Editing Disorders of Ejaculation and Orgasm (section)

=== Management ===
* DE is associated with high levels of relationship distress, sexual dissatisfaction, anxiety about their sexual performance, and general health issues
*'''Treatment may include patient/couple psychoeducation and/or psychosexual therapy, lifestyle changes, pharmacotherapy, or integrated treatment'''

==== Options (4): ====

# '''Psychological strategies'''
# '''Lifestyle changes'''
# '''Pharmacotherapy'''
# '''Vibratory stimulation and electroejaculation'''

===== Psychological strategies =====
* If organic and pharmacologic causes have been eliminated, referral to an expert psychosexual therapist is usually indicated to evaluate the causative psychological and behavioral issues.

===== Lifestyle changes =====
* Changes include enjoying more time together to achieve greater intimacy, minimizing alcohol consumption, having sex when not tired, and practicing techniques that maximize penile stimulation such as pelvic floor training

===== Pharmacotherapy =====
* '''Options include pseudophedrine (alpha-agnonist), reboxetine (SNRI), carbegoline, amantadine, oxytocin, burpropion, buspirone, and cyrohetadine.'''
** '''These drugs facilitate ejaculation''' by either a central dopaminergic, antiserotonergic, or oxytocinergic mechanism of action or a peripheral adrenergic mechanism of action. However, no drugs have been approved by regulatory agencies for this purpose and most drugs that have been identified for potential use have '''limited efficacy''', impart significant side effects, or are as yet considered experimental in nature.
* Results are relatively poor in men with psychogenic DE and neuropathic DE.

===== Vibratory stimulation and electroejaculation =====

*Several techniques for obtaining semen in men with SCI with ejaculatory dysfunction have been reported including vibratory stimulation and electroejaculation, both of which are associated with a significantly high risk of autonomic dysreflexia (see Surgery for Infertility Chapter Notes).