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There are three basic mechanisms involved in normal ante-grade ejaculationemissionexpulsionand orgasmand each of these components possesses separate neural pathwaysEjaculatory dysfunction can result from disruption of any point in this cascade of eventsSeveral recent studies have clarified some aspects of the physiology of ejaculationEmissionwhich begins with closure of the bladder neck to prevent retrograde flow of seminal fluid and sperm into the bladderrefers to the deposition of seminal fluid and sperm from the distal epididymisvas deferensseminal vesiclesand prostate into the posterior urethraWitt and Grantmyre 1993

2 Department of UrologyTulane University Health Sciences CenterNew OrleansLAUSA.

Past studies have revealed high discontinuation rates among men taking dapoxetine for PEeven though trials have shown effectivenessThe current study reported on discontinuation rates and reasons during a 2-year period.

Expulsion refers to the forcible antegrade propulsion of semen through the urethral meatuswhich is caused by contractions of the periurethral and pelvic floor muscles and concurrent relaxation of the external urethral sphincter and urogenital diaphragmThe sympathetic nervous system controls both emission and bladder neck closureand acts through alpha adrenergic receptorsThe neural signals that lead to ejaculation originate from afferent-sensory stimuli in the glans penis and genitaliaThese stimuli are transmitted by means of the pudendal nerve to higher centers in the brainWitt and Grantmyre 1993

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