Problemy z ejakulacją – Rokowania, prognozy i postęp choroby

Problemy z ejakulacją
Rokowania, prognozy i postęp choroby

Zaburzenia ejakulacji u mężczyzn obejmują przedwczesny wytrysk (PE), opóźnioną ejakulację (DE), wytrysk wsteczny (RE) oraz anejaulację, a ich rokowanie zależy od typu zaburzenia (pierwotne vs nabyte), etiologii (biologicznej lub psychologicznej), wieku pacjenta, chorób współistniejących oraz stosowanych leków. Przedwczesny wytrysk definiuje się jako wytrysk do około 2 minut od penetracji, z brakiem kontroli i dyskomfortem psychicznym, a jego częstość kliniczna wynosi poniżej 5%, mimo że do 30% mężczyzn zgłasza objawy. Leczenie PE opiera się na farmakoterapii (SSRI, klomipramina, dapoksetyna, miejscowe środki znieczulające) oraz terapii behawioralnej, z najlepszymi wynikami przy podejściu łączonym. Opóźniona ejakulacja, charakteryzująca się opóźnionym lub brakiem wytrysku w 75-100% prób przez co najmniej 6 miesięcy, wymaga diagnostyki różnicowej pod kątem neuropatii nerwu sromowego, chorób współistniejących i zaburzeń erekcji, a leczenie obejmuje SSRI, sildenafil oraz terapię psychoseksualną.

Problemy z ejakulacją – Prognoza (przewidywanie wyników leczenia)

Czynniki wpływające na prognozę
Prognoza w przedwczesnym wytrysku
Prognoza w opóźnionej ejakulacji
Prognoza w wytrysku wstecznym
Wpływ wieku na prognozę
Znaczenie dyskomfortu w prognozie
Podejście terapeutyczne a prognoza
Znaczenie współpracy z personelem medycznym
Rekomendacje farmakologiczne a rokowanie
Podsumowanie rokowania
Kolejne rozdziały

Problemy z ejakulacją – Prognoza (przewidywanie wyników leczenia)

Problemy z ejakulacją należą do najczęstszych zaburzeń seksualnych u mężczyzn, które mogą mieć znaczący wpływ na jakość życia i samoocenę pacjenta.¹² Zaburzenia ejakulacji obejmują szerokie spektrum objawów – od przedwczesnego wytrysku, przez opóźnioną ejakulację, do całkowitego braku wytrysku (anejakulacji) lub wytrysku wstecznego. Prognoza w tych zaburzeniach zależy od wielu czynników, które omówimy szczegółowo w dalszej części artykułu.

Czynniki wpływające na prognozę

Rokowanie w zaburzeniach ejakulacji jest uzależnione od kilku kluczowych czynników:³⁴

Typ zaburzenia – czy jest to zaburzenie pierwotne (obecne od początku aktywności seksualnej) czy nabyte (pojawiające się po okresie prawidłowego funkcjonowania)
Przyczyna zaburzenia – czynniki biologiczne vs psychologiczne
Wiek pacjenta – częstość występowania zaburzeń ejakulacji wzrasta z wiekiem
Choroby współistniejące – szczególnie zaburzenia metaboliczne, sercowo-naczyniowe, hormonalne
Stosowane leki – niektóre mogą znacząco wpływać na funkcje ejakulacyjne
Motywacja pacjenta do leczenia i współpraca z terapeutą

⁵⁶

Prognoza w przedwczesnym wytrysku

Przedwczesny wytrysk (PE) jest definiowany jako wytrysk występujący przed lub krótko po penetracji, bez poczucia kontroli, któremu towarzyszy dyskomfort psychiczny pacjenta.⁷ Przy odpowiednim podejściu terapeutycznym, rokowanie w tej grupie zaburzeń jest stosunkowo dobre:⁸

Pierwotny (lifelong) PE – definicyjnie charakteryzuje się słabą kontrolą ejakulacji, towarzyszącym dyskomfortem i czasem do wytrysku wynoszącym około 2 minut od początku penetracji, obecnym od początku aktywności seksualnej⁹
Nabyty (acquired) PE – charakteryzuje się stale słabą kontrolą ejakulacji, towarzyszącym dyskomfortem i znacznie skróconym czasem do wytrysku w porównaniu z wcześniejszymi doświadczeniami seksualnymi¹⁰

W leczeniu przedwczesnego wytrysku skuteczne są zarówno interwencje farmakologiczne, jak i behawioralne.¹¹ Rokowanie jest korzystniejsze przy zastosowaniu podejścia łączonego – połączenia farmakoterapii z psychoterapią.¹²

Należy zauważyć, że mimo iż do 30% mężczyzn zgłasza przedwczesny wytrysk, niewielu z nich ma faktyczny czas latencji ejakulacji (czas między penetracją a wytryskiem) krótszy niż dwie minuty, co sprawia, że rzeczywista częstość występowania klinicznego PE jest niższa niż 5%.¹³

