Ejaculatory Disorders Disease

BASICS

DESCRIPTION

Premature ejaculation: Inability to constantly control the ejaculatory reflex is a common sexual disorder affecting all age groups. Definition criteria vary, e.g., inability to maintain an erection of sufficient duration to satisfy a partner, or ejaculation that occurs before individual wants it to. Natural biological response is to ejaculate within 2 minutes after vaginal penetration. Ejaculatory control is an acquired behavior that increases with experience.

Retarded ejaculation: A condition in which erection is normal, or prolonged, but ejaculation does not occur
Retrograde ejaculation: The valve at the base of the bladder fails to close during ejaculation and the ejaculate is forced backward into the bladder. Erection and sexual pleasure are usually not diminished.
System(s) affected: Reproductive, Nervous
Genetics: No known genetic pattern
Incidence/Prevalence in USA: Premature ejaculation is common (particularly in the adolescent)
Predominant age: All age groups
Predominant sex: Male only

SIGNS AND SYMPTOMS

Ejaculation occurring before individual wishes
Ejaculation does not occur following normal erection (including masturbation)

CAUSES

Never any ejaculate (Anejaculation)
- Congenital structural disorder (Müllerian duct cyst, Wolffian abnormality)
- Acquired (radical prostatectomy, postinfectious, post-traumatic, T10-12 neuropathy)
Retrograde ejaculation
- TURP (Transurethral Resection of the Prostate) (25%)
- Surgery on the neck of the bladder
- Extensive pelvic surgery
- Retroperitoneal lymph node dissection for testicular cancer (also can produce failure of emission)
- Neurologic disorders, e.g., multiple sclerosis
- Drugs, e.g., amoxapine, desipramine, imipramine
Retarded ejaculation
- Rarely may be due to underlying painful disorder, e.g., prostatitis, seminal vesiculitis
- May be psychogenic as part of erectile dysfunction
- Sympathectomy, e.g., spinal cord injury, diabetes mellitus
- Some drugs may impair ejaculation, e.g., certain MAO inhibitors, SSRIs, alpha-blockers, antipsychotics, tricyclic antidepressants
Premature ejaculation
- Sexual inexperience
- High level of sexual arousal
- Fear of sexually transmitted disease
- Anxiety
- Guilty feelings about sex
- Interpersonal maladaptation (marital problems, unresponsiveness of mate)
- Lack of privacy

RISK FACTORS

Listed with Causes

DIAGNOSIS

LABORATORY

Laboratory test results are usually normal
Post-ejaculate urinalysis will confirm retrograde ejaculation when infertility is a concern

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

Look for diabetes, multiple sclerosis, spinal cord injury

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Detailed sexual history

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Identification of any medical cause (even if not reversible) helps patient accept condition
Improve partner communication
Reduce performance pressure through reassurance
Use sensate focus therapy
Techniques to learn ejaculatory control, e.g., coronal squeeze technique or start-and-stop technique
Use of a variety of resources may be necessary, e.g., psychiatrists, psychologists, sex therapists, vascular surgeons, urologists, endocrinologists, neurologists
If drugs are a possible cause, consider discontinuing or changing dosage
Retrograde ejaculation may be helped if intercourse occurs when bladder is full

SURGICAL MEASURES

N/A

ACTIVITY

No restriction

DIET

No special diet except for diabetics

PATIENT EDUCATION

See General Measures

FOLLOW UP

PREVENTION/AVOIDANCE

Better sexuality education may reduce problems

POSSIBLE COMPLICATIONS

Psychological impact on some males - signs of severe inadequacy, self-doubt, additional anxiety and guilt

EXPECTED COURSE AND PROGNOSIS

Often improves with therapy and counseling

MISCELLANEOUS

ASSOCIATED CONDITIONS

Neurological disorders, e.g., multiple sclerosis
Prostatitis
Psychological disorders
Interpersonal disorders

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: Age alone does not cause ejaculation problems
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.