Delayed ejaculation refers to a difficulty or inability of a man to reach an orgasm and to ejaculate semen. The causes can be physical or psychological.
if a man takes longer than 30 minutes of penetrative sex to ejaculate, despite a normal erection, it is considered delayed ejaculation.
Delayed ejaculation affects around 1 to 4 percent of men.
It can result in distress for both the man and his partner. It can trigger anxiety about general health, low libido, and sexual dissatisfaction. Relationship problems include a fear of rejection for both parties and concern for couples who wish to start a family.
Most men will experience delayed ejaculation at some point in their lives, but for some, it is a lifelong problem.
Delayed ejaculation can have a psychological or biological cause. There can also be overlap between the two. It can be a lifelong condition, where a man has always had difficulty reaching an orgasm, but more commonly, delayed ejaculation occurs after a period of normal function.
Physical causes of delayed ejaculation include:
- Medication side effects: Delayed ejaculation may be an adverse effect of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), anti-anxiety drugs, blood pressure medication, painkillers, and other medications.
- Alcohol or the use of certain recreational drugs can have an impact.
- Nerve damage, including stroke, spinal cord injury, surgery, multiple sclerosis, and severe diabetes, can lead to abnormal ejaculatory function.
- Increasing age can decrease the sensitivity of the penis to sexual stimulation.
An acquired case is usually determined as having a psychological cause if it only happens in specific situations. For example, it is more likely that delayed ejaculation has a psychological basis if a man is able to ejaculate normally when masturbating, but experiences a delay during sex with a partner.
Some psychological factors that may underlie delayed ejaculation include:
- early life history including abuse, difficulties bonding, neglect by parents, negative sexual upbringing
- unexpressed anger
- unwillingness to enjoy pleasure
- religious belief, perhaps that sexual activity is a sin
- fear of, for instance, semen or female genitalia, or of somehow hurting or defiling a partner through ejaculation
- fear of pregnancy
- issues of lost confidence or performance anxiety – for example, anxiety about body image that interrupts the process of sexual stimulation
Certain types of masturbatory behavior may play a role in developing delayed ejaculation.
One specialist in delayed ejaculation found a relationship between the condition and the following masturbatory patterns:
- masturbating more often, typically more than three times a week
- having a style of masturbation that cannot be matched by sexual intercourse, particularly a high speed, high pressure, or high-intensity form
- if the partner’s hand, mouth, or vagina is unable to easily duplicate the learned style
- the sex partner differs from the fantasy used during masturbation to reach an orgasm
Dr. Michael Perelman, clinical professor of psychiatry, reproductive medicine and urology at the Weill Medical College of Cornell University, New York, observed that most men he had seen with delayed ejaculation reported no problems reaching an orgasm and ejaculating via masturbation.
Some men with the condition needed to employ an “idiosyncratic” form of self-manipulation to reach orgasm, such as rubbing the penis against the bed sheets, masturbating with pressure on a particular spot when reading erotic books, and even masturbating by “urethral instrumentation” – inserting a foreign body down into the opening of the penis.
Delayed ejaculation is diagnosed when a man is concerned about a marked delay or infrequency of achieving ejaculation during most sexual encounters over a period of 6 months or more, and when other problems have been ruled out.
To reach a diagnosis, a doctor will speak with the individual about symptoms and how often they occur. They will then rule out other potential medical problems, such as infections, hormonal imbalance, and so on. This may involve using blood and urine tests.
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Treatment for delayed ejaculation depends on the cause. For instance, if SSRIs are the issue, an alternative drug may be prescribed.
If excessive alcohol or non-prescription drug use are factors, reducing or eliminating these may help. If there are other medical conditions, managing the primary condition, such as a neurological problem, may help resolve the delayed ejaculation.
Primary cases of delayed ejaculation may not be straightforward to treat. They often require the help of professional counselors such as psychologists, psychotherapists, psychosexual counselors, sex therapists, or couple’s therapists.
Psychologists recognize that there is no single intervention that works for all patients and that the key to successful treatment is to identify the source of the problem and to use appropriate, targeted therapy to deal with the psychological factors that trigger or contribute to the problem.
Some medications may help improve the symptoms of delayed ejaculation, but none have yet been specifically approved to treat it.
Drugs with some reported benefits include:
- Cyproheptadine (Periactin), an allergy medication
- Amantadine (Symmetrel), a drug used to treat Parkinson’s
- Buspirone (Buspar), an anti-anxiety medication
Successful treatment depends on the cause of the delayed ejaculation and the type of treatment.
Anyone who has concerns about sexual function speaks with a doctor so that the right course of action can be taken.