Prognoza w opóźnionej ejakulacji

Opóźniona ejakulacja (DE) jest definiowana jako znaczne opóźnienie wytrysku lub wyraźna rzadkość czy brak wytrysku podczas prawie wszystkich lub wszystkich okazji (75-100% czasu) aktywności seksualnej z partnerem, utrzymujące się przez co najmniej 6 miesięcy i powodujące znaczny dyskomfort pacjenta.¹⁴

Rokowanie w opóźnionej ejakulacji jest zróżnicowane i zależy od kilku czynników:¹⁵

Przyczyna – jeśli DE ma charakter sytuacyjny, prawdopodobnie przyczyna jest psychologiczna; jeśli jest uogólniona, problem jest prawdopodobnie biologiczny¹⁶
Mechanizm powstania – częstą przyczyną jest neuropatia nerwu sromowego, spowodowana np. jazdą na rowerze z wąskim siodełkiem¹⁷
Obecność chorób współistniejących – szczególnie zaburzeń erekcji¹⁸

DE niesie ze sobą problemy związane z niezdolnością do osiągnięcia orgazmu oraz niepłodnością.¹⁹ Przed włączeniem farmakoterapii, pacjent powinien być zbadany pod kątem odwracalnych przyczyn.²⁰

Rokowanie poprawia się, gdy stosowane jest leczenie skojarzone, obejmujące zarówno farmakoterapię, jak i terapię psychologiczną/seksualną.²¹ Tradycyjna behawioralna terapia seksualna w opóźnionej ejakulacji przebiega następująco: mężczyzna zaczyna od masturbacji, a następnie rozpoczyna stosunek, gdy jest prawie gotowy do ejakulacji.²²

Prognoza w wytrysku wstecznym

Wytrysk wsteczny (RE) to stan, w którym nasienie zamiast być wyrzucane na zewnątrz, trafia do pęcherza moczowego.²³ Większość mężczyzn nie wymaga leczenia tego schorzenia, ponieważ nadal mogą cieszyć się zdrowym życiem seksualnym, a stan ten nie ma niekorzystnych skutków dla ich zdrowia.²⁴

Prawdziwa częstość występowania RE jest trudna do oszacowania.²⁵ Jeśli leczenie jest wymagane (zwykle z powodu chęci posiadania dziecka), istnieją opcje do wypróbowania.²⁶ Mężczyźni, którzy chcą mieć dzieci, mogą mieć pobrane plemniki z moczu lub jąder do zastosowania w inseminacji domacicznej lub zapłodnieniu in vitro (IVF).²⁷

Wpływ wieku na prognozę

Z wiekiem obserwuje się wyraźny wzrost częstości występowania zaburzeń ejakulacji.²⁸ Badania pokazują, że:²⁹

Częstość zaburzeń ejakulacji wzrasta z 3% u mężczyzn w wieku 50-54 lat do 35% u mężczyzn w wieku 70-78 lat
Zaburzenia ejakulacji u starszych mężczyzn są prawdopodobnie spowodowane kilkoma współistniejącymi chorobami, w tym zaburzeniami metabolicznymi i sercowo-naczyniowymi, zwiększoną częstością występowania niedoboru testosteronu, zwiększonym stosowaniem leków i zmniejszoną aktywnością fizyczną

³⁰

Po skorygowaniu o wiek i powszechne choroby współistniejące, zaburzenia ejakulacji były znacząco związane z objawami ze strony dolnych dróg moczowych (LUTS), a mężczyźni z ciężkimi LUTS byli 3,3 razy bardziej narażeni na zaburzenia ejakulacji.³¹ Ma to znaczący negatywny wpływ na jakość życia, nie tylko w odniesieniu do funkcji orgazmicznej, ale także płodności, biorąc pod uwagę stosunkowo wczesny początek łagodnego przerostu prostaty (BPH).³²

Znaczenie dyskomfortu w prognozie

Warto zauważyć, że mimo iż dyskomfort/cierpienie pacjenta jest uwzględniane w kryteriach diagnostycznych zaburzeń ejakulacji, jego wkład w diagnozę przedwczesnego wytrysku jest najmniejszy i wynosi tylko 3,6%.³³

Ustalenia badań wskazują, że znajomość nasilenia objawów PE – na przykład zakresu braku kontroli ejakulacyjnej i krótkości czasu latencji ejakulacji – zasadniczo niweluje wszelki dodatkowy wkład dyskomfortu/cierpienia w diagnozę PE.³⁴

Mimo braku użyteczności dyskomfortu/cierpienia w diagnozie PE, jego ocena jest kluczową częścią prognozy, strategii leczenia i oceny leczenia.³⁵ Zaburzenia ejakulacji mogą mieć dewastujący wpływ na samoocenę.³⁶ Mogą również przyczyniać się do niskiego libido i braku zainteresowania aktywnością seksualną.³⁷

