The pathophysiology of delayed ejaculation

Abstract

Delayed ejaculation (DE) is probably least studied, and least understood of male sexual dysfunctions, with an estimated prevalence of 1–4% of the male population. Pathophysiology of DE is multifactorial and including psychosexual-behavioral and cultural factors, disruption of ejaculatory apparatus, central and peripheral neurotransmitters, hormonal or neurochemical ejaculatory control and psychosocial factors. Although knowledge of the physiology of the DE has increased in the last two decade, our understanding of the different pathophysiological process of the causes of DE remains limited. To provide a systematic update on the pathophysiology of DE. A systematic review of Medline and PubMed for relevant publications on ejaculatory dysfunction (EjD), DE, retarded ejaculation, inhibited ejaculation, and climax was performed. The search was limited to the articles published between the January 1960 and December 2015 in English. Of 178 articles, 105 were selected for this review. Only those publications relevant to the pathophysiology, epidemiology and prevalence of DE were included. The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE. Despite the many publications on this disorder, there still is a paucity of publications dedicated to the subject.

Regular penis-root masturbation, a novel behavioral therapy in the treatment of primary premature ejaculation

“…reported that patients with primary DE have penile shaft rather than glans hyposensitivity, though it is not stated if the patients have unusual masturbation. Through unusual masturbation, patients with DE may develop the autosexual patterns that produce different types of orgasm from what they experience with a partner 15…”

Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

“…Erectile dysfunction, PE, and painful ejaculation are the leading sexual symptoms of urogenital infections. However, there is no definitive evidence of the actual frequency of DE/AE in patients with urogenital infections or of the true pathophysiological role of these inflammatory disorders in ejaculatory delay [ 75 ]. Urogenital infections can produce scarring and obstruction anywhere in the male reproductive tract.…”

Contemporary management of ejaculatory dysfunction

“…DE, anejaculation, and anorgasmia are among the least common and least understood male sexual health dysfunctions. The estimated prevalence of DE is 1–4% of the male population ( 99 ). These disorders are thought of as related entities on one end of a spectrum, with PE on the other end of the spectrum ( 100 ).…”

“…Anatomically, damage to pelvic nerves (following prostatectomy, RPLND, TURP, bladder neck incision, or other colorectal or pelvic surgery), and spinal cord injuries may also cause DE ( 17 , 99 , 100 , 105 , 113 , 114 ).…”