Premature Ejaculation Alternative Treatment

Ejaculation Guru

In This Video You'll Discover: How I personally went from lasting less than 10 seconds in bed to over 30 minutes in bed. The real reason so many men suffer from premature ejaculation. And exactly what to do about it. How long you should be lasting if you want to truly satisfy a woman This, by the way, comes from a study carried out by a major University. The number #1 thing holding most men back from getting control over their orgasms and how you can change it. (By the way, most guys don't even realize this is holding them back, but it's critical to understand if you want to learn to last long in bed) What most porn stars will Never tell you about porn and its influence on your sexual stamina. The truth about penis size and its links with how long you last. What the number #1 reason is for relationships ending. and how premature ejaculation is critically linked to it. Why you should Avoid 99% of people trying to sell you long lasting condoms, creams or pills. Read more here...

Ejaculation Guru Summary


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Ejaculation By Command

Everything is explained here in clear, concise and easy-to-understand instructions. The insights, tools and techniques in this program have been rigorously tried, tested and proven effective not only by me, but by thousands of other men who are now enjoying lovemaking that lasts so much longer than before. Here's a Very partial list of what you're going to learn inside this exciting new program: How to overcome mental barriers to sexual endurance develop iron-clad stamina and confidence by using these 9 specific techniques I am going to give you. A primal sexual technique that adds massive control to your arousal. and puts a woman over the edge with sexual excitement. she'll have to have you Right Then And There. and nothing will be able to stop her. 4 powerful breathing strategies that will amplify your staying power and prolong your orgasm for as long as you desire (97% of men screw up their breathing and end up ejaculating too soon) Specific guided love muscle exercises to skyrocket your ejaculatory control and your ability to withstand intense sexual stimulation (The secret is in the step-by-step process, which you'll learn in detail) The Pleasure Acclimatizing technique to train and condition your ejaculation reflexes so that you will Automatically last longer without tipping over in a hurry (this is one of the stamina secrets that Top porn actors use All The Time ) Have you ever blown your load even Before penetration starts. and wondered how the hell that happened? Here's the little-known and closely-guarded Total Immersion technique you can use to Outlast her during sex (it's much easier than you think. when you know the secret) Read more here...

Ejaculation By Command Summary

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The Ejaculation Distribution Theory of Premature Ejaculation

Waldinger (5,49) formulated a new theory on the etiology and genesis of lifelong premature ejaculation. He postulated that lifelong premature ejaculation is not an Figure 9.2 The IELT (29) measured by stopwatch in a sample of 110 Dutch males with lifelong premature ejaculation. Ninety percent ejaculates within 1 min and 80 ejaculates within 30 s (48). Figure 9.2 The IELT (29) measured by stopwatch in a sample of 110 Dutch males with lifelong premature ejaculation. Ninety percent ejaculates within 1 min and 80 ejaculates within 30 s (48). acquired disorder due to habituation of initial hurried intercourses, as has been suggested by Masters and Johnson. Instead, Waldinger argues that early ejaculation is part of a normal biological variability of the intravaginal ejaculation latency time (IELT) in men, with a possible familial genetic vulnerability (5,23,49). In 1994, Waldinger et al., introduced and defined the IELT as a measure for pharmacological research (29). The IELT is the time...

Premature ejaculation

Premature ejaculation (PE) refers to the persistent or recurrent discharge of semen with minimal sexual stimulation before, on, or shortly after penetration, before the person wishes it, and earlier than he expects it. In making the diagnosis of PE, the clinician must take into account factors that affect the length of time that the man feels sexually excited. These factors include the age of the patient and his partner, the newness of the sexual partner, and the location and recent frequency of sexual activity. Premature ejaculation (PE) is a common complaint. The available evidence supports the notion that control and modulation of sexual excitement is learned behavior. If someone has learned it incorrectly or inadequately, they can relearn it. PE is only rarely caused by a physical or structural problem in these cases it is usually associated with other physical symptoms, usually pain. In rare cases, PE may be associated with a neurological condition infection of the prostate gland...

Premature Ejaculation and Genetics

In 1943, Schapiro noted that men with premature ejaculation seemed to have family members with similar complaints (19). Remarkably, this interesting observation has never been cited. To investigate the potential familial occurrence of premature ejaculation, I routinely asked 237 consecutively enrolled men with premature ejaculation about the family occurrence of similar complaints (23). Because of embarrassment only 14 men consented to ask male relatives about ejaculation latency. These 14 men reported a total of 11 first degree male relatives with information available for direct personal interview. In fact, 10 relatives fulfilled our strictly defined criterion of an ejaculation time of 1 min or less. In this small selected group of men, the calculated risk of having a first relative with premature ejaculation was 91 (CI 59-99). Therefore, the odds of family occurrence are much higher than the suggested population prevalence rate of 4-39 . Moreover, the high odds ratio indicates a...

