Psychosocial aspects of ejaculatory dysfunction and male reproduction

Wincze, JP

November 2015

Fertility and Sterility 2015; doi:10.1016/j.fertnstert.2015.07.1155 (Epub ahead of print)

The most prevalent sexual dysfunction experienced by men, ED is estimated to affect 10% of men aged 35 years or younger and 50% of men aged over 60 years.

Biological factors, psychosocial factors, or a combination of both may contribute to ED. Younger men experiencing ED when attempting to conceive are more likely to be experiencing performance anxiety rather than related medical factors. In this situational ED, men typically experience ED with their partner but not during private masturbation.
The quality of the couple’s relationship and the behaviour of the partner is often overlooked in ED treatment. Some partners may feel ED is a reflection of their man’s feelings for them or the intensity of their desire to conceive may indirectly place pressure on their partner. Couples focused on conception may also overlook the importance of creating a stimulating environment for sexual activity to occur.

Individual, partner/relationship and environmental factors need to be considered. Where ED is strongly associated with pressure to conceive, treatment of performance anxiety is the most likely option to manage ED. Sensate focus is a procedure designed to help men focus on the sensations and process of sex rather than on penis activity and the outcome of sex. Couples are educated to remove blame, increase sexual communication, and to explore sexual activity other than penis-vaginal intercourse until performance anxiety has decreased.

Prevalence rates of PE vary greatly in the literature, most likely due to varying definitions and measurement tools. Conservative estimates suggest 1-3% of men experience PE.

Limited potential biological factors have been identified (e.g. disturbances in serotonergic neurotransmission, different cortical evoked potential) and there have been many psychological factors explored but none have been validated with quality research. It’s likely that worry over PE can lead to performance anxiety and subsequent ED.

Couples need accurate and normative information about PE, and should be encouraged to adopt a flexible behavioural approach to sexual relations. Sex needs to be positioned as a pleasurable activity no matter how quickly the man ejaculates, and that the female’s orgasm can precede or follow penis-vaginal intercourse.

DE is thought to be less prevalent then ED or PE as a presenting problem. Estimates are difficult to obtain due inconsistent definitions and research approaches but it is generally agreed to occur in <1%-3% of the male population.

Many biological (e.g. certain pharmacologic agents and diseases) and psychological factors (e.g. performance anxiety, idiosyncratic masturbatory styles) have been identified as potential contributors to DE.

The management of DE is similar to that of ED and PE: providing accurate information and removing blame, and the use of senate focus to reduce performance anxiety. If idiosyncratic masturbatory practices are contributing to DE, masturbation retraining to a style more resembling the sensations of penis-vaginal intercourse may be useful.

Men with no known medical factors may experience difficulty with conception due to erectile dysfunction (ED), premature ejaculation (PE), or delayed ejaculation (DE).

There are multiple potential biological and psychosocial factors that contribute to ejaculatory dysfunction in men attempting conception with a partner.

Patients are likely to benefit from the provision of accurate and reassuring information, addressing issues of performance anxiety, and suggestions about the importance of a sexually stimulating environment.

This is a literature review conducted by a single author with a method not described; it is possible that the review is significantly biased by the single reviewer’s own perceptions and interests.

The application of biopsychosocial theory in this article lacked sufficient consideration of social factors around heteronormative relationships in Western countries (e.g. the social construction of ‘masculinity’).