Podejście terapeutyczne a prognoza

Najskuteczniejszym podejściem terapeutycznym w zaburzeniach ejakulacji jest połączenie terapii biologicznej i psychologicznej.³⁸ W większości przypadków skuteczną interwencją jest zaangażowanie obojga partnerów w rozwiązanie problemu.³⁹

Panel ekspertów zaleca podejmowanie wspólnych decyzji jako podstawę w leczeniu zaburzeń ejakulacji; zaangażowanie partnera/partnerów seksualnych w podejmowanie decyzji, gdy jest to możliwe, może umożliwić optymalizację wyników.⁴⁰

Najczęstszym podejściem behawioralnym nauczanym przez terapeutów seksualnych jest technika „ściśnięcia” lub podejście określane jako „start i stop”.⁴¹ Podsumowując, w odpowiednich okolicznościach i przy ciągłej motywacji zaburzenia ejakulacji można przezwyciężyć.⁴²

Znaczenie współpracy z personelem medycznym

Niezależnie od problemów psychologicznych, przed rozpoczęciem programu leczenia behawioralnego zawsze zaleca się dobre badanie medyczne lub urologiczne.⁴³ Jeśli masz uporczywy problem z ejakulacją, odwiedź swojego lekarza rodzinnego, który omówi z tobą problem i może cię zbadać lub skierować do specjalisty.⁴⁴

Lekarze powinni ocenić historię medyczną, relacyjną i seksualną oraz przeprowadzić ukierunkowane badanie fizykalne w celu oceny pacjenta z przedwczesnym wytryskiem.⁴⁵ Lekarze powinni rozważyć skierowanie mężczyzn z diagnozą przedwczesnego wytrysku do specjalisty w dziedzinie zdrowia psychicznego z doświadczeniem w zdrowiu seksualnym.⁴⁶

Najważniejszą lekcją, którą muszą wyciągnąć mężczyźni i ich partnerzy, jest to, że istnieje nadzieja i istnieją terapie, które mogą pomóc rozwiązać problem trudności z ejakulacją.⁴⁷

Rekomendacje farmakologiczne a rokowanie

W leczeniu zaburzeń ejakulacji stosowane są określone grupy leków, które mogą znacząco poprawić rokowanie:⁴⁸

W przedwczesnym wytrysku: lekarze powinni zalecać codzienne stosowanie SSRI; klomipraminy lub dapoksetyny na żądanie (tam, gdzie są dostępne); oraz miejscowe środki znieczulające prącia jako farmakoterapie pierwszego rzutu⁴⁹
W opóźnionej ejakulacji: leczenie jest zwykle prowadzone za pomocą SSRI i sildenafilu (Viagra)⁵⁰
W przypadku współistniejących zaburzeń erekcji: lekarze powinni leczyć mężczyzn z opóźnioną ejakulacją i współistniejącą dysfunkcją erekcyjną zgodnie z wytycznymi AUA dotyczącymi zaburzeń erekcji⁵¹

Rola klinicysty w leczeniu PE i DE polega na przeprowadzeniu odpowiedniego badania, zapewnieniu edukacji i oferowaniu dostępnych metod leczenia, które są racjonalne i oparte na solidnych danych naukowych.⁵²

Podsumowanie rokowania

Problemy z ejakulacją, choć powszechne wśród mężczyzn i często powodujące uczucia wstydu i zakłopotania, w większości przypadków mogą być skutecznie leczone.⁵³ Rokowanie zależy od:

Rodzaju i przyczyny zaburzenia – zaburzenia nabyte i o podłożu psychogennym zwykle mają lepsze rokowanie
Wieku pacjenta – młodszy wiek zwykle wiąże się z lepszą prognozą
Zastosowanego leczenia – podejście łączone (farmakoterapia + psychoterapia) daje najlepsze wyniki
Motywacji pacjenta – zaangażowanie w proces terapeutyczny jest kluczowe dla sukcesu
Zaangażowania partnera – włączenie partnera do procesu terapeutycznego poprawia rokowanie

Należy podkreślić, że dla wielu mężczyzn uczucia wstydu uniemożliwiają im poszukiwanie pomocy medycznej i profesjonalnej.⁵⁴ Jednak doświadczenie wielu klinicystów sugeruje, że problemy z ejakulacją nie są rzadkie i mogą być źródłem znacznego zakłopotania i niezadowolenia dla pacjentów.⁵⁵

Podsumowując, przy odpowiednim podejściu terapeutycznym i współpracy pacjenta, większość zaburzeń ejakulacji może być skutecznie leczona, co prowadzi do poprawy jakości życia seksualnego i ogólnego dobrostanu psychicznego pacjenta.

