Materiały źródłowe

• #1 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). In emission, seminal fluid is delivered to the posterior urethra. […] Many of these etiologic factors are not supported by good evidence-based data, but rather are based on case reports and case series. […] 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.

• #1 The Mechanisms of Ejaculation | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4684-2892-6_7

  Ejaculation is a complex process which occurs in a series of chronologically dependent phases in coordination with several organ systems. […] In spite of the biological importance of ejaculation for mankind and especially for the human psyche, very little is known of its mechanisms in humans. […] Most present knowledge is based on investigation in animals. […] So far, our knowledge of ejaculation in man is based on study of diseased patients in whom sexual dysfunction is usually only one symptom among many. […] The human being is understandably a difficult and inaccessible animal for studies of ejaculation. […] Studies of sex life, orgasm, and the like have long been taboo, and so barely available for evaluation.

• #1 Neurons for Ejaculation and Factors Affecting Ejaculation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9138817/

  Ejaculation is defined as the ejection of contents collectively from the vas deferens, seminal vesicle, prostate and Cowpers glands. It is completely controlled by a population of neurons present in the lumbar spinal cord. The presence of lesion in these neurons ceases the ejaculatory behavior in males. […] The L3L4 (lumbar) segment, the spinal cord region responsible for ejaculation, nerve cell bodies, also called lumbar spinothalamic (LSt) cells, which are denoted as spinal ejaculation generators or lumbar spinothalamic cells [Lst]. Lst cells activation causes ejaculation. […] The presence of a spinal ejaculatory generator has recently been confirmed in humans. […] Injury to these neurons acutely compromises ejaculation; hence, these neurons, besides carrying ejaculation-specific sensory information to the brain, also trigger ejaculation.

• #1 Neurons for Ejaculation and Factors Affecting Ejaculation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9138817/

  Activation of lumbar spinothalamic cells or spinal ejaculation generators causes ejaculation. […] Ejaculatory dysfunction can be classified into four types: premature ejaculation, retrograde ejaculation, delayed ejaculation, and anejaculation. […] Premature ejaculation [PE] is the most common type of ejaculation dysfunction in men, with a prevalence of up to 75%. […] ETIOPATHOGENESIS OF PREMATURE EJACULATION: Psychological and biological factors have conventionally been responsible for this. […] RE can be induced in one individual undergoing treatment for lower urinary tract symptoms using an alpha-receptor antagonist. Other drugs used for the treatment of hypertension, antidepressants, and antipsychotics have similar effects. […] Retrograde ejaculation causes ejaculatory dysfunction, wherein partial or complete passage of semen enters the urinary bladder rather than passing out through the urethra, which occurs due to complete contraction inhibition of the bladder neck. […] These are unusual forms of male ejaculatory dysfunction, indicated by a noticeable delay in ejaculation or an inability to achieve ejaculation. […] The identification of a potential spinal ejaculation generator is an important breakthrough in the field of sexual function.

• #1 Neurons for Ejaculation and Factors Affecting Ejaculation

  https://www.mdpi.com/2079-7737/11/5/686

  Neurons for Ejaculation and Factors Affecting Ejaculation […] Ejaculation is defined as the ejection of contents collectively from the vas deferens, seminal vesicle, prostate and Cowper’s glands. […] The presence of lesion in these neurons ceases the ejaculatory behavior in males. […] The L3–L4 (lumbar) segment, the spinal cord region responsible for ejaculation, nerve cell bodies, also called lumbar spinothalamic (LSt) cells, which are denoted as spinal ejaculation generators or lumbar spinothalamic cells [Lst]. […] Lst cells activation causes ejaculation. […] Different types of ejaculatory dysfunction in humans include premature ejaculation (PE), retrograde ejaculation (RE), delayed ejaculation (DE), and anejaculation (AE). […] Ejaculatory dysfunction can be classified into four types: premature ejaculation, retrograde ejaculation, delayed ejaculation, and anejaculation.

• #1 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. 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.

• #1 Ejaculatory disorders: pathophysiology and management | Nature Reviews Urology

  https://www.nature.com/articles/ncpuro1016

  Ejaculatory dysfunction (EjD) is one of the most common male sexual disorders, yet EjD is still frequently misdiagnosed or overlooked as a result of numerous patient and physician barriers. […] Conventional algorithms for managing ejaculatory disorders are based either on an organic or psychogenic etiology, with the latter more traditionally considered the main cause. […] Ejaculation involves cerebral sensory areas, motor centers and several spinal nuclei that are tightly interconnected. […] Selective serotonin reuptake inhibitors and topical anesthetic creams can provide good efficacy for treating PE, even if a clear understanding of the etiology of lifelong PE is lacking.

• #1 :: 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.

