Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

Abstract

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. It is often quite concerning to patients and their partners, and sometimes frustrates couples' attempts to conceive. This article aims to review the pathophysiology of DE and anejaculation (AE), to explore our current understanding of the diagnosis, and to present the treatment options for this condition. Electronic databases were searched from 1966 to October 2017, including PubMed (MEDLINE) and Embase. We combined “delayed ejaculation,” “retarded ejaculation,” “inhibited ejaculation,” or “anejaculation” as Medical Subject Headings (MeSH) terms or keywords with “epidemiology,” “etiology,” “pathophysiology,” “clinical assessment,” “diagnosis,” or “treatment.” Relevant sexual medicine textbooks were searched as well. 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. There is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. Treatment should be cause-specific. There are many approaches to treatment planning, including various psychological interventions, pharmacotherapy, and specific treatments for infertile men. An approved form of drug therapy does not exist. A number of approaches can be employed for infertile men, including the collection of nocturnal emissions, prostatic massage, prostatic urethra catheterization, penile vibratory stimulation, probe electroejaculation, sperm retrieval by aspiration from either the vas deferens or the epididymis, and testicular sperm extraction.

The Potential Associations of Pornography Use with Sexual Dysfunctions: An Integrative Literature Review of Observational Studies

“…Delayed ejaculation describes a sexual dysfunction occurring in men, manifested by prolonged time required to ejaculate or complete inability to achieve it. Due to the complexity of psychosexual and psychosocial factors that contribute to its pathogenesis, there are no universal methods of treatment [35]. Its potential causes include, among many, frequent masturbation and the occurrence of significant discrepancies between real sexual intercourse with a partner and sexual fantasy preferred during masturbation [35,36].…”

“…Due to the complexity of psychosexual and psychosocial factors that contribute to its pathogenesis, there are no universal methods of treatment [35]. Its potential causes include, among many, frequent masturbation and the occurrence of significant discrepancies between real sexual intercourse with a partner and sexual fantasy preferred during masturbation [35,36]. Both masturbation and sexual fantasy are often associated with pornography use thus its potential relationship with the onset of delayed ejaculation is hypothetically plausible.…”

Male Ejaculatory Endophenotypes: Revealing Internal Inconsistencies of the Concept in Heterosexual Copulating Rats

“…These claims come across in spite of the long-held recognition that, with regard to sexual traits, intrasexual variability is as large as intersexual variability ( Whalen, 1991 ), that the origin of brain sexual differences within and across sexual populations is multifaceted ( McCarthy et al, 2018 ) and that there might be a continuum of sexual traits ( Epstein et al, 2012 ; Walton et al, 2016 ) that could explain sexual fluidity ( Diamond, 2016 ; Diamond et al, 2017 ; Luoto et al, 2019 ) within and across the sexes. In addition, ejaculatory endophenotypes, as it is the case for other endophenotypes (e.g., Gottesman and Gould, 2003 ; Burmeister et al, 2008 ; Iacono et al, 2014 ; Jonas and Markon, 2014 ; for critical reviews see Flint and Munafò, 2007 ; Walters and Owen, 2007 ), are even alleged to be genetically determined ( Pattij et al, 2005 ; Waldinger and Olivier, 2005 ; Olivier et al, 2006 ; Santtila et al, 2010 ; Abdel-Hamid and Ali, 2018 ; Olivier and Olivier, 2019 ), and therefore they must be the heritable, state-independent, and largely immune to social context and sexual experience once the ejaculatory pattern has been established. In addition, ejaculatory endophenotypes might also be associated to characteristic brains ( Ozcan et al, 2001 ; Waldinger and Schweitzer, 2005 ; Hyun et al, 2008 ; Chen, 2016 ; Zhang et al, 2017 ; Yang et al, 2018 ).…”

Which of available selective serotonin reuptake inhibitors (SSRIs) is more effective in treatment of premature ejaculation? A randomized clinical trial

“…The most common type of sexual dysfunction in men is premature ejaculation (PE) ( 1 ). PE, such as delayed ejaculation is concerning to patients and their partners ( 2 ). No standard time is defined for ejaculation.…”

“…Depending on the satisfaction of couples in sexual relationship, the ejaculation time varies from couple to couple ( 3 ). On the basis of the report of the second International Society for Sexual Medicine meeting (ISSM) for the definition of PE: ( 1 ) lifelong PE is defined as ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience; and acquired PE is a clinically significant and bothersome decrement in latency time, often to about 3 minutes or less; ( 2 ) in all or nearly all vaginal penetrations, the patients have no ability to delay ejaculation; and ( 3 ), leading to distress, bother, disappointment, behavioral disorders or the avoidance of confidence sexual relationship and other negative personal consequences. Men with acquired PE are older, have cardiovascular disorders, comorbid diseases and erectile dysfunction ( 4 , 5 ).…”