Scientific Research Into Physical Causes Of Retarded Ejaculation

Physical causes

There are many other causes of ejaculatory disorders, especially surgery. Ejaculatory dysfunction has been reported in about 40% of men with bilateral sympathectomy at the L2 level. There is an even higher rate of emission failure in men who have surgery with high bilateral retroperineal lymphadenectomy.

Dysfunction of the sphincter of the bladder neck may occur after prostatectomy, which may lead to retrograde ejaculation into the bladder. Other conditions which can give rise to ejaculatory disorders include a history of disease and pelvic surgery (although of course one must be careful not to mistake the phenomena of orgasm without ejaculation for delayed ejaculation: this phenomenon may that be nothing more than retrograde ejaculation, where no ejaculation is observed because of the retrograde ejaculation, while orgasm occurs naturally and is succeeded by loss of erection).

Also, there are chronic medical conditions that can affect male sexual performance and orgasm. Angina, for example, is a strong suspect in this regard, while cigarette smoking can cause vascular insufficiency and decreasing levels of penile nitrous oxide.

As many men will know heavy consumption of alcohol or other recreational drugs may well inhibit the genital nervous and vascular system so that they do not operate correctly.

The most common medical conditions causing various forms of sexual difficulties are diabetes and high blood pressure - how to lower blood pressure is described here - and it's also well-known that various drugs which are available on prescription can induce male orgasmic disorder: these include Alpha and Beta adrenergic blockers, sympathetic nerve blockers, monoamine oxidase inhibitors, antidepressants, tricyclic antidepressants and SSRIs.

The Matter Of Brain Chemistry

Many studies have shown changes in brain chemistry - in serotonin levels, in fact - affect the delay before a man ejaculates. This implies that some men may actually have brain chemistry which predisposes them to ejaculate more slowly or quickly than average. (Though whether the change in brain chemistry is the cause or the effect of some other function remains open to speculation.) This of course opens the possibility of drug treatment for men who have had lifelong delayed ejaculation (male orgasmic disorder). At the moment, there are no drugs available for retarded ejaculation treatment, but research continues.

However, one area where drugs may play a part in a man's inability to ejaculate during sex is in causing the condition. There are many medications and non-prescription drugs, including alcohol, which can cause ejaculatory problems. In addition, the time taken for men to attain orgasm and release during climax increases with age. In the case of drugs which can cause delays in ejaculating or difficulties in reaching orgasm, there are often alternatives available.

Sometimes low levels of testosterone are implicated in the condition: in such cases, a full hormonal profile and check up by a qualified and competent andrologist is indicated.

As far as the treatment of delayed ejaculation is concerned, the first approach might be to investigate the possibility of changes in the man's drug regimen.

This might mean eliminating iatrogenic causes such as Alpha adrenergic blockers or antihypertensives, antidepressants, and antipsychotics. When antidepressants are implicated, switching to bupropion and mirtazapine may be helpful, as they have fewer side effects on the sexual system than SSRIs. Adjunctive therapies such as alpha sympathomimetrics may be helpful. Sildenafil and Imipramine may be effective in psychotropic-induced male orgasmic disorder.

Stimulation of the penis is required in most circumstances to achieve both emission and ejaculation. Efferent nerve impulses travel from the pudendal nerves until they reach the region of the upper lumbar spinal sympathetic nuclei. At this point the hypogastric nerve acts as a conduit for impulses which activate both secretions and the movement of sperm from the epididymis through the vas deferens, seminal vesicles and prostate to the base of the urethra. When the internal urethral sphincter closes and the external urethral sphincter relaxes, the semen is directed into the bulb at the base of the penis - this is the moment of emission.

But the mechanism of orgasm is one of the parts of the sexual process which is still far from understood. It involves central nervous system integration in response to various sexual stimuli, but emission, ejaculation, and orgasm are all associated with various other non-genital stimuli and responses in the body. For example, think of the involuntary contractions of the anal sphincter, the rapid breathing, the raised heart beat, or the elevation of blood pressure during sexual activity.

The somatomotor efferent branch of the pudendal nerve stimulates the bulbocavernous muscle into a series of rhythmic contractions, the effect of which is to force the semen through a narrowing of the urethra, producing a more or less powerful ejaculation of between 2 and 5 ml of semen. This is an involuntary action, but it involves an integration of both autonomic and somatic systems.

The network in the brain which controls the final output of all stimulation relating to ejaculation includes the posteromedial bed nucleus of the stria terminalis, along with the posterodorsal medial amygdaloid nucleus, and the parvicellular part of the subparafasicular thalamus.

It appears that the ejaculation reflex in man is mostly regulated by central serotonergic and dopaminergic systems while other neurotransmitters including acetylcholine, oxytocin, adrenaline and nitric oxide appear to have a secondary role.

There's evidence that serotonin 5HT exerts some kind of inhibitory role in the process of ejaculation through the brain's descending pathways. 5HT receptor subtypes A B and C have been associated with the modulating effect of serotonin on ejaculation.

Pharmacological manipulation of the serotonergic system has been undertaken in experimental rats, where SSRIs [selective serotonin re-uptake inhibitors] were the most effective compounds in the delaying of the ejaculation. Presynaptic 5HT1A receptors appear to be responsible for decreasing ejaculatory latency; postsynaptic 5H1B and 5H2C receptors appear to prolong ejaculatory latency.

In various animal models, dopamine levels measured in the medial preoptic area of the hypothalamus apparently progressively increased during sexual excitation and intercourse, while GABA receptor antagonists inhibited sexual behavior. Muscular contractions during the moment of ejaculation are, according to some research, affected by oxytocin.

All in all, therefore, with this relationship between serotonergic receptors and the effects that inhibit the sexual mechanism, and the effects that excite the sexual mechanism, the altered levels of 5HT, or varying receptor sensitivity in the central nervous system centers that modulate ejaculation, it's most likely that these altered levels of 5HT lie behind ejaculatory disorders. It's been suggested for example the serotonin has the capacity to suppress ejaculation by interrupting the effect of oxytocin.

However, despite all this research, the exact role and importance of various neurotransmitters in the etiology of delayed ejaculation is far from clear due to the multifactorial and extraordinarily complex nature of the male ejaculation reflex.

Transient sympathoadrenal activation during sexual activity which is associated with various increases in adrenaline and noradrenaline plasma levels have been reported as associated with male orgasm. And yet the association of vasopressin, luteinizing hormone, follicle stimulating hormone, growth hormone, cortisol and various other hormones to male orgasm all remain unclear.

Even though both oxytocin and prolactin levels are clearly observable as peaking immediately after the moment of orgasm, prolactin is a more reliable indicator of male orgasm.

So in the face of poor confirmation from various experiments of any hypothesis related to the mechanism of retarded ejaculation and how it may be treated, it follows that investigation has been limited, and the results of those studies which have been conducted are unclear.

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