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The hormonal control of ejaculation

Nature Reviews Urology volume 9, pages 508–519 (2012)Cite this article

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Abstract

Hormones regulate all aspects of male reproduction, from sperm production to sexual drive. Although emerging evidence from animal models and small clinical studies in humans clearly point to a role for several hormones in controlling the ejaculatory process, the exact endocrine mechanisms are unclear. Evidence shows that oxytocin is actively involved in regulating orgasm and ejaculation via peripheral, central and spinal mechanisms. Associations between delayed and premature ejaculation with hypothyroidism and hyperthyroidism, respectively, have also been extensively documented. Some models suggest that glucocorticoids are involved in the regulation of the ejaculatory reflex, but corresponding data from human studies are scant. Oestrogens regulate epididymal motility, whereas testosterone can affect the central and peripheral aspects of the ejaculatory process. Overall, the data of the endocrine system in regulating the ejaculatory reflex suggest that widely available endocrine therapies might be effective in treating sexual disorders in these men. Indeed, substantial evidence has documented that treatments of thyroid diseases are able to improve some ejaculatory difficulties.

Key Points

  • Oxytocin is actively involved in regulating orgasm and ejaculation via peripheral, central and spinal mechanisms

  • Peripheral prolactin levels might mirror central serotonergic tone

  • Associations between delayed ejaculation and premature ejaculation with hypothyroidism and hyperthyroidism, respectively, have been extensively documented

  • Animal models suggest that glucocorticoids might be involved in the regulation of the ejaculatory reflex, but data in human are scant

  • The epididymis is a male target for oestrogens that regulate epididymal motility by conditioning the responsiveness of the contractile hormones and local peptides

  • Hypogonadal symptoms and low testosterone levels might reduce the ability to ejaculate, which suggests that androgens have a central and peripheral role in the ejaculation reflex

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Figure 1: Neurological control of ejaculation.
Figure 2: The association with PRL levels and psychological and anxiety scores.
Figure 3: Hormone levels as a function of ejaculatory difficulties.
Figure 4: The hormonal regulation of the ejaculatory continuum.
Figure 5: Weighted odds ratio of hyperthyroidism between men with PE and a control population.

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Authors and Affiliations

  1. Medical Department, Endocrinology Unit, Azienda Usl Bologna Maggiore-Bellaria Hospital, Largo Nigrisoli 2, Bologna, 40133, Italy

    Giovanni Corona

  2. Department of Experimental Medicine, School of Sexology, University of L'Aquila, Coppito, Building 2 Room A2/54, Via Vetoio,, L'Aquila, 67100, Italy

    Emmanuele A. Jannini

  3. Sexual Medicine and Andrology Unit and Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, Florence, 50139, Italy

    Linda Vignozzi, Giulia Rastrelli & Mario Maggi

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  1. Giovanni Corona
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  2. Emmanuele A. Jannini
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  3. Linda Vignozzi
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  4. Giulia Rastrelli
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  5. Mario Maggi
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Contributions

G. Corona, L. Vignozzi, G. Rastrelli and M. Maggi researched the data for the article. G. Corona, E. A. Jannini, L. Vignozzi and M. Maggi contributed substantially to the discussion of the article content. G. Corona and M. Maggi wrote the article. G. Corona, E. A. Jannini, L. Vignozzi and M. Maggi edited the manuscript before submission.

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Correspondence to Mario Maggi.

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Corona, G., Jannini, E., Vignozzi, L. et al. The hormonal control of ejaculation. Nat Rev Urol 9, 508–519 (2012). https://doi.org/10.1038/nrurol.2012.147

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