Operational Definition of Premature Ejaculation

For evidence-based research, it is of utmost importance to have a definition of premature ejaculation. However, because of conflicting ideas about the essence of premature ejaculation, sexologists have never reached an agreement on a definition. DSM-IV (47) defines premature ejaculation as persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before the person wishes it. Until recently, any scientific basis for the DSM-IV definition was lacking. For instance, the meaning of persistent, recurrent, minimal, and shortly after is vague and certainly needs further qualification. In order to get an empirically operationalized definition, Waldinger and co-workers investigated 110 consecutively enrolled men with lifelong premature ejaculation (48). In this study, men and their female partners were instructed to use a stopwatch at home during each coitus for a period of 4 weeks (Fig. 9.2). It was found that 10 of these men ejaculated...

Reproductive biology

Information on the patterns of sigmodontine copulatory behavior is sparse. Calomys, however, is a relatively well known genus in this regard. There is information on three of the 11 species of the genus. They display intravaginal penile thrusting and multiple ejaculations, in combination with single or multiple pre-ejaculatory intromissions. Locks are either rare or absent. In addition, C. musculinus, a non-monogamous species, undergoes a stereotyped precopulatory behavior composed mostly of agonistic behaviors in which the female and the male play the aggressive and submissive roles, respectively (Laconi and Castro-Vasquez, 1998).

Neurophysiology Ejaculation

Emission During the emission phase, semen (e.g., sperm and seminal fluids) is deposited into the posterior urethra through contractions of the smooth muscles of the vasa deferentia, seminal vesicles, and prostate. At the same time, the internal sphincter of the urinary bladder is closed, thereby preventing retrograde passage of the semen into the bladder. The closure of the sphincter also prevents urine from mixing with the semen. Emission and bladder neck closure are mediated through the thoracolumbar sympathetic system. It is suggested that the sensation of ejaculatory inevitability parallels the emission phase.

Male Rat Sexual Behavior

Male rat studies have demonstrated that serotonin (5-HT) and 5-HT receptors are involved in the ejaculatory process. As far as is currently known, 5-HT2C and 5-HT1A receptors determine the speed of ejaculation. For example, studies with D-lysergic acid diethylamide and quipazine, which are nonselective 5-HT2C agonists, suggest that stimulating 5-HT2C receptors delays ejaculation (3). However, which equally stimulates 5-HT2A and 5-HT2C receptors, also increases ejaculation latency (4), whereas the selective 5-HT2A receptor agonist 2,5-dimethoxy-4-methylampheta-mine does not have this effect (3). On the other hand, activation of postsynaptic 5-HT1A receptors by the selective 5-HT1A receptor agonist 8-hydroxy-2-(di-n-propylaminotetralin) in male rats resulted in shorter ejaculation latency (3). On the basis of these male rat studies, Waldinger (1,5) has hypothesized that premature ejaculation is related to a hypofunction of the 5-HT2C receptor and or a hyperfunction of the 5-HT1A...

Plate 85 Spermatic Cord And Ductus Deferens

The ductus (vas) deferens continues from the duct of the epididymis as a thick-walled muscular tube that leaves the scrotum and passes through the inguinal canal as a component of the spermatic cord. At the deep inguinal ring, it continues into the pelvis and, behind the urinary bladder, joins with the seminal vesicle to form the ejaculatory duct. The ejaculatory duct then pierces the prostate gland and opens into the urethra. Mature sperm are stored in the terminal portion (tail) of the ductus epididymis. These sperm are forced into the ductus deferens by intense contractions of the three smooth muscle layers of the ductus deferens following appropriate neural stimulation. Contraction of the smooth muscle of the ductus deferens continues the movement of the sperm through the ejaculatory duct into the urethra during the ejaculatory reflex. The seminal vesicles (see Plate 87) are not storage sites for sperm but, rather, secrete a fructose-rich fluid that becomes part of the ejaculated...

