Premature ejaculation can be life-long (primary) or aquired. There are numerous theories as to the cause, but most cases are probably multi-factorial with a contribution from both psychological and physical factors. This is believed to be the most common sexual dysfunction in males. The lifelong prevalence of premature ejaculation is roughly 4% but as many as 30% of men of all ages will self-report it.
Retrograde ejaculation is the process whereby the semen is passed in a retrograde fashion into the bladder as opposed to anterograde out the urethra. There are three potential causes to this problem; anatomic, neurologic, and pharmacologic. Anatomic causes can result from prior prostate surgery (i.e. transurethral resection of the prostate) or from congenital disorders. Neurologic disorders can interfere with the ability of the bladder neck to close during emission and ejection. This can be a result of diabetes mellitus or retroperitoneal or pelvic surgery. Finally, certain medications result in a paralysis of the bladder neck which often results in retrograde ejaculation.
Delayed ejaculation and anorgasmia involve the inability of the patient to achieve orgasm (ejaculation) in a timely manner, and in severe cases men fail to achieve orgasm on any occasion. Failure to achieve orgasm may be due to inadequate sexual stimulation, psychological disorders or medical conditions. Psychological disorders and/or psychosocial variables may include relationship stressors, partner conflict, and personal distress regarding sexuality. Other causes of this condition include the use of certain anti-depressant medications (fluoxetine, sertraline, paroxitine, fluvoxamine, citalopram) and sensory neurologic disorders affecting penile sensation (as may occur with diabetic nerve damage). Finally, there are men for whom there is no clear etiology for this problem who are believed to have either a physiological or idiopathic form of this condition.
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