Delayed ejaculation

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Delayed ejaculation
Other namesRetarded ejaculation, inhibited ejaculation
SpecialtyUrology

Delayed ejaculation (DE) is a man's inability or persistent difficulty in achieving orgasm, despite typical sexual desire and sexual stimulation. Generally, a man can reach orgasm within a few 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.[1] Delayed ejaculation is closely related to anorgasmia. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the definition of DE requires 1 of 2 symptoms: either a marked delay in or a marked infrequency or absence of ejaculation on 75% to 100% of occasions for at least 6 months of partnered sexual activity without the individual desiring delay, and causing significant distress to the individual. DE is meant to describe any and all of the ejaculatory disorders that result in a delay or absence of ejaculation. The Third International Consultation on Sexual Medicine defined DE as an intravaginal ejaculation latency time threshold beyond 20 to 25 minutes of sexual activity, as well as negative personal consequences such as bother or distress. Of note, most men's intravaginal ejaculation latency time range is approximately 4 to 10 minutes. While ejaculatory latency and control were significant criteria to differentiate men with DE from those without ejaculatory disorders, bother/distress did not emerge as a significant factor.[2] Delayed ejaculation is the least common of the male sexual dysfunctions, and can result as a side effect of some medications. In one survey, 8% of men reported being unable to achieve orgasm over a two-month period or longer in the previous year.[3] DEs are either primary and lifelong or acquired. Acquired DEs may be situational. While most men do experience occasional or short term delayed ejaculation issues, the prevalence of lifelong DE and acquired long-term DE is estimated around 1% and 4%, respectively.[4]

Signs and symptoms

Causes

The etiologies of delayed ejaculation can be age-related, organic, psychological, or pharmacological.[5] Primary lifelong DEs are poorly understood and rarely explained by few congenital anatomic causes (viz., Müllerian duct cyst, Wolfian duct abnormalities, prune belly syndrome, imperforate anus, congenital ejaculatory duct obstruction, genetic abnormalities including cystic fibrosis, etc.)

  • Anatomic causes (acquired ejaculatory duct obstruction)
  • Infective/Inflammation (residual damage from acute infections, chronic infections, urethritis, prostatitis, orchitis, genitourinary tuberculosis, schistosomiasis, lichen sclerosis, etc.)
  • Neurogenic causes (diabetic autonomic neuropathy, spinal cord or nerve root injury from trauma or disc prolapse, multiple sclerosis, etc.). DE can be due to the injury to pelvic nerves responsible for orgasm from trauma as a result of pelvic surgery (viz., prostate surgery including transurethral resection of prostate and bladder neck incision, proctocolectomy, bilateral sympathectomy, abdominal aortic aneurysmectomy, para-aortic lymphadenectomy etc.). 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.[6]
  • Some researchers believe that circumcision has a negative effect on men's ejaculation during sex, while others believe that circumcision has no effect.[7][8][9][10] Those who believe in the negative effects of circumcision, such as a reduction of sexual sensitivity in the penis, claim that the part of the penis that is removed during circumcision is one of the most important and sensitive parts involved in receiving sexual pleasure, and that after its removal, sexual pleasure decreases.[11][12][13][14] However, researchers who argue against the negative effects of circumcision on men's sexual pleasure, citing the research and conclusions of international medical bodies such as the World Health Organization and important academic centers, state that circumcision does not have a noticeable effect on the sensitivity of the penis.[15][16][17][18]
  • Endocrine (hypogonadism, pituitary disorders such as hyperprolactinaemia and Cushing's disease, thyroid disorders, etc.). Although low testosterone level had been considered a risk factor in the past, more recent studies have not confirmed any association between ejaculation times and serum testosterone levels.[19][20]
  • Delayed ejaculation is a possible side effect of alcohol[3] and certain medications, including antipsychotics, antidepressants including selective serotonin reuptake inhibitors (SSRIs), opiates such as morphine or oxycodone, many benzodiazepines such as Valium or Xanax, and certain antihypertensives including thiazide diuretics, alpha-adrenergic blockers and ganglion blockers.[21][22] Although they may increase sexual desire, stimulants such as amphetamines and cocaine have an inhibitory effect on ejaculation, and can cause erectile dysfunction and reduced penile sensitivity via their vasoconstrictive effects.[23]
    • Psychological and lifestyle factors have been discussed as potential contributors, including insufficient sleep, distraction due to worry, distraction from the environment, anxiety about pleasing their partner and anxiety about relationship problems.[24]
    • Religious guilt over sex can cause delayed ejaculation.[25]
    • "Spectatoring", the problem of perceiving sex as a performance rather than a mutual experience and process of pleasure "in the moment" can cause delayed ejaculation.[25]
    • Men who are solely aroused by sexual fetishes may be unable to ejaculate from regular intercourse.[25]