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Materiały źródłowe

#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. […] 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. […] Regardless of the psychological issues, a good medical or urologic work-up is always encouraged before embarking on a behavioral treatment program.
#2 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
Ejaculation and orgasm are distinct but simultaneous events that occur with peak sexual arousal. It is typical for men to have some control over the timing of ejaculation during a sexual encounter. Men who ejaculate before or shortly after penetration, without a sense of control, and who experience distress related to this condition may be diagnosed with Premature Ejaculation (PE). […] There also exists a population of men who experience difficulty achieving sexual climax, sometimes to the point that they are unable to climax during sexual activity; these men may be diagnosed with Delayed Ejaculation (DE). […] While up to 30% of men have self-reported PE, few of these men have an ejaculation latency times (the time between penetration and ejaculation) of less than two minutes, making the actual prevalence of clinical PE and DE less than 5%.
#3 Epidemiology of delayed ejaculation – Sante – Translational Andrology and Urology
https://tau.amegroups.org/article/view/10793/html
Specifically, the above studies have reported that certain demographic and clinical factors correlate with ejaculatory dysfunctions. […] DE appears to be positively related to age […] and the prevalence differs among races. […] The true incidence of RE is also difficult to estimate. […] Anejaculation occurs in 0.14% of the general population, according to Kinsey. […] The prevalence of DE appears to be moderately and positively related to age, which is not surprising in view of the fact that ejaculatory function as a whole tends to diminish as men age. […] The results of a community-based study of 1,688 men in the Netherlands showed that the prevalence of ejaculatory dysfunctions (defined as ejaculation with a decreased amount of semen or anejaculation) increased from 3% in men aged 5054 years to 35% in those aged 7078 years.
#4 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 common behavioral approach taught by sex therapists is either the squeeze technique or an approach described as start and stop. […] In summary, under the right circumstances and with ongoing motivation, ejaculation disorders can be overcome. […] 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). […] 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. […] The patient must be checked to see if there are reversible causes before being given medication.
#5 Epidemiology of delayed ejaculation – Sante – Translational Andrology and Urology
https://tau.amegroups.org/article/view/10793/html
Ejaculatory dysfunctions in the aged male are most probably due to several comorbidities, including metabolic and cardiovascular disorders, increased prevalence of T deficiency, increased use of medications, and decreased exercise. […] In effect, advancing age and increasing comorbidities were associated with greater prevalence of ejaculatory dysfunction (up to 35% in those aged 7078 years). […] After adjusting for age and common comorbidities, ejaculatory dysfunctions were significantly associated with LUTS and men with severe LUTS were 3.3 times more likely to report ejaculation disorders. […] This has a significant negative impact on quality of life, not only in regard to orgasmic function, but also for fertility, considering the relatively early onset of BPH. […] Finally, this article has also focused on the importance of the hormonal milieu on male ejaculation.
#6 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/
Problems of delayed ejaculation tend to be somewhat rare and not well understood by psychologists and sex therapists. […] For many men, feelings of shame prevent them from seeking medical and professional help. […] In spite of the lack of information regarding delayed ejaculation, the most successful approach, for sex therapists, is to engage both members of the couple into addressing the problem. […] Ejaculatory problems can have a devastating affect on self-esteem. […] 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.
#7 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
Ejaculation and orgasm are distinct but simultaneous events that occur with peak sexual arousal. It is typical for men to have some control over the timing of ejaculation during a sexual encounter. Men who ejaculate before or shortly after penetration, without a sense of control, and who experience distress related to this condition may be diagnosed with Premature Ejaculation (PE). […] There also exists a population of men who experience difficulty achieving sexual climax, sometimes to the point that they are unable to climax during sexual activity; these men may be diagnosed with Delayed Ejaculation (DE). […] While up to 30% of men have self-reported PE, few of these men have an ejaculation latency times (the time between penetration and ejaculation) of less than two minutes, making the actual prevalence of clinical PE and DE less than 5%.
#8 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/
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. […] As the man becomes more sexually experienced, latency of ejaculation increases although not always to the satisfaction of the man and his partner. […] Although less common, some men develop early ejaculatory problems later in life. […] As mentioned, the most effective approach is a combination of psychological assistance and medical intervention. […] Urologists and other medical doctors typically treat early ejaculation with a combination of medications and creams.
#9 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
The Panel recommends shared decision-making as fundamental in the management of disorders of ejaculation; involvement of sexual partner(s) in decision making, when possible, may allow for optimization of outcomes. […] Lifelong premature ejaculation is defined as poor ejaculatory control, associated bother, and ejaculation within about 2 minutes of initiation of penetrative sex that has been present since sexual debut. […] 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 advise patients that ejaculatory latency is not affected by circumcision status.
#10 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
The Panel recommends shared decision-making as fundamental in the management of disorders of ejaculation; involvement of sexual partner(s) in decision making, when possible, may allow for optimization of outcomes. […] Lifelong premature ejaculation is defined as poor ejaculatory control, associated bother, and ejaculation within about 2 minutes of initiation of penetrative sex that has been present since sexual debut. […] 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 advise patients that ejaculatory latency is not affected by circumcision status.
