Introduction and objectives: Pathogenesis of delayed ejaculation (DE) is rather unknown, although the contribution of various psychological, marital, hormonal and neurological factors has been advocated.
Methods: In this study we systematically investigated the relative relevance of the aforementioned factors in a large sample (1632) of men, seeking medical help for sexual dysfunction. Delayed ejaculation was defined according to Kaplan criteria. In particular mild/moderate DE (MMDE) was diagnosed if ejaculation and climax were still possible, but only with great effort and after prolonged intercourse (mild DE) or possible only with autoerotism, although in the presence of the partner, but not during coitus (moderate DE). Anejaculation or severe DE (ASDE) was diagnosed if orgasm and ejaculation could not be obtained at all (anejaculation) or could be obtained but only with autoerotism conducted in the absence of the partner (severe DE).
Results: Mild and moderate DE (MMDE) generally recognized different risk factors than the most severe forms (anejaculation/severe DE; ASDE). ASDE was essentially coupled to the presence of neurological diseases or to the use of serotoninergic drugs. Serotoninergic drugs also significantly increase (by at least ten-fold) the risk for MMDE, which, however was also coupled to other relational (impaired partners climax, patients hypoactive sexual desire, HSD) or intra-psychic (stress at work) factors. At multiple regression analysis, some organic conditions (such as psychiatric disorders and hypogonadism) were also associated to MMDE. In particular, hypogonadism retained significance for DE even after adjustment for HSD (Adj. OR=2.08[1.113.89]; P<0.05), suggesting other effects of testosterone deficiency on the ejaculatory reflex, besides reduced libido.
Conclusions: In conclusion, the present study demonstrates that multiple psychobiological determinants are associated to DE, a still obscure condition which substantially impairs psychosexual equilibrium of the couple.
01 - 05 Apr 2006
European Society of Endocrinology