Diagnosis

Diagnosis and management of DE warrant one of the most comprehensive medical evaluation in sexual health assessment that includes a full medical and sexual history performed along with a detailed physical examination. Understanding the quality of the sexual response cycle (desire, arousal, ejaculation, orgasm, and refractory period); details of the ejaculatory response, sensation, frequency, and sexual activity/techniques; cultural context and history of the disorder; partner's assessment of the disorder and if the partner has any sexual dysfunction themselves; and the overall satisfaction of the sexual relationship are all important to garner during history-taking.[26]

Treatment

Sex therapy

Medication

There is as yet no reliable medication for all cases of delayed ejaculation. Some studies have found that PDE5 inhibitors such as Viagra have little effect.[27] Viagra can have a delaying effect on ejaculation, possibly through additional effect in the brain or decrease of sensitivity in the head of the penis.[28] Cabergoline, an agonist of dopamine D2 receptors which inhibits prolactin production, was found in a small study to fully restore orgasm in one third of anorgasmic subjects, and partially restore orgasm in another third. Limited data has shown that the drug amantadine may help to relieve SSRI-induced orgasmic dysfunction.[29][30][31] Cyproheptadine, buspirone, stimulants such as amphetamines (including the antidepressant bupropion), nefazodone has been used to treat SSRI-induced anorgasmia.[32] Reducing the SSRI dosage may also resolve anorgasmia problems. Yohimbine has been shown to be effective in the treatment of orgasmic dysfunction in men.[33]

Other

Meditation has demonstrated effectiveness in case studies.[34]

