Marcel D Waldinger

Leyenburg Hospital, The Hague, The Netherlands

Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute for Neurosciences, Utrecht University, Utrecht, The Netherlands

Introduction 217

Neurophysiology 218

Ejaculation 218

Orgasm 219

Neurobiology of Ejaculation 219 Serotonin, 5-Hydroxytryptamine Neurotransmission and

5-HT Receptors 219

Male Rat Sexual Behavior 220

Neuroanatomy 221

Positron Emission Tomography-Scan Studies in Humans 222

Premature Ejaculation 223

History 223

The First Period (1887-1917): Early Ejaculation 223 The Second Period (1917-1950):

Neurosis and Psychosomatic Disorder 223

The Third Period (1950-1990): Learned Behavior 224 The Fourth Period (1990 to Present): Neurobiology and Genetics 224

Prevalence 224

Evidence-Based Medicine 224

Evidence-Based Research: Psychotherapy 225

Evidence-Based Research: Drug Treatment 226

Operational Definition of Premature Ejaculation 227

The "Ejaculation Distribution Theory" of Premature Ejaculation 227

Ejaculation Threshold Hypothesis 229

Course of Rapidity 230

Premature Ejaculation and Genetics 230

Treatment 231

Drug Treatment for Premature Ejaculation 231

Daily Treatment with Serotonergic Antidepressants 232

As-Needed Treatment with Antidepressants 232

As-Needed Treatment with Anesthetic Topical Ointments 233

Psychotherapy and Behavioral Therapy 233

Retarded Ejaculation 233

Definition 234

Symptoms 234

Prevalence 234

Lifelong Delayed Ejaculation 235

Psychological Approach 235

Neurobiological Approach 235

Treatment of Lifelong Delayed Ejaculation 236

Acquired Delayed Ejaculation 237

Psychological Factors 237

Organic Factors 237

Treatment of Acquired Delayed Ejaculation 237

Research and Methodology 238

Retrograde Ejaculation 238

Definition 238

Symptoms 238

Etiology 239

Treatment 239

Anesthetic Ejaculation (Ejaculatory Anhedonia) 239

Definition 239

Symptoms 239

Etiology 240

Treatment 240

Partial Ejaculatory Incompetence 240

Definition 240

Symptoms 240

Etiology 240

Treatment 241

Painful Ejaculation 241

Definition Symptoms Etiology Treatment

241 241 241 241 241

242 242 242 242 242

PostOrgasmic Illness Syndrome

Definition Symptoms Etiology

Treatment Conclusions References

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