[An update on ejaculation physiology and premature ejaculation definition, prevalence data, and etiology].
[An update on ejaculation physiology and premature ejaculation definition, prevalence data, and etiology].
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DOI：
10.1016/s1138-3593(15)30002-2
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发表时间：
2014-07-01
期刊：
影响因子：
--
通讯作者：
Mas, M
中科院分区：
文献类型：
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作者：
Mas, M
射精包括两个同步的阶段：a)射精，收缩输精管、前列腺和精囊，以及膀胱颈将精液排出到尿路；它是由交感神经调节的；b)排出，精液通过会阴肌肉有节奏的收缩向外推进。射精是由复杂的脊椎反射引起的，其基本成分在腰骶髓内。主要传入信号来自对阴茎龟头的机械刺激，并由骶骨感觉根传递。射精反射受到大脑通过易性和抑制性下行信号的强烈调制影响。包括5-羟色胺和多巴胺在内的几种中枢神经递质调节射精反射。测量或估计的阴道内射精潜伏期时间(IELT)可为射精反射提供临床有用的评估。新的DSM-5对早泄(PE)的定义包括一个特定的射精时间标准(IELT大约一分钟或更短)。已经提出了四种不同的PE亚型，它们的患病率不同。PE的病因学是多因素的，心理和生物因素相互作用导致了这种疾病。一些与5-羟色胺和多巴胺神经传递相关的基因多态性可能使携带者易于发生PE。在慢性前列腺炎、甲状腺功能亢进症和早泄患者中，PE的患病率很高。
Ejaculation consists of two synchronized phases: a) emission, the contraction of the vas deferens, prostate and seminal vesicles and bladder neck expelling the seminal fluid to the urethra; it is mediated by sympathetic nerves, and b) expulsion, seminal fluid outward propulsion by the rhythmic contraction of perineal muscles. Ejaculation results from a complex spinal reflex having its essential components within the lumbosacral cord. The main afferent signals derive from mechanical stimulation of the glans penis and are conveyed by sacral sensory roots. The ejaculatory reflex is under strong modulatory influence from the brain through both facilitatory and inhibitory descending signals. Several central neurotransmitters including serotonin and dopamine modulate the ejaculatory reflex. The intravaginal ejaculatory latency time (IELT), measured or estimated, provides clinically useful assessment of the ejaculatory reflex. The new DSM-5 definition of premature ejaculation (PE) includes a specified time to ejaculation criterion (IELT of about one minute or shorter). Four subtypes of PE, showing different prevalence rates, have been proposed. PE etiology is multifactorial with interacting psychological and biological factors contributing to the disorder. A number of genetic polymorphisms related to serotonin and dopamine neurotransmission may predispose the bearers to developing PE. High prevalence rates of PE have been found in patients with chronic prostatitis, hyperthyroidism, and premature ejaculation.