Major ejaculatory disorders

Ejaculatory duct obstruction
Premature ejaculation
Delayed ejaculation
Painful ejaculation

Ejaculatory duct obstruction
Ejaculatory duct obstruction occurs when the ejaculatory ducts are narrowed or completely obstruction. It can result in a lower volume of semen, of less projectile force of the semen during orgasm, and in pain in the pelvis.

Premature ejaculation
Disorders of ejaculatory timing can be separated into those concerning premature ejaculation or delayed ejaculation. Premature ejaculation is also called uncontrolled ejaculation. The Diagnostic and Statistical Manual of Mental Disorders further expands the definition to "persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it . . . ," which is associated with ". . . marked distress or interpersonal difficulty.

Premature ejaculation is also defined as the inability to delay ejaculation long enough to allow the woman to reach orgasm in at least 50% of a couple's sexual encounters. This is not as acceptable a definition for many, because some women would take 45 minutes or more to reach an orgasm. In addition, women are variable in their ability to achieve orgasm in other ways.

In handling the premature ejaculation, the first basic thing is an accurate diagnosis of the patient. There should be complete medical and sexual history that involves early experience, level of sexual knowledge, past sexual practice, cultural myths, masturbatory practices, homosexual experiences and history of negative sexual experiences. Ejaculatory disorder-specific physical examination involves physical signs of chronic systemic illness, neurologic examination, sign of endocrine dysfunction, secondary sex characteristics, testicular exam, gynecomastia, structural penile lesions/plaque or a Peyronie's disease.

Many would say that the work-up for premature ejaculation would not be complete with repetitive prostatic massage and several examinations of the prostatic fluid looking for pus and obstruction.

Delayed ejaculation
Delayed ejaculation is also called retarded ejaculation.

This disorder occurs in 4% of sexually dysfunctional males according to some sources, but may be an under-reported and under-recognized disorder. Delayed ejaculation is the incapacity to achieve ejaculation despite erection, appetite and stimulation. Patients suffering from delayed ejaculation can often eventually produce an ejaculation with intercourse or masturbation.

Delayed ejaculation can occur from prostatitis, as a side effect of Serotonin Reuptake Inhibitors (SSRIs) or result of occult sensory neuropathy from diabetes or trauma. The diagnosis is made when the patient complains of an inability to obtain an ejaculation with his sexual partner, or if it takes much longer to ejaculate than it previously did.

Treatment is aimed at discovering the underlying cause and targeting it. Pharmaceuticals must be examined such as major tranquilizers, tricyclic antidepressants, monoamine oxidase inhibitors, antihypertensives, benzodiazepines, and alcohol. Keep in mind that tricyclic antidepressants decrease libido and SSRIs increase behavioral arousal.

Painful ejaculation
Men who ejaculate physiologically normal manner without pleasure can be further classified into those who experience pain and those who do not experience any pleasure during ejaculation.

Because the issue of diminished sexual desire cannot currently be defined on a hormonal level, a serum testosterone level should be obtained in all patients. In younger men, follicle-stimulating hormone, luteinizing hormone, and serum prolactin levels should be determined to differentiate primary and secondary (pituitary-hypothalamic) testicular failure.

Some patients complain of perineal or scrotal pain either during or shortly after ejaculation. Such pain often causes anxiety regarding subsequent ejaculations. Inflammatory, obstructive, or psychological in nature, this condition can occur with prostatitis, urethritis, epididymitis, after vasectomy, or with ejaculatory duct obstruction.

People who face a loss of sexual desire are not necessarily psychologically disturbed. Common organic problems associated with loss of desire include chronic illness, thyroid disorders, disfiguring trauma, congenital disfigurement, and pituitary disorders. While this disorder does not represent a serious psychological difficulty, some of the social and possibly interpersonal factors should be dealt with.