Page 78 - Remedial Andrology

Table 20: Etiological Causes of Delayed Ejaculation and Anejaculation [852]

Ageing Men Degeneration of penile afferent nerves inhibited ejaculation
Congenital Mullerian duct cyst
Wolfian duct abnormalities
Prune Belly Syndrome
Imperforate Anus
Genetic abnormalities
Anatomic causes Transurethral resection of prostate
Bladder neck incision
Circumcision
Ejaculatory duct obstruction (can be congenital or acquired)
Neurogenic causes Diabetic autonomic neuropathy
Multiple sclerosis
Spinal cord injury
Radical prostatectomy
Proctocolectomy
Bilateral sympathectomy
Abdominal aortic aneurysmectomy
Para-aortic lymphadenectomy
Infective/Inflammation Urethritis
Genitourinary tuberculosis
Schistosomiasis
Prostatitis
Orchitis
Endocrine Hypogonadism
Hypothyroidism
Prolactin disorders
Medication Antihypertensives; thiazide diuretics
Alpha-adrenergic blockers
Antipsychotics and antidepressants
Alcohol
Antiandrogens
Ganglion blockers
Selective serotonin reuptake Inhibitors
Psychological Acute psychological distress
Relationship distress
Psychosexual skill deficit
Disconnect between arousal and sexual situations
Masturbation style

6.3.3 Investigation and treatment
Patients should have a full medical and sexual history performed along with a detailed physical examination
when evaluating for DE. It is not uncommon for clinicians to feel uncomfortable with the level of sexual
information that is warranted in obtaining a full sexual history. Understanding the details of the ejaculatory
response, sensation, frequency, and sexual activity/techniques; cultural context and history of the disorder;
quality of the sexual response cycle (desire, arousal, ejaculation, orgasm, and refractory period); partner’s
assessment of the disorder and if the partner suffers from any sexual dysfunction her/himself; and the overall
satisfaction of the sexual relationship are all important to garner during history-taking [853]. Investigation by
a sex therapist is often required to help obtain a complete psychological evaluation. It is incumbent on the
clinician to diagnose medical pathologies that cause or contribute to DE, such as assessing the hormonal
milieu, anatomy, and overall medical condition. Good communication between the sex therapist and medical
practitioner is vital to successful diagnosis and treatment of DE.

6.3.3.1 Psychological aspects and intervention
There is scarce literature on the psychological aspects relating to DE, as well as on empirical evidence
regarding psychological treatment efficacy. Studies on psychological aspects have revealed that men with
DE show a strong need to control their sexual experiences. Delayed ejaculation is associated with difficulties
surrendering to sexual pleasure during sex - i.e., the sense of letting go [854] - which denotes a psychological

SEXUAL AND REPRODUCTIVE HEALTH - MARCH 2021 77