Maternal effects on HPG function and mating behavior

Solicitation behaviors in the female rat are highly dependent on context. In smaller confines, the most common pattern of paracopulatory (or pro-ceptive) behavior is that of hopping, darting, and ear wiggling. However, when a receptive female is tested in a larger area that affords the opportunity to retreat from the male, the approach-withdrawal pattern prevails and reveals the females ability to pace the mating with the male (Erskine, 1989). Female rats pace the rate of male intromissions and thus ejaculation by withdrawal from the male following each intromission. The latency to return to the male is longer after ejaculation than after an intromission, which in turn is longer than after a mount with an intromission (Erskine et al., 2004 Yang and Clemens, 1996). As testing proceeds over the courses of multiple ejaculatory sequences, the interintromission interval increases (Coopersmith et al., 1996). Testing in the pacing chamber revealed considerable differences in sexual behavior...

Anatomical And Morphological Relationships Of The Male Reproductive System

Testicular Lobule

The male reproductive system comprises the gonads (two testes), excretory ducts (epididymis, vas deferens, and ejaculatory duct), and several accessory structures (prostate, seminal vesicles, bulbourethral glands, and penis). These are illustrated in Figure 12-1. The duct system connects each testis to the urethra and functions to transport the mature spermatozoa during ejaculation. It is composed of the epididymis, ductus deferens, and ejaculatory duct. The vas deferens is a 7- to 8-cm tubule connecting the epididymis with the ejaculatory duct (see Figure 12-1). The passage of sperm through the vas deferens is accomplished by peristaltic contractions of smooth muscle in the duct wall. Vasectomy, which is the bilateral ligation of the vas deferens, has been established as an effective and safe male contraceptive procedure. However, the current success rate for the reversal of vasectomy (as judged by the subsequent production The ejaculatory duct is located at the merger of the vas...

Etiologysexual Disorder

In this chapter, I omitted all sorts of methodologically weak publications in the field of psychotherapy that have been published during the last 30 years. Unfortunately, in last decade hardly any or even no progress has been made in the development of evidence-based research into the psychology and psychotherapy of ejaculatory disturbances. Instead, I have tried to provide you with up-to-date knowledge about the neurobiology and pharmacological treatment of ejaculatory disorders. Most of it, however, pertains to premature ejaculation. I hope and am also convinced that in the near future, with the development of new animal models of ejaculatory disturbances, the use of brain-imaging techniques in humans, and interest of pharmaceutical companies, also the other ejaculatory and orgasm disturbances, will become amenable for effective drug treatment. Nevertheless, one should always talk with patients, inform them about the most recent knowledge of their ejacu-latory problem, and most of...

Figure Of Renal System Of Female

Renal Fascia Around Kidney

Common ejaculatory duct Corpus caverosum Corpus spongiosum Cowper's gland Epididymis Glans penis Prepuce Prostate gland Scrotum Seminal vesicle Symphysis pubis Testis Ureter Urethra Urinary bladder Vas deferens Identify the following structures on the model of the male reproductive system common ejaculatory duct, corpus cavernosum, corpus spongiosum, Cowper's gland, epididymis, glanspenis, prepuce, prostate gland, scrotum, seminal vesicle, spermatic cord, symphysis pubis, testis, ureter, urethra and vas deferens.

Lifelong Delayed Ejaculation

Unfortunately there is no drug treatment available for delayed ejaculation in men. In animals, the 5-HT1A receptor agonist, 8-OH-DPAT, fastens the ejaculation latency, but such selective 5-HT1A agonists are not yet available for safe human use. Another possibility is a selective blockade of the 5-HT2C receptor. However, in a stopwatch controlled study in men with premature ejaculation, the 5-HT2C receptor blocking antidepressants, nefazodone and mirtazapine, did not lead to either delayed ejaculation or a faster ejaculation time. By vibratory stimulation (93) of the penis an ejaculation can be induced. The percentage of success to cure lifelong delayed ejaculation, however, is unknown. Electrical stimulation (94) of the internal ejaculatory organs by a transrectal electrical probe (electro-ejaculation) is mainly used to obtain semen in paraplegic men. This intervention is extremely painful in men with normal sensation and is not an option to treat lifelong delayed ejaculation....

Models For Treating Sexual Dysfunction Sex Therapy

Sex therapy was based on the development of a treatment plan conceptualized from the rapid assessment of the immediate and remote causes of SD while maintaining rapport with the patient (6,7). The sex therapist assigned structured erotic experiences carried out by the couple individual in the privacy of their own homes. These exercises were designed to correct dysfunctional sexual behavior patterns, as well as positively altering cognitions regarding sexual attitudes and self-image. This home play modified the immediate causes of the sexual problem, allowing the individual to have mostly positive experiences and created a powerful momentum for successful treatment outcome. Interventions aimed at correcting or challenging maladaptive cognitions were incorporated into the treatment process (8). The individually tailored exercises acted as therapeutic probes and were progressively adjusted until the individual or couple was gradually guided into fully functional sexual behavior (4,6)....