#11 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/
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. […] As the man becomes more sexually experienced, latency of ejaculation increases although not always to the satisfaction of the man and his partner. […] Although less common, some men develop early ejaculatory problems later in life. […] As mentioned, the most effective approach is a combination of psychological assistance and medical intervention. […] Urologists and other medical doctors typically treat early ejaculation with a combination of medications and creams.
#12 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
Clinicians should consider referring men diagnosed with premature ejaculation to a mental health professional with expertise in sexual health. […] 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. […] Clinicians should treat men who have delayed ejaculation and comorbid erectile dysfunction according to the AUA Guidelines on Erectile Dysfunction.
#13 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
Ejaculation and orgasm are distinct but simultaneous events that occur with peak sexual arousal. It is typical for men to have some control over the timing of ejaculation during a sexual encounter. Men who ejaculate before or shortly after penetration, without a sense of control, and who experience distress related to this condition may be diagnosed with Premature Ejaculation (PE). […] There also exists a population of men who experience difficulty achieving sexual climax, sometimes to the point that they are unable to climax during sexual activity; these men may be diagnosed with Delayed Ejaculation (DE). […] While up to 30% of men have self-reported PE, few of these men have an ejaculation latency times (the time between penetration and ejaculation) of less than two minutes, making the actual prevalence of clinical PE and DE less than 5%.
#14 Epidemiology of delayed ejaculation – Sante – Translational Andrology and Urology
https://tau.amegroups.org/article/view/10793/html
A large body of literature on diminished ejaculatory disorders has been generated without the use of a clear diagnostic definition. […] Delayed ejaculation (DE) is one of the diminished ejaculatory disorders, which range from varying delays in ejaculatory latency to a complete inability to ejaculate. […] DE can be defined as lifelong, from the first sexual experience, or acquired, i.e., subsequent to a normal period of sexual functioning. […] There are not definite criteria for evaluating men complaining of DE. […] In fact, DSM-V defines DE as a marked delay in ejaculation or a marked infrequency or absence of ejaculation on almost all or all occasions (75100% of the time) of partnered sexual activity without the individual desiring delay, persisting for at least 6 months and causing significant distress to the individual.
#15 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/
Problems of delayed ejaculation tend to be somewhat rare and not well understood by psychologists and sex therapists. […] For many men, feelings of shame prevent them from seeking medical and professional help. […] In spite of the lack of information regarding delayed ejaculation, the most successful approach, for sex therapists, is to engage both members of the couple into addressing the problem. […] Ejaculatory problems can have a devastating affect on self-esteem. […] 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.
#16 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 common behavioral approach taught by sex therapists is either the squeeze technique or an approach described as start and stop. […] In summary, under the right circumstances and with ongoing motivation, ejaculation disorders can be overcome. […] 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). […] 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. […] The patient must be checked to see if there are reversible causes before being given medication.
#17 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 common behavioral approach taught by sex therapists is either the squeeze technique or an approach described as start and stop. […] In summary, under the right circumstances and with ongoing motivation, ejaculation disorders can be overcome. […] 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). […] 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. […] The patient must be checked to see if there are reversible causes before being given medication.
#18 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
Clinicians should consider referring men diagnosed with premature ejaculation to a mental health professional with expertise in sexual health. […] 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. […] Clinicians should treat men who have delayed ejaculation and comorbid erectile dysfunction according to the AUA Guidelines on Erectile Dysfunction.
#19 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 common behavioral approach taught by sex therapists is either the squeeze technique or an approach described as start and stop. […] In summary, under the right circumstances and with ongoing motivation, ejaculation disorders can be overcome. […] 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). […] 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. […] The patient must be checked to see if there are reversible causes before being given medication.
#20 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 common behavioral approach taught by sex therapists is either the squeeze technique or an approach described as start and stop. […] In summary, under the right circumstances and with ongoing motivation, ejaculation disorders can be overcome. […] 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). […] 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. […] The patient must be checked to see if there are reversible causes before being given medication.
#21 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. […] 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. […] Regardless of the psychological issues, a good medical or urologic work-up is always encouraged before embarking on a behavioral treatment program.
#22 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/
Problems of delayed ejaculation tend to be somewhat rare and not well understood by psychologists and sex therapists. […] For many men, feelings of shame prevent them from seeking medical and professional help. […] In spite of the lack of information regarding delayed ejaculation, the most successful approach, for sex therapists, is to engage both members of the couple into addressing the problem. […] Ejaculatory problems can have a devastating affect on self-esteem. […] 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.