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

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

  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 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. […] Treatment should be cause-specific. There are many approaches to treatment planning, including various psychological interventions, pharmacotherapy, and specific treatments for infertile men.

• #1 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.

• #1 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 most important lesson to be learned by men and their partners is that there is hope and there are therapies that can help resolve the distress of ejaculatory difficulties. […] The most common sexual dysfunction for men is ejaculatory disorder. […] Treatment is usually with SSRIs and Sildenafil (Viagra). […] The disorder may be lifelong or acquired, global or situational, with different treatments. […] It can be biogenic, psychogenic or mixed. […] The classic definition of rapid ejaculation is if the man ejaculates within 1 minute of penetration. […] It is theorized that the central regulation is by dopamine and penile hypersensitivity, so treatment may be with Sildenafil and local anesthetic. […] 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.

• #1 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. […] 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.

• #1

  https://journals.lww.com/ajandrology/fulltext/2019/21050/premature_ejaculation__an_update_on_definition_and.1.aspx

  The neurobiological theory hypothesized that lifelong PE in humans may be attributed, in part, to decreased central serotonergic neurotransmission, 5-hydroxytryptamine 2C (5-HT2C) receptor hyposensitivity, and/or 5-hydroxytryptamine 1A (5-HT1A) receptor hypersensitivity. […] The exact pathophysiology linking prostatitis and PE is unknown. However, it has been proposed that prostatic inflammation may lead to altered sensation and modulation of the ejaculatory reflex through a neurophysiologic pathway. […] Ejaculatory disorders, mostly PE, are commonly experienced by patients with chronic renal insufficiency. […] Some studies found significantly lower seminal plasma magnesium levels in men with PE. […] An association was found between varicoceles and PE in patients consulting for sexual dysfunction.

• #1 Orgasm and Ejaculation Disorders | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-031-11701-5_7

  To conclude, the well-documented efficacy of selective serotonin reuptake inhibitors (SSRIs) such as paroxetine and the on-demand on label molecule dapoxetine in increasing intravaginal ejaculatory latency time (IELT) in men with PE supports the role of an impairment over the serotonergic inhibitory control of the ejaculatory process, at least in some men with PE. […] The pathophysiological mechanism remains unclear with many hypotheses postulated. […] Although this holds true, considering the role of the prostate in the ejaculatory mechanism, a direct influence of the local inflammation in the pathogenesis of a few cases of APE seems possible. […] The true pathophysiological mechanisms behind DE remain unclear.

• #1 Delayed Ejaculation: Background, Etiology, Pathophysiology

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

  Hyperprolactinemia has been associated with both decreased sexual desire and a decreased ability to reach orgasm in males. […] Reportedly, the intensity of orgasm correlates with the ejaculatory volume; thus, declines in ejaculatory volume can result in reduced sexual pleasure. […] The increased frequency of delayed ejaculation in men older than 50 years may be associated with age-related loss of fast-conducting peripheral sensory nerves, as well as with age-related reduction in the secretion of sex steroids. […] The succession of erection, ejaculation, and orgasm creates the impression that these events might have a common physiologic substrate. […] Normal ejaculation is a brief event consisting of two phases: emission and expulsion. […] The somatomotor efferent of the pudendal nerve then produces subsequent rhythmic contractions of the bulbocavernous muscle, forcing the semen through a pressurized passage and yielding 25 mL of ejaculate.

• #1 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

  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. […] 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. […] 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.

• #1 Ejaculatory Disorders: Pathophysiology and Management

  https://www.medscape.org/viewarticle/569396_3

  In many cases PE is the only complaint presented, but patients frequently present with other sexual problems, such as erectile dysfunction (ED). […] It could be inferred that PE and ED share a vicious cycle, in which a man trying to control his ejaculation instinctively reduces his level of excitation (which can lead to ED), and a man trying to achieve an erection attempts to increase his excitation (which can lead to PE). […] In addition, many patients with ED might ejaculate early to hide the weakness of their erection. […] Recently, hyperthyroidism has been shown to be a possible promoting factor of PE. […] As the relationship between thyroid hormones and ejaculatory dysfunction is currently unknown, three possible sites of action have been hypothesized: the sympathetic nervous system, the serotoninergic system and the endocrine/paracrine system. […] In addition, thyroid hormone receptors have been identified in animal and human testes, and might also be present in other male genital tract structures that trigger ejaculation.