Extent Of Local Tumour Spread

Extracapsular Spread Prostate

This is not to be confused with similar looking ejaculatory duct type epithelium which is oriented to loose, vascular connective tissue. Advanced disease manifests spread into seminal vesicle, prostatic urethra and bladder. Presentation can be by an anterior rectal mass or stricture and PSA staining of rectal biopsy material is of use. Frozen pelvis is a clinical term meaning tumour extension to the pelvic wall(s) with fixation and is designated pT4. Optional descriptors are pT4a (bladder neck, external sphincter, rectum) and pT4b (levator muscles, fixed to pelvic wall). Note that the normal prostatic apex may incorporate some striated muscle fibres and cancer lying in relation to these does not necessarily imply extraprostatic disease.

Evidence Based Medicine

For many decades, premature ejaculation was considered to be a psychological disorder that had to be treated with psychotherapy. However, psychological treatments and underlying theories mostly relied on case reports, series of case report studies, and opinions of some leading psychotherapists and sexologists. They were not based on controlled studies. I believe this to be a typical example of authority- or opinion-based medicine (15). In contrast to authority-based medicine, evidence-based medicine (26) has been accepted today as the hallmark for clinical research and medical practice. Particularly in last decade, randomized clinical trials with clomipramine (27,28) and some SSRIs (29-33) have repeatedly demonstrated the efficacy of serotonergic antidepressants to delay ejaculation. In spite of these studies, the belief persists among those involved in sexology that premature ejaculation is a psychological disorder. In order to unravel this dichotomy, it is important to apply...

Accessory sex glands

Seminal vesicles develop as evaginations of the mesonephric (Wolffian) ducts in the region of future ampullae. The wall of the seminal vesicles contains a mucosa, a thin layer of smooth muscle, and a fibrous coat (Fig. 21.26). The mucosa is thrown into numerous primary, secondary, and tertiary folds that increase the secretory surface area. All of the irregular chambers thus formed, however, communicate with the lumen. though prostaglandins were first isolated from the prostate gland (hence the name), they are actually synthesized in large amounts in the seminal vesicles. Contraction of the smooth muscle coat of the seminal vesicles during ejaculation discharges their secretion into the ejaculatory ducts and helps to flush sperm out of the urethra. The secretory function and morphology of the seminal vesicles are under the control of testosterone.

Postmenopausal Dyspareunia

Attempts to lessen the pain through the use of water-based lubricants and topical estradiol cream had not been successful, and she did not wish to try systemic hormone replacement therapy for fear of developing breast cancer. A detailed sexual history revealed that Brenda had suffered from intermittent pain during intercourse for at least 15 years but had never complained about it, and that Alexander had always had difficulties with ejaculatory control. Over the past 4 years, Brenda reported difficulty getting sexually aroused, diminished lubrication, postcoital bleeding, and less interest in sex. Their current sexual frequency was less than once every 3 months, a frustrating situation for Alexander, who had hoped that their youngest child leaving home in the previous year would result in more frequent sexual activity. In the previous 5 years, the couple had also experienced significant life stressors including the sudden death of Brenda's mother and major financial problems....

Viclinical Considerations

It produces the following clinical findings underdevelopment of the penis, scrotum (microphallus, hypospadias, and bifid scrotum), and prostate gland. The epididymis, ductus deferens, seminal vesicle, and ejaculatory duct are nonnal. These clinical findings have led to inference that DHT is essential for the development of the external genitalia and prostate gland in gcnotypic XY fetuses. 2. It produces the following clinical findings underdevelopment of the penis and scrotum (microphallus, hypospadias, and bifid scrotum) and prostate gland. The epididymis, ductus deferens, seminal vesicle, and ejaculatory duct are normal. The clinical findings in 17a-HSD deficiency and 5a-reductase 2 deficiency are very similar.

The Interactional View

The interactional view assumes that vaginistic complaints have a function in maintaining the balance between partners, or in the emotional functioning of the woman herself. In this sense, the complaint can form a solution There are very few authors who explain the phenomenon of vaginismus fully on the basis of this view. However, much of the literature mentions the behavior and the personality structure of the male partner. He comes forward as a low self-confidence, anxious, passive, dependent person who is afraid of failure and for whom sex is a loaded subject (27,38,39). The partners of vaginistic women are believed to often suffer from sexual problems themselves, such as impotence and premature ejaculation (29,35,39,40). Despite these problems, the couple usually look very harmonic on the outside. They give the impression of being very well suited (18,37). In a recent study, rates of parital discord were equal to the general population (3). It speaks for itself that within the...

