Background:
Sexual dysfunction can include issues that go beyond erection, and these include premature ejaculation, delayed ejaculation, anejaculation, sex drive (libido) issues, retrograde ejaculation, or orgasmic dysfunction.
Premature ejaculation (PE) is a common male sexual complaint with prevalence rates ranging between 3 and 30% of men. PE may be acquired or lifelong, and includes ejaculation which occurs prior to 1 minute (or up to 3 minutes depending on guideline definition) of vaginal penetration. This occurs on all or nearly all occasions of vaginal penetration, leading to distress and frustration. Questionnaires such as the Premature Ejaculation Diagnostic Tool (PEDT) can be used online to calculate severity of premature ejaculation. The management of acquired PE depends on the cause, while lifelong PE is usually best managed with SSRI medication (such as paroxetine or dapoxetine) or topical anesthetic.
Delayed ejaculation (DE) as the persistent or recurrent difficulty in, or absence of, orgasm after a normal sexual excitement phase during sexual activity which causes personal distress. There are no exact cutoff times, but the typical sexually functional male ejaculates 4-10 minutes following intromission. Therefore, the time to ejaculate beyond 25 or 30 minutes associated with significant distress or exhaustion/irritation qualifies for this diagnosis. Causes include congenital disorders (Mullerian or Wolffian duct abnormalities of vas, ejaculatory duct, or seminal vesicle function) as well as trauma (prostate surgery or spinal cord injury), infection, disease, neuropathy (multiple sclerosis or diabetes for example), psychological (anxiety), and medication side effects (SSRI antidepressants). There can be significant patient concern associated with each of these conditions.
Retrograde ejaculation (RE) involves failure of the bladder neck to close during ejaculation with resultant semen reflux in to the bladder, with consequent low-volume ejaculate and low or absent sperm count with subsequent infertility. This condition may result from congenital issue, trauma to the spine, retroperitoneal lymph node dissection (RPLND), diabetes, bladder neck surgery. Treatment goals are to restore ejaculation in the normal direction either medically (by increasing bladder neck tone with sympathomimetic medication and/or anticholinergic medication). Alternatively, viable spermatozoa may be obtained from post-ejaculatory urine specimen and these may be used for IVF/ICSI.
Treatment of Sexual Dysfunction:
Each of these clinical issues has various treatment options available which can be discussed in more detail following an in-depth consultation with history and physical examination. Treatment may include integrated care with pharmacotherapy and/or psychosexual therapy.
We are pleased to further discuss sexual dysfunction concerns; please contact the Center for additional information or to schedule a consultation.
- Sexual dysfunction includes a wide variety of symptoms including ejaculation and orgasm abnormalities.
- There are many factors affecting ejaculation including state of mind, neurologic, and pelvic surgical history.
