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Related Experiment Video

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

Qingqiang Gao1, Baibing Yang1, Youfeng Han1

  • 1Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.

Translational Andrology and Urology
|September 15, 2025
PubMed
Summary

Situational delayed ejaculation involves sympathetic hyperactivity, indicated by shorter penile sympathetic skin response latency. This dysfunction correlates with anxiety and altered masturbation patterns, suggesting a distinct clinical entity.

Keywords:
Delayed ejaculationanxietyintravaginal anejaculationsituational delayed ejaculation (SD-DE)sympathetic skin response (SSR)

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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.