Inhibited Ejaculation (Delayed Ejaculation and Anejaculation)

Etiology

Inhibited ejaculation (IE) consists of delayed ejaculation (DE) and anejaculation (AE), two conditions along the same clinical spectrum. Inhibited ejaculation refers to persistent or recurrent difficulty, delay in, or the inability to achieve ejaculation despite sufficient sexual stimulation.

Delayed ejaculation and AE may be lifelong or acquired, constant or situational, and patients with DE and AE may or may not experience concurrent orgasm. Viagra sublingual – cheap ed treatment.

Delayed ejaculation and AE can be caused by a number of factors, including medical conditions, surgical procedures, and psychological issues. Any factors affecting the central control of ejaculation, the afferent and/or efferent nerve supply to the vas deferens, bladder neck, penis, and pelvic floor, can potentially lead to DE or AE. Aging is a leading risk factor for IE. Aging-related changes suggested by some authors that lead to IE include: progressive loss of the fast conducting peripheral sensory axons, collagen infiltration of myelin, and atrophy of the dermis, which collectively can lead to an aging-related hypoanesthesia of the penis. Spinal cord injury can also lead to IE. In contrast to erectile function, a man’s ability to ejaculate increases as the level of his spinal cord injury descends, and less than 5% of men with complete upper motor neuron lesions have intact ejaculatory capability. Sometimes, surgical procedures can result in IE. Such procedures include aortic bypass surgery, repair of aortic aneurysms, or other operations involving the periaortic region or pelvis. A particular example of this type of surgery that is familiar to urologists is retroperitoneal lymph node dissection. Retroperitoneal lymph node dissection is often used in treating testicular cancer and may involve the removal of the postganglionic sympathetic nerves emanating from the sympathetic chain and hypogastric plexus. The result of this intervention is ablation of the efferent stimulation for seminal emission and bladder neck closure, essential components of successful ejaculation. Nerve-sparing techniques using modified templates to preserve the essential sympathetic nerves are now commonly employed and result in a high degree of retained ejaculatory function. Even with a nerve-sparing approach, other factors such as large retroperitoneal tumor mass or preoperative chemotherapy increase the risk of postoperative ejaculatory dysfunction. Clomid Australia

Medical conditions can also lead to IE. While much has been written recently about the negative effects of diabetes mellitus (DM) on erectile function, the issues of ejaculatory dysfunction associated with DM are less well studied.