ABSTRACT
Introduction 217
Neurophysiology 218
Ejaculation 218
Orgasm 219
Neurobiology of Ejaculation 219
Serotonin, 5-Hydroxytryptamine Neurotransmission and
5-HT Receptors 219
Male Rat Sexual Behavior 220
Neuroanatomy 221
Positron Emission Tomography-Scan Studies in Humans 222
Premature Ejaculation 223
History 223
The First Period (1887-1917): Early Ejaculation 223
The Second Period (1917-1950):
Neurosis and Psychosomatic Disorder 223
The Third Period (1950-1990): Learned Behavior 224
The Fourth Period (1990 to Present): Neurobiology
and Genetics 224
Prevalence 224
Evidence-Based Medicine 224
Evidence-Based Research: Psychotherapy 225
Evidence-Based Research: Drug Treatment 226
Operational Definition of Premature Ejaculation 227
The “Ejaculation Distribution Theory” of Premature Ejaculation 227
Ejaculation Threshold Hypothesis 229
Course of Rapidity 230
Premature Ejaculation and Genetics 230
Treatment 231
Drug Treatment for Premature Ejaculation 231
Daily Treatment with Serotonergic Antidepressants 232
As-Needed Treatment with Antidepressants 232
As-Needed Treatment with Anesthetic Topical Ointments 233
Psychotherapy and Behavioral Therapy 233
Retarded Ejaculation 233
Definition 234
Symptoms 234
Prevalence 234
Lifelong Delayed Ejaculation 235
Psychological Approach 235
Neurobiological Approach 235
Treatment of Lifelong Delayed Ejaculation 236
Acquired Delayed Ejaculation 237
Psychological Factors 237
Organic Factors 237
Treatment of Acquired Delayed Ejaculation 237
Research and Methodology 238
Retrograde Ejaculation 238
Definition 238
Symptoms 238
Etiology 239
Treatment 239
Anesthetic Ejaculation (Ejaculatory Anhedonia) 239
Definition 239
Symptoms 239
Etiology 240
Treatment 240
Partial Ejaculatory Incompetence 240
Definition 240
Symptoms 240
Etiology 240
Treatment 241
Painful Ejaculation 241
Definition 241
Symptoms 241
Etiology 241
Treatment 241
PostOrgasmic Illness Syndrome 241
Definition 241
Symptoms 242
Etiology 242
Treatment 242
Conclusions 242
References 242
INTRODUCTION
Ejaculation and orgasm usually occur simultaneously in men even though
ejaculation and orgasm are two separate phenomenona. Ejaculation occurs in
the genital organs, whereas orgasmic sensations, being related to the genitals,
are mainly a cerebral event which involves the whole body. In a few clinical
syndromes, orgasm or ejaculation appears to exist independent of each other.
For example, men with anesthetic ejaculation experience a normal ejaculation,
but suffer from an absence of orgasmic sensation. On the other hand, men with
premature ejaculation suffer from a disturbed speed of ejaculation, but do have
intact orgasmic sensation.
