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Ejaculatory Dysfunction

Ejaculatory Dysfunction

Ejaculation is a reflex mediated by the spinal cord, which coordinates autonomic and motor outflow, integrating these with the excitatory and inhibitory effects from descending cerebral pathways. The normal male ejaculatory response comprises two phases: emission and expulsion, which are under autonomic and somatic control, respectively. During emission, smooth muscles of the vas deferens, the seminal vesicles and the prostate, as well as their secretions, are involved. At the end, the mixture of spermatozoa from the epididymis and the vas deferens, together with the secretions of the seminal vesicles, represents about 50% of the ejaculate; and the prostate, which secretes nearly the other half of the semen, is made available in the prostatic (posterior) urethra. Orgasm is caused when friction on the glans penis and other stimuli send signals to the brain and spinal cord. Orgasm generally accompanies the expulsion phase, which occurs once an ejaculatory 'point of no return' has been reached. Nerves stimulate muscle contractions along the seminal vesicles, prostate, and the ducts of the epididymis and vas deferens. These contractions force semen into the urethra. Contraction of the muscles around the urethra further propels the semen through and out of the penis. The neck (base) of the bladder also constricts to keep semen from flowing backward into the bladder.

Ejaculation and Ejaculatory Dysfunction

  • Causes
  • Types and Symptoms

    There are several ways in which the ejaculatory process can become dysfunctional, leading to a partial or complete loss of ejaculation. These may be of either psychogenic or organic origin, and several drugs are also implicated.

    Types of ejaculatory disorders and their possible causes:

    Never any ejaculate: Congenital structural disorder or acquired (radical prostatectomy, post-infectious state, posttraumatic, spinal cord neuropathy)

    Retrograde ejaculation: Transurethral resection of the prostate (25%). Surgery on the neck of the bladder, or extensive pelvic surgery. Retroperitoneal lymph node dissection for testicular cancer (also may produce failure of emission). Neurologic disorders (e.g., multiple sclerosis) and some drugs.

    Retarded ejaculation: Rarely may be caused by an underlying painful disorder (e.g., prostatitis, seminal vesiculitis). May be psychogenic as part of erectile dysfunction. Sympathectomy (e.g., spinal cord injury). Some drugs may impair ejaculation (e.g., certain analgesics, antidepressants, NSAIDs, opiates, alcohol).

    Premature ejaculation: Sexual inexperience. High level of sexual arousal and/or long interval since last ejaculation.Anxiety, guilty feelings about sex, or interpersonal maladaptation (e.g., marital problems, unresponsiveness of partner).Lack of privacy.

    Ejaculatory dysfunction is one of the most common male sexual disorders, yet it is still frequently misdiagnosed or overlooked as a result of numerous patient and physician barriers. The wide spectrum ranges from premature or rapid ejaculation, through delayed ejaculation, to a complete inability to ejaculate—otherwise known as anejaculation— and includes retrograde ejaculation and painful ejaculation.

    Premature ejaculation (PE)

    Also known as rapid ejaculation, it is the condition whereby a patient ejaculates with minimal sexual stimulation and before he wishes it to occur. It can be life-long (primary) or secondary (acquired). This is believed to be the most common sexual dysfunction in males with almost 30% of men of all ages suffering from this condition. It could be inferred that PE and ED share a vicious cycle, in which a man trying to control his ejaculation instinctively reduces his level of excitation (which can lead to ED), and a man trying to achieve an erection attempts to increase his excitation (which can lead to PE).

    Delayed ejaculation and anejaculation

    Also known as retarded orgasm, it is a very difficult sexual disorder to treat. This condition involves the inability of the patient to achieve orgasm (ejaculation) in a timely manner and in severe cases men fail to achieve orgasm on any occasion (anejaculation). Given that most sexually functional men ejaculate within about 3–8 min following intromission, men with latencies beyond 20–30 min and consequent distress or men who simply cease sexual activity due to exhaustion or irritation qualify for a diagnosis of delayed ejaculation.

    Retrogade ejaculation (RE)

    It is the process whereby the semen is passed in a retrograde fashion into the bladder as opposed to out the urethra. Patients are orgasmic with anejaculation, as there is failure of the bladder neck to close during ejaculation. RE can be congenital or more commonly acquired after prostate or bladder surgery.

    Painful ejaculation

    Painful ejaculation is when painful, burning sensations are felt during or following ejaculation. Pain can be felt in the perineum (the area between the anus and the genitals) and the urethra (a tube that runs from the bladder to the end of the penis). This is an uncommon problem that may have psychological or organic causes, e.g. acute or chronic prostatitis (inflammation of the prostate gland), and urethritis (inflammation of the urethra), an infection that may inflame the area around the penis, blockages in the ejaculatory duct, or nerve damage to the penis. The condition can cause discomfort in the testes and interfere with sexual pleasure.

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