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Psychobiological Correlates of Delayed Ejaculation in Male Patients With Sexual Dysfunctions

GIOVANNI CORONA^*,

EDOARDO MANNUCCI

GIANCARLO BALERCIA

VALERIO CHIARINI

From the ^* Andrology Unit, Department of Clinical Physiopathology, University of Florence, Italy; Endocrinology Unit, Maggiore-Bellaria Hospital Bologna, Italy; Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Italy; Endocrinology Unit, Polytechnic University of Marche Ancona, Italy; ^|| Spinal Unit, Neurophysiopathology Service, University of Florence, Italy; ^¶ Humanitas Clinical Institute, Rozzano, Milan, Italy; and ^# International Institute of Sexology, Florence, Italy.

Correspondence to: Prof Mario Maggi, Andrology Unit, Department of Clinical Physiopathology, Viale Pieraccini 6, 50139 Florence, Italy (e-mail: m.maggi{at}dfc.unifi.it).

The pathogenesis of delayed ejaculation (DE) is rather unknown, though the contribution of various psychological, marital, hormonal, and neurological factors has been advocated. In this study we systematically investigated the relative relevance of the aforementioned factors in 1632 men who were seeking medical help for sexual dysfunction. The severity of DE was classified according to Kaplan criteria. Mild and moderate forms of DE (MMDE) recognized different risk factors than the most severe ones (anejaculation or severe DE [ASDE]). ASDE was essentially coupled with the presence of neurological diseases or with the use of serotoninergic drugs. Serotoninergic drugs also significantly increase (by at least 10-fold) the risk for MMDE, which, however, was also coupled with other relational factors (eg, partner's impaired climax, patient's hypoactive sexual desire [HSD]) or intrapsychic factors (eg, stress at work). At multiple regression analysis, some organic pathological conditions (such as psychiatric disorders and hypogonadism) were also associated with MMDE. In particular, hypogonadism retained significance for DE even after adjustment for HSD (adjusted odds ratio = 2.08 [1.11-3.89]; P < .05), suggesting other effects of testosterone deficiency on the ejaculatory reflex besides reduced libido. In conclusion, the present study demonstrates that multiple psychobiological determinants are associated with DE, a still obscure condition that substantially impairs psychosexual equilibrium of the couple.

     Key words: SIEDY, structured interview, testosterone

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