Gao Qingqiang, Yang Baibing, Han Youfeng, Dai Yutian, Yu Wen, Ni Dawei
Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Department of Urology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China.
Transl Androl Urol. 2025 Aug 30;14(8):2315-2324. doi: 10.21037/tau-2025-348. Epub 2025 Aug 25.
Situational delayed ejaculation (SD-DE, intravaginal anejaculation phenotype) is a clinically significant disorder marked by preserved masturbatory function but persistent coital anejaculation. This condition substantially impairs quality of life and causes significant distress. The underlying neurophysiology, particularly autonomic mechanisms, remains unclear. This study aimed to investigate sympathetic function in SD-DE using penile sympathetic skin response (PSSR) and assess its clinical correlates.
Sixty-seven SD-DE patients and 65 normal controls (NCs) were enrolled. PSSR latency and amplitude, penile sensory threshold (PST), and clinical characteristics (including psychological evaluations via the Self-Rating Anxiety Scale, SAS) were systematically analyzed to evaluate sympathetic nervous system function.
SD-DE patients exhibited significantly shorter PSSR latency compared to NCs (P<0.001), indicating sympathetic hyperactivity. A significant negative correlation was observed between PSSR latency and anxiety scores (P<0.001), suggesting stress-mediated sympathetic overactivation. SD-DE patients also demonstrated higher PST (P=0.03), increased masturbation frequency (>2 times/week: 38.81% 20.00%, P=0.02), and a higher prevalence of atypical masturbation (28.36% 3.08%, P<0.001), reflecting compensatory sensorimotor adaptations.
These findings establish sympathetic dysfunction as a core feature of SD-DE [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 302.74], with PSSR serving as an objective biomarker. The intravaginal anejaculation phenotype represents a distinct clinical entity within DSM-5 302.74, informing targeted therapeutic strategies. In the future, it is necessary to further verify its pathological circuit mechanism by combining multimodal neuroimaging techniques.
情境性延迟射精（SD-DE，阴道内射精表型）是一种具有临床意义的疾病，其特征为自慰功能正常但性交时持续无法射精。这种情况严重损害生活质量并导致极大困扰。其潜在的神经生理学机制，尤其是自主神经机制，仍不清楚。本研究旨在使用阴茎交感皮肤反应（PSSR）来研究SD-DE中的交感神经功能，并评估其临床相关性。
招募了67例SD-DE患者和65名正常对照（NCs）。系统分析了PSSR潜伏期和波幅、阴茎感觉阈值（PST）以及临床特征（包括通过自评焦虑量表SAS进行的心理评估），以评估交感神经系统功能。
与NCs相比，SD-DE患者的PSSR潜伏期明显更短（P<0.001），表明交感神经功能亢进。PSSR潜伏期与焦虑评分之间存在显著负相关（P<0.001），提示压力介导的交感神经过度激活。SD-DE患者还表现出更高的PST（P=0.03）、自慰频率增加（>2次/周：38.81%对20.00%，P=0.02）以及非典型自慰的患病率更高（28.36%对3.08%，P<0.001），反映了代偿性感觉运动适应。
这些发现确立了交感神经功能障碍是SD-DE[《精神疾病诊断与统计手册》第五版（DSM-5）302.74]的核心特征，PSSR可作为一种客观生物标志物。阴道内射精表型代表了DSM-5 302.74中一种独特的临床实体，为靶向治疗策略提供了依据。未来，有必要通过结合多模态神经成像技术进一步验证其病理回路机制。
