Pathogenesis of delayed ejaculation (DE) is rather unknown, although the contribution of various psychological, marital, hormonal and neurological factors has been advocated.

In this study we systematically investigated the relative relevance of the aforementioned factors in 1632 men, seeking medical help for sexual dysfunction. The severity of DE was classified according to Kaplan criteria.

Mild and moderate forms of DE (MMDE) recognized different risk factors than the most severe ones (anejaculation/ severe DE; ASDE). ASDE was essentially coupled to the presence of neurological diseases or to the use of serotoninergic drugs. Serotoninergic drugs also significantly increase (by at least ten-fold) the risk for MMDE, which, however was also coupled to other relational (impaired partnerʼs climax, patientʼs hypoactive sexual desire, HSD) or intrapsychic (stress at work) factors. At multiple regression analysis, some organic pathological conditions (such as psychiatric disorders and hypogonadism) were also associated to MMDE. In particular, hypogonadism retained significance for DE even after adjustment for HSD (Adj. OR= 2.08[1.11-3.89]; p<0.05), suggesting other effects of testosterone deficiency on the ejaculatory reflex, besides reduced libido.

The present study demonstrates that multiple psychobiological determinants are associated to DE, a still obscure condition that substantially impairs psychosexual equilibrium of the couple.