Sexological approach to ejaculatory dysfunction¹

Abstract

Ejaculatory disorders include premature, deficient (delayed ejaculation and anejaculation) and retrograde ejaculation. A rare symptom connected to ejaculatory disorders is male anorgasmia. In the past, ejaculatory disorders were considered as typical relational and psychological symptoms. For this reason, a number of behavioural and psycho-relational approaches have flourished from the first ideas of curing sexual problems with empirical therapy, focusing on the symptoms of sexual pathology. Such treatment includes assessment, behavioural and educational components, psychotherapy in the context of the relationship and sexual timetables. Recent advances in understanding the importance and frequency of ejaculatory disorders, insights into their organic and non-organic pathophysiology and the efficacy of a growing arsenal of pharmacological therapies lead to a new challenge which can be confronted only with the development of new, integrated therapeutic alternatives from a modern somato-psychic and holistic viewpoint.

Ejaculatory dysfunction and depression: pharmacological and psychobiological interactions

“…Orgasm is the cognitive experience of pleasure that coincides with ejaculation. 2,3 Sensory receptors on the glans trigger afferent nerves that pass through the penile dorsal nerve into the spinothalamic tract and to the thalamus and sensory cortex. From these central nervous system (CNS) regions, efferent nerves run through the anterolateral column of the sympathetic ganglia at T 12 -L 3 .…”

Evidence for a genetic etiology to ejaculatory dysfunction

“…12 Approximate prevalence estimates of DE in sexually active men have been reported to be 1-4%, 12,13 whereas Nathan 14 found the prevalence to be as low as 0.15% in the general male population. Rosen 12 suggested that DE may be associated with a variety of surgical or medical conditions, and in most cases, the use of antiadrenergic or neuroleptic drugs.…”

On-demand Take of Dapoxetine for the Treatment of Lifelong Premature Ejaculation: Prospective, Randomized, Placebo Controlled Study

“…Table3: intravaginal ejaculatory latency time(IELT), premature ejaculation diagnostic tools(PEDT) score ,sexual satisfaction score(SSS) of patients and sexual partners of group B during the study period * P<0.01 Discussion PE is a common type of male sexual dysfunction disease.It can be a cause of personal distress which may also affect the relationship with their partners.While many patients puzzled by PE don't seek any medical measures,if they do, psychological therapy, behavior therapy, drug therapy and surgical therapy will be used in the treatment.Previously, PE was considered to be a disease related with psychological problems [6]. Psychotherapy involve education both patients and their partners,which may improve their sexual skills and increase self-confidence and reduce anxiety during sex [7].However, the majority of studies aim to treat PE by psychotherapy didn't meet the criteria for high level evidence based studies [8].The effectiveness of behavior therapy reported was different, with poor compliance of the patient.Although their utility are limited today, they are used to treat PE combined with drugs [9].…”