| Delayed ejaculation can cause psychological distress for the man who has the problem, and create stress between sex partners. The problem – a relatively rare sexual dysfunction of both medical and psychological causes – is often misdiagnosed.
What is delayed ejaculation? Delayed ejaculation is one of the ejaculatory dysfunctions (abbreviated to EjD in research papers) and probably the least understood. It is also the least common form of male sexual dysfunction, affecting an estimated 1-4% of men. Compare this with how many men get premature ejaculation: based on estimates of how many at least think they have a problem with rapid ejaculation, the range for that condition is between 15-30%. Delayed ejaculation falls in the middle of the spectrum of ejaculatory dysfunction: • Premature ejaculation (ejaculation always, or nearly always happening before sexual penetration has been achieved, or within about a minute of penetration) • Delayed ejaculation • Anejaculation (inability to ejaculate, including “retrograde ejaculation” and “painful ejaculation”). The term “delayed ejaculation” recently became the officially preferred name for what had once been labeled “male orgasmic disorder.” What was considered a derogatory meaning has also been conferred on the disorder. Other terms that are used for the condition are “ejaculatory insufficiency and “retarded ejaculation”. In summary, delayed ejaculation is the difficulty or inability of a man to reach an orgasm and ejaculate semen. The problem is diagnosed when a man is concerned about a problem during most sexual intercourse encounters over at least six months, with a marked delay or marked infrequency of achieving ejaculation – when other problems have been ruled out and in spite of a normal erection and sexual stimulation. What causes delayed ejaculation? Delayed ejaculation can have a psychological or biological cause – and there can be overlap between the two. It can be a lifelong condition in which the man has always had difficulty reaching an orgasm, or, more commonly, acquired, in which there has been a time when the man’s ejaculatory function was normal. Biological causes of delayed ejaculation will be ruled out first. Organic reasons for a case could be disease or a factor such as medication, and this underlying cause can be addressed. Diagnosis of delayed ejaculation “Delayed ejaculation” is the preferred term for a diagnosis that used to be called “male orgasmic disorder.” The diagnosis is made only when a man’s orgasm response and ejaculation of semen is delayed or absent, and this problem has persisted. How long is too long for a man to reach an orgasm? Men’s average times to reach an orgasm are as unique and varied as men are, and the latency between penetration and ejaculation relates to numerous biological and psychological factors that are specific to each individual. Similarly, there is no strict amount of time having penetrative sex that clinicians would consider to be diagnostic of delayed ejaculation. Men with the diagnosis showed an average of 20 minutes of “intravaginal ejaculation latency time” (IELT) – which is simply the time between penetrating the vagina and ejaculating inside it. This figure is about four times longer than a “normal” time to ejaculation in healthy men, an average IELT of just over 5 minutes (around 6.5 minutes in men aged 18 to 30 years; just over 5 minutes in 31-50-year-olds; and just over 4 minutes for older men). The study that found an average of 20 minutes in men who had delayed ejaculation also cited normal latency times of between 4 minutes and 10 minutes. Other authors of research and information on delayed ejaculation also give intravaginal times for a diagnosis of over 20 mins, with some giving a window of 20 to 30 mins, and others saying between 30 and 60 minutes. What difficulties are created by delayed ejaculation? Being unable to ejaculate within a desired amount of time is often misunderstood as being no problem. It can be misperceived, even by clinicians and therapists, as offering some benefit, by offering sufficient time for a man’s partner to enjoy multiple orgasms. The truth, however, is that while some partners do enjoy the extended intercourse, many become distressed by questions such as, “does he really desire me?” Partners may feel rejected, blame themselves, and become angry. Extended intercourse can also cause pain or even injury, and sex may be stopped as a result of exhaustion and discomfort. A case of delayed ejaculation meeting all the criteria for the diagnosis can cause quality-of-life issues and the risk of ill effects on mental health: • Significant sexual dissatisfaction • Relationship distress • Anxiety over male sexual performance and about general health. Men with delayed ejaculation are more likely to suffer anxiety and depression. Treatment of delayed ejaculation Treatment depends on the cause of the delayed ejaculation, so may be simple in the case of it being due to medication such as SSRI antidepressant, in which case doctors can help with a switch to an alternative. Similarly, if excessive alcohol or illicit drug use are to blame, simply limiting or stopping intake should help. So, too, if other medical conditions underlie the problem: managing the, for example, neurological cause may resolve a secondary problem of delayed ejaculation. Doctors know that no single intervention works for all patients, and that the key to successful treatment is to identify the source of the problem and to select therapy that helps to deal with those factors that are precipitating (triggering) the problem or maintaining it. Examples include: • Sex education • Reducing goal-oriented anxiety • Recommending increased and more genitally-focused stimulation during sex with a partner • Role playing to exaggerate the ejaculatory moment, both when the man is on his own, or in front of his partner.
The most common issue underlying delayed ejaculation is previous masturbatory behavior, and practical tips have also been recommended by authors of a study that investigated penis stimulation in men who have the condition. The authors cite this method: “Patients should temporarily suspend masturbatory activity – at least reducing the frequency – and limit orgasmic release to their desired goal activity, for example, orgasm during penetrative sexual encounters with their partner.” Also recommended are ways to bring the experience of having penetrative sex closer to that of successful ejaculation during masturbation: “Patients should use fantasy and bodily movements during intercourse, which make the thoughts and sensation intensity comparable to the experienced conditions in masturbation.” Painful ejaculation Pain during ejaculation may obviously cause a man to delay his orgasm, and can lead to him avoiding sex altogether. Such a problem can cause frustration, relationship difficulties, and anxiety and depression. A number of possible causes might be suspected for a man with painful ejaculation, including genitourinary inflammation, sexually transmitted infection, nerve damage, chronic pelvic pain, blockage of the ejaculatory system, radiation therapy to the pelvis, prostate cancer, or psychological issues. Antidepressants, spermicides, and contraceptive creams have also been implicated. Source: Medical news today |