Ejaculatory dysfunction is the inability of a man to successfully ejaculate semen from the penis at the occasion of sexual climax.Typically, ejaculatory disorders fall into two categories.These are: delayed ejaculation and early ejaculation.In the vast majority of cases, the most effective therapeutic approach for ejaculatory dysfunction is a combination of biologic and psychological therapy.The main types of male sexual dysfunction are:1. Erectile dysfunction (difficulty getting/keeping an erection)2. Ejaculatory Dysfunctiona. Premature ejaculation (reaching orgasm too quickly)b. Delayed or inhibited ejaculation (reaching orgasm too slowly or not at all)c. Retrograde or no ejaculation (dry orgasm)3. Low libido (reduced interest in sex)Ejaculatory dysfunction is one of the most frequent male sexual disorders, but is still often misdiagnosedA normal sexual response cycle consists of four interactive, nonlinear stages:1.Desire,2.Arousal,3.Orgasm and4.ResolutionIn males, orgasm normally coincides with ejaculation, but represents a distinct cognitive and emotional cortical event.Psychological causes might include:1. Concern about sexual performance2. Marital or relationship problems3. Depression, feelings of guilt4. Effects of past sexual trauma5. Work-related stress and anxietyPhysical causes of overall ejaculatory dysfunction may be:1. Low testosterone levels2. Prescription drugs (antidepressants, high blood pressure medicine)3. Blood vessel disorders such as atherosclerosis (hardening of the arteries) and high blood pressure4. Stroke or nerve damage from diabetes or surgery5. Smoking6. Alcoholism and drug abuseProblems with ejaculation are:1. Premature ejaculation (PE) 75%— Ejaculation that occurs before or too soon after penetration2. Inhibited or delayed ejaculation 8% — Ejaculation does not happen or takes a very long time3. Retrograde ejaculation — During orgasm, the ejaculate is forced to return back into the bladder rather than through the end of the penis4. Anejaculation — Absence of ejaculationNormal ejaculation involves:1. An emission phase, when semen is positioned in the penis near the prostate, and2. An ejaculation phase, when the semen is forcefully expelled from the penis.Ejaculation occurs at sexual climax, or the expulsion of the sperm.Climax is different from an orgasm, which is centered in the brain and associated with ejaculation.The mechanics of ejaculation are similar to a sneeze: both are reflexes with a point of no return.The average time from sexual penetration by the male to ejaculation is nine minutesDiagnosis:Sexual History1. Blood tests to check the testosterone levels, blood sugar (for diabetes), and cholesterol2. Blood pressure check3. Rectal exam to check the prostate4. Examination of the penis and testicles5. Other tests can show if the patient have problems with the nerve impulses or blood flow to the penis.Treatment:Treatments for ejaculatory dysfunction are medications, behavioral therapy (for premature ejaculation) and sometimes surgery.TABLE OF CONTENTIntroductionChapter 1 Ejaculatory DysfunctionChapter 2 CausesChapter 3 DiagnosisChapter 4 TreatmentChapter 5 AnejaculationChapter 6 Delayed ejaculationChapter 7 Retrograde ejaculationChapter 8 Premature ejaculationEpilogue