• #1 Ejaculatory Disorders: Pathophysiology and Management

  https://www.medscape.org/viewarticle/569396_3

  Also, anxiety (general or related to sexual performance), guilt (from a belief that sexual activity is sinful), and fear (of pregnancy, sexually transmitted diseases and/or being discovered) have frequently been suggested as causes of PE. […] Contrary to the classic psychosexual approach, Waldinger et al. have theorized, on the basis of animal models, that PE is not a psychological disorder but rather a neurobiological phenomenon due to chronic (genetic or acquired) central serotoninergic hypoactivity. […] Nevertheless, animal studies cannot be easily extrapolated to human sexual behavior, and further research is needed to clarify the role of the serotoninergic system in the pathogenesis of PE. […] Among peripheral neurobiological causes, major neurological disorders such as multiple sclerosis, spina bifida and spinal cord tumors are rare.

• #1 Ejaculatory Disorders: Pathophysiology and Management

  https://www.medscape.org/viewarticle/569396_3

  Studies have been performed to investigate the etiology and pathogenesis of PE, but clear mechanisms have yet to be defined. […] The pathophysiology of PE can be differentiated into five distinct areaspsychorelational, neurobiological, urological, hormonal and andrological which, consequently, suggests five different therapeutic approaches. […] Pathogenesis from dysfunctional psychorelational concepts is the most studied cause of PE. […] According to this theory, distortions of beliefs and false convictions about sexuality, established in childhood as a consequence of adverse influences on sexual behavior, might lead to sexual dysfunction such as PE. […] During early sexual experiences PE is frequent and might even be considered normal. […] In men with PE, however, they might not allow themselves to receive the sensory feedback of those sensations occurring immediately before orgasm, which would enable the ejaculatory reflex to be brought under voluntary control.

• #1

  https://journals.lww.com/ajandrology/fulltext/2019/21050/premature_ejaculation__an_update_on_definition_and.1.aspx

  Premature ejaculation (PE) is the most common male sexual dysfunction, which represents a diagnostic as well as a therapeutic challenge for physicians. […] While the exact etiology of PE has not been clearly elucidated, several risk factors have been strongly reported in the literature. Clearly, to understand the revised definition of PE, its etiology and pathophysiology is necessary to improve the clinical management of this medical condition and form the basis of future research in this regard. […] The etiology of PE has been traditionally divided into psychogenic and biogenic factors. Psychogenic factors include psychodynamic theories, early experience, sexual conditioning, anxiety, and technique and frequency of sexual activity. Biogenic factors include penile hypersensitivity, hyperexcitable ejaculatory reflex, hyperarousability, endocrinopathy, genetic predisposition, and 5-hydroxytryptamine (5-HT) receptor dysfunction (neurobiological theory).

• #1 KoreaMed Synapse

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

  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. […] 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.

• #1 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/

  Ejaculatory problems can have a devastating affect on self-esteem. […] Ejaculation problems may also contribute to a low libido and lack of interest in sexual activity. […] 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. […] In July 2003, the World Health Organization recommended that the term pre-mature ejaculation be replaced by the more neutral phrase early ejaculation. […] By definition, early ejaculation is an ejaculation that occurs before it is desired. […] A significant amount of distress from the man or his partner almost always accompanies an early ejaculation.

• #1 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 largely be divided into low libido, erectile dysfunction, Peyronies disease and ejaculatory and orgasmic disorders. 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. Orgasmic dysfunction is the diminished intensity of an orgasm or an inability to achieve orgasm during sexual stimulation and can coexist with ejaculatory disorders. […] The best treatment approach for ejaculatory and orgasmic dysfunctions is a multimodal approach, with pharmacological, psychological and behavioural techniques used in combination. Behavioural techniques for premature ejaculation include the stop-start technique (patients cease genital stimulation until arousal sensation subsides) or squeeze technique (squeezing of the glans prepuce during heightened arousal), while those with delayed orgasm might benefit from sexual counselling on arousal methods, genital stimulation or role-playing to increase sexual intimacy.

• #1 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/

  For men, erectile dysfunction and ejaculatory problems are the most common sexual difficulties. […] In contrast, ejaculatory problems continue to be commonplace among men and often create feelings of shame and embarrassment for those men who struggle with this difficulty. […] When does an ejaculation problem become a disorder? This is a subjective question and is based on the level of distress that is experienced by the man or his partner. […] Typically, ejaculatory disorders fall into two categories. These are: delayed ejaculation and early ejaculation. […] In the vast majority of cases, the most effective therapeutic approach for ejaculatory dysfunction is a combination of biologic and psychologic therapy. […] From a medical perspective, ejaculatory dysfunction is often considered to be a nerve related issue.

• #1 Ejaculation problems

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

  Delayed ejaculation (male orgasmic disorder) is classed as either: experiencing a significant delay before ejaculation, being unable to ejaculate at all, even though the man wants to and his erection is normal. […] Like premature ejaculation, delayed ejaculation can be caused by psychological and physical factors. […] Physical causes of delayed ejaculation include: diabetes, spinal cord injuries, multiple sclerosis, surgery to the bladder or prostate gland, increasing age. […] Many medicines are known to cause delayed ejaculation, including: antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), medicines to treat high blood pressure, such as beta-blockers, antipsychotics, used to treat episodes of psychosis. […] Retrograde ejaculation is a rarer type of ejaculation problem. It happens when semen travels backwards into the bladder instead of through the urethra.

