Ejaculatory dysfunction obviously becomes important in the younger male when fatherhood is of concern but, even then, its role in fertility is often looked at only as a problem in transport of sperm. The organs involved in the process of ejaculation are the epididymides, vasa deferentia, prostate, seminal vesicles, bladder neck, and bulbourethral glands. Neural control of ejaculation consists of the ejaculatory reflex, which is mediated at the thoracolumbar level and involves a coordinated interaction of the sympathetic and parasympathetic autonomic nervous systems. Premature ejaculation and delayed ejaculation are the two conditions of importance. Men with a nerve-sparing retroperitoneal lymph node dissection (RPLND) will have innervation of the ejaculatory organs, and the stimulation afforded by drug therapy may be enough to allow seminal emission or bladder neck closure. Penile vibratory stimulation (PVS) is usually recommended as the first line of treatment for anejaculation in men with spinal cord injury (SCI).

Encompassing a broad spectrum of conditions, ejaculatory dysfunction (EjD) includes premature ejaculation (PE), anejaculation(AE), and retrograde ejaculation (RE). This chapter discusses the incidence rate, diagnosis methods and treatment options available for treating EjD. Behavioral/psychological treatments, topical anesthetic agents, serotonin reuptake inhibitors (SSRIS) and phosphodiesterase (PDE)-5 inhibitors are the treatment options available for PE. Penile vibratory stimulation, electroejaculation, and surgical sperm extraction from the epididymis or testes are all successful methods for obtaining sperm for later use with ART in AE where the success rates of other methods are low. Common causes of RE can be categorized as anatomic, neurogenic, pharmacological, or idiopathic in origin. Anticholinergics, alpha-adrenergic agonists, or similar combinations may be used to modulate bladder neck activity but are not as effective as imipramine, which should be considered the first-line therapeutic agent for RE.