[Disorders of ejaculation]

Ejaculatory disorders include premature ejaculation (p. e.), deficient ejaculation (d. e.) and retrograde ejaculation (r. e.). On the basis of the history and simple investigations, the various disorders are relatively easy to differentiate. History taking should include information about the ability to ejaculate, including nocturnal emission and the ability to experience orgasm. Investigations mainly include the demonstration of sperm in the postmasturbation urine, analysis of the ejaculate, determination of the secretion markers of the adnexa and ultrasonographic examination of the genital organs. The treatment of choice in premature ejaculation is sexual therapeutic behavioral training, where necessary in combination with medication to delay ejaculation, e. g. diazepam or chlorodizepoxid. In the absence of underlying organic disease deficient ejaculation is treated with behavioral therapy or vibrator stimulation of the glans. Postoperative or post-traumatic disorders, however, often require transrectal electrojaculatory stimulation or sperm aspiration from vas deferens. There are three principles of management of retrograde ejaculation: 1. conversion of retrograde into antegrade ejaculation by drug therapy, 2. harvesting of sperm from postorgasm urine and 3. surgical treatment. Our own observations have shown that drug treatment of ejaculatory dysfunction is ineffective in patients with anorgasm or when postmasturbation urine contained no spermatozoa. Currently male infertility due to ejaculatory problems can be effectively treated, where necessary in combination with the new methods of assisted fertilisation, for which purpose, however, accurate identification of the ejaculation disorder presenting is required.