Delayed ejaculation (DE) is a complex condition with multifactorial pathophysiology, diverse clinical manifestations, various risk factors, and a prognosis that can be influenced by several factors.
Pathophysiology
- Neurobiological factors: The ejaculatory process is controlled by the autonomic and somatic nervous systems, with central command located at the thoracolumbar and lumbosacral levels of the spinal cord. Serotonin (5-HT) plays an inhibitory role in the central control of ejaculation, with 5-HT1A cerebral autoreceptors and spinal 5-HT1B and 5-HT2C receptors mediating its effects
- Hormonal factors: Associations between delayed ejaculation and hypothyroidism have been documented, suggesting a role for thyroid hormones in the regulation of ejaculation
Clinical manifestations
- Lifelong DE: Defined as a lifelong, consistent, bothersome inability to achieve ejaculation, or excessive latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate
- Acquired DE: Defined as an acquired, consistent, bothersome inability to achieve ejaculation, or an increased latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate
Risk factors
- Erectile dysfunction: Patients with DE and comorbid erectile dysfunction should be treated according to the erectile dysfunction guidelines
- Testosterone deficiency: Treatment to normalize serum testosterone levels should be considered in patients with DE and testosterone deficiency
Prognosis
- The prognosis of DE can be influenced by several factors, including the underlying cause, the presence of comorbid conditions, and the patient's response to treatment.
- Shared decision-making is fundamental in the management of DE, and involvement of sexual partner(s) in decision making, when possible, may allow for optimization of outcomes
In conclusion, DE is a complex condition with multifactorial pathophysiology, diverse clinical manifestations, and various risk factors. The prognosis depends on factors like the underlying cause, comorbid conditions, and response to treatment. Management requires a comprehensive approach that includes patient education, medical management, and, in some cases, referral to a mental health professional with expertise in sexual health