Skip to main content

Advertisement

SpringerLink
Log in

Ejaculatory disorders: epidemiology and current approaches to definition, classification and subtyping

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Ejaculatory disorders (disorders of emission, ejaculation and orgasm) are the most frequent sexual complaint. Conventional algorithms on ejaculatory disorders are based on an organic or psychogenic dichotomy, with the latter being traditionally considered the main etiological cause. The scope of this review is to propose a new classification of ejaculatory disorders, with special emphasis on epidemiology and subtyping of the most frequent: premature ejaculation (PE). There is growing agreement on definition, diagnosis, and treatment options. In many cases, ejaculatory disorders can be classified by psycho-neuro-uro-endocrine symptoms. Epidemiological data, new classifications and subtyping, together with new diagnostic procedures and the availability of pharmacological aids, place this topic in the mainframe of sexual medicine. This will soon demolish the barriers to seeking help perceived by patients suffering ejaculatory disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Waldinger MD (2002) The neurobiological approach to premature ejaculation. J Urol 168:2359–2367

    Article  PubMed  Google Scholar 

  2. Grenier G, Byers ES (1995) Rapid ejaculation: a review of conceptual, etiological, and treatment issues. Arch Sex Behav 24:447–472

    Article  CAS  PubMed  Google Scholar 

  3. Newman HF, Reiss H, Northrup JD (1991) Physical basis of emission, ejaculation, and orgasm in the male. Urology 19:341–350

    Article  Google Scholar 

  4. Jannini EA, Simonelli C, Lenzi A (2002) Disorders of ejaculation. J Endocrinol Invest 25:1006–1019

    CAS  PubMed  Google Scholar 

  5. Buffum J (1992) Prescription drugs and sexual function. Psychiatr Med 10:181–198

    CAS  PubMed  Google Scholar 

  6. Newman H, Reiss H, Northup J (1982) Physical basis of emission, ejaculation, and orgasm in the male. Urology 4:341–350

    Article  Google Scholar 

  7. Lee SS, Sun GH, Yu DS, Chen HI, Chang SY (2000) Giant hydronephrosis of a duplex system associated with ureteral ectopia: a cause of retrograde ejaculation. Arch Androl 45:19–23

    Article  CAS  PubMed  Google Scholar 

  8. Thomas AJ (1983) Ejaculatory dysfunction. Fertil Steril 39:445–454

    PubMed  Google Scholar 

  9. Yavetz H, Yogev L, Hauser R, Lessing JB, Paz G, Homonnai ZT (1994) Retrograde ejaculation. Hum Reprod 9:381–386

    CAS  PubMed  Google Scholar 

  10. Sandler B (1979) Idiopathic retrograde ejaculation. Fertil Steril 32:474–575

    CAS  PubMed  Google Scholar 

  11. Dunsmuir WD, Holmes SAV (1996) The aetiology and management of erectile, ejaculatory, and fertility problems in men with diabetes mellitus. Diabetic Med 13:700–708

    Article  CAS  PubMed  Google Scholar 

  12. Malone PR, Cook A, Edmonson R, Gill MW, Shearer RJ (1988) Prostatectomy: patients’ perception and long-term follow-up. Br J Urol 61:234–238

    CAS  PubMed  Google Scholar 

  13. Jeffries JJ, Vanderhaeghe L, Remington GJ, Al-Jeshi A (1996) Clozapine-associated retrograde ejaculation. Can J Psychiatry 41:62–63

    CAS  PubMed  Google Scholar 

  14. Shiloh R, Weizman A, Weizer N, Dorfman-Etrog P, Munitz H (2001) Risperidone-induced retrograde ejaculation. Am J Psychiatry 158:650

    Article  CAS  Google Scholar 

  15. Foreman MM, Hall JL, Love RL (1989) The role of the 5-HT2 receptor in the regulation of sexual performance of male rats. Life Sci 45:1263–1270

    Article  CAS  PubMed  Google Scholar 

  16. Marson L, McKenna KE (1994) Serotoninergic neurotoxic lesions facilitate male sexual reflexes. Pharmacol Biochem Behav 47:883–888

