Signs, Symptoms, and Causes of Ejaculation Disorder
Although erectile dysfunction has become the most well-known aspect of male sexual dysfunction lately, the most prevalent male sexual disorders continue to be ejaculatory dysfunctions according to NCBI. Ejaculatory/orgasmic disorders are extremely common male sexual dysfunctions that appear to afflict men of all ages.
Ejaculatory disorders are divided into four categories:
- Premature Ejaculation– PE is defined as ejaculation that occurs due to a lack of ejaculatory control interfering with sexual and/or emotional well-being in self, in partner, or in both.
- Delayed Ejaculation– DE is characterized by a man’s inability to ejaculate within a certain amount of time while experiencing normal sexual stimulation.
- Retrograde Ejaculation-RE transpires when the semen that would normally be expelled from the penis is instead directed backwards into the bladder. This is usually an indication of essential malfunctioning of the internal sphincter in the bladder.
- Anejaculation/Anorgasmia– AE and Anorgasmia are often used synonymously, which is incorrect. AE refers specifically to the absence of physical ejaculation which may or may not be triggered by an orgasm. Anorgasmia is simply the lack of orgasm whether ejaculation happens or not.
Disorders of ejaculation and other similar conditions can be caused by psychological distress.
The management of premature ejaculation is largely dependent upon etiology. Lifelong PE is usually managed with PE pharmacotherapy such as selective serotonin re-uptake inhibitor [SSRI] or a topical anesthetic. PE management is aimed specifically toward the cause of the PE and may include erectile dysfunction (ED) pharmacotherapy if comorbid ED is found to be an issue as well. Psychogenic or relationship influences may indicate a need for behavioral therapy. Retrograde ejaculation is often managed with a combination of education, reassurance, pharmacotherapy, and sometimes bladder neck reconstruction. According to the NCBI, delayed ejaculation, anejaculation, and/or anorgasmia may be rooted biogenically and/or psychogenically. Recommendations are for men with age-related penile hypoanesthesia to be educated further on the condition, reassured, and instructed in revised sexual techniques which maximize arousal.
Even though pharmacologic treatment for certain ejaculatory disorders exists, the other ejaculatory disorders are less studied and not as well understood. Because orgasm can be perceived as physical (most commonly occurring at the time of ejaculation), psychological, emotional, or any combination of these, the physiology of the ejaculatory reflex is complex. This complexity makes classification of the role of individual causes for abnormalities extremely difficult. However, recent research has illuminated more concerning the role of serotonin and dopamine in regard to the central level of physiology for arousal as well as orgasm. Other recent studies have served up proof of the role of ejaculation and orgasm and understanding the interaction between what causes them. The probability of developing pharmaceutical agents that are effective in treating such issues becomes a more distinct possibility as further understanding of regulation of the process of ejaculation increases.