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

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

  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. […] Masturbation may also help men learn to control their level of arousal, which is essential for delaying orgasm. […] For men who aren’t helped by any of these techniques, there’s a pharmaceutical option. Since some antidepressants — selective serotonin reuptake inhibitors, or SSRIs — are known to cause delayed ejaculation, researchers tried them as a way to treat premature ejaculation. […] A short-acting SSRI called dapoxetine has been developed specifically for premature ejaculation. According to a 2006 study published in The Lancet, when taken one to three hours before sex, the drug increased the time from penetration to ejaculation from 1.75 minutes to 2.78 minutes for men treated with 30 milligrams of the drug. […] Whatever your ejaculation problem, there are solutions. The key is to get help. And we don’t just mean from a doctor, although that’s important — ejaculation problems can be signs of more serious medical issues, after all.

• #1 Delayed ejaculation – Wikipedia

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

  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. […] 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.

• #1 Overview of Male Sexual Function and Dysfunction – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/male-sexual-function-and-dysfunction/overview-of-male-sexual-function-and-dysfunction

  Ejaculatory dysfunction can be broadly classified into 2 types: […] Diminished ability to produce ejaculate is usually due to advanced age, pathology, or iatrogenic causes, while the abnormal timing of ejaculation is more often related to psychological factors. […] Retrograde ejaculation can have multiple causes. Neuropathy from diabetes mellitus and certain medications such as alpha blockers (eg, tamsulosin for benign prostatic hyperplasia [BPH]) can cause impaired relaxation of the urethral sphincter, and surgical BPH procedures such as transurethral resection of the prostate (TURP) can cause permanent iatrogenic retrograde ejaculation. […] Anejaculation can be caused by seminal tract obstruction, neurological dysfunction, injury, radiation, or surgery. A classic cause of anejaculation is radical prostatectomy for prostate cancer, which results in removal of seminal vesicles and, consequently, elimination of semen production.

• #1 Investigation of ejaculatory disorder by silodosin in the treatment of prostatic hyperplasia | BMC Urology | Full Text

  https://bmcurol.biomedcentral.com/articles/10.1186/1471-2490-12-29

  To assess the ejaculatory disorder caused by silodosin in the prostatic hyperplasia patients who carry out sexual actions (sexual intercourse, masturbation). […] Ejaculatory disorder occurred in 38 (42%) of the 91 silodosin administration cases. […] When the investigation was conducted only in those who exercised sexual actions, ejaculatory disorder was observed in 38 (95%) of these 40 patients, indicating a high incidence. […] It was demonstrated that the administration of silodosin induced ejaculatory disorder at a high incidence. […] The incidence of ejaculatory disorder among the LUTS/BPH patients under treatment with oral silodosin is higher than that in comparison with that caused by other 1 blockers. […] The incidence of ejaculatory disorder is mostly reported on the basis of adverse reaction reports in the clinical trials.

• #1 Investigation of ejaculatory disorder by silodosin in the treatment of prostatic hyperplasia | BMC Urology | Full Text

  https://bmcurol.biomedcentral.com/articles/10.1186/1471-2490-12-29

  The incidence of ejaculatory disorder among the patients who carry out sexual actions even under the treatment with oral 1 blockers should be handled as the true incidence. […] Regarding the ejaculatory disorder onset mechanism by 1 blocker, the contraction disorder of seminal vesicle and spermatic duct at the time of ejaculation is assumed as a major cause. […] The ejection disorder due to the insufficient contraction of seminal vesicle and spermatic duct is conceivable as the mechanism of ejaculatory disorder by tamuslosin. […] The questionnaire survey this time disclosed that the incidence of ejaculatory disorder and the frequency of semen disappearance were high in the patients taking oral silodosin at the standard dose prescribed in Japan in this questionnaire survey. […] It is still considered necessary to provide sufficient information on the ejaculatory disorder as an adverse reaction before starting the treatment with silodosin.

• #1 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. Etiologies of DO/AO include medication-induced, psychogenic, endocrine, and genitopelvic dysesthesia. […] There remains a paucity of standardized treatments for men with ejaculatory and/or orgasmic dysfunction. […] Male orgasmic dysfunction can be dichotomized as two ends of a spectrum: premature ejaculation (PE) versus DO and anorgasmia (AO). […] Recently, the American Urological Association (AUA) released the Disorders of Ejaculation guidelines that we will also highlight. […] Several etiologies have been identified in the pathophysiology of DO, owing to the multifactorial, complex nature of the disorder. 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%).

