Ejaculatory disorders

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

Causes

• Never any ejaculate
  
  • Congenital structural disorder (Mullerian duct cyst, Wolffian abnormality)
    
  • Acquired (radical prostatectomy, postinfectious, post-traumatic, T10-12 neuropathy)
• Retrograde ejaculation
  
  • TURP (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, eg, multiple sclerosis
    
  • Drugs, eg, amoxapine, desipramine, imipramine
• Retarded ejaculation
  
  • Rarely may be due to underlying painful disorder, eg, prostatitis, seminal vesiculitis
    
  • May be psychogenic as part of erectile dysfunction
    
  • Sympathectomy, eg, spinal cord injury, diabetes mellitus
    
  • Some drugs may impair ejaculation, eg, 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

Differential Diagnosis: N/A

Laboratory

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

Surgical Measures: N/A

Activity
No restrictions

Diet
No special diet except for diabetics

Patient Education
See General Measures

Medications

Drugs of Choice

Contraindications: N/A

Precautions: N/A

Significant possible interactions: N/A

Alternative Drugs: N/A

Followup

Patient Monitoring
As needed depending on type of therapy

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/Prognosis
Often improves with therapy and counseling

Miscellaneous

Associated Conditions

Age-Realted Factors

Pediatric: N/A

Geriatric: Age alone does not cause ejaculation problems

Others: N/A

Pregnancy: N/A

Synonyms

ICD-9-CM
608.89 Other specified disorders of male genital organs, other
306.59 Physiological malfunction arising from mental factors, genitourinary, other
302.75 Psychosexual dysfunction with premature ejaculation

See Also: N/A

Other Notes: N/A

Abbreviations: N/A

Author(s)
Bruce Block, MD

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