed in Box 1. Modifying lifestyle behaviours, managing reversible risk factors and optimising existing medical conditions are important first-line management options before pharmacotherapy.

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

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

  Psychosexual counselling is an important consideration since the psychogenic component is common; ideally it should be done with the patients partner. […] The best treatment approach for ejaculatory and orgasmic dysfunctions is a multimodal approach, with pharmacological, psychological and behavioural techniques used in combination. […] Dapoxetine, a short-acting selective serotonin reuptake inhibitor (SSRI), is the only approved medication for premature ejaculation. […] Testosterone therapy is effective to improve orgasm in patients with hypogonadism. […] Comprehensive clinical assessment with relevant laboratory testing is important to assess for MSD.

• #57 Ejaculation Problems: Retrograde Ejaculation, Inhibited Ejaculation Symptoms and Home Treatment

  https://www.webmd.com/sexual-conditions/mens-sexual-problems

  The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire. […] There are different types of ejaculation disorders, including: […] Premature ejaculation, the most common form of sexual dysfunction in men, often is due to nervousness over how well they will perform during sex. […] In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events, and psychological factors, including a strict religious background that causes the person to view sex as sinful. […] Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). […] In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation.

• #58 Premature Ejaculation: Treatments and Causes

  https://www.medicalnewstoday.com/articles/how-to-treat-premature-ejaculation

  Doctors will ask certain questions to determine whether a person has PE. These questions might include: How often does PE happen? […] PE typically has a psychological or medical cause. […] PE is a treatable condition. […] There are various treatments a person can try, including prescription medications, topical creams and sprays, home remedies, and exercises.

• #59 Delayed Ejaculation: Informed Diagnosis and Treatment | Psychology Today

  https://www.psychologytoday.com/us/blog/sexual-tipping-point/201812/delayed-ejaculation-informed-diagnosis-and-treatment

  The difference between what a man experiences in coupled sex, versus self-stimulation, must be explored. […] In summary, high-frequency idiosyncratic masturbation, combined with fantasy-partner disparity, often predispose men to experience problems with arousal and ejaculation. […] A sex therapist should be able to explain how the mental and physical erotic stimulation a man is receiving is insufficient for him to ejaculate in the manner he prefers, and how this can be changed to achieve the desired result. Of course, successful treatment will depend on a mans willingness to follow therapeutic recommendations, which will be influenced by the extent of organic/medical complications, relational issues, and potentially deeper patient/partner psychodynamic problems. […] Most urologists find treating DE to be difficult and challenging. However, for many men and couples, it is often possible to successfully overcome DE especially with the guidance of a well-trained sex therapist.

• #60 An observational, national and multicentric study to describe the detection, diagnosis and treatment of erectile dysfunction and premature ejaculation from the patient’s perspective | Revista Internacional de Andrología

  https://www.elsevier.es/es-revista-revista-internacional-andrologia-262-articulo-an-observational-national-multicentric-study-S1698031X22000887

  The treatment of the male partner’s ED results in a substantial improvement in the female partner’s sexual function. […] Spanish patients put off seeking medical aid, and one third of them still do not regard a sexual disorder as a cause for concern and a reason to see a doctor. […] Most treatments used in ED (oral therapies) and PE (dapoxetine) proved to have a significant benefit in sexual intercourse for patients and their partners. […] The patients regarded the specialist physicians as well-versed in sexual diseases and open to discussing treatment options, although broaching the subject of sexual problems continues to constitute a major difficulty for patients in the doctor’s office.

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