• #1 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. […] 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.

• #1 Ejaculation problems

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

  Ejaculation problems are common sexual problems in men. […] The 3 main types of ejaculation problems are: premature ejaculation, delayed ejaculation, retrograde ejaculation. […] Premature ejaculation is a common ejaculation problem. It’s where the male ejaculates sooner than he or his partner wishes during sexual arousal. […] Various psychological and physical factors can cause a man to suddenly experience premature ejaculation. […] Common physical causes include: prostate problems, thyroid problems an overactive thyroid or an underactive thyroid, using recreational drugs. […] Common psychological causes may include: depression, stress, relationship problems, anxiety about sexual performance. […] It’s possible for a man to have experienced premature ejaculation since becoming sexually active.

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

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

  Ejaculation is a complex physiological process that comprises emission and expulsion processes and is mediated by interwoven neurological and hormonal pathways. Any interference with those pathways may cause a wide range of ejaculatory disorders. The spectrum of ejaculation disorders includes premature ejaculation (PE), retarded or delayed ejaculation, anejaculation, painful ejaculation, retrograde ejaculation, anorgasmia and haemospermia. […] The aetiology of PE is relatively unknown, with limited data to support suggested biological and psychological hypotheses, including anxiety, penile hypersensitivity and 5-hydroxytryptamine (HT) receptor dysfunction. It has been hypothesised that the pathophysiology of lifelong PE is mediated by a complex interplay of central and peripheral serotonergic, dopaminergic, oxytocinergic, endocrinological, genetic and epigenetic factors.

• #1 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 causes of premature ejaculation are unclear. Many theories have been suggested, including that PE was the result of masturbating quickly during adolescence to avoid being caught, performance anxiety, passive-aggressive behavior or having too little sex; but there is little evidence to support any of these theories. […] Several physiological mechanisms have been hypothesized to contribute to causing premature ejaculation, including serotonin receptors, a genetic predisposition, elevated penile sensitivity and nerve conduction atypicalities. […] The nucleus paragigantocellularis of the brain has been identified as having involvement in ejaculatory control.

• #1 Premature Ejaculation: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/435884-overview

  Premature ejaculation is believed to be a psychological problem and does not represent any known organic disease involving the male reproductive tract or any known lesions in the brain or nervous system. The organ systems directly affected by premature ejaculation include the following: Male reproductive tract (ie, penis, prostate, seminal vesicles, testicles, and their appendages) […] A number of investigators have found differences in nerve conduction/latency times and hormonal differences in men who experience premature ejaculation compared with individuals who do not. The theory is that some men have hyperexcitability or oversensitivity of their genitalia, which prevents downregulation of their sympathetic pathways and delay of orgasm. […] Electroencephalography and neuroimaging studies have detected abnormal spontaneous and evoked brain activation responses to erotic stimuli as well as brain structure changes in premature ejaculation patients. A study by Yang et al using functional magnetic resonance imaging (fMRI) demonstrated that patients with lifelong premature ejaculation have an abnormal brain control network, which may contribute to the reduced central control of rapid ejaculation.

• #1 Ejaculatory Disorders: Pathophysiology and Management

  https://www.medscape.org/viewarticle/569396_3

  Clinical studies have demonstrated that a short frenulum, penile hypersensitivity and reflex hyperexcitability could be important contributing factors to PE. […] Nevertheless, Vanden Broucke et al. has demonstrated that penile sensitivity measurements do not correlate with ejaculation latency times (ELT) in men with normal sexual function; therefore, ELT variability cannot be explained by differences in penile sensitivity, at least in normal men. […] Moreover, the reproducible variation in ELT probably cannot be explained by differences in peripheral sensation, although this does not exclude the possibility that penile sensitivity has a role in creating a significantly lowered ejaculatory threshold in patients with PE. […] Sometimes urological or andrological disease can lead to PE. […] There is a high prevalence of chronic prostatitis in men with PE (56.5%), suggesting that prostatic inflammation is a predisposing condition for PE.

• #1 The pathophysiology of acquired premature ejaculation – McMahon – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/11133/html

  However, Corona et al. elegantly demonstrated high levels of free floating anxiety in A-PE. […] In conclusion, the etiological approach of psychology to PE in general and to A-PE in particular should be re-thought. Psychological involvement can be either a cause or caused by A-PE. […] The relationship between chronic prostatitis, CPPS and PE is supported by several recently published studies which focus more on epidemiology and largely ignore treatment. […] In summary, the urologic literature has shown a higher prevalence of CP or CPPS among PE patients and vice versa. There is also an association between the dimensions of the patients CP, i.e., duration of symptoms and levels of inflammation, and the possibility of having PE. […] Together, this evidence strongly supports the idea that CP may be a common cause of both acquired and lifelong PE, thus it should be ruled out, especially in men with associated pelvic pain and/or urinary symptoms.

