Table 1. Etiological factors that may be involved in the pathophysiology of delayed ejaculation and anejaculation.

I. Psychosexual and psychosocial factors	II. Organic and biological factors
a. Fears:	Aging
- Fear of pregnancy and fertility issues
- Fear of castration and death
- Fear of annihilation associated with loss of semen
- Fear of loss of control
- Fear of exposure and subsequent shame concerning the problem
- Fears of abandonment/rejection
- Fears of intimacy and loss of autonomy
- Fears of hurting/defiling the partner
- Fear of retaliation by the female or by other males
- Success phobia
b. Sexual orientation conflicts	Genetic factors (see Table 2)
c. Hostility and resentment	Neurobiological factors
d. Obsessive-compulsive personality traits	Congenital anatomical factors:
	• Müllerian duct cyst
	• Wolffian duct abnormalities
	• Prune belly syndrome
	• Posterior urethral valves
	• Complete male epispadias
	• Bladder exstrophy
	• Sacral Tarlov cyst
	• Imperforate anus
	• Seminal megavesicle
e. Performance anxiety	Neurogenic causes:
	• Diabetic autonomic neuropathy
	• Multiple sclerosis
	• Spinal cord injury
	• Radical prostatectomy
	• Pelvic radiation therapy
	• Proctocolectomy
	• Bilateral sympathectomy
	• Abdominal aortic aneurysmectomy
	• Para-aortic lymphadenectomy.
	• Pelvic fracture-urethral distraction defect injury
	• Adult circumcision
f. Lack of self-assertion	Infection/inflammation:
	- Urethritis
	- Genitourinary tuberculosis
	- Schistosomiasis
	- Prostatitis
	- Orchitis
	- Orchialgia in testis cancer survivors
g. An unwillingness to give of oneself in love	Endocrine:
	- Hypogonadism
	- Hypothyroidism
	- Hyperprolactinemia
h. Strong religious convictions, leading to guilt	Medications (Table 3)
i. Autosexual orientation:
- Positive reinforcement associated with self-masturbation
j. Unusual masturbation techniques:
- High-frequency masturbation
- Idiosyncratic and vigorous masturbation style
- Disparity between the reality of sex with a partner and preferred sexual fantasy during masturbation
k. Relationship factors:
- Disparity between fantasy and partner
- Partner sexual dysfunction
l. Diminished sexual desire
m. Insufficient sexual arousal and female sexual dysfunction
n. Depression and other psychiatric diseases