#23 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. […] Delayed ejaculation can suddenly start to happen after previously having no problems, or (less commonly) the man may have always experienced it. […] 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. […] But if treatment is required (usually because of wanting to father a child), there are options to try. […] Men who want to have children can have sperm taken from their urine or testicles for use in intrauterine insemination or in-vitro fertilisation (IVF).
#24 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. […] Delayed ejaculation can suddenly start to happen after previously having no problems, or (less commonly) the man may have always experienced it. […] 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. […] But if treatment is required (usually because of wanting to father a child), there are options to try. […] Men who want to have children can have sperm taken from their urine or testicles for use in intrauterine insemination or in-vitro fertilisation (IVF).
#25 Epidemiology of delayed ejaculation – Sante – Translational Andrology and Urology
https://tau.amegroups.org/article/view/10793/html
Specifically, the above studies have reported that certain demographic and clinical factors correlate with ejaculatory dysfunctions. […] DE appears to be positively related to age […] and the prevalence differs among races. […] The true incidence of RE is also difficult to estimate. […] Anejaculation occurs in 0.14% of the general population, according to Kinsey. […] The prevalence of DE appears to be moderately and positively related to age, which is not surprising in view of the fact that ejaculatory function as a whole tends to diminish as men age. […] The results of a community-based study of 1,688 men in the Netherlands showed that the prevalence of ejaculatory dysfunctions (defined as ejaculation with a decreased amount of semen or anejaculation) increased from 3% in men aged 5054 years to 35% in those aged 7078 years.
#26 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. […] Delayed ejaculation can suddenly start to happen after previously having no problems, or (less commonly) the man may have always experienced it. […] 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. […] But if treatment is required (usually because of wanting to father a child), there are options to try. […] Men who want to have children can have sperm taken from their urine or testicles for use in intrauterine insemination or in-vitro fertilisation (IVF).
#27 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. […] Delayed ejaculation can suddenly start to happen after previously having no problems, or (less commonly) the man may have always experienced it. […] 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. […] But if treatment is required (usually because of wanting to father a child), there are options to try. […] Men who want to have children can have sperm taken from their urine or testicles for use in intrauterine insemination or in-vitro fertilisation (IVF).
#28 Epidemiology of delayed ejaculation – Sante – Translational Andrology and Urology
https://tau.amegroups.org/article/view/10793/html
Specifically, the above studies have reported that certain demographic and clinical factors correlate with ejaculatory dysfunctions. […] DE appears to be positively related to age […] and the prevalence differs among races. […] The true incidence of RE is also difficult to estimate. […] Anejaculation occurs in 0.14% of the general population, according to Kinsey. […] The prevalence of DE appears to be moderately and positively related to age, which is not surprising in view of the fact that ejaculatory function as a whole tends to diminish as men age. […] The results of a community-based study of 1,688 men in the Netherlands showed that the prevalence of ejaculatory dysfunctions (defined as ejaculation with a decreased amount of semen or anejaculation) increased from 3% in men aged 5054 years to 35% in those aged 7078 years.
#29 Epidemiology of delayed ejaculation – Sante – Translational Andrology and Urology
https://tau.amegroups.org/article/view/10793/html
Specifically, the above studies have reported that certain demographic and clinical factors correlate with ejaculatory dysfunctions. […] DE appears to be positively related to age […] and the prevalence differs among races. […] The true incidence of RE is also difficult to estimate. […] Anejaculation occurs in 0.14% of the general population, according to Kinsey. […] The prevalence of DE appears to be moderately and positively related to age, which is not surprising in view of the fact that ejaculatory function as a whole tends to diminish as men age. […] The results of a community-based study of 1,688 men in the Netherlands showed that the prevalence of ejaculatory dysfunctions (defined as ejaculation with a decreased amount of semen or anejaculation) increased from 3% in men aged 5054 years to 35% in those aged 7078 years.
#30 Epidemiology of delayed ejaculation – Sante – Translational Andrology and Urology
https://tau.amegroups.org/article/view/10793/html
Ejaculatory dysfunctions in the aged male are most probably due to several comorbidities, including metabolic and cardiovascular disorders, increased prevalence of T deficiency, increased use of medications, and decreased exercise. […] In effect, advancing age and increasing comorbidities were associated with greater prevalence of ejaculatory dysfunction (up to 35% in those aged 7078 years). […] After adjusting for age and common comorbidities, ejaculatory dysfunctions were significantly associated with LUTS and men with severe LUTS were 3.3 times more likely to report ejaculation disorders. […] This has a significant negative impact on quality of life, not only in regard to orgasmic function, but also for fertility, considering the relatively early onset of BPH. […] Finally, this article has also focused on the importance of the hormonal milieu on male ejaculation.
#31 Epidemiology of delayed ejaculation – Sante – Translational Andrology and Urology
https://tau.amegroups.org/article/view/10793/html
Ejaculatory dysfunctions in the aged male are most probably due to several comorbidities, including metabolic and cardiovascular disorders, increased prevalence of T deficiency, increased use of medications, and decreased exercise. […] In effect, advancing age and increasing comorbidities were associated with greater prevalence of ejaculatory dysfunction (up to 35% in those aged 7078 years). […] After adjusting for age and common comorbidities, ejaculatory dysfunctions were significantly associated with LUTS and men with severe LUTS were 3.3 times more likely to report ejaculation disorders. […] This has a significant negative impact on quality of life, not only in regard to orgasmic function, but also for fertility, considering the relatively early onset of BPH. […] Finally, this article has also focused on the importance of the hormonal milieu on male ejaculation.