• #1 Retrograde ejaculation – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/retrograde-ejaculation/symptoms-causes/syc-20354890

  Retrograde ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. […] Retrograde ejaculation isn’t harmful, but it can cause male infertility. Treatment for retrograde ejaculation is generally only needed to restore fertility. […] During retrograde ejaculation, semen travels into the bladder instead of exiting the body through the penis. […] With retrograde ejaculation, the bladder neck muscle doesn’t tighten properly. As a result, sperm can enter the bladder instead of being ejected out of your body through the penis. […] Several conditions can cause problems with the muscle that closes the bladder during ejaculation. […] A dry orgasm is the primary sign of retrograde ejaculation. But dry orgasm the ejaculation of little or no semen can also be caused by other conditions, including:

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

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

  Premature ejaculation is by far the biggest complaint that men have about their sexual performance. After studying data gathered by the National Health and Social Life Survey, sociologist Edward Laumann, PhD, estimated that a third of American men complain that they ejaculate too quickly. They want to last longer during intercourse to prolong the pleasure, both for themselves and their partners. […] 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. […] Retrograde ejaculation is the least common of the ejaculation problems. It causes semen to back into the bladder during orgasm instead of exiting by way of the penis. The semen is then later flushed out when you urinate. Retrograde ejaculation can be caused by diabetes, nerve damage, various medications, and surgery that disturbs the sphincter muscle. It’s harmless and won’t interfere with the feeling of orgasm.

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

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

  The aetiology of DE can be psychological, organic (e.g., incomplete spinal cord lesion or iatrogenic penile nerve damage), or pharmacological (e.g., SSRIs, antihypertensive drugs, or antipsychotics). […] Generally, anejaculation shares similar aetiological factors with DE and retrograde ejaculation. […] The process of ejaculation requires complex co-ordination and interplay between the epididymis, vas deferens, prostate, seminal vesicles, bladder neck and bulbourethral glands. Upon ejaculation, sperm are rapidly conveyed along the vas deferens and into the urethra via the ejaculatory ducts. From there, the semen progresses in an antegrade fashion, partly maintained by coaptation of the bladder neck and rhythmic contractions of the periurethral muscles, co-ordinated by a centrally mediated reflex. Any factor that disrupts this reflex and inhibits contraction of the bladder neck may lead to retrograde passage of semen into the bladder.

• #1 Ejaculation problems

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

  Retrograde ejaculation happens when the neck of the bladder does not close and semen passes into the bladder. […] Causes of retrograde ejaculation include prostate gland surgery, bladder surgery, diabetes, multiple sclerosis, and a class of medicines known as alpha blockers. […] Most men do not need treatment for retrograde ejaculation because they are still able to enjoy a healthy sex life and the condition does not have adverse effects on their health.

• #1 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. Under normal circumstances, ejaculation propels semen forward through a man’s urethra and out the tip of his penis. This is because a tiny sphincter (circular muscle) at the entrance to the bladder shuts the opening to the bladder and prevents semen from entering. Retrograde ejaculation is when the semen travels backwards into the bladder. […] In retrograde ejaculation, the muscle that shuts the bladder does not function normally. This allows all or part of the semen to travel backward (retrograde) into the bladder at the time of ejaculation. When this happens, less semen comes out the tip of the penis. […] Retrograde ejaculation has several possible causes, including: Damage from surgery to the muscles of the bladder, or to the nerves that control these muscles. This damage can occur as a complication of the following surgical procedures: Prostate surgery Men who have had a transurethral prostatectomy (removal of prostate tissue through the urethra) have a 10-15 % chance of retrograde ejaculation. A prostatectomy (surgery to remove the entire prostate gland, either for cancer or benign enlargement) results in a higher risk of retrograde ejaculation after the procedure.

• #1 Retrograde Ejaculation – Harvard Health

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

  Nerve damage caused by medical illness. This is especially common in men with multiple sclerosis or with long-term, poorly controlled diabetes. […] 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 some men, retrograde ejaculation requires treatment because it interferes with fertility. This treatment varies depending on the cause. If your retrograde ejaculation is a side effect of medication, your doctor probably will switch you to a drug that does not affect ejaculation. […] If your retrograde ejaculation is the result of damage to the nerves or muscles of your bladder, then it may not be possible to restore normal ejaculation. If this is the case, and you are hoping to father a child, a fertility specialist may be able to help. In cases of retrograde ejaculation, three of the more commonly used assisted fertilization procedures are: Intrauterine insemination (using a small catheter to put washed sperm inside your partner’s uterus at the time of ovulation), In-vitro fertilization (incubating eggs and sperm together in the laboratory to produce fertilization), Intracytoplasmic sperm injection (injecting a single sperm into your partner’s egg to cause fertilization). […] Simple therapies have a good chance of decreasing retrograde ejaculation enough to allow conception. In men who do not respond to medication, fathering a child may still be possible with the help of assisted fertilization procedures.

