Ejaculatory disorders

Abstract

Ejaculatory/orgasmic disorders are common male sexual dysfunctions, and include premature ejaculation (PE), inhibited ejaculation, anejaculation, retrograde ejaculation, and anorgasmia.Premature ejaculation management is largely dependent upon aetiology. Life-long PE is best managed with PE pharmacotherapy (selective serotonin re-uptake inhibitor [SSRI] and/or topical anaesthetics). The management of acquired PE is aetiology-specific and may include erectile dysfunction (ED) pharmacotherapy in men with co-morbid ED. Behavioural therapy is indicated when psychogenic or relationship factors are present and is often best combined with PE pharmacotherapy in an integrated treatment programme. Delayed ejaculation, anejaculation, and/or anorgasmia may have a biogenic and/or psychogenic aetiology. Men with age-related penile hypoanesthesia should be educated, reassured, and instructed in revised sexual techniques which maximize arousal. No drugs have yet been approved by regulatory agencies for this purpose, and most drugs identified for potential use have limited efficacy, impart significant side effects, or are considered experimental in nature.