A comprehensive medical and sexual history is the most important aspect in the diagnosis of men with ejaculatory dysfunction. A focused genital exam is also indicated in most circumstances. Testosterone is often the most commonly performed blood test in the evaluation of ejaculatory dysfunction.
Premature ejaculation (PE), also known as rapid ejaculation, lacks a definition that is agreed upon by all practitioners, but essentially is the condition whereby a patient ejaculates with minimal sexual stimulation and before he wishes it to occur.
Premature ejaculation is currently defined by the International Society of Sexual Medicine as a lifelong history of ejaculation occurring within less than one minute of penetration (lifelong PE), or a clinically significant and bothersome reduction in latency time, often to about three minutes or less (acquired PE). Patients will also have reduced or absent ejaculatory control. Premature ejaculation often causes negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.
Patients with retrograde ejaculation will have a normal sensation of orgasm and climax but will have little to no anterograde (forward) propulsion of semen. This is often referred to as a dry orgasm. This process is diagnosed by the finding of seminal fluid and/or sperm within a urine specimen obtained immediately after orgasm.
Delayed ejaculation or anorgasmia involves the inability of the patient to achieve orgasm (ejaculation) in a timely manner, and in severe cases, involves failure to achieve orgasm on any occasion. As men age, there is an increase in the time it takes to achieve ejaculation. However, in some men, this increase may lead to the inability to ejaculate within a 30-minute time period from the initiation of sexual stimulation.
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