Sexual Dysfunction in Men
Premature ejaculation, or inadequate ejaculatory control, is the inability to exert voluntary control over the ejaculatory reflex, so that once a man reaches a certain level of sexual arousal or excitement, he ejaculates reflexively and rapidly soon after or even before vaginal penetration. Organic causes of premature ejaculation involve congenital conditions; neurological problems; side effects of medications; and other health problems, including hormonal changes (especially hormone medications used for infertility treatment). Psychological factors (apart from learned response) may be related to infertility with its emphasis on sex for procreation; the man’s (or couple’s) attempts to make the sexual encounter as brief as possible; or habituated rapid ejaculation to provide specimens for infertility treatment.
Inhibited or Delayed Ejaculation
Inhibited or delayed ejaculation or orgasm (sometimes referred to as retarded ejaculation) is the persistent and recurrent inhibition of orgasm, manifested by delay or absence of ejaculation following adequate sexual excitement. It is commonly defined as difficulty or inability to ejaculate during sexual intercourse or masturbation. Historically, physical causes have been rare; although delayed ejaculation may be symptomatic of underlying medical conditions or due to physical conditions such as spinal cord injury. Recently, delayed ejaculation has been identified as a common side effect of some antidepressant medications, particularly SSRIs. Psychological etiology may be due to performance anxiety; depression; anger; guilt regarding sex in general or with certain partners; relationship problems; traumatic sexual history; religious orthodoxy; prolonged fear of pregnancy leading to conditioned response; history of withdrawal method of birth control; gender identity issues; cultural factors; and/or partner unresponsiveness. Recently it has been suggested that delayed or retarded ejaculation is due to a combination of insufficient arousal to reach orgasm in intercourse and reflex inhibition.