Gerald Hurowitz, M.D.·Published 3 April 2006·3 min read
Key points
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.
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
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
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 ActivityNo restrictions DietNo special diet except for diabetics Patient EducationSee General Measures Medications Drugs of Choice
Premature ejaculation may respond to topical anesthesia gel applied under a condom for 30 minutes prior to intercourse. Clomipramine or sertraline have been shown to delay ejaculation for 4-6 minutes.
Switching antidepressants to bupropion, nefazodone, or mirtazapine or possibly trazodone often eliminates drug-induced ejaculatory disturbance
Retarded orgasm and ejaculation in patients who must continue SSRI drugs may respond to sildenafil Contraindications: N/A Precautions: N/A Significant possible interactions: N/A Alternative Drugs: N/A Followup Patient MonitoringAs needed depending on type of therapy Prevention/AvoidanceBetter sexuality education may reduce problems Possible ComplicationsPsychological impact on some males - signs of severe inadequacy, self-doubt, additional anxiety and guilt Expected Course/PrognosisOften improves with therapy and counseling Miscellaneous Associated Conditions
Neurological disorders, e.g., multiple sclerosis
Prostatitis
Psychological disorders
Interpersonal disorders Age-Realted FactorsPediatric: N/A Geriatric: Age alone does not cause ejaculation problems Others: N/A Pregnancy: N/A Synonyms
Premature ejaculation
Retarded ejaculation
Retrograde ejaculation
Inhibited orgasm in males ICD-9-CM608.89 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
Biological Treatments for Paraphilias and Paraphilia-Related Disorders
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