Editing Disorders of Ejaculation and Orgasm (section)

=== Causes of retrograde ejaculation, delayed ejaculation, anejaculation, and anorgasmia ===
* '''Any psychological or medical disease or surgical procedure that interferes with either central control of ejaculation or the peripheral sympathetic nerve supply to the vas and bladder neck, the somatic efferent nerve supply to the pelvic floor, or the somatic afferent nerve supply to the penis can result in delayed ejaculation, anejaculation, retrograde ejaculation, and/or anorgasmia.'''
*'''Psychogenic'''
** '''Often described as inhibited ejaculation'''
** Usually related to sexual performance anxiety; in some men, may be associated with orthodoxy of religious belief; guilt and anxiety about “spilling seed”
** Disparity between the reality of sex with the partner and the sexual fantasy used during masturbation may inhibit sexual arousal and thus represent another contributor to DE
* '''Aging male'''
** '''Degeneration of penile afferent nerves and Pacinian corpuscles'''
* '''Endocrine'''
** '''Diabetes'''
** '''Hypogonadism and low testosterone are associated with DE or anejaculation'''
** '''Hypothyroidism is strongly associated with delayed ejaculation, hyperthyroidism is rarely associated with premature ejaculation'''
** '''Hyperprolactinemia''', via inhibition of hypothalamic GnRH is associated with low testosterone, reduced sexual desire, ED, and DE. The effect of prolactin on ejaculation is possibly mediated via its action on the serotinergic system
* '''Neurogenic'''
** '''Causes'''
***'''Surgical'''
****'''Radical prostatectomy'''
*****After RP/RALP, men no longer ejaculate, but maintain a sense of orgasm
****'''Retroperitoneal lymph node dissection'''
*****'''Anejaculation occurs in the majority of the patients in non–nerve-sparing techniques. With nerve sparing techniques, antegrade ejaculation is maintained in 80-100% of patients'''
****** The superior hypogastric plexus, a fenestrated network of fibers anterior of the lower abdominal aorta, is responsible for ejaculation and is mediated by the sympathetic system. The hypogastric nerves exit bilaterally at the inferior pole of the superior hypogastric plexus and have connections with the S1 to S2 roots. Normal emission requires integrity of this system. During RPLND, these nerves are difficult to recognize and might be damaged, resulting in decreased semen volume or dry ejaculation.
****Proctocolectomy
****Bilateral sympathectomy
****Abdominal aortic aneurysmectomy
****Para-aortic lymphadenectomy
***'''Radiotherapy'''
****Pathways for ejaculation are included in the RT fields for rectal and prostate carcinomas
***'''Diabetes (autonomic neurpathy)'''
***'''Multiple sclerosis'''
***'''Stroke'''
***'''Spinal cord injury'''
****'''Unlike erectile capacity, the ability to ejaculate increases with descending levels of spinal injury'''
*****< 5% of patients with complete upper motor neuron lesions retain the ability to ejaculate
* '''Medication:'''
** '''SSRIs''', '''antipsychotics, tricyclic antidepressants, thiazide diuretics,''' α-Methyldopa, phenothiazine, alcohol abuse
*** '''60% of patients on SSRIs report some form of treatment-related sexual dysfunction, most commonly ejaculatory dysfunction'''
*** '''Antipsychotics can cause either a direct and/or indirect dopamine antagonism or increased prolactin levels and are commonly associated with DE and retrograde ejaculation.'''
*** Retrograde ejaculation associated with antipsychotics is thought to be due to antagonistic effects on the α-adrenergic system at the level of the bladder neck
* '''Anatomic'''
** '''Transurethral resection of prostate''', bladder neck incision
*** TURP carries a high incidence of retrograde ejaculation
* '''Congenital'''
** Müllerian duct cyst, Wolffian duct abnormality, Prune belly syndrome
* '''Infection (causing obstruction)'''
** Urethritis, genitourinary tuberculosis, schistosomiasis
** Sexually transmissible infections such as gonorrhea or nonspecific urethritis can produce cicatrization and obstruction anywhere in the male reproductive tract, especially if treatment is delayed.
** Urinary infection, especially if complicated by epididymitis, also can produce obstruction that may be situated at the ejaculatory duct level.