Revisiting Post-Ejaculation Refractory Time—What We Know and What We Do Not Know in Males and in Females

Abstract

Introduction The post-ejaculation refractory time (PERT), the period after a single ejaculation when further erections and ejaculations are inhibited, has been studied and well-documented in male rats. Since its first attribution in men by Masters and Johnson and its inaccurate delineation in their graphic sexual response model in 1966 it has been infrequently studied whereas scant attention has been paid to any such possible activity in women after female ejaculation. Aim To critically review our current knowledge about PERT in rats and humans and describe and correct shortcomings and errors in previous publications and propose corrections. Methods Review of published literature. Main Outcome Measures Identifying evidence-based data to support authority-based facts. Results The review exposes the extremely limited evidence-based data that our knowledge of PERT is based on. The paucity of data for most aspects of human PERT is remarkable; even the generally accepted statement that the duration of PERT increases with age has no published support data. Conclusions Despite numerous studies in rats the mechanisms and site(s) of the activity are poorly understood. Dopaminergic and adrenergic pathways are thought to shorten PERT whereas serotonergic pathways lengthen its duration. Raising the brain serotonin levels in men using SSRIs helps reduce early or premature ejaculation. Rats have an absolute PERT (aPERT) during which erection and ejaculation is inhibited and a relative PERT (rPERT) when a stronger or novel stimulus can, whether such phases exist in men is unexamined. Apart from possible depressed activity in the amygdala and penile dorsal nerve and rejection of prolactin as a major factor in PERT little or no significant advance in understanding human male PERT has occurred. No evidence-based data on women’s PERT after female ejaculation exists. New investigations in young and older men utilizing brain imaging and electromagnetic tomography are priority studies to accomplish.

Caenorhabditis elegans male sensory-motor neurons and dopaminergic support cells couple ejaculation and post-ejaculatory behaviors

“…In mammals, since the amount of sperm decreases in the male reproductive tract after ejaculation, the refractory period may provide an opportunity to re-establish sperm count (Judd et al, 1997; Levin, 2009; Tlachi-Lopez et al, 2012). To determine if, in C. elegans , a longer refractory period might increase the amount of sperm transferred, we counted the number of sired progeny as a proxy for successful ejaculation.…”

“…In humans, rats, and other animals, a period of disinterest and mating inability follows ejaculation in males (Beach and Holz-Tucker, 1949; Masters and Johnson, 1966; Barfield and Geyer, 1972; Oomura et al, 1983; Ureshi et al, 2002). Primarily studied in rodents, sexual disinterest and inability following mating are described in two ways: the refractory period, defined by the short term duration between consecutive ejaculations (Levin, 2009), and sexual satiation or exhaustion, a period of time following repeated copulations where the male rats require 6–14 days to regain sexual potency (Beach and Jordan, 1956). If a male rat is considered to be sexually satiated, he cannot sire progeny even if he engages in copulatory activity (Tlachi-Lopez et al, 2012; Lucio et al, 2014).…”

“…Neurotransmitters and hormones such as serotonin and prolactin may extend the period of inactivity, while others such as dopamine and norepinephrine may shorten it (McIntosh and Barfield, 1984a, 1984b, 1984c; Buvat et al, 1985; Marson and McKenna, 1992). However, the basic structure and function of mating circuits that exhibit a period of inactivity are still being elucidated (Levin, 2009; Turley and Rowland, 2013). …”

The human female orgasm: critical evaluations of proposed psychological sequelae

“…However, if orgasm provided a ''dose'' of satiety in women, with every orgasm presumably providing the same regulatory dose, several known features of female orgasm do not fit this model. Women have a capacity for multiple orgasms (Levin, 2007(Levin, , 2009. Also, partner context predicts orgasmic functioning in women.…”

Hypertension: The Link Between Erectile Dysfunction and Coronary Artery Disease

“…The first event that leads most men to recognize that their erectile function is beginning to change is the presumed increase in the refractory period that they experience as they begin to age. [27][28][29] In most men, this recognition usually occurs sometime between the third and fourth decades of life. We propose that this presumed increase in the refractory period is all part and parcel of the natural aging-related ED (ARED) that all men experience, albeit at different time periods and different rates of progression.…”