Comprehensive review of the anatomy and physiology of male ejaculation: Premature ejaculation is not a disease

Abstract

Human semen contains spermatozoa secreted by the testes and a mixture of components produced by the bulbo-urethral and Littre (paraurethral) glands, prostate, seminal vesicles, ampulla, and epididymis. Ejaculation is used as a synonym for the external ejection of semen, but it comprises two phases: emission and expulsion. As semen collects in the prostatic urethra, the rapid preorgasmic distension of the urethral bulb is pathognomonic of impeding orgasm, and the man experiences a sensation that ejaculation is inevitable (in women, emission is the only phase of orgasm). The semen is propelled along the penile urethra mainly by the bulbocavernosus muscle. With Kegel exercises, it is possible to train the perineal muscles. Immediately after the expulsion phase the male enters a refractory period, a recovery time during which further orgasm or ejaculation is physiologically impossible. Age affects the recovery time: as a man grows older, the refractory period increases. Sexual medicine experts consider premature ejaculation only in the case of vaginal intercourse, but vaginal orgasm has no scientific basis, so the duration of intercourse is not important for a woman's orgasm. The key to female orgasm are the female erectile organs; vaginal orgasm, G-spot, G-spot amplification, clitoral bulbs, clitoris-urethra-vaginal complex, internal clitoris and female ejaculation are terms without scientific basis. Female sexual dysfunctions are popular because they are based on something that does not exist, i.e. the vaginal orgasm. The physiology of ejaculation and orgasm is not impaired in premature ejaculation: it is not a disease, and non-coital sexual acts after male ejaculation can be used to produce orgasm in women. Teenagers and men can understand their sexual responses by masturbation and learn ejaculatory control with the stop-start method and the squeeze technique. Premature ejaculation must not be classified as a male sexual dysfunction. It has become the center of a multimillion dollar business: is premature ejaculation-and female sexual dysfunction-an illness constructed by sexual medicine experts under the influence of drug companies?

Longitudinal muscular column in the prostatic urethral wall: Its form, shape, and possible function based on mathematical simulation in ejaculation

“…Seminal emission contributes to the sensory stimuli that trigger ejaculation in intact males 4 . Due to the combination of bladder neck coaptation and compression of the urethra distally by the external sphincter, the inflow of seminal fluid is compartmentalized within a high‐pressure zone now created in the PSU (termed a “high‐pressure ejaculatory area”) 1–8,10,32 . Distention of the posterior urethra by the seminal fluid bolus stimulates a reflex arc that triggers expulsion 7 .…”

“…Recent findings related to the pathophysiology of ejaculation have expanded our knowledge of male sexual function and have allowed the development of new instruments to investigate ejaculatory disorders 1–8,10,43,44 . Clinically, ejaculatory dysfunction of varying degrees from retrograde ejaculation (RE) to anejaculation (AE), is one of the most common male sexual disorders 4,6–8 .…”

“…Ejaculation is integral to normal sexual function, and involves two successive phases: emission and expulsion 1–8 . For the efficient expulsion of sperm from the urethral meatus, coordination of an intricate sequence of neurophysiological events and contraction of numerous smooth and striated muscle groups are required, as well as the absence of anatomical obstruction 1–8 . Specific muscles are involved in each phase of ejaculation 1–8 .…”

“…For the efficient expulsion of sperm from the urethral meatus, coordination of an intricate sequence of neurophysiological events and contraction of numerous smooth and striated muscle groups are required, as well as the absence of anatomical obstruction 1–8 . Specific muscles are involved in each phase of ejaculation 1–8 . In the emission phase, seminal fluid is secreted into the prostatic urethra (PSU) by sequential epithelial secretion and smooth muscle contractions in the epididymis, ductus deferens, seminal vesicles (SVs), prostate, ejaculatory ducts (EDs), and there is simultaneous closure of the bladder neck and the external urethral sphincter and contraction of the periurethral musculature 1–8 …”

“…Specific muscles are involved in each phase of ejaculation 1–8 . In the emission phase, seminal fluid is secreted into the prostatic urethra (PSU) by sequential epithelial secretion and smooth muscle contractions in the epididymis, ductus deferens, seminal vesicles (SVs), prostate, ejaculatory ducts (EDs), and there is simultaneous closure of the bladder neck and the external urethral sphincter and contraction of the periurethral musculature 1–8 …”