• #1 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

  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.

• #1 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. […] There is a spectrum of DE disorders ranging from increased latency to ejaculation to absent ejaculation (anejaculation) and including DE, retrograde ejaculation, painful ejaculation, and anorgasmia. […] 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. […] A report of generalized, lifelong MOD with no orgasm at all (across an array of stimulative techniques) suggests an organic etiology. […] Urologic classifications are usually explicit in differentiating between failure to ejaculate and absence of orgasm.

• #1 KoreaMed Synapse

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

  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. […] Difficulty in ejaculating has been reported in patients with congenital abnormalities that may compromise the functions of the vas deferens, ejaculatory duct, prostate, seminal vesicle, and urethra. […] 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. […] Ejaculation and orgasm usually occur together, but not always. The sensation of orgasm in the absence of antegrade ejaculation suggests retrograde ejaculation, absence of puberty, or genital tract obstruction.

• #2 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 :: 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.

• #2 Neurons for Ejaculation and Factors Affecting Ejaculation

  https://www.mdpi.com/2079-7737/11/5/686

  Neurons for Ejaculation and Factors Affecting Ejaculation […] Ejaculation is defined as the ejection of contents collectively from the vas deferens, seminal vesicle, prostate and Cowper’s glands. […] The presence of lesion in these neurons ceases the ejaculatory behavior in males. […] The L3–L4 (lumbar) segment, the spinal cord region responsible for ejaculation, nerve cell bodies, also called lumbar spinothalamic (LSt) cells, which are denoted as spinal ejaculation generators or lumbar spinothalamic cells [Lst]. […] Lst cells activation causes ejaculation. […] Different types of ejaculatory dysfunction in humans include premature ejaculation (PE), retrograde ejaculation (RE), delayed ejaculation (DE), and anejaculation (AE). […] Ejaculatory dysfunction can be classified into four types: premature ejaculation, retrograde ejaculation, delayed ejaculation, and anejaculation.

• #2 :: 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 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.

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

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

  Delayed ejaculation may have pathologic, neurological, hormonal, pharmaceutical, or psychological causes. […] Some of the causes your healthcare provider may consider include: […] Pathologic causes, such as heart disease (which can lower blood pressure), diabetes, prostate problems, and urinary tract infection […] Neurological causes, like stroke, neuropathy, spinal cord injury, or multiple sclerosis […] Hormonal causes, including thyroid problems, hypogonadism (low testosterone), and Cushing’s disease […] Medication side effects, including benzodiazepines like Valium (diazepam), selective serotonin reuptake inhibitors (SSRI) antidepressants, opioids like Oxycontin (oxycodone), antihypertensives (including diuretics), and certain antipsychotics […] Psychological problems can both cause and contribute to DE.

• #2 Orgasm and Ejaculation Disorders | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-031-11701-5_7

  Disorders of ejaculations are among the most complex complaints of patients seeking first medical help for sexual dysfunction. […] Although numerous preclinical and clinical studies have been published over the last two decades, the true pathophysiological mechanisms behind ejaculation remain unclear. […] Although this holds true, PE pathophysiology remains an undoubtedly complex topic even though compelling evidence has accumulated over the years, both on animal and human models. […] Serotonin (5-HT) is the neurotransmitter of greatest interest in the control of ejaculation. […] It has been hypothesized and subsequently demonstrated that LPE in humans may be explained by a hyposensitivity of the 5-HT2C and/or hypersensitivity of the 5-HT1A receptors. […] Indeed, it has been demonstrated the presence of a neural network at the peripheral level (within the spinal cord) responsible for the ejaculatory reflex whereby serotonin plays a major role in controlling ejaculation.

• #2 The 3 types of ejaculation problems (yes, 3!)

  https://www.numan.com/premature-ejaculation/causes/3-types-of-ejaculation-problems

  For a long-term solution, its important to get to the bottom of whats causing your premature ejaculation. […] Delayed ejaculation can be caused by physical or psychological conditions. […] Physical causes of delayed ejaculation include: Pelvic nerve injury, Urinary tract infection, Birth defect, Hormone deficiencies such as hypothyroidism (low thyroid hormone level) or hypogonadism (low testosterone level), Diabetes, Prostate or bladder surgery, Spinal cord injury, Multiple sclerosis, Neurological diseases, Old age, Medications such as antidepressants (sometimes used to treat premature ejaculation), high blood pressure medication, muscle relaxants, painkillers or diuretics, Recreational drugs or excessive alcohol intake. […] The root cause of delayed ejaculation can also be psychological, such as: Relationship problems, Anxiety or depression, Stress, Early sexual trauma, Strict upbringing.