#32 Epidemiology of delayed ejaculation – Sante – Translational Andrology and Urology
https://tau.amegroups.org/article/view/10793/html
Ejaculatory dysfunctions in the aged male are most probably due to several comorbidities, including metabolic and cardiovascular disorders, increased prevalence of T deficiency, increased use of medications, and decreased exercise. […] In effect, advancing age and increasing comorbidities were associated with greater prevalence of ejaculatory dysfunction (up to 35% in those aged 7078 years). […] After adjusting for age and common comorbidities, ejaculatory dysfunctions were significantly associated with LUTS and men with severe LUTS were 3.3 times more likely to report ejaculation disorders. […] This has a significant negative impact on quality of life, not only in regard to orgasmic function, but also for fertility, considering the relatively early onset of BPH. […] Finally, this article has also focused on the importance of the hormonal milieu on male ejaculation.
#33 Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?
https://pmc.ncbi.nlm.nih.gov/articles/PMC9537260/
Bother/distress provided the least unique contribution to the PE diagnosis, at 3.6%. […] Our findings indicate that knowing the severity of PE symptomologyâfor example, the extent of lack of ejaculatory control and the shortness of ELâessentially nullifies any added contribution from bother/distress in the diagnosis of PE. […] Despite the lack of utility of bother/distress in the diagnosis of PE, we nevertheless view its assessment as a key part of prognosis, treatment strategy, and treatment assessment.
#34 Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?
https://pmc.ncbi.nlm.nih.gov/articles/PMC9537260/
Bother/distress provided the least unique contribution to the PE diagnosis, at 3.6%. […] Our findings indicate that knowing the severity of PE symptomologyâfor example, the extent of lack of ejaculatory control and the shortness of ELâessentially nullifies any added contribution from bother/distress in the diagnosis of PE. […] Despite the lack of utility of bother/distress in the diagnosis of PE, we nevertheless view its assessment as a key part of prognosis, treatment strategy, and treatment assessment.
#35 Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?
https://pmc.ncbi.nlm.nih.gov/articles/PMC9537260/
Bother/distress provided the least unique contribution to the PE diagnosis, at 3.6%. […] Our findings indicate that knowing the severity of PE symptomologyâfor example, the extent of lack of ejaculatory control and the shortness of ELâessentially nullifies any added contribution from bother/distress in the diagnosis of PE. […] Despite the lack of utility of bother/distress in the diagnosis of PE, we nevertheless view its assessment as a key part of prognosis, treatment strategy, and treatment assessment.
#36 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/
Problems of delayed ejaculation tend to be somewhat rare and not well understood by psychologists and sex therapists. […] For many men, feelings of shame prevent them from seeking medical and professional help. […] In spite of the lack of information regarding delayed ejaculation, the most successful approach, for sex therapists, is to engage both members of the couple into addressing the problem. […] Ejaculatory problems can have a devastating affect on self-esteem. […] 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.
#37 Ejaculation Problems: Too Fast, Too Slow or Not at All? » Sexual Medicine » BUMC
https://www.bumc.bu.edu/sexualmedicine/informationsessions/ejaculation-problems-too-fast-too-slow-or-not-at-all/
Problems of delayed ejaculation tend to be somewhat rare and not well understood by psychologists and sex therapists. […] For many men, feelings of shame prevent them from seeking medical and professional help. […] In spite of the lack of information regarding delayed ejaculation, the most successful approach, for sex therapists, is to engage both members of the couple into addressing the problem. […] Ejaculatory problems can have a devastating affect on self-esteem. […] 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.
#38 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. […] 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. […] Regardless of the psychological issues, a good medical or urologic work-up is always encouraged before embarking on a behavioral treatment program.
#39 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/
Problems of delayed ejaculation tend to be somewhat rare and not well understood by psychologists and sex therapists. […] For many men, feelings of shame prevent them from seeking medical and professional help. […] In spite of the lack of information regarding delayed ejaculation, the most successful approach, for sex therapists, is to engage both members of the couple into addressing the problem. […] Ejaculatory problems can have a devastating affect on self-esteem. […] 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.
#40 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
The Panel recommends shared decision-making as fundamental in the management of disorders of ejaculation; involvement of sexual partner(s) in decision making, when possible, may allow for optimization of outcomes. […] Lifelong premature ejaculation is defined as poor ejaculatory control, associated bother, and ejaculation within about 2 minutes of initiation of penetrative sex that has been present since sexual debut. […] 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 advise patients that ejaculatory latency is not affected by circumcision status.
#41 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 common behavioral approach taught by sex therapists is either the squeeze technique or an approach described as start and stop. […] In summary, under the right circumstances and with ongoing motivation, ejaculation disorders can be overcome. […] 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). […] 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. […] The patient must be checked to see if there are reversible causes before being given medication.
#42 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 common behavioral approach taught by sex therapists is either the squeeze technique or an approach described as start and stop. […] In summary, under the right circumstances and with ongoing motivation, ejaculation disorders can be overcome. […] 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). […] 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. […] The patient must be checked to see if there are reversible causes before being given medication.
