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Introduction

Premature ejaculation is characterized by uncontrolled ejaculation and decreased ejaculatory latency (ie, time from penetration to ejaculation).  It can occur as an isolated symptom or in association with other sexual disorders (eg, erectile dysfunction).  The exact etiology is often unclear and treatment is only required if the condition causes distress for the patient and/or partner.  Selective serotonin reuptake inhibitors, which prolong ejaculatory latency, are often effective.

Physiology

Sexual arousal is the primary stimulus for tumescence (ie, erection), and repetitive penile stimulation eventually leads to ejaculation, a complex process that is coordinated by the central and peripheral (somatic and autonomic) nervous systems.  Ejaculation occurs in 2 phases:

  • Emission:  Sperm and seminal fluid are secreted into the prostatic (ie, posterior) urethra.
  • Expulsion:  Rhythmic contractions of the bulbospongiosus and ischiocavernosus muscles propel semen through the urethra and out the meatus.  This is typically when orgasm occurs.

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