Delayed ejaculation

For controlled delay, see orgasm control.

Delayed ejaculation is the inability to ejaculate or persistent difficulty in achieving orgasm despite the presence of normal sexual desire and sexual stimulation. Normally a man can achieve orgasm within 0–5 minutes of active thrusting during sexual intercourse,^[1] whereas a man with delayed ejaculation either does not have orgasms at all or cannot have an orgasm until after prolonged intercourse which might last for 30–45 minutes or more. In most cases delayed ejaculation presents the condition in which the man can climax and ejaculate only during masturbation, but not during sexual intercourse.

Causes

Psychological causes of delayed ejaculation

Psychological causes of delayed ejaculation might include numerous factors that prevent a man from achieving orgasm during sexual intercourse. Among those factors are insufficient sleep, distraction due to worry, distraction from the environment, anxiety about pleasing his partner and anxiety about relationship problems. (Mann, Jay 1976, Delayed Ejaculation)

Physical causes

One of the main causes of delayed ejaculation is adaptation to a certain masturbatory technique. The sensations a man feels when masturbating may bear little resemblance to the sensations he experiences during intercourse. Factors such as pressure, angle and grip during masturbation can make for an experience so different from sex with a partner that the ability to ejaculate is reduced or eliminated.

Physical causes of delayed ejaculation may imply some diseases and conditions which affect a man's ability to achieve orgasm. These include many neurological (for example stroke or damage to the back or spinal cord) and endocrine diseases (diabetes), prostate problems, some allergies^{[citation needed]} and high blood pressure. As well difficulty in achieving orgasm can result from pelvic surgery that involved trauma to pelvic nerves which are responsible for orgasm. Some men report a lack of sensation in the nerves of the glans penis, which may or may not be related to external factors, including a history of circumcision.

Delayed ejaculation might be a side effect of some medications, usually of some antidepressants (e.g. prozac), antipsychotics (mellaril) and antihypertensives (guanethidine).^[2] Ejaculation will also take longer if the man has recently ejaculated. Another reason for delayed ejaculation is excessive use of alcohol (colloquially referred to as "whiskey dick" and "brewer's droop"). In this case physical and psychological causes might co-exist. Opiate-based medications and recreational drugs can prevent or delay ejaculation as they paralyze or slow all involuntary muscles, such as the ones that control dilation of the eyes, digestion, urination and ejaculation. Weight can also be a factor, as it slows blood flow to the penis.

Complications

Delayed ejaculation can cause a variety of complications, both for men who suffer from it, as well as for their partners. A positive aspect can occur in cases where delayed ejaculation contributes to increased sexual satisfaction of a partner (who can potentially experience greater sexual satisfaction during long-lasting intercourse sessions). However, after some time this is likely to become annoying for both partners when the man suffering from delayed ejaculation cannot, in spite of all efforts, achieve orgasm (or only achieves it after an extended period of time). Overall, the situation can worsen: both partners can choose to avoid sexual contact which does not result in orgasm. Consequently, both partners suffer from sexual dissatisfaction, becoming likely to lose sexual desire.

Treatment

Treatment of delayed ejaculation depends on severity of the disorder and on its causes. For instance, a condition with no ejaculation at all may require urology, while absence of ejaculation only in sexual intercourse may be solved by sex therapy.

Urology

If a man has never had ejaculation through any kind of sexual stimulation (such as vaginal or anal intercourse, oral sex, masturbation, wet dreams) then he should consult a urologist in order to find out whether there is a physical abnormality and then get necessary treatment which depends on the abnormality revealed.

Sex therapy

If the disorder is not so severe and a man can ejaculate through some form of stimulation, he should apply to a sex therapist specializing in this area. This is very important in cases when a man can ejaculate through any form of stimulation but intercourse. Usually treatment for this disorder includes both partners.

Therapy usually involves homework assignments and exercises intended to help a man get used to having orgasms through insertional intercourse, either vaginal, anal or oral, i.e. through the way he is not accustomed to. Commonly the couple is advised to go through three stages.^[3] At the first stage a man masturbates in the presence of his partner. Sometimes this is not an easy matter as a man might be used to having orgasms alone. After a man learns to ejaculate in the presence of his partner, the couple gets to another stage where the man's hand is replaced with the hand of his partner. Step by step a man learns to ejaculate closer and closer to the desired orifice. In the final stage the receptive partner inserts the insertive partner's penis into the partner's vagina, anus or mouth as soon as the ejaculation is felt to be imminent. Thus a man gradually learns to ejaculate inside the desired orifice.