    Article  CAS  PubMed  Google Scholar 

  17. Waldinger MD, Zwinderman AH, Schweitzer DH, Olivier B (2004) Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis. Int J Impot Res 16:369–381

    Article  CAS  PubMed  Google Scholar 

  18. Kinsey AC, Pomeroy WB, Martin CE (1948) Sexual behavior in the human male. WB Saunders, Philadelphia

  19. Rowland DL, Cooper SE, Schneider M (2001) Defining premature ejaculation for experimental and clinical investigations. Arch Sex Behav 30:235–253

    Article  CAS  PubMed  Google Scholar 

  20. Cooper A, Magnus R (1984) A clinical trial of the beta blocker propranolol in premature ejaculation. J Psychosom Res 28:331–336

    Article  CAS  PubMed  Google Scholar 

  21. Spiess WF, Geer JH, O’Donohue WT (1984) Premature ejaculation: investigation of factors in ejaculatory latency. J Abn Psychol 93:242–245

    Article  CAS  Google Scholar 

  22. Strassberg DS, Mahoney JM, Schaugaard M, Hale VE (1990) The role of anxiety in premature ejaculation: a psychophysiological model. Arch Sex Behav 19:251–258

    Article  CAS  PubMed  Google Scholar 

  23. Shover LR, Friedman JM, Weiler SJ, Heiman JR, Lo Piccolo J (1982) Multiaxial problem-oriented system for sexual dysfunction. Arch Gen Psych 39:614–619

    Google Scholar 

  24. Colpi GM, Fanciullacci F, Beretta G, Negri L, Zanollo A (1986) Evoked sacral potentials in subjects with true premature ejaculation. Andrologia 18:583–586

    CAS  PubMed  Google Scholar 

  25. Masters WH, Johnson VE (1970) Human sexual inadequacy. Little, Brown, Boston

  26. Kaplan HS (1974) The new sex therapy: active treatment of sexual dysfunction. Brunner/Mazel, New York

    Google Scholar 

  27. Vandereycken W (1986) Towards a better delineation of ejaculatory disorders. Acta Psychiatr Belg 86:57–63

    CAS  PubMed  Google Scholar 

  28. Montague DK, Jarow J, Boderick GA, Dmochowski RR, Heaton JP, Lue TF, Nehra A, Sharlip ID (2004) AUA guidelines on the pharmacologic management of premature ejaculation. J Urol 172:290–294

    Article  PubMed  Google Scholar 

  29. American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd edn. APA, Washington

  30. Waldinger MD, Hengeveld MW, Zwinderman AH (1994) Paroxetine treatment of premature ejaculation: a double-blind, randomized, placebo-controlled study. Am J Psychiatry 151:1377–1379

    CAS  PubMed  Google Scholar 

  31. Waldinger MD (2003) Towards evidence-based drug treatment research on premature ejaculation: a critical evaluation of methodology. Int J Impot Res 15:309–313

    Article  CAS  PubMed  Google Scholar 

  32. Frank E, Anderson C, Rubinstein D (1978) Frequency of sexual dysfunction in “normal” couples. N Engl J Med 299:111–115

    CAS  PubMed  Google Scholar 

  33. Schein M, Zyzanski SJ, Levine S, Medalie JH, Dickman RL, Alemagno SA (1988) The frequency of sexual problems among family practice patients. Fam Pract Res J 7:122–134

    CAS  PubMed  Google Scholar 

  34. Nazareth I, Boynton P, King M (2003) Problems with sexual function in people attending London general practitioners: cross sectional study. Br Med J 327:1–6

    Google Scholar 

  35. Aschka C, Himmel W, Ittner E, Kochen MM (2001) Sexual problems of male patients in family practice. J Fam Pract 50:773–778

    CAS  PubMed  Google Scholar 

  36. Laumann EO, Paik A, Rosen RC (1999) Sexual dysfunction in the United States: prevalence and predictors. JAMA 281:537–544

    Article  CAS  PubMed  Google Scholar 

  37. Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, Wang T, GSSAB Investigators’ Group (2005) Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res 17:39–57