#43 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. […] 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. […] Regardless of the psychological issues, a good medical or urologic work-up is always encouraged before embarking on a behavioral treatment program.
#44 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. […] Delayed ejaculation can suddenly start to happen after previously having no problems, or (less commonly) the man may have always experienced it. […] 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. […] But if treatment is required (usually because of wanting to father a child), there are options to try. […] Men who want to have children can have sperm taken from their urine or testicles for use in intrauterine insemination or in-vitro fertilisation (IVF).
#45 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
The Panel recommends shared decision-making as fundamental in the management of disorders of ejaculation; involvement of sexual partner(s) in decision making, when possible, may allow for optimization of outcomes. […] Lifelong premature ejaculation is defined as poor ejaculatory control, associated bother, and ejaculation within about 2 minutes of initiation of penetrative sex that has been present since sexual debut. […] 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 advise patients that ejaculatory latency is not affected by circumcision status.
#46 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
Clinicians should consider referring men diagnosed with premature ejaculation to a mental health professional with expertise in sexual health. […] 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. […] Clinicians should treat men who have delayed ejaculation and comorbid erectile dysfunction according to the AUA Guidelines on Erectile Dysfunction.
#47 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 common behavioral approach taught by sex therapists is either the squeeze technique or an approach described as start and stop. […] In summary, under the right circumstances and with ongoing motivation, ejaculation disorders can be overcome. […] 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). […] 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. […] The patient must be checked to see if there are reversible causes before being given medication.
#48 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 common behavioral approach taught by sex therapists is either the squeeze technique or an approach described as start and stop. […] In summary, under the right circumstances and with ongoing motivation, ejaculation disorders can be overcome. […] 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). […] 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. […] The patient must be checked to see if there are reversible causes before being given medication.
#49 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
Clinicians should consider referring men diagnosed with premature ejaculation to a mental health professional with expertise in sexual health. […] 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. […] Clinicians should treat men who have delayed ejaculation and comorbid erectile dysfunction according to the AUA Guidelines on Erectile Dysfunction.
#50 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 common behavioral approach taught by sex therapists is either the squeeze technique or an approach described as start and stop. […] In summary, under the right circumstances and with ongoing motivation, ejaculation disorders can be overcome. […] 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). […] 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. […] The patient must be checked to see if there are reversible causes before being given medication.
#51 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
Clinicians should consider referring men diagnosed with premature ejaculation to a mental health professional with expertise in sexual health. […] 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. […] Clinicians should treat men who have delayed ejaculation and comorbid erectile dysfunction according to the AUA Guidelines on Erectile Dysfunction.
#52 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
Regardless, the experience of many clinicians suggest that the problem is not rare and can be a source of considerable embarrassment and dissatisfaction for patients. […] Disturbances of the timing of ejaculation can pose a substantial impediment to sexual enjoyment for men and their partners. […] The understanding of the neurobiological phenomena that comprise ejaculation and orgasm is limited. […] A number of psychological health, behavioral, and pharmacotherapy options exist for both PE and DE; however, none of these pharmacotherapy options have achieved approval from the United States Food and Drug Administration and their use in the treatment of PE is considered off-label. […] The role of the clinician in managing PE and DE is to conduct appropriate investigation, to provide education, and to offer available treatments that are rational and based on sound scientific data.
#53 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. […] 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. […] Regardless of the psychological issues, a good medical or urologic work-up is always encouraged before embarking on a behavioral treatment program.
#54 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/
Problems of delayed ejaculation tend to be somewhat rare and not well understood by psychologists and sex therapists. […] For many men, feelings of shame prevent them from seeking medical and professional help. […] In spite of the lack of information regarding delayed ejaculation, the most successful approach, for sex therapists, is to engage both members of the couple into addressing the problem. […] Ejaculatory problems can have a devastating affect on self-esteem. […] 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.
#55 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
Regardless, the experience of many clinicians suggest that the problem is not rare and can be a source of considerable embarrassment and dissatisfaction for patients. […] Disturbances of the timing of ejaculation can pose a substantial impediment to sexual enjoyment for men and their partners. […] The understanding of the neurobiological phenomena that comprise ejaculation and orgasm is limited. […] A number of psychological health, behavioral, and pharmacotherapy options exist for both PE and DE; however, none of these pharmacotherapy options have achieved approval from the United States Food and Drug Administration and their use in the treatment of PE is considered off-label. […] The role of the clinician in managing PE and DE is to conduct appropriate investigation, to provide education, and to offer available treatments that are rational and based on sound scientific data.