There are a group of men with delayed ejaculation (DE) where the etiology as well as the consequences of the dysfunction are unclear. The aim of the present study was to explore, from a psychodynamic perspective, personality traits among men seeking treatment due to DE. During a 2.5-year period, a consecutive series of 14 men with DE were seeking help at Karolinska University hospital, Sweden. Full medical history and physical examination, sexological case-history and psychological assessments were performed by physicians and a psychotherapist. The results found all patients to be healthy. Mean age was 34 years (range 20-43 years). No other sexual dysfunction occurred. With one exception, they were sexually active. The psychological assessment (The Karolinska Psychodynamic Profile; KAPP) found patients to have difficulties in areas of dependency and separation, control and impulse control, regression in the service of the ego, coping with aggressive affects, alexithymic traits, sexual function, and satisfaction. The results add a deeper understanding of personality traits among healthy patients with DE, which may be a tool for the case history, and offer new treatment strategies. We suggest that DE can be the physical manifestation of some specific personality difficulties, and thus, ejaculation becomes the goal in itself and not the climax of an enjoyable adventure.

BACKGROUND: Delayed ejaculation is a small but important subsection of ejaculatory dysfunction, with prevalence estimated at 1-4%. It is most commonly defined by DSM-IV-TR criteria, as \"a persistent delay in, or absence of, orgasm in a male following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person\'s age, judges to be adequate in focus, intensity, and duration.\" The pathophysiology of delayed ejaculation is related to disruptions in ejaculatory apparatus, nervous transmission, hormonal or neurochemical ejaculatory control, or psychosocial factors.
OBJECTIVE: To update the clinician on the evaluation and treatment of delayed ejaculation.
METHODS: The keywords \"delayed ejaculation\" and \"retarded ejaculation\" were utilized to search Pubmed for relevant publications.
METHODS: 319 results were generated from the search, and those publications judged relevant to the pathophysiology, epidemiology, evaluation, and treatment of delayed ejaculation were included in the review.
RESULTS: 110 articles were ultimately selected for inclusion in this review.
CONCLUSIONS: The evaluation of this condition requires a focused history and physical, which includes a detailed sexual history, examination of the genitalia, and inquiry into the status of the partner. Laboratory tests are aimed at the detection of abnormalities in the blood count, glucose level, hormone levels, or kidney function. If a correctable etiology is discovered, treatment is directed towards the reversal of this condition. In some cases, the delayed ejaculation may be a lifelong problem. Also, in some cases the etiology of the delayed ejaculation may be irreversible, such as in the case of age-related sensation loss or diabetes-related neuropathy. In these instances treatment may require a combination of behavioral modification, sexual therapy, or perhaps pharmaceutical drugs. Participation of the partner in therapy may sometimes be necessary. Future investigations will continue to elucidate the complex biological and psychosocial factors which contribute to delayed ejaculation, leading to more effective treatments. Shin DH and Spitz A. The evaluation and treatment of delayed ejaculation. Sex Med Rev 2014;2:121-133.

Delayed ejaculation (DE) is probably least studied, and least understood of male sexual dysfunctions, with an estimated prevalence of 1-4% of the male population. Pathophysiology of DE is multifactorial and including psychosexual-behavioral and cultural factors, disruption of ejaculatory apparatus, central and peripheral neurotransmitters, hormonal or neurochemical ejaculatory control and psychosocial factors. Although knowledge of the physiology of the DE has increased in the last two decade, our understanding of the different pathophysiological process of the causes of DE remains limited. To provide a systematic update on the pathophysiology of DE. A systematic review of Medline and PubMed for relevant publications on ejaculatory dysfunction (EjD), DE, retarded ejaculation, inhibited ejaculation, and climax was performed. The search was limited to the articles published between the January 1960 and December 2015 in English. Of 178 articles, 105 were selected for this review. Only those publications relevant to the pathophysiology, epidemiology and prevalence of DE were included. The pathophysiology of DE involves cerebral sensory areas, motor centers, and several spinal nuclei that are tightly interconnected. The biogenic, psychogenic and other factors strongly affect the pathophysiology of DE. Despite the many publications on this disorder, there still is a paucity of publications dedicated to the subject.

BACKGROUND: Masturbation is a common sexual activity among people of all ages throughout life. It has been traditionally prohibited and judged as immoral and sinful by several religions. Although it is no longer perceived as a negative behavior, masturbation is often omitted in the diagnostic inquiry of patients with sexual problems.
OBJECTIVE: The aims of this study are to increase the awareness of clinicians to the importance of including questions regarding masturbatory habits in the process of sexual history taking, to analyze cases of male sexual dysfunction (SD) associated with unusual masturbatory practices, and to propose a practical tool for clinicians to diagnose and manage such problems.
METHODS: A clinical study of four cases that include a range of unusual masturbatory practices by young males who applied for sex therapy is described. An intervention plan involving specific questions in case history taking was devised. It was based on detailed understanding of each patient\'s masturbatory practice and its manifestation in his SD.
METHODS: Effects of identifying and altering masturbatory practices on sexual function.
RESULTS: The four men described unusual and awkward masturbatory practices, each of which was associated with different kinds of SD. The unlearning of the masturbatory practices contributed notably to improvement of their sexual function.
CONCLUSIONS: The four cases in this study indicate that the detailed questioning of masturbatory habits is crucial for a thorough assessment and adequate treatment of sexual problems in men. We propose specific questions on masturbatory behavior as well as a diagnostic and therapeutic flowchart for physicians and sex therapists to address those problems.