    Article  CAS  PubMed  Google Scholar 

  38. Corona G, Petrone L, Mannucci E, Jannini EA, Mansani R, Magini A, Giommi R, Forti G, Maggi M (2004) Psyco-biological correlates of rapid ejaculation in patients attending to an andrologic unit for sexual dysfunctions. Eur Urol 46:615–622

    Article  CAS  PubMed  Google Scholar 

  39. Laumann EO, Nicolosi A, Glasser DB, Paik A, Buvat J, Gingell C, Moreira E, Hartmann U, Brock G, Wang T (2003) Prevalence of sexual problems among men and women aged 40 to 80 years: results of an international survey. Proceedings of the 2nd International Consultation on Erectile and Sexual Dysfunctions, 28 June– 1 July 2003, Paris

    Google Scholar 

  40. Spiess WF, Geer JH, O’Donohue WT (1984) Premature ejaculation: investigation of factors in ejaculatory latency. J Abnorm Psychol 93:242–245

    Article  CAS  PubMed  Google Scholar 

  41. Strassberg DS, Kelly MP, Carroll C, Kircher JC (1987) The psychophysiological nature of premature ejaculation. Arch Sex Behav 16:327–336

    Article  CAS  PubMed  Google Scholar 

  42. Waldinger MD, Hengeveld MW, Zwinderman AH, Olivier B (1998) An empirical operationalization study of DSM-IV diagnostic criteria for premature ejaculatio. Int J Psychiatry Clin Pract 2:287–293

    Google Scholar 

  43. Xin ZC, Chung WS, Choi YD, Seong DH, Choi YJ, Choi HK (1996) Penile sensitivity in patients with primary premature ejaculation. J Urol 156:979–981

    Article  CAS  PubMed  Google Scholar 

  44. Cold CJ, Van Howe RS (1998) Somatosensory evoked potentials in patients with primary premature ejaculation. J Urol 159:2103–2104

    Article  CAS  Google Scholar 

  45. Ozcan C, Ozbek E, Soylu A, Yilmaz U, Guzelipek M, Balbay M (2001) Auditory event-related potentials in patients with premature ejaculation. Urology 58:1025–1029

    Article  CAS  PubMed  Google Scholar 

  46. Boneff AN (1972) Topical treatment of chronic prostatitis and premature ejaculation. Int Urol Nephrol 4:183–186

    CAS  PubMed  Google Scholar 

  47. Screponi E, Carosa E, Di Stasi E, Pepe M, Carruba G, Jannini EA (2001) Prevalence of chronic prostatitis in men with premature ejaculation. Urology 58:198–202

    Article  CAS  PubMed  Google Scholar 

  48. Brown AJ (2000) Ciprofloxacin as cure of premature ejaculation. J Sex Marital Ther 26:351–352

    Article  CAS  PubMed  Google Scholar 

  49. Liang C-Z, Zhang X-J, Hao Z-Y, Shi HQ, Wang KX (2004) Prevalence of sexual dysfunction in Chinese men with chronic prostatitis. Br J Urol Int 93:568–570

    Google Scholar 

  50. Jannini EA, Ulisse S, D’Armiento M (1995) Thyroid hormone and male gonadal function. Endocrine Rev 16:443–459

    Article  CAS  Google Scholar 

  51. Hartmann U (1997) Psychological subtypes of erectile dysfunction: results of statistically analyses and clinical practice. World J Urol 16:56–64

    Article  Google Scholar 

  52. Sachs BD (2000) Contextual approaches to the physiology and classification of erectile function, erectile dysfunction, and sexual arousal. Neurosci Biobehav Rev 24:541–560

    Article  CAS  PubMed  Google Scholar 

  53. Sachs BD (2003) The false organic-psychogenic distinction and related problems in the classification of erectile dysfunction. Int J Impot Res 15:72–78

    Article  PubMed  Google Scholar 

  54. Carosa E, Benvenga S, Trimarchi F, Lenzi A, Pepe M, Simonelli C, Jannini EA (2002) Lack of sexual activity for erectile dysfunction causes a reversible reduction of LH bioavability. Int J Impotence Res 14:93–99