See also

References

  1. ↑ Knowles, David R. (2005-06-01). "Delayed ejaculation". A.D.A.M. Medical Encyclopedia. A.D.A.M., Inc. Retrieved 2007-05-24.
  2. ↑ Rowland DL, Cote-Leger P. Moving Toward Empirically Based Standardization in the Diagnosis of Delayed Ejaculation. J Sex Med. 2020 Oct;17(10):1896–1902. doi: 10.1016/j.jsxm.2020.07.017. Epub 2020 Aug 20. PMID 32828700.
  3. ↑ 3.0 3.1 Strassberg, D. S., & Perelman, M. A. (2009). Sexual dysfunctions. In P. H. Blaney & T. Millon (Eds.), Oxford textbook of psychopathology (2nd ed.), (pp. 399–430). NY: Oxford University Press.
  4. ↑ Di Sante S, Mollaioli D, Gravina GL, Ciocca G, Limoncin E, Carosa E, Lenzi A, Jannini EA. Epidemiology of delayed ejaculation. Transl Androl Urol. 2016 Aug;5(4):541-8. doi: 10.21037/tau.2016.05.10. PMID 27652226; PMCID: PMC5002002.
  5. ↑ Abdel-Hamid IA, Ali OI. Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment. World J Mens Health. 2018 Jan;36(1):22–40. https://doi.org/10.5534/wjmh.17051
  6. ↑ Dias J, Freitas R, Amorim R, Espiridião P, Xambre L, Ferraz L, Adult circumcision and male sexual health: a retrospective analysis, Andrologia, 20 April 2013 doi:10.1111/and.12101 [1]
  7. ↑ Bañuelos Marco, Beatriz; García Heil, Jessica Leigh (2021). "Circumcision in childhood and male sexual function: a blessing or a curse?". International Journal of Impotence Research. 33 (2): 139–148. doi:10.1038/s41443-020-00354-y. ISSN 1476-5489. PMC 7985026. PMID 32994555.
  8. ↑ Gao, Jingjing; Xu, Chuan; Zhang, Xiansheng (2016). "AB221. Effects of adult male circumcision on premature ejaculation: results from a prospective study in China". Translational Andrology and Urology. 5 (Suppl 1): 221. doi:10.21037/tau.2016.s221. ISSN 2223-4691. PMC 4842720.
  9. ↑ Kim, Hyuncheol (2016-06-08). "Long-term Effects of Male Circumcision on Risky Sexual Behaviors and STD Infections: Evidence from Malawian Secondary Schools". AEA Randomized Controlled Trials. doi:10.1257/rct.1335-1.0. Retrieved 2024-01-06.
  10. ↑ Warees, Warees M.; Anand, Sachit; Rodriguez, Alexander M. (2023), "Circumcision", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30571057, retrieved 2024-01-06
  11. ↑ "Sorrells, M. L., Snyder, J. L., Reiss, M. D., Eden, C., Milos, M. F., Wilcox, N., & Van Howe, R. S. (2007). Finetouch pressure thresholds in the adult penis. BJU Int, 99 (4), 864-869". BJU.
  12. ↑ Collins, S.; Upshaw, J.; Rutchik, S.; Ohannessian, C.; Ortenberg, J.; Albertsen, P. (2002). "Collins, S., Upshaw, J., Rutchik, S. O., C., Ortenberg, J., & Albertsen, P. (2002). Effects of circumcision on male sexual function: Debunking a myth? J Urol, 167, 2111-2112". J Urol. 167 (5): 2111–2112. doi:10.1016/S0022-5347(05)65097-5. PMID 11956452.
  13. ↑ Coursey, J. W.; Morey, A. F.; McAninch, J. W.; Summerton, D. J.; Secrest, C.; White, P.; Miller, K.; Pieczonka, C.; Hochberg, D.; Armenakas, N. (2001). "Coursey, J. W., Morey, A. F., McAninch, J. W., Summerton, D. J., Secrest, C.,White, P., et al. (2001). Erectile function after anterior urethroplasty. J Urol, 166 (6), 2273-2276". J Urol. 166 (6): 2273–2276. doi:10.1016/S0022-5347(05)65549-8. PMID 11696750.
  14. ↑ Ahmady, Kameel Et al 2023: Blade of Tradition in the Name of Religion (A Phenomenological Investigation into Male Circumcision in Iran), Scholar's Press Publishing, Republic of Moldova.
  15. ↑ Ongun, Sakir; Dursun, Murat; Egriboyun, Sedat (2020). "The effect of post-circumcision mucosal cuff length on premature ejaculation". Canadian Urological Association Journal. 14 (7): E309–E312. doi:10.5489/cuaj.6016. ISSN 1911-6470. PMC 7337711. PMID 32017696.
  16. ↑ Gao, Jingjing; Xu, Chuan; Zhang, Jingjing; Liang, Chaozhao; Su, Puyu; Peng, Zhen; Shi, Kai; Tang, Dongdong; Gao, Pan; Lu, Zhaoxiang; Liu, Jishuang; Xia, Lei; Yang, Jiajia; Hao, Zongyao; Zhou, Jun (2015-01-28). "Effects of Adult Male Circumcision on Premature Ejaculation: Results from a Prospective Study in China". BioMed Research International. 2015: e417846. doi:10.1155/2015/417846. ISSN 2314-6133. PMC 4324807. PMID 25695078.
  17. ↑ Namavar, Mohammad Reza; Robati, Boroomand (2011). "Removal of foreskin remnants in circumcised adults for treatment of premature ejaculation". Urology Annals. 3 (2): 87–92. doi:10.4103/0974-7796.82175. ISSN 0974-7796. PMC 3130485. PMID 21747599.
  18. ↑ "Sebastián A Bernaschina-Rivera, BS, Alexandra I López-Chaim, BS, José A Cordero-Pacheco, BS, Raúl Fernández-Crespo, MD, José Quesada-Olarte, MD, Rafael Carrión, MD Sexual Medicine Reviews, Volume 11, Issue 4, October 2023, Pages 412–420". academic.oup.com. Retrieved 2024-01-06.
  19. ↑ Morgentaler A, Polzer P, Althof S, Bolyakov A, Donatucci C, Ni X, Patel AB, Basaria S. Delayed Ejaculation and Associated Complaints: Relationship to Ejaculation Times and