Sympathetic hyperactivity in situational delayed ejaculation (intravaginal anejaculation phenotype): a...

Area of Science:

• Neuroscience
• Urology
• Psychiatry

Background:

• Situational delayed ejaculation (SD-DE) is characterized by preserved masturbatory function but persistent coital anejaculation.
• This condition significantly impacts quality of life and causes distress.
• The underlying neurophysiology, particularly autonomic mechanisms, remains unclear.

Purpose of the Study:

• To investigate sympathetic function in SD-DE patients using penile sympathetic skin response (PSSR).
• To assess the clinical correlates of sympathetic dysfunction in SD-DE.

Main Methods:

• Sixty-seven SD-DE patients and 65 normal controls (NCs) were enrolled.
• Penile sympathetic skin response (PSSR) latency and amplitude, penile sensory threshold (PST), and clinical characteristics (including Self-Rating Anxiety Scale, SAS) were analyzed.
• Sympathetic nervous system function was evaluated.

Main Results:

• SD-DE patients showed significantly shorter PSSR latency (sympathetic hyperactivity) compared to NCs (P<0.001).
• Shorter PSSR latency negatively correlated with anxiety scores (P<0.001), indicating stress-mediated sympathetic overactivation.
• SD-DE patients had higher PST, increased masturbation frequency, and a higher prevalence of atypical masturbation, suggesting compensatory adaptations.

Conclusions:

• Sympathetic dysfunction is a core feature of SD-DE (DSM-5 302.74), with PSSR as an objective biomarker.
• The intravaginal anejaculation phenotype is a distinct clinical entity within DSM-5 302.74, informing targeted therapies.
• Future research should combine multimodal neuroimaging to verify pathological circuit mechanisms.