Epidemiology Of Sexual Dysfunction

Some recent studies went beyond collecting pure epidemiological data and studied the impact of sexual dysfunction on men suffering from various sexual dysfunctions. For instance, Moore et al. (36) described that younger men suffering from erectile dysfunction reported comparatively less relationship satisfaction, greater depressive symptomatology, more negative reactions from partners, and less job satisfaction than older men. They concluded that older men experience less difficulty than younger men adjusting to life with erectile dysfunction. Symonds et al. (37) interviewed men with self-diagnosed premature ejaculation. In their relatively small sample, they found that men with premature ejaculation had a sense that premature ejaculation was causing (not exclusively) Laumann et al. (43) have recently completed a survey of 27,500 men and women aged 40-80 in 29 countries. In Northern European countries, lack of sexual interest was reported in 25.3 of women. Problems with orgasm and...

Secondary Sex Organs

Each ductus deferens and its corresponding seminal vesicle converge to form a short tube called the ejaculatory duct. The ejaculatory duct opens into the urethra within the prostate gland. The ejaculatory duct carries both spermatozoa and seminal vesicle fluid.

Treatment Psychological Treatments

(101), sexual problems were seen as consequences of (nonsexual) psychological conflicts, immaturity, and relational conflicts. Masters and Johnson proposed to directly attempt to reverse the sexual dysfunction by a kind of graded practice and focus on sexual feelings (sensate focus). If sexual arousal depends directly on sexual stimulation, that very stimulation should be the topic of discussion (masturbation training). A sexual dysfunction was no longer something pertaining to the individual, rather, it was regarded as a dysfunction of the couple. It was assumed that the couple did not communicate in a way that allowed sexual arousal to occur when they intended to produce it. Treatment goals were associated with the couple concept the treatment goal was for orgasm through coital stimulation. This connection between treatment format and goals was lost once Masters and Johnson's concept was used in common therapeutic practice. People came in for treatment as individuals. Intercourse...

Acquired Delayed Ejaculation

The onset of ejaculation delay may be sudden or gradual and deteriorates progressively to global unremitting ejaculatory inhibition. A rather normal delay of ejaculation occurs during aging. Androgen deficiency or hypogonadism may be accompanied by loss of sexual desire and delay of ejaculation. Any neurological disease, injury, or surgical procedure that traumatizes the lumbar sympathetic ganglia and the connecting nerves (multiple sclerosis, diabetic neuropathy, abdo-minoperineal resection, lumbar sympathectomy) may lead to a delay or failure of ejaculation. A wide range of drugs (SSRIs, tricyclic antidepressants, antipsychotics, alpha-sympathicolytics) can impair the ejaculatory process through central and peripheral mechanisms. Alcohol can delay or abolish ejaculation by a direct effect after acute abuse and indirectly by neurological or hormonal disturbances during chronic abuse.

Plate 87 Seminal Vesicle

The mucosa rests on a thick layer of smooth muscle that is directly continuous with that of the ductus deferens, from which the seminal vesicle evaginates. The smooth muscle consists of an indistinct inner circular layer and an outer longitudinal layer (compare with the three layers of the ductus epididymis and the ductus deferens, Plate 84), which are difficult to distinguish. Contraction of the smooth muscle coat during ejaculation forces the secretions of the seminal vesicles into the ejaculatory ducts. Beyond the smooth muscle is the connective tissue of the adventitia.

Combination Therapy for Sexual Dysfunction Integrating Sex Therapy and Sexual Pharmaceuticals

Combination therapy is the therapeutic modality of choice for any SDs. Combination therapy refers to a concurrent or step-wise integration of psychological and medical interventions. We have previously described developing adherence for this approach to ED, with enthusiasm growing within the FSD treatment community (36). Combination therapy is already being recommended for PE, and is likely to be recommended for the full range of ejaculatory disorders (41). Although desire disorders for men and women have a strong psychosocial cultural component, there is little doubt that sexual desire has biological underpinnings and is likely to be distributed on the same bell-shaped distribution curve as other human characteristics. This simply means that all SDs have a bio-psychosocial basis and that treatment must incorporate medical and psychological dimensions. Without adequate desire, motivation, and realistic expectations, treatment outcome is likely to be disappointing and with high...

