Disorders of orgasm and ejaculation in men.
BACKGROUND
Ejaculatory/orgasmic disorders are common male sexual dysfunctions, and include premature ejaculation (PE), inhibited ejaculation, anejaculation, retrograde ejaculation, and anorgasmia.


OBJECTIVE
To provide recommendations and guidelines concerning current state-of-the-art knowledge for management of ejaculation/orgasmic disorders in men.


METHODS
An international consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 25 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge of disorders of orgasm and ejaculation represent the opinion of seven experts from seven countries developed in a process over a 2-year period.


METHODS
Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.


RESULTS
Premature ejaculation management is largely dependent upon etiology. Lifelong PE is best managed with PE pharmacotherapy (selective serotonin re-uptake inhibitor [SSRI] and/or topical anesthetics). The management of acquired PE is etiology specific and may include erectile dysfunction (ED) pharmacotherapy in men with comorbid ED. Behavioral therapy is indicated when psychogenic or relationship factors are present and is often best combined with PE pharmacotherapy in an integrated treatment program. Retrograde ejaculation is managed by education, patient reassurance, pharmacotherapy, or bladder neck reconstruction. Delayed ejaculation, anejaculation, and/or anorgasmia may have a biogenic and/or psychogenic atiology. Men with age-related penile hypoanesthesia should be educated, reassured, and instructed in revised sexual techniques which maximize arousal.


CONCLUSIONS
Additional research is required to further the understanding of the disorders of ejaculation and orgasm.
Rowland
David
D
Valparaiso University, Psychology, Valparaiso, IN, USA.
McMahon
Chris G
CG
Abdo
Carmita
C
Chen
Juza
J
Jannini
Emmanuele
E
Waldinger
Marcel D
MD
Ahn
Tai Young
TY
D000465:Algorithms; D000779:Anesthetics, Local / Q000627:therapeutic use; D001521:Behavior Therapy; D004542:Ejaculation / Q000502:physiology; D006801:Humans; D008297:Male; D008511:Medicine / Q000379:methods / Q000592:standards; D009819:Office Visits; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D015995:Prevalence; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D044347:Sexology / Q000379:methods / Q000592:standards; D012735:Sexual Dysfunction, Physiological / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D014572:Urology / Q000379:methods / Q000592:standards
D000779:Anesthetics, Local; D017367:Selective Serotonin Reuptake Inhibitors