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

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

  Acquired premature ejaculation is defined as consistently poor ejaculatory control, associated bother, and ejaculation latency that is markedly reduced from prior sexual experience during penetrative sex. […] Clinicians should assess medical, relationship, and sexual history and perform a focused physical exam to evaluate a patient with premature ejaculation. […] Clinicians should recommend daily SSRIs; on demand clomipramine or dapoxetine (where available); and topical penile anaesthetics as first-line pharmacotherapies in the treatment of premature 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. […] 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.

• #2 Delayed ejaculation – Wikipedia

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

  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. […] 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.

• #2 About tamsulosin – NHS

  https://www.nhs.uk/medicines/tamsulosin/about-tamsulosin/

  The main side effects of tamsulosin are feeling dizzy and problems when ejaculating (such as little or no semen).

• #2 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.

• #2 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 largely be divided into low libido, erectile dysfunction, Peyronies disease and ejaculatory and orgasmic disorders. 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. Orgasmic dysfunction is the diminished intensity of an orgasm or an inability to achieve orgasm during sexual stimulation and can coexist with ejaculatory disorders. […] The best treatment approach for ejaculatory and orgasmic dysfunctions is a multimodal approach, with pharmacological, psychological and behavioural techniques used in combination. Behavioural techniques for premature ejaculation include the stop-start technique (patients cease genital stimulation until arousal sensation subsides) or squeeze technique (squeezing of the glans prepuce during heightened arousal), while those with delayed orgasm might benefit from sexual counselling on arousal methods, genital stimulation or role-playing to increase sexual intimacy.

• #2 Neurons for Ejaculation and Factors Affecting Ejaculation

  https://www.mdpi.com/2079-7737/11/5/686

  Premature ejaculation [PE] is the most common type of ejaculation dysfunction in men, with a prevalence of up to 75%. […] ETIOPATHOGENESIS OF PREMATURE EJACULATION: Psychological and biological factors have conventionally been responsible for this. […] Factors include endocrine, genetic, urological, and others. […] Diabetes mellitus (DM) is another common disease. […] Ejaculatory dysfunction occurs in 40% of men with diabetes. […] Retrograde ejaculation causes ejaculatory dysfunction, wherein partial or complete passage of semen enters the urinary bladder rather than passing out through the urethra. […] ETIOPATHOGENESIS OF RETROGRADE EJACULATION: These factors are classified as pharmacological, neurogenic and other causes of retrograde ejaculation. […] Delayed ejaculation and anejaculation are the least commonly studied forms of male ejaculatory dysfunction, with an approximate prevalence of 1–4% in males. […] The identification of a potential spinal ejaculation generator is an important breakthrough in the field of sexual function.

• #2 Premature ejaculation – Wikipedia

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

  PE may be caused by prostatitis or as a medication side effect. […] The pathophysiology of lifelong PE is mediated by a complex interplay of central and peripheral serotonergic, dopaminergic, oxytocinergic, endocrinological, genetic and epigenetic factors. […] Acquired PE may occur due to psychological problems – such as sexual performance anxiety, and psychological or relationship problems – and/or co-morbidity, including erectile dysfunction, prostatitis and hyperthyroidism. […] The physical process of ejaculation requires two actions: emission and expulsion. […] Sympathetic motor neurons control the emission phase of ejaculation reflex, and expulsion phase is executed by somatic and autonomic motor neurons.

• #2 Retrograde Ejaculation – Harvard Health

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

  Nerve damage caused by medical illness. This is especially common in men with multiple sclerosis or with long-term, poorly controlled diabetes. […] 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 some men, retrograde ejaculation requires treatment because it interferes with fertility. This treatment varies depending on the cause. If your retrograde ejaculation is a side effect of medication, your doctor probably will switch you to a drug that does not affect ejaculation. […] If your retrograde ejaculation is the result of damage to the nerves or muscles of your bladder, then it may not be possible to restore normal ejaculation. If this is the case, and you are hoping to father a child, a fertility specialist may be able to help. In cases of retrograde ejaculation, three of the more commonly used assisted fertilization procedures are: Intrauterine insemination (using a small catheter to put washed sperm inside your partner’s uterus at the time of ovulation), In-vitro fertilization (incubating eggs and sperm together in the laboratory to produce fertilization), Intracytoplasmic sperm injection (injecting a single sperm into your partner’s egg to cause fertilization). […] Simple therapies have a good chance of decreasing retrograde ejaculation enough to allow conception. In men who do not respond to medication, fathering a child may still be possible with the help of assisted fertilization procedures.

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