Delayed Ejaculation Disorder

Delayed ejaculation is also known as impaired ejaculation. It is a disorder where it takes a prolonged period of sexual stimulation for a man to reach orgasm and to ejaculate (the expulsion of semen from the body). Some men suffering from this disorder are not able to achieve ejaculation at all. 

Overview

If it takes a man longer than 30 minutes of constant sexual activity to ejaculate, even with a normal erection, he falls under the category of having delayed ejaculation. Delayed ejaculation affects approximately 1 to 4 percent of men.  The problem can result in stress for both the man and his sexual partner. It also produces anxiety about overall health, lower levels of libido, sexual displeasure, relationship problems including a fear of rejection for both partners, and concern for couples who are wishing to have a baby. Most men will have delayed ejaculation at some point in their lives, but for some men, it is a lifelong disorder.

Successful treatment is dependent upon the cause of delayed ejaculation and the type of ongoing treatment. However, overall there is a good prognosis for delayed ejaculation.

A man is caught in Exhibitionistic Disorder

Causes of Delayed Ejaculation Disorder:

Psychological causes include:

  • Anxiety, Depression, or other mental health conditions
  • Relationship issues related to stress or related concerns
  • Performance anxiety
  • Poor body image
  • Cultural, or religious restrictions
  • Differences between sexual fantasies and reality

Medications and substances include:

  • Certain anti-depressants
  • Some medications of high blood pressure
  • Diuretics
  • Antipsychotic medications
  • Anti-seizure medications
  • Excessive use of alcohol

Physical causes include:

  • Certain birth defects disturb the male reproductive system
  • Injury to the nerves of the pelvic floor that regulate orgasm
  • Urinary tract infections
  • Prostate surgery
  • Diabetic neuropathy, nerve damage to the spinal cord, or stroke
  • The lower level of thyroid hormone or lower level of testosterone
  • Retrograde ejaculation, i.e. passing of semen backward into the bladder rather than coming out of the penis
  • In some men, a physical issue that may delay ejaculation can lead to anxiety about ejaculation during sexual activity. This anxiety in turn may further worsen the ejaculation problem.

Complications of Delayed Ejaculation Disorder:

Delayed ejaculation negatively impacts self-esteem and creates feelings of inadequacy, insufficiency, disappointment, and negativity. Men who suffer from the disorder might avoid intimacy with others due to the fear of failure.

Other complications may include:

  1. Absent or minimal sexual pleasure
  2. Anxiety about sex
  3. Male infertility
  4. Lower libido
  5. Stress and Depression

Delayed ejaculation can also give rise to conflicts in relationships, often stemming from misinterpretations on the part of both partners.

Treatment or psychotherapy can however help to resolve these issues. By enabling honest and open communication, understanding can often be reached.

Symptoms of Delayed Ejaculation Disorder:

Delayed ejaculation occurs when a man needs more than 30 minutes of sexual stimulation to reach orgasm and to ejaculate. Some men can only ejaculate with the help of manual or oral stimulation. Some cannot ejaculate at all.

Every so often, men might face difficulty in reaching orgasm during sexual intercourse or while engaged in other sexual activity with a partner. Some men can ejaculate only when masturbating. Delayed ejaculation is divided into 2 types based on symptoms:

  • Lifelong vs. acquired:  With lifelong delayed ejaculation, the issue is present from the time of puberty. Acquired delayed ejaculation occurs after a period of normal sexual functioning.
  • Generalized vs. situational. Generalized delayed ejaculation isn’t limited to certain sex partners or certain kinds of stimulation. Situational delayed ejaculation occurs only under certain circumstances.

Diagnosis of Delayed Ejaculation Disorder:

A physical exam and medical history might be enough to diagnose and recommend treatment for delayed ejaculation. Diagnostic tests for underlying problems can include:

  • Physical exam: This might involve careful physical assessment of your penis and testicles. The doctor will use a light touch to make sure you have a normal sensation in your genitals.
  • Blood tests. Your health care provider may ask for a blood sample to send to the lab to look for the signs of cardiovascular disease, a low testosterone level, diabetes, and other health issues.
  • Urine tests (urinalysis). Urine tests are performed to look for the signs of diabetes, urinary tract infections, other infections, and other underlying health conditions.

Treatment of Delayed Ejaculation disorder:

The treatment of delayed ejaculation is dependent upon the underlying cause, but it might include taking medication, making changes to currently prescribed medications, and psychological counseling.

Medications:

If you are currently taking any medication that might be causing delayed ejaculation, switching the medications may fix the problem. At times, adding a medication might help.

There are not any specific drugs that have been specifically approved for the treatment of delayed ejaculation. Medications, however, are used to treat and help with distressing symptoms.

Medications that are used to treat delayed ejaculation include the following:

  • Amantadine, which is a Parkinson’s medication
  • Buspirone, an anti-anxiety medication
  • Cyproheptadine, a medication for allergy

Psychological counseling (psychotherapy):

Psychotherapy can help by discussing the thoughts, emotions, and stress that can be contributing to, or the result of, delayed ejaculation. Seeking a therapist that specializes in sexual disorders will help promote a therapeutic relationship that is more comfortable for you. The therapist will also address any potential underlying mental health issues such as depression or anxiety. Your partner may be integrated into sessions to address any concerns about ejaculation issues that may be negatively impacting your relationship and how to work through them together.