Dysfunctions related to the sexual response cycle:Delayed Ejaculation

Features

Delayed ejaculation is a medical condition in which a male is unable to ejaculate, either during intercourse or with manual stimulation in the presence of a partner. Most men ejaculate within 2 to 4 minutes after onset of active thrusting in intercourse. Men with delayed ejaculation may be entirely unable to ejaculate in some circumstances (for example, during intercourse), or may only be able to ejaculate with great effort and after prolonged intercourse (for example 30 to 45 minutes).

Epidemiology

This is less common than premature ejaculation.

Causes

The most common causes for delayed ejaculation are psychological. Common psychological causes include:

  • A religious background causing the person to see sex as sinful;
  • Lack of attraction towards partner;
  • Conditioning caused by unique or atypical masturbation patterns;
  • Traumatic events e.g. learning one's partner has cheated;
  • Some factors like anger towards the partner may be involved;
  • Other causes:
    • Certain drugs like antidepressants;
    • Neurological diseases like stroke or nerve damage to the back and spinal cord.

Treatment

Currently, no effective and safe drugs are available to accelerate ejaculation time in men. The best way to treat lifelong delayed ejaculation is, thus far, to inform the patients about biological and psychological inhibiting factors which they need to avoid, and to remain critical about unrealistic expectations from psychotherapy.

Psychotherapy may be useful in subgroups, particularly in the absence of effective and safe drugs.

If a man has never ejaculated through any form of stimulation (such as wet dreams, masturbation, or intercourse), a urologist should be consulted to determine if there is a congenital or physical cause.

If, however, he is able to ejaculate in a reasonable period of time by some form of stimulation, he should seek sex therapy from a therapist specializing in ejaculatory problems. Treatment usually includes both partners. The therapist will usually educate the couple about the fundamentals of sexual response and how to communicate and guide the partner to provide ideal stimulation, rather than trying to make a sexual response occur. Therapy commonly involves a series of homework assignments wherein the couple, in the privacy of their home, engage in sexual activities that reduce performance pressure and focus on pleasure.

Typically, sexual intercourse will be prohibited for a limited period of time, while the couple gradually enhances their ability to enjoy ejaculation through other types of stimulation. In cases where there is a problematic relationship or an inhibition of sexual desire between the couple, therapy to enhance the relationship and emotional intimacy may be required as a preliminary step.

Sometimes hypnosis may be a useful adjunct to therapy, particularly if a partner is not willing to participate in therapy. Self-treatment of this problem will probably be unsuccessful in most cases.

If a medication is believed to be the cause of the problem, other medication options may be discussed. (Never stop taking any medicine without first talking to your doctor.) This may be difficult in certain instances, especially when the medication is working appropriately to solve a pre-existing medical or psychological problem.

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