Inhibited or retarded ejaculation (RE) is one of the least understood of the male sexual dysfunctions. RE has a relatively low prevalence (< 3%). RE is one of the diminished ejaculatory disorders, which is a subset of male orgasmic disorders. This pathology results in depression, anxiety, lack of sexual confidence. Failure of ejaculation may be a lifelong (primary) of acquired (secondary) problem. In some instances, a somatic condition can cause the disorder of ejaculation. Disruption of sympathetic or somatic innervation has the potential to affect ejaculatory process and orgasm. Usually ejaculation and orgasm occur simultaneously in men. However, the terms of disorder ejaculation and orgasm are not identical according modern ideas about the neurophysiological triggers of these processes. The ejaculatory reflex comprises sensory receptors and areas, afferent pathways, cerebral sensory and motor centers, spinal motor centers and efferent pathways. Neurochemically, the reflex includes a complex interplay between central serotonergic and dopaminergic neurons. Cholinergic, adrenergic and oxitocinergic systems have the secondary role. The dominant neurotransmitters are dopamine and serotonin.
Currently, there are no effective and safe drugs available to accelerate ejaculation time. The most effective methods of correcting lifelong RE are psycho – and sex therapy. The best way to treat men with primary RE is to inform them about exiting factors that may retard ejaculation and to instruct them through counselling. The benefit of the therapy depends on the severity of the RE and responsiveness of the patient. Psychotherapy may be useful in some groups, especially in absence of effective or safe drugs. However, the psychological approach to solution of this problem is often disappointing. Further research on the neurophysiological aspects of ejaculation is very important to understand the pathogenic mechanisms of RE and invent the new ways to solve this problem.
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