Delayed ejaculation
Encyclopedia
Delayed ejaculation is the inability to ejaculate or persistent difficulty in achieving orgasm
despite the presence of normal sexual desire and sexual stimulation
. Normally a man can achieve orgasm within 0–5 minutes of active thrusting during sexual intercourse
, whereas a man with delayed ejaculation either does not have orgasms at all or cannot have an orgasm until after prolonged intercourse which might last for 30–45 minutes or more. In most cases delayed ejaculation presents the condition in which the man can climax and ejaculate only during masturbation
, but not during sexual intercourse.
Physical causes of delayed ejaculation may imply some diseases and conditions which affect a man's ability to achieve orgasm. These include many neurological (for example stroke or damage to the back or spinal cord) and endocrine disease
s (diabetes), prostate
problems, some allergies
and high blood pressure
. As well difficulty in achieving orgasm can result from pelvic surgery
that involved trauma
to pelvic nerves which are responsible for orgasm. Some men report a lack of sensation in the nerves of the glans penis, which may or may not be related to external factors, including a history of circumcision.
Delayed ejaculation might be a side effect
of some medications, usually of some antidepressants (e.g. prozac), antipsychotics (mellaril) and antihypertensives (guanethidine
). Ejaculation will also take longer if the man has recently ejaculated. Another reason for delayed ejaculation is excessive use of alcohol
(colloquially referred to as "whiskey dick" and "brewer's droop"). In this case physical and psychological causes might co-exist. Opiate-based medications and recreational drugs can prevent or delay ejaculation as they paralyze or slow all involuntary muscles, such as the ones that control dilation of the eyes, digestion, urination and ejaculation. Weight can also be a factor, as it slows blood flow to the penis.
may be solved by sex therapy.
, masturbation, wet dreams) then he should consult a urologist in order to find out whether there is a physical abnormality and then get necessary treatment which depends on the abnormality revealed.
Therapy usually involves homework assignments and exercises intended to help a man get used to having orgasms through insertional intercourse, either vaginal, anal or oral, i.e. through the way he is not accustomed to. Commonly the couple is advised to go through three stages. At the first stage a man masturbates in the presence of his partner. Sometimes this is not an easy matter as a man might be used to having orgasms alone. After a man learns to ejaculate in the presence of his partner, the couple gets to another stage where the man's hand is replaced with the hand of his partner. Step by step a man learns to ejaculate closer and closer to the desired orifice. In the final stage the receptive partner inserts the insertive partner's penis
into the partner's vagina, anus or mouth as soon as the ejaculation is felt to be imminent. Thus a man gradually learns to ejaculate inside the desired orifice.
Some sexologists recommend sex toys to train the patient to respond to vaginal or anal stimulation. This is especially effective in cases where the masturbatory technique is the source of the problem.
In some cases hypnosis
can help with the problem, especially if a partner does not want to participate in therapy. Meditation
has also been seen to be effective in case studies.
Naturally, if delayed ejaculation is caused by a disease, the disease is first of all treated. In those cases when delayed ejaculation is a side effect of medication the man's physician is to review other medication options.
In the case of alcohol addiction a man should get necessary treatment intended to help treat his addiction.
For many people it has proven to be the case that overly frequent masturbation on the part of the man is the root cause of his delayed vaginal ejaculation. Ceasing masturbation for a few days is often an effective and easy way to achieve more rapid orgasm during intercourse, because doing this will stop desensitization of the nerves in the penis. Also, different positions and rates of pelvic motion on the part of the receptive partner can be instrumental in achieving simultaneous orgasm.
There is yet no reliable medication for delayed ejaculation. PDE5 inhibitors such as Viagra have little effect. In fact, Viagra has a delaying effect on ejaculation, possibly through additional effect in the brain or decrease of sensitivity in the head of the penis. Case studies have reported some success with serotonin antagonists (amantadine
) and dopaminergic agents (bupropion
, buspirone
), though large, controlled studies are lacking, likely due to the rarity of the condition relative to other forms of male sexual dysfunction.
For the successful treatment of delayed ejaculation caused by medication, recovery totally depends on whether the physician can discontinue the medication.
and his sexual response. He should be aware that anxiety and fears can interfere with having a normal and satisfying sexual experience.
A man who wants to avoid ejaculation problems should concentrate on the pleasure he gets rather than worrying about when and whether his ejaculation is going to occur. The partner should also be tactful and should not put pressure on the man by asking him whether he has ejaculated or not. Instead a partner should create a relaxed atmosphere in which a man will feel free and enjoy sexual pleasure without worrying about ejaculation. Open discussion of anxieties and fears contribute to better sexual relationships and normal sexual satisfaction.
Orgasm
Orgasm is the peak of the plateau phase of the sexual response cycle, characterized by an intense sensation of pleasure...
despite the presence of normal sexual desire and sexual stimulation
Sexual stimulation
Sexual stimulation is any stimulus that leads to, enhances and maintains sexual arousal, and may lead to ejaculation and/or orgasm...
