How successful is the Treatment of Inhibited Ejaculation-from Authority to Evidence Based Medicine?

This presentation will explore the definition, prevalence, etiology, diagnosis and treatment of inhibited or retarded ejaculation (RE) from both an evidence-based and authority-based perspective. RE has a relatively low prevalence (<3%), yet this condition results in considerable distress, anxiety, and lack of sexual confidence for those suffering from it. Furthermore, men with partners often experience impairment of both the sexual and nonsexual aspects of their relationships, with such negative effects compounded when procreation is a consideration. The definition of RE is ambiguous, due to the variability and paucity of data regarding normal coital ejaculatory latency. RE is influenced by both biogenic and psychogenic components, which may vary over time both between and within individuals. While specific pathophysiology can often be identified, further elucidation of the biogenic components of this dysfunction will require greater understanding of the physiological mechanisms underlying ejaculation. Yet, the most useful strategies for understanding RE will integrate rather than isolate the various biogenic and psychogenic aspects of this dysfunction. Evidence based evaluation and treatment protocols for this disorder are less available, than for other sexual dysfunctions. However, in general reports suggest better treatment efficacy when the etiology is predominantly psychogenic. Treatment protocols using psychological/sex therapy approaches are in greater abundance than pharmaceutical approaches. Yet the level of evidence remains low, for both medical and psychosocial approaches, even among those that are reportedly highly effective. As with erectile dysfunction (ED) and premature ejaculation (PE), if safe and efficacious oral pharmaceuticals are eventually developed specifically for this condition, the treatment algorithm is likely to undergo significant alteration. Even then, however, there is a growing belief among eminent authorities, which is supported by emerging evidence, that the most effective approaches are likely to result from a combination treatment paradigm that integrates sex coaching with pharmacotherapy.


Conflict of Interest: None disclosed
Financial Support/Funding: None disclosed
Recorded: Sydney, Australia, April 2007