Ejaculatory Dysfunction

Abstract

Over the past two decades our understanding of ejaculatory dysfunction has evolved from the initial premise that these conditions were almost exclusively due psychological factors to a new understanding. We now understand that men with lifelong premature ejaculation may have an underlying genetic predisposition to rapid ejaculation and that men with acquired premature ejaculation may have, in addition to a variety of psychorelational factors including global anxiety, sexual performance anxiety and depression, be also suffering comorbid erectile dysfunction, chronic prostatitis and a variety of less common conditions including hyperthyroidism. Interested parties have observed a paradigm shift in the way we classify, define, evaluate, diagnose and treat ejaculatory disorders. Our understanding of these disorders is not as advanced as is our understanding of other sexual dysfunctions particularly erectile dysfunction. However there is a growing awareness and an increased level of interest from clinicians, scientists and industry parties which promises future major advances in the management of these important disorders.

Testosterone Replacement in Androgen-Deficient Men With Ejaculatory Dysfunction: A Randomized Controlled Trial

“…Androgen deficiency is not the sole contributor to ejaculatory dysfunction. Ejaculation is a complicated physiological process that requires coordination between neuroanatomy and neurophysiology involving spinal and cerebral centers (33). Hence, dysfunction of any of these processes may result in ejaculatory dysfunction irrespective of serum T concentrations.…”

The pathophysiology of delayed ejaculation

“…In a recently published comprehensive review on EjDs, Phillips et al provided an excellent explanation of the physiology and pathophysiology of ejaculations, including DE, due to congenital abnormalities (33). The pathophysiology of DE in relation to congenital abnormalities is complex and is dependent upon anatomical variations of the pelvic floor and the physiological functioning of the organs located into the pelvic floor.…”

“…The urogenital sinus reabsorbs the lower end of this structure, and the ureteric orifices are thus separated from the vasa deferentia, seminal vesicles and ejaculatory ducts. If too much of the proximal vas precursor is absorbed, a variable amount of the proximal vas, seminal vesicle, and/or ejaculatory duct may be absent (33). …”

“…A local Wolffian duct abnormality involves the loss of a variable amount of the vas deferens, seminal vesicle, and/or ejaculatory duct, and sometimes part of the ipsilateral urinary system as well (33-35). Most of the patients with prune belly syndrome have abnormal ejaculations and probably abnormal emissions.…”

“…Most of the patients with prune belly syndrome have abnormal ejaculations and probably abnormal emissions. Whether the primary abnormality is retrograde ejaculation or lack of emission is not clear (33,36). …”