Ejaculation Threshold Hypothesis

According to this threshold hypothesis, it appears to be the level of 5-HT2C and 5-HT1A receptor activation that determines the setpoint and associated ejaculation latency time of an individual man. In case of men with premature ejaculation or any man using serotonergic antidepressants, the SSRIs and clomipramine activate the 5-HT2C receptor and therefore switch the setpoint to a higher level leading to a delay in ejaculation. The effects of SSRIs on the setpoint appear to be individually determined some men respond with extreme delay whereas others only experience a small delay at the same dose of the drug. Moreover, cessation of treatment results in a uniform reset of the setpoint within 3-5 days to

Evolution Of Current Treatment Approaches

Start-stop technique for the treatment of rapid ejaculation was first described by Semans in 1956 (10). However, the major use of behavioral techniques to treat sexual problems began after the publication of Human Sexual Inadequacy by Masters and Johnson in 1970 (11). In the 1980s, case reports began appearing in the psychiatric literature about using monoamine oxidase inhibitors and low dose antipsychotic drugs to treat rapid ejaculation (12). However, the use of psychiatric drugs to treat rapid ejaculation became much more common after the introduction of the selective serotonin reuptake inhibitors.

Positron Emission Tomography Scan Studies in Humans

Although male rat studies are of utmost importance for a better understanding of the neurobiology of ejaculation, brain imaging studies in humans are the tools which provide a better understanding of how the human brain mediates ejaculation and orgasm. Brain imaging studies will probably lead to a deeper insight into which parts of the brain mediate ejaculation and which parts are involved in the mechanism of orgasm, how these neural areas are linked to each other, and which parts are disturbed in the different ejaculatory and orgasm disturbances. The first Positron Emission Tomography (PET)-scan study during ejaculation has recently been conducted by Holstege et al. (14). Eleven healthy male volunteers were brought to ejaculation by manual stimulation of their female partner. The PET technique using radioactive water (H 5O) shows increases or decreases in blood flow in distinct parts of the brain, representing increases or decreases of activation of neurons in these areas. It was...

Psychological Therapies for Men with ED

The third group of men includes those with the presence of other psychological morbidity such as dysthymia or mild depression, substance misuse, relational problems, or other sexual problems such as loss of desire or ejaculatory disturbance. These may require a more proactive input from the psychosexual therapist, which may incorporate psychosexual therapy, relationship therapy, often integrated with management from one or more mental health professionals for any associated mental health disorders.


In PE, ejaculation occurs earlier than the patient and or the couple would like, thus preventing full satisfaction from intercourse, especially on the part of the sexual partner, who frequently fails to attain orgasm. PE is almost invariably accompanied by marked emotional upset and interpersonal difficulties that may add frustration to an already tense situation, which makes the loss of sexual fulfillment even worse. It is also important to differentiate male orgasm from ejaculation. Some men are able to distinguish between the two events and enjoy the


Waldinger (5,15) distinguishes four periods in the approach to and treatment of premature ejaculation. The First Period (1887-1917) Early Ejaculation In 1887, Gross (16) described the first case of early ejaculation in medical literature. A second report of von Krafft-Ebing (17) followed in 1901. Although publications were rare, it is worth noting that during the first 30 years of its existence in the medical literature, early ejaculation was viewed as an abnormal phenomenon but not significantly as a psychological disturbance. In 1917, Abraham (18) described early ejaculation as ejaculatio praecox and stated that it was a symptom of a neurosis caused by unconscious conflicts. Treatment should consist of classic psychoanalysis. On the other hand, some physicians stated that premature ejaculation was due to anatomical urological abnormalities, such as a too short foreskin frenulum or changes in the posterior urethra, which had to be treated with incision of the foreskin or...


Premature ejaculation is often cited as being the most common male sexual dysfunction. The exact prevalence, however, is unknown as this appeared difficult to determine. Although it has been estimated that as many as 36 of all men in the general population experience premature ejaculation (24), other estimates have been lower. For example, Gebhard and Johnson (25), from a reanalysis of the Kinsey data, determined that 4 of the men interviewed reported ejaculating within 1 min of intromission. The large differences in prevalence numbers are mainly due to the use of various and often totally different definitions of premature ejaculation that have been used. Only by the general use of an empirically defined definition and identical tools to measure the ejaculation time, methodologically correct epidemiological studies can provide reliable prevalence data. Such studies have not been performed yet.


Owing to a congenital or acquired anatomical and or functional failure of closure of the internal sphincter of the bladder (bladderneck) during the ejaculatory process, sperm passes into the bladder. Most frequently the cause is a transure-thral prostatectomy, a surgical treatment of benign prostatic hypertrophy. But any traumatic, neurogenic or drug-induced interference with the thoracolumbar sympathetic nervous system may lead to retrograde ejaculation. Spinal cord injury through trauma, birth defect, neoplasm, or surgery and abdominopelvic surgery, retroperitoneal lymph node dissection or total lymphadenectomy, and diabetes may also result in retrograde flow of semen.

