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Ejaculation | A Phenomenon that Troubles Modern Men

Anastasios D. Kalantzis, Surgeon Urologist-Andrologist

 

Ejaculation disorders are the commonest form of sexual dysfunction in men.

 

With the term "premature ejaculation" we refer to the lack of the man's ability to control his own ejaculation, which results in sexual climax (orgasm) occurring involuntarily, with minimum sexual stimulation, before, during or almost immediately after penetration, and before he wishes it.

 

The entire process consists of 3 phases. At first there is increase of the prostatic gland and the seminiferous tubules secretions. Then the sperm migrates and remains in the posterior urethra where, aided by a reflexive mechanism, its exit is impaired, and in the third and final ejaculation phase the sperm (now semen) is propelled through the urethra.

 

Several neuro-anatomy and neuro-physiology studies have located the ejaculation control centers in the frontal lobe of the brain, as well as in the Broca's area.

 

A man suffers from premature ejaculation when he ejaculates within two minutes of penetration.

 

With occurrence percentage reaching 20-30%, premature ejaculation is the commonest male sexual dysfunction. The majority of men have at least one occurrence of premature ejaculation in their lives. Often, teenagers and young men have premature ejaculations during their first sexual encounters, until they learn to control their orgasm.

 

This condition can be caused by psychological and biological factors. The causes may be physical such as vascular, neurogenic, hormonal, chronic diseases, use of medical substances, infections, undercurrent malignant conditions of the lower urogenital system etc., or advanced age. In most cases, however, the causes are psychogenic (depression, performance anxiety etc.).

 

In its fourth edition, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies the sexual disorders in 4 categories:

1) Primary / Secondary

2) Due to a general medical condition

3) Substance-related

4) Undefined

 

Each of the 4 DSM-IV categories includes disorders of all 3 sexual phases (libido, arousal and orgasm).

 

Premature ejaculation may be primary or secondary. Primary ejaculation concerns individuals with predisposition since puberty, while Secondary occurs to individuals who in the past had an acceptable level of ejaculation control and for unknown reasons started experiencing premature ejaculation later in life. Secondary ejaculation does not indicate a general medical condition, nor is it usually substance-related.

 

It is common that men with this disorder are fastidious, introvert, self-conscious, insecure; they feel inferior and have great difficulty in expressing their thoughts and emotions. A result of their character, their personality and their problem is their constant defensive attitude towards their partner; they incriminate themselves and consequently, both libido and intercourse are hindered.

 

The behavior and attitude of the sexual partner plays an important role in dealing with this disorder. It has been observed that men who suffer from premature ejaculation are men who are highly attracted to or derive intense pleasure from their partner, or feel fear towards them, considering them more experienced or indifferent during the sexual encounter. Also interpersonal dynamics contribute to the development of this disorder, as premature ejaculation can be caused by a problematic relationship (constant or unresolved conflicts, competition etc.).

 

Treatment is achieved through administration of medication and psychotherapeutic support, depending on the causes of the condition.