    Article  CAS  Google Scholar 

  55. Shapiro B (1943) Premature ejaculation: a review of 1130 cases. J Urol 50:374–377

    Google Scholar 

  56. Wein AJ, Van Arsdale KN (1988) Drug-induced male sexual dysfunction. Urol Clin North Am 15:23–31

    CAS  PubMed  Google Scholar 

  57. Buffum J (1982) Pharmacosexology: the effects of drugs on sexual function—a review. J Psychoactive Drugs 14:5–44

    CAS  PubMed  Google Scholar 

  58. Monteiro WO, Noshirvani HF, Marks IM, Lelliott PT (1987) Anorgasmia from clomipramine in obsessive-compulsive disorder. A controlled trial. Br J Psychiatry 151:107–112

    CAS  PubMed  Google Scholar 

  59. Harrison WM, Rabkin JG, Ehrhardt AA, Stewart JW, McGrath PJ, Ross D, Quitkin FM (1986) Effects of antidepressant medication on sexual function: a controlled study. J Clin Psychopharmacol, 6:144–149

    Google Scholar 

  60. Fahmy I, Kamal A, Metwali M, Rhodes C, Mansour R, Serour G, Aboulghar M (1999) Vigorous prostatic massage: a simple method to retrieve spermatozoa for intracytoplasmatic sperm injection in psychogenic anejaculation. 14:2050–2053

  61. Geboes K, Steeno O, De Moor P (1975) Primary anejaculation: diagnosis and therapy. Fertil Steril 26:1018–1020

    CAS  PubMed  Google Scholar 

  62. Nehra A, Werner MA, Bastuba M, Title C, Oates RD (1996) Vibratory stimulation and rectal probe electro-ejaculation as therapy for patients with spinal cord injury: semen parameters and pregnancy rates. J Urol 155:554–559

    Article  CAS  PubMed  Google Scholar 

  63. Bors E, Comarr AE (1960) Neurological disturbances of sexual function with special reference to 529 patients with spinal cord injury. Urol Surv 10:191–195

    Google Scholar 

  64. Korenman SG (1998) Sexual function and dysfunction. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR (eds) Williams’ textbook of endocrinology, 9th edn. . Saunders, Philadelphia, pp 928–948

  65. Williams W (1985) Anaesthetic ejaculation. J Sex Marital Ther 11:19–29

    CAS  PubMed  Google Scholar 

  66. Kaplan HS (1993) Post-ejaculatory pain syndrome. J Sex Marital Ther 19:91–103

    CAS  PubMed  Google Scholar 

  67. Waldinger MD, Schweitzer DH (2002) Postorgasmic illness syndrome: two cases. J Sex Marital Ther 28:251–255

    Article  PubMed  Google Scholar 

  68. Gingell C, Nicolosi A, Glasser DB, Brock G, Buvat J (2002) Sexual behaviors and functioning in mature men: results of an international survey. 2nd World Congress of Men’s Health. 25–27 October 2002, Vienna

    Google Scholar 

  69. Jannini EA, Simonelli C, Lenzi A (2002) Sexological approach to ejaculatory disorders. Int J Androl 25:317–323

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are indebted to Mss. Marie-Hélène Hayles and Rosaria Caruso for help with the English. Our compliments and gratitude to Paola Minelli and Sabrina Luccarini for the secretarial work. This paper has been partially supported by the Italian Ministry of Education grants.

Author information

Authors and Affiliations

  1. Course of Endocrinology and Medical Sexology, Department of Experimental Medicine, University of L’Aquila, Coppito, Bldg. 2, Room A2/54, 67100 L’Aquila, Italy

    Emmanuele A. Jannini

  2. Chair of Endocrinology, Department of Medical Physiopathology, 1st University of Rome “La Sapienza”, 00161 Rome, Italy

    Andrea Lenzi

Authors
  1. Emmanuele A. Jannini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Lenzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emmanuele A. Jannini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jannini, E.A., Lenzi, A. Ejaculatory disorders: epidemiology and current approaches to definition, classification and subtyping. World J Urol 23, 68–75 (2005). https://doi.org/10.1007/s00345-004-0486-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-004-0486-9

Keywords

Search

Navigation