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Delayed ejaculation

Definition

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. Ejaculation is the action in which semen is release from the penis.

Alternative Names

Ejaculatory incompetence; Sex - delayed ejaculation; Retarded ejaculation

Causes, incidence, and risk factors

Most men ejaculate within a few 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).

Delayed ejaculation can result from psychological or physical causes.

Common psychological causes include:

  • A strict religious background causing the person to view sex as sinful
  • Lack of attraction for a partner
  • Conditioning caused by unique or atypical masturbation patterns
  • Traumatic events (such as being discovered in masturbation or illicit sex, or learning one's partner is having an affair)

Some factors, such as anger toward the partner, may be involved.

Physical causes may include:

  • Use of certain drugs (such as prozac, mellaril, and guanethidine)
  • Neurological disease such as a stroke or nerve damage to the spinal cord or back

Signs and tests

Stimulation of the penis with a vibrator or other stimulatory device may determine if an underlying physical (often neurological) problem exists. A neurological examination may uncover other nerve problems associated with delayed ejaculation.

Treatment

If the 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.

Expectations (prognosis)

Outpatient treatment commonly requires about 12 - 18 sessions with an average success rate in the range of 70 - 80%.

A more positive outcome is associated with having a previous history of satisfying sexual experiences, a short duration of the problem, feelings of sexual desire, feelings of love toward one's sexual partner, motivation for treatment, and absence of serious psychological problems.

If medications are causing the problem, your health care provider may recommond switching or stopping the medicine (if possible). A full recovery is possible if this can be done.

Complications

Marital stress, sexual dissatisfaction, inhibited sexual desire, and avoidance of sexual contact may result if the problem is not addressed and remedied. If pregnancy is desired, sperm may have to be collected using other methods because of the lack of ejaculation.

Prevention

Healthy attitudes toward sexuality and one's own genitals helps prevent delayed ejaculation. It is also vitally important to realize that you cannot will a sexual response, just as you cannot will yourself to go to sleep or to perspire. The harder one tries to have a certain sexual response, the more it becomes inhibited.

To minimize the pressure, a man should absorb himself in the pleasure of the moment, without worrying about whether or when he will ejaculate. The partner should create a relaxed atmosphere, free of pressure, rather than create pressure with questions about whether or not ejaculation has occurred. Finally, any fears or anxieties, such as fear of pregnancy or disease, should be openly discussed.

References

Lue TF, Broderick GA. Evaluation and management of erectile dysfunction and premature ejaculation. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 22.

Moore DP, Jefferson JW. Erectile dysfunction. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier; 2004:chap 100.

Moore DP, Jefferson JW. Inhibited male orgasm. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier; 2004:chap 102.


Review Date: 9/22/2009
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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