Ejaculatory Inhibition - Causes, Types and Risk Factors

Introduction

Ejaculation inhibition is one of the least frequent, least investigated, and least understood male sexual dysfunctions. Both the male and his partner are likely to experience a loss of sexual fulfillment due to this disorder. In addition, men who cannot ejaculate and reach orgasm have various psychological effects, including worry, distress, and a lack of confidence in their sexual interactions. Ejaculation inhibition is a phrase used to describe a change in the pattern of ejaculation and orgasm that includes retrograde ejaculation, variable delays in ejaculation latency, and complete inability to ejaculate (anejaculation). This group also includes reductions in the volume, force, and sensation of ejaculation.

What Causes Ejaculatory Inhibition?

The etiology of ejaculation inhibition is frequently multifaceted, coming from many biological or psychogenic variables affecting the man's biologic ejaculatory latency in varying combinations throughout his life.

Psychological Reasons

Many psychological and relational factors have been traditionally implicated as confounding factors in the etiology of ejaculation inhibition, including

• Fear of pregnancy and problems with fertility.

• Fear of being castrated and dying.

• The fear of annihilation linked to the loss of sperm.

• The fear of losing control.

• Fear of coming out or being exposed and, as a result, feeling ashamed about the problem.

• Abandonment or rejection fears.

• Intimacy phobias and a loss of autonomy.

• Fear of injuring or defiling one's relationship.

• Fear of being retaliated against by the female or other males.

• Fear of achieving success (success phobia).

Physiological Reasons

• Penile sensitivity has decreased (hypothesized).

• Response system that is inherently sluggish or muted.

• The ejaculatory threshold is high.

Pathophysiological Reasons

• Medication can be an iatrogenic cause.

• Trauma or pelvic surgery (for example - spinal cord injury, prostatectomy, resection of the prostate).

• Neuropathy is a condition that affects neural functioning (diabetes, and other diseases affecting the nervous system).

• Endocrinology (hypogonadism, hypothyroidism).

• Age-related.

Religious Beliefs and Orthodoxy

• Strong auto sexuality (masturbation).

• Reduced sexual desire.

• Sexual arousal or excitement is insufficient.

• Anxiety about sexual performance.

• The relational disparity in sexual dysfunction between fantasy partners.

Infections or Inflammations

• Urethritis (urethral inflammation).

• Genitourinary tuberculosis (urinary tract infections caused by tuberculosis bacteria).

• Schistosomiasis (a disease caused by parasitic worms).

• Prostatitis (prostate gland infection).

• Orchitis (infection of the testes).

• Orchialgia in testis cancer survivors (deep testicular pain in cancer survivors).

Does Masturbation Cause Ejaculatory Inhibition?

Another well known pathophysiological cause for ejaculatory inhibition is "autosexual" orientation, which refers to males who prefer masturbation to partnered sex. Many men with ejaculatory inhibition engage in self-stimulation that differs from what they would do with a partner in terms of the pace, pressure, duration, and intensity required to produce an orgasm. As a result, they prepare themselves for the possibility of having problems achieving orgasm with a partner, and as a result, they develop acquired ejaculatory inhibition.

What Are the Different Types of Ejaculatory Inhibition?

Ejaculatory inhibition can be categorized into four categories as follows:

• Lifelong Ejaculatory Inhibition - A retrograde inhibition or incompetence present from puberty.

• Acquired Ejaculatory Inhibition - After a time of normal sexual function, acquired ejaculatory inhibition develops.

• Generalized Ejaculatory Inhibition - Ejaculatory suppression is not restricted to specific sex partners or types of stimulation.

• Situational Ejaculatory Inhibition - Only in particular instances situational ejaculatory suppression occurs.

What Are the Factors That Increase the Risk of Ejaculatory Inhibition?

Risk factors are those whose presence increases the likelihood of the condition. For example, a few risk factors for ejaculatory inhibition are:

• Age - Men's physique and sexual responses alter as they grow older. Ejaculatory inhibition is more common in older patients who have more concurrent conditions. In older patients, depression, peripheral vascular disease, diabetes, late-onset hypogonadism, higher BMI (body mass index), and psychological disorder appear to contribute to ejaculatory inhibition.

• Lifestyle - Smoking, obesity, alcohol consumption, inactivity, and loneliness (such as the loss of a spouse) are all known to be potent inhibitors of ejaculation and overall sexual function and satisfaction.

• Sexual Attitude, Anxiety, and Sexual Skills - Ejaculatory inhibition can be caused by discontent, performance anxiety, and discomfort. When coping with ejaculatory inhibition in infertility situations, distress grows, which can have negative implications in relationships. Suppressed anger, fear of pregnancy, fear of "defiling" a partner by ejaculation, or unwillingness or inability to embrace pleasure are some of the proposed psychological roots of ejaculatory inhibition.

What Happens if You Do Not Address Ejaculatory Inhibition?

• Ejaculatory inhibition can occur due to underlying pathological conditions such as inflammation of reproductive organs or distortion of ducts, which needs medical attention.

• It is difficult to generalize, but sexual dissatisfaction caused by ejaculatory inhibition can result in increased anxiety, low self-esteem and sense of self, body-image difficulties, and a sense of worthlessness in both sexual partners.

• Sex can boost communication and feelings of connection for certain people. People who do not feel like they have enough sex due to ejaculatory inhibition may worry that something is wrong with their relationship or that their partner is losing interest in them, leading to severe relationship issues.

Is It Possible to Overcome Ejaculatory Inhibition?

Workup and treatment are tailored to the underlying concerns based on the etiology of ejaculatory obstruction. Ejaculatory inhibition treatments include the art of balancing the physiological, psychological, social, and behavioral factors that contribute to the disease can be broken down into medication, penile vibratory stimulation, psychological (sexual therapy, masturbation retraining).

• Pharmacotherapy - The removal of pharmaceuticals that have been shown to increase ejaculatory inhibition, such as hypertension drugs and the administration of drugs and hormone supplements like oxytocin, have been shown to treat the disease.

• Penile Vibratory Stimulation (PVS) - Electro ejaculation treatments such as penile vibratory stimulation (PVS) have been utilized to treat ejaculatory difficulties in neurogenic patients for many years. Ejaculation can be obtained by stimulating the pudendal nerves, which helps to activate the ejaculatory reflex in patients with ejaculatory inhibition. Therefore, when PVS is used with medical therapy, the efficacy of ejaculatory inhibition treatment improves.

• Sex Therapy - Increased genital specific stimulation, sexual education, roleplaying alone and in front of his spouse, masturbatory retraining practices, anxiety reduction on ejaculation and performance, and recalibrating the mismatch of sexual fantasies with arousal are some of the psychological treatments that can help to treat ejaculatory inhibition.

Conclusion

Ejaculation physiology is quite complicated. Ejaculatory inhibition, unlike premature ejaculation, is a rare clinical condition with no consensus on its etiology or therapy. Patients with ejaculatory inhibition are assessed using a comprehensive medical history, physical examination, and laboratory tests to guarantee a correct diagnosis. However, many ejaculatory inhibition patients are successfully treated with tailored psychological therapy.