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Spontaneous Ejaculation: A Focused Review for the Clinicians.

Ibrahim A Abdel-Hamid1, Omar I Ali2

  • 1Division of Andrology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

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Summary

Spontaneous ejaculation (SE) is an underreported ejaculatory dysfunction occurring without sexual stimulation. This review details its causes, symptoms, and treatments, including psychotherapy and medication.

Keywords:
Disorders of EjaculationDrugsInvoluntary EjaculationPsychogenicRabiesSpinal CordSpontaneous EjaculationSpontaneous Emission

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Area of Science:

  • Reproductive Medicine
  • Urology
  • Sexual Medicine

Background:

  • Spontaneous ejaculation (SE) is an involuntary ejaculatory event occurring without sexual stimulation, often causing distress.
  • Understanding of SE is limited, and awareness among healthcare providers is low.

Purpose of the Study:

  • To comprehensively review the etiopathogenesis, clinical features, diagnosis, and treatment of spontaneous ejaculation.
  • To increase awareness and understanding of SE among clinicians.

Main Methods:

  • A systematic literature search was conducted across multiple databases (PubMed/MEDLINE, Scopus, Cochrane Library, EMBASE, PsycINFO, ProQuest, Academic Search Complete, Google Scholar, CINAHL) up to August 2020.
  • Publications focusing on SE, spontaneous emission, or involuntary ejaculation were identified and analyzed.

Main Results:

  • The review identified 36 publications on 43 patients with SE.
  • Potential causes include spinal cord lesions, psychological factors, rabies, and drug-induced effects.
  • Mechanisms may involve adrenergic/dopaminergic/serotonergic system imbalances, damaged inhibitory pathways, or penile hyperexcitability.
  • SE can occur spontaneously or be triggered by non-sexual stimuli like urination, defecation, or anxiety.
  • Treatment options include psychoanalytic therapy, SSRIs (paroxetine, citalopram, sertraline), silodosin, and anxiolytics. Drug-induced SE may resolve with dose adjustment or withdrawal.

Conclusions:

  • Spontaneous ejaculation is a rare ejaculatory dysfunction characterized by ejaculation without sexual arousal, often triggered by non-sexual contexts.
  • Psychotherapy and pharmacotherapy show potential for managing SE.
  • Further research is needed to elucidate the precise underlying mechanisms of SE.