A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men

Abstract

BackgroundThere is an increasing interest in nonpremature ejaculatory dysfunction (non-PE EjD). The frontier of sexual medicine has shifted slowly from erectile dysfunction (ED) to premature ejaculation (PE) and now to non-PE EjD. Two factors have contributed to this shift. First is the search for new areas of research and of novel treatments and second is the better characterization of ejaculatory disorders. The development of questionnaires that better characterize the type of ejaculatory dysfunction (EjD) has helped to identify the problem with more precision in different populations.Interest in the global sexual practice patterns gave insight into the prevalence of non-PE EjD in different areas of the world. Within the non-PE EjD itself, a shift in focus occurred over the years. Early and related to prostatic surgery and retroperitoneal lymph node dissection (RPLND) retrograde ejaculation was reported. With the development of α-blockers and finasteride, retrograde ejaculation, EjD and/or orgasmic dysfunction were reported as A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men Raouf SeyamAbstract Introduction: A better understanding of ejaculatory disorders has led to an increasing interest in nonpremature ejaculatory dysfunction (non-PE EjD). Current reviews on the subject use a symptom-based classification to describe ejaculatory dysfunction even when it is a single case report. While these reviews provide important information on the disorder, a clearer picture of the prevalence of non-PE EjD in relation to the community and various pathophysiologic states is needed. Objectives: The objective of this study was to provide a systematic review of studies of non-PE EjD excluding single case reports. Methods: A systematic review of Medline for terms including ejaculation, orgasm or hematospermia. Association with terms delay, pain or headache was made. The search was restricted to male gender and articles written in English. Abstracts were reviewed and those mainly concerned with premature ejaculation were excluded. Results: A total of 333 articles on non-PE EjD were identified. The condition was reported in community-based studies. In certain patient populations, non-PE EjD was commonly reported in association with antidepressant and antipsychotic treatments, in patients with chronic prostatitis/chronic pelvic pain syndrome, patients with lower urinary tract symptoms particularly in association with medical or surgical treatment, patients with retroperitoneal surgery and in patients with neurological diseases. Few articles were concerned with treatment options. Conclusion: There is a significant prevalence of non-PE EjD in the community and in association with particular disease states or as a side effect of medical or surgical interventions. There is a need to direct efforts to prevent and treat these conditions. Keywords: anhedonia, aspermia, ejaculation, epidemiology, headache, hemospermia, orgasm, pain, prevalence adverse events. It became clear ...

The Effect of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) on Erectile Function: A Systematic Review and Meta-Analysis

“…Sexual dysfunction is thought to be more prevalent in CP/CPPS patients, and CP/CPPS is known to be closely related to premature ejaculation [ 33 ] and nonpremature ejaculatory dysfunctions such as painful ejaculation [ 34 ] in previous studies. As for the relationship between CP/CPPS and ED, there is still some controversy.…”

Contemporary management of ejaculatory dysfunction

“…Otherwise, treatment should proceed in a step-wise fashion. Discontinuation of drugs known to interfere with orgasm, as listed above, is the first step ( 41 , 115 ). Modification of therapy regimens may also be advisable.…”

The office management of ejaculatory disorders

“…Pharmacologically induced RE can be reversed through the intermittent use of a medication (which relaxes the bladder neck) or the use of a lower dose (110,111). Furthermore, ejaculation with a full bladder, which increases bladder neck closure, is a simple method for facilitating the restoration of normal ejaculation (112).…”