. Normally a man can achieve orgasm within 0–5 minutes of active thrusting during sexual intercourse
Sexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
, whereas a man with delayed ejaculation either does not have orgasms at all or cannot have an orgasm until after prolonged intercourse which might last for 30–45 minutes or more. In most cases delayed ejaculation presents the condition in which the man can climax and ejaculate only during masturbation
Masturbation
Masturbation refers to sexual stimulation of a person's own genitals, usually to the point of orgasm. The stimulation can be performed manually, by use of objects or tools, or by some combination of these methods. Masturbation is a common form of autoeroticism...
, but not during sexual intercourse.
Psychological causes of delayed ejaculation
Psychological causes of delayed ejaculation might include numerous factors that prevent a man from achieving orgasm during sexual intercourse. Among those factors are insufficient sleep, distraction due to worry, distraction from the environment, anxiety about pleasing his partner and anxiety about relationship problems. (Mann, Jay 1976, Delayed Ejaculation)Physical causes
One of the main causes of delayed ejaculation is adaptation to a certain masturbatory technique. The sensations a man feels when masturbating may bear little resemblance to the sensations he experiences during intercourse. Factors such as pressure, angle and grip during masturbation can make for an experience so different from sex with a partner that the ability to ejaculate is reduced or eliminated.Physical causes of delayed ejaculation may imply some diseases and conditions which affect a man's ability to achieve orgasm. These include many neurological (for example stroke or damage to the back or spinal cord) and endocrine disease
Endocrine disease
Endocrine diseases are disorders of the endocrine system. The branch of medicine associated with endocrine disorders is known as endocrinology.-Types of endocrine disease:Broadly speaking, endocrine disorders may be subdivided into three groups:...
s (diabetes), prostate
Prostate
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
problems, some allergies
Allergy
An Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
and high blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
. As well difficulty in achieving orgasm can result from pelvic surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
that involved trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
to pelvic nerves which are responsible for orgasm. Some men report a lack of sensation in the nerves of the glans penis, which may or may not be related to external factors, including a history of circumcision.
Delayed ejaculation might be a side effect
Adverse effect
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
of some medications, usually of some antidepressants (e.g. prozac), antipsychotics (mellaril) and antihypertensives (guanethidine
Guanethidine
Guanethidine is an antihypertensive drug that reduces the release of catecholamines, such as norepinephrine. Guanethidine is transported across the sympathetic nerve membrane by the same mechanism that transports norepinephrine itself , and uptake is essential for the drug's action...
). Ejaculation will also take longer if the man has recently ejaculated. Another reason for delayed ejaculation is excessive use of alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
(colloquially referred to as "whiskey dick" and "brewer's droop"). In this case physical and psychological causes might co-exist. Opiate-based medications and recreational drugs can prevent or delay ejaculation as they paralyze or slow all involuntary muscles, such as the ones that control dilation of the eyes, digestion, urination and ejaculation. Weight can also be a factor, as it slows blood flow to the penis.
Complications
Delayed ejaculation can cause a variety of complications, both for men who suffer from it, as well as for their partners. A positive aspect can occur in cases where delayed ejaculation contributes to increased sexual satisfaction of a partner (who can potentially experience greater sexual satisfaction during long-lasting intercourse sessions). However, after some time this is likely to become annoying for both partners when the man suffering from delayed ejaculation cannot, in spite of all efforts, achieve orgasm (or only achieves it after an extended period of time). Overall, the situation can worsen: both partners can choose to avoid sexual contact which does not result in orgasm. Consequently, both partners suffer from sexual dissatisfaction, becoming likely to lose sexual desire.Treatment
Treatment of delayed ejaculation depends on severity of the disorder and on its causes. For instance, a condition with no ejaculation at all may require urology, while absence of ejaculation only in sexual intercourseSexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
may be solved by sex therapy.
Urology
If a man has never had ejaculation through any kind of sexual stimulation (such as vaginal or anal intercourse, oral sexOral sex
Oral sex is sexual activity involving the stimulation of the genitalia of a sex partner by the use of the mouth, tongue, teeth or throat. Cunnilingus refers to oral sex performed on females while fellatio refer to oral sex performed on males. Anilingus refers to oral stimulation of a person's anus...
, masturbation, wet dreams) then he should consult a urologist in order to find out whether there is a physical abnormality and then get necessary treatment which depends on the abnormality revealed.