Other

If relationships in a couple are found problematic, therapy intended to enhance emotional intimacy might be required as a preliminary step.

Some sexologists recommend sex toys to train the patient to respond to vaginal or anal stimulation. This is especially effective in cases where the masturbatory technique is the source of the problem.^{[citation needed]}

In some cases hypnosis can help with the problem, especially if a partner does not want to participate in therapy. Meditation has also been seen to be effective in case studies.^[4]

Naturally, if delayed ejaculation is caused by a disease, the disease is first of all treated. In those cases when delayed ejaculation is a side effect of medication the man's physician is to review other medication options.

In the case of alcohol addiction a man should get necessary treatment intended to help treat his addiction.

For many people it has proven to be the case that overly frequent masturbation on the part of the man is the root cause of his delayed vaginal ejaculation. Ceasing masturbation for a few days is often an effective and easy way to achieve more rapid orgasm during intercourse, because doing this will stop desensitization of the nerves in the penis. Also, different positions and rates of pelvic motion on the part of the receptive partner can be instrumental in achieving simultaneous orgasm.^{[citation needed]}

There is yet no reliable medication for delayed ejaculation. PDE5 inhibitors such as Viagra have little effect.^[5] In fact, Viagra has a delaying effect on ejaculation, possibly through additional effect in the brain or decrease of sensitivity in the head of the penis.^[6] Case studies have reported some success with serotonin antagonists (amantadine) and dopaminergic agents (bupropion, buspirone), though large, controlled studies are lacking, likely due to the rarity of the condition relative to other forms of male sexual dysfunction.^{[citation needed]}

Prognosis

Any of the following factors are signs of a better outcome: having sexual desire, being in love with the sexual partner, being eager to get rid of the problem, absence of deep psychological problems, short duration of the disorder and having satisfying sexual experiences before.

For the successful treatment of delayed ejaculation caused by medication, recovery totally depends on whether the physician can discontinue the medication.

Prevention

First of all a man should have a healthy attitude towards sexuality and his sexual response. He should be aware that anxiety and fears can interfere with having a normal and satisfying sexual experience.

A man who wants to avoid ejaculation problems should concentrate on the pleasure he gets rather than worrying about when and whether his ejaculation is going to occur. The partner should also be tactful and should not put pressure on the man by asking him whether he has ejaculated or not. Instead a partner should create a relaxed atmosphere in which a man will feel free and enjoy sexual pleasure without worrying about ejaculation. Open discussion of anxieties and fears contribute to better sexual relationships and normal sexual satisfaction.

See also

• Premature ejaculation
• Sexual repression, a state in which a person is prevented from expressing his/her sexuality

References

1. ^ Knowles, David R. (2005-06-01). "Delayed ejaculation". A.D.A.M. Medical Encyclopedia. A.D.A.M., Inc.. http://www.nlm.nih.gov/medlineplus/ency/article/001954.htm. Retrieved 2007-05-24. 
2. ^ drugs.com > Delayed ejaculation Review Date: 6/5/2007. Reviewed By: Marc Greenstein, DO, Urologist, North Jersey Center for Urologic Care
3. ^ Dr. David Delvin (2007-06-25). "Delayed ejaculation (retarded ejaculation)". NetDoctor.co.uk. http://www.netdoctor.co.uk/sex_relationships/facts/ejaculatoryincompetence.htm. Retrieved 2007-10-25. 
4. ^ M. M. Delmonte (June 1984). "Case reports on the use of meditative relaxation as an intervention strategy with retarded ejaculation". Springer Netherlands. http://www.springerlink.com/content/v673716h15l1672n/. Retrieved 2007-10-25. 
5. ^ The Carlat Psychiatry Report > PDE-5 Inhibitors: Which to Choose? Published in The Carlat Psychiatry Report. December 2004, Volume 2, Number 12
6. ^ WebMD Health News > Viagra, Paxil Help Premature Ejaculation. May 29, 2002. By Martin F. Downs.

External links

• Medline Plus Medical Encyclopedia - Delayed ejaculation.