A bihormonal model of normal sexual stimulation; the etiology of prematureejaculation

The physiological sexual excitation is mediated both by the sympathetic and the parasympathetic nervous system. The antagonism between testosterone (T t) and estrogens (Es) as well as the fact that the dynamics of the sexual e xcitation in the male are antagonistic to those in the female are nowadays well-known; hence, the hypothesis was emitted that the sympathoparasympathe tic sexual excitation is bihormonal mediated, consisting in a very active s exual hormone associated with a weak antagonistic hormone. Most studies show a serotonergic (ejaculatory) involvement in premature eja culation (PE). Nevertheless, an effective treatment of PE is rather difficu lt with selective serotonin reuptake inhibitor drugs and other clinical dat a even suggest that changes in PE actually involve at first the sexual exci tation process and only secondly the ejaculation reflex. Thus, a therapeutic model for PE is set up, starting from the physiological aspects described and from the presumed pathophysiological mechanism in PE . (C) 2001 Harcourt Publishers Ltd.