Contemporary Management of Ejaculatory Dysfunction

Marisa Gray; Jacqueline Zillioux; Iyad Khourdaji; Ryan P. Smith


Transl Androl Urol. 2018;7(4):686-702. 

In This Article

Abstract and Introduction


Although erectile dysfunction is the most common disorder of male sexual health, ejaculatory dysfunction is the most common form of sexual dysfunction experienced by men. Ejaculatory dysfunction covers a broad range of disorders that we have divided into four main categories: premature ejaculation, delayed ejaculation (DE)/anorgasmia, unsatisfactory sensation of ejaculation (including painful ejaculation and ejaculatory anhedonia), and absent ejaculate (including retrograde ejaculation and aspermia). We also cover several special scenarios including hematospermia, spinal cord injury and fertility with anejaculation. In this paper, we will review the anatomy and pathophysiology of normal ejaculation to establish the baseline knowledge of how this pathway can go awry. We will then briefly review the critical diagnostic criteria, pertinent steps in evaluation, risk factors, and causes (if known) for each of the ejaculatory disorders. Finally, the bulk of the paper will discuss current management strategies of each disorder.


Ejaculatory dysfunction is the most common form of sexual dysfunction experienced by men.[1] Ejaculatory dysfunction covers a broad range of disorders including premature ejaculation (PE), anejaculation, painful ejaculation, and hematospermia. This report will review the anatomy and physiology of normal ejaculation, investigate the pathophysiologic processes explaining disorders of ejaculation and subsequently discuss the strategies currently utilized to manage such disorders.[2]

Ejaculatory dysfunction has a wide range of severity as symptomatology varies based on subjective interpretation by the patient. Moreover, there is no standard characterization of symptom bother as an unbearable change in sexual function to one man may be of little bother to another. The term dysfunction is thus reserved for ejaculatory issues that cause significant distress to the patient.

Epidemiological studies performed in the US and Europe estimate that upwards of 30% of males have experienced ejaculatory dysfunction.[3] However, due to the sensitive nature of this topic, this figure likely underestimates the true prevalence. The most commonly reported disorder experienced by men is PE followed by delayed and painful ejaculation.[3,4]