Sex therapy
If the disorder is not so severe and a man can ejaculate through some form of stimulation, he should apply to a sex therapist specializing in this area. This is very important in cases when a man can ejaculate through any form of stimulation but intercourse. Usually treatment for this disorder includes both partners.Therapy usually involves homework assignments and exercises intended to help a man get used to having orgasms through insertional intercourse, either vaginal, anal or oral, i.e. through the way he is not accustomed to. Commonly the couple is advised to go through three stages. At the first stage a man masturbates in the presence of his partner. Sometimes this is not an easy matter as a man might be used to having orgasms alone. After a man learns to ejaculate in the presence of his partner, the couple gets to another stage where the man's hand is replaced with the hand of his partner. Step by step a man learns to ejaculate closer and closer to the desired orifice. In the final stage the receptive partner inserts the insertive partner's penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
into the partner's vagina, anus or mouth as soon as the ejaculation is felt to be imminent. Thus a man gradually learns to ejaculate inside the desired orifice.
Other
If relationships in a couple are found problematic, therapy intended to enhance emotional intimacy might be required as a preliminary step.Some sexologists recommend sex toys to train the patient to respond to vaginal or anal stimulation. This is especially effective in cases where the masturbatory technique is the source of the problem.
In some cases hypnosis
Hypnosis
Hypnosis is "a trance state characterized by extreme suggestibility, relaxation and heightened imagination."It is a mental state or imaginative role-enactment . It is usually induced by a procedure known as a hypnotic induction, which is commonly composed of a long series of preliminary...
can help with the problem, especially if a partner does not want to participate in therapy. Meditation
Meditation
Meditation is any form of a family of practices in which practitioners train their minds or self-induce a mode of consciousness to realize some benefit....
has also been seen to be effective in case studies.
Naturally, if delayed ejaculation is caused by a disease, the disease is first of all treated. In those cases when delayed ejaculation is a side effect of medication the man's physician is to review other medication options.
In the case of alcohol addiction a man should get necessary treatment intended to help treat his addiction.
For many people it has proven to be the case that overly frequent masturbation on the part of the man is the root cause of his delayed vaginal ejaculation. Ceasing masturbation for a few days is often an effective and easy way to achieve more rapid orgasm during intercourse, because doing this will stop desensitization of the nerves in the penis. Also, different positions and rates of pelvic motion on the part of the receptive partner can be instrumental in achieving simultaneous orgasm.
There is yet no reliable medication for delayed ejaculation. PDE5 inhibitors such as Viagra have little effect. In fact, Viagra has a delaying effect on ejaculation, possibly through additional effect in the brain or decrease of sensitivity in the head of the penis. Case studies have reported some success with serotonin antagonists (amantadine
Amantadine
Amantadine is the organic compound known formally as 1-adamantylamine or 1-aminoadamantane. The molecule consists of adamantane backbone that has an amino group substituted at one of the four methyne positions. This pharmaceutical is sold under the name Symmetrel for use both as an antiviral and an...
) and dopaminergic agents (bupropion
Bupropion
Bupropion is an atypical antidepressant and smoking cessation aid. The drug is a non-tricyclic antidepressant and differs from most commonly prescribed antidepressants such as SSRIs, as its primary pharmacological action is thought to be norepinephrine-dopamine reuptake inhibition...
, buspirone
Buspirone
Buspirone is an anxiolytic psychoactive drug of the azapirone chemical class, and is primarily used to treat generalized anxiety disorder Bristol-Myers Squibb gained FDA approval of buspirone in 1986 for treatment of GAD...
), though large, controlled studies are lacking, likely due to the rarity of the condition relative to other forms of male sexual dysfunction.
Prognosis
Any of the following factors are signs of a better outcome: having sexual desire, being in love with the sexual partner, being eager to get rid of the problem, absence of deep psychological problems, short duration of the disorder and having satisfying sexual experiences before.For the successful treatment of delayed ejaculation caused by medication, recovery totally depends on whether the physician can discontinue the medication.
Prevention
First of all a man should have a healthy attitude towards sexualityHuman male sexuality
Human male sexuality covers physiological, psychological, social, cultural, and political aspects of the human male sexual response and related phenomenon...
and his sexual response. He should be aware that anxiety and fears can interfere with having a normal and satisfying sexual experience.
A man who wants to avoid ejaculation problems should concentrate on the pleasure he gets rather than worrying about when and whether his ejaculation is going to occur. The partner should also be tactful and should not put pressure on the man by asking him whether he has ejaculated or not. Instead a partner should create a relaxed atmosphere in which a man will feel free and enjoy sexual pleasure without worrying about ejaculation. Open discussion of anxieties and fears contribute to better sexual relationships and normal sexual satisfaction.
See also
- Premature ejaculationPremature ejaculationPremature ejaculation is a condition in which a man ejaculates earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation....
- Sexual repressionSexual repressionSexual repression, also known as sexual ethics, is a state in which a person is prevented from expressing their sexuality. Sexual repression is often associated with feelings of guilt or shame being associated with sexual impulses...
, a state in which a person is prevented from expressing his/her sexuality
External links
- Medline Plus Medical Encyclopedia - Delayed ejaculation.