Ductus Deferens

The ductus deferens begins at the inferior pole of the testes, ascends to enter the spermatic cord, transits the inguinal canal, and enters the abdominal cavity by passing through the deep inguinal ring. It is joined by the seminal vesicle at the ampulla of the ductus deferens, to form the ejaculatory duct. The ejaculatory duct passes through the prostate gland and opens into the prostatic urethra at the urethral crest.

Trichina worm

Classified as animal (mammal) parasites and the causal organism of the disease trichinosis, they are small roundworms that live mainly in rats and other small mammals such as pigs that pick up the worm while rooting for food. Adults have a length of 0.055-0.158 in (1.4-4.0 mm), with males measuring 0.055-0.063 in (l.4-1.6 mm) in length and females 0.118-0.158 in (3.0-4.0 mm) in length. Males and females have distinct features. Females possess a uterus and vulva. The vulva is located near the middle of the esophagus, which is about one-third the length of the body. Males have a single gonad, but no copula-tory spicule, and have an ejaculatory duct. Structures identifiable on both sexes include the muscular esophagus, stichosome, and intestine. Stichosomes are formed by a single short row of stichocytes, following a short muscular esophagus. The color of the external surface of the adult is translucent and white. Both sexes are more slender at the anterior than at the posterior, but do...

Marcel D Waldinger

Premature Ejaculation 223 The First Period (1887-1917) Early Ejaculation 223 The Second Period (1917-1950) Operational Definition of Premature Ejaculation 227 The Ejaculation Distribution Theory of Premature Ejaculation 227 Premature Ejaculation and Genetics 230 Drug Treatment for Premature Ejaculation 231 Anesthetic Ejaculation (Ejaculatory Anhedonia) 239 Partial Ejaculatory Incompetence 240


In DSM-IV (American Psychiatric Association, 1994), retarded ejaculation is termed Male Orgasmic Disorder and defined as a persistent or recurrent delay in, or absence of, orgasm in a male following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person's age, judges to be adequate in focus, intensity, and duration. In more simple terms, retarded ejaculation means that a man finds it difficult or impossible to ejaculate, despite the presence of adequate sexual stimulation, erection, and conscious desire to achieve orgasm. Some of these men may struggle to ejaculate with such desperation that they may physically exhaust themselves, and sometimes even their partner, in the attempt. Delayed ejaculation may occur in coitus, masturbation (either by the patient or by the partner), as well as during anal or oral intercourse. Throughout the years, a variety of terms have been used to refer to this eja-culatory disorder. Synonyms for delayed...

Figure 2120

Ejaculatory ducts, ductus deferens, epididymis, and efferent ductules are all developed from the mesonephric duct and tubules. The seminiferous tubules, straight tubules, and rete testis develop from the indifferent gonads. The prostate gland develops from the prostatic primordium that originates from the pelvic urethra.

Human whipworm

They derive their name from the characteristic whip-like shape. Adults are 1.2-2.0 in (30-50 mm) in length, with a thread-like anterior end that becomes thicker at the posterior end. Both sexes have two distinct body regions. Males are 1.2-1.8 in (30-45 mm) in length, while adult females are 1.4-2.0 in (35-50 mm) in length. Females are very attenuated on the anterior three-fifths of the body, and become greatly expanded in the posterior two-fifths. Males are similarly shaped, but the swollen posterior is less pronounced. For most of the body's length, there is an area designated as the bacillary band, which is a combination of hypodermal and glandular tissues. The glandular tissue opens up to the exterior through cuticular pores. They have a mouth with a simple opening, and do not have lips. The buccal cavity is tiny and is provided with a minute spear. The esophagus is very long, occupying about two-thirds of the body length and consists of a...


In male rats, Coolen and co-workers (9-13) demonstrated the presence of distinct ejaculation-related neural activation in several brain regions following ejaculation the posteromedial part of the bed nucleus of the stria terminalis (BNSTpm), a lateral subarea in the posterodorsal part of the medial amygdala (MEApd), the posterodorsal preoptic nucleus (PD), and the medial part of the parvicellular subparafascicular nucleus (SPFp) of the thalamus. These brain regions containing ejaculation-induced activation are extensively interconnected and reciprocally connected with the MPOA (12), forming an ejaculation-related subcircuit within the larger brain circuits underlying male sexual behavior (12). The functional significance of this ejaculation-subcircuit is still poorly understood but it might well be that these areas play a role in satiety and thus mediate the post-ejaculatory interval. Truitt and Coolen (13) highlighted the role of the lumbar spinal cord in the processing of...


The diagnosis is usually readily made on the basis of the patient's history and the presence of the DSM-IV-TR diagnostic criteria. Male orgasmic disorder may be part of a complex of sexual malfunctioning that may include erectile dysfunction, abnormalities in ejaculation (such as premature ejaculation or retrograde ejaculation), and hypoactive sexual desire disorder.


Orgasm, premature ejaculation, functional dyspareunia, functional vaginismus, and ego-dystonic homosexuality. In DSM-IIIR, ego-dystonic homosexuality was deleted and sexual aversion disorder was added. The names of certain diagnoses were changed. For example, inhibited sexual desire became hypoactive sexual desire disorder. Sexual arousal disorder and male erectile disorder were substituted, respectively, for inhibited male and female sexual arousal disorders. Throughout, changes in criteria sets have been minimal. In DSM-IV, most of the names and criteria sets resemble DSM-IIIR. The requirement that a disorder be diagnosed only if it causes significant personal distress was added to put a high threshold for diagnosis (45). The DSM based classification remains unclear. For instance, it intermingles terms of sexual dysfunction(s) and sexual disorder(s) in an unclear manner. Current nomenclature includes hypoactive sexual desire disorder, sexual aversion disorder, sexual arousal...

Course of Rapidity

It is generally believed that aging delays ejaculation. This assumption, might be true for men with a normal or average ejaculation time but has never been investigated in men with premature ejaculation. In a stopwatch study (48) of 110 consecutively enrolled men (aged 18-65 years) with lifelong premature ejaculation, 76 reported that throughout their lives, their speed of ejaculation had remained as rapid as at the first sexual contacts in puberty and adolescence, 23 reported that it had become even gradually faster with aging, and only 1 reported that it had become slower. From these data, it is questioned whether the fixed rapidity and even paradoxical shortening of the ejaculation latency time while getting older should be recognized as a part of the pathogenetic process of premature ejaculation. According to Waldinger, early ejaculation is thought of as a part of a normal biological variation of the IELT in men, but its paradoxical or fixed course through life is considered as...

Figure 2124

The ampulla has taller, branched mucosal folds that often show glandular diverticula. The muscle coat surrounding the ampulla is thinner than that of the rest of the ductus deferens, and the longitudinal layers disappear near the origin of the ejaculatory duct. The epithelium of the ampulla and ejaculatory duct appears to have a secretory function. The cells contain large numbers of yellow pigment granules. The wall of the ejaculatory duct does not have a muscularis layer the fibromuscular tissue of the prostate substitutes for it.

Figure 2129

The penis is innervated by somatic, sympathetic, and parasympathetic nerves. Many sensory nerve endings are distributed throughout the tissue of the penis, and sympathetic and parasympathetic visceral motor fibers innervate the smooth muscle of the trabeculae of the tunica albu-ginea and the blood vessels. Both sensory and visceral motor fibers play essential roles in erectile and ejaculatory responses.

Richard Balon

In the last decades of the 20th century, major changes have occurred in our understanding, conceptualization, and treatment of sexual problems. Much of this change was heralded in by the development of oral therapies for the treatment of erectile disorders, the off-label usage of serotonergic antidepressants to treat rapid ejaculation, the increasingly common use of unapproved use of androgens

Evolving Models

A 26-year-old male who complains being distressed because ejaculating within 30-60 sec after penetration during sex with his wife, but reports no rapid ejaculation while masturbating technically meets the diagnostic criteria for premature ejaculation. Nevertheless, the diagnosis of premature ejaculation does not fully describe the scope and psychology of his sexual dysfunction. The same could be implied in the case of 67-year-old married male who started to compulsively masturbate about 2 years ago. He thinks about other men being around at times while masturbating, or at times he masturbates just without any thoughts, in various places, for example, while driving. Is his diagnosis sexual disorder not otherwise specified Or obsessive-compulsive disorder Do these diagnoses-labels help the clinician in any way

Sex Therapy

They had maintained reasonably effective sexual interchange during their marraige. Mr. A. had no difficulty with erection, reasonable ejaculatory control, and . . . had been fully committed to the marriage. Mrs. A., occasionally orgasmic during intercourse and regularly orgasmic during her occasional masturbatory experiences, had continued regularity of coital exposure with her husband until 5 years prior to referral for therapy.

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