Ejaculatory and orgasmic disorders are prevalent and distressing for many men with sexual concerns. They are best categorized into functional, neurological and anatomical problems, with the emphasis on whether the problem is presented as primarily a sexual or a medical concern for the patient. Ejaculatory and orgasmic concerns can present with, or be independent of, erection dysfunction. After physiology is explained, taking a sexual history and relevant physical examination issues are reviewed. An algorithm is described for distinguishing the disorders. Rapid or fast ejaculation can be managed by behavioural, pharmaceutical or medical methods. Delayed or inhibited ejaculation is more difficult to manage. The primary role of the family physician is to understand the differential diagnosis of these disorders, to not miss a reversible cause of them, and to refer those disorders that are difficult to assess and manage.
