Dapoxetine and premature ejaculation
Abstract
The ejaculatory reflex comprises a complex reflex synchrony involving the central and peripheral nervous systems. Receptors and sensory areas, afferent pathways, cerebral sensory areas, cerebral motor centers, spinal motor centers, and efferent motor centers are involved in the ejaculatory reflex. These areas also jointly modulate other aspects of sexual response (1). Neurochemically, this reflex involves a complex interaction between serotonergic and dopaminergic and, secondarily, cholinergic, adrenergic, oxytocinergic, and γ-aminobutyric (GABA) neurons. While dopamine promotes seminal emission/ejaculation via D2 receptors, serotonin is inhibitory. This aspect needs to be clear, as knowledge of this neurophysiology will guide the treatment: serotonergic stimulation of 5-HT2c receptors results in delayed ejaculation, while stimulation of postsynaptic 5-HT1a receptors results in shortening of ejaculatory latency (2-4). The peripheral events leading to ejaculation are controlled by the synergistic activation of autonomic functions (sympathetic and parasympathetic) and somatic portions of the nervous system. The origin of the autonomic and somatic motor efferent roots originates in the thoracolumbar and lumbosacral segments. Autonomic and somatic coordination are controlled in the L3–L5 region by a group of neurons called spinal ejaculatory generators. This nucleus, in conjunction with the autonomic system and the spinal somatic nuclei, is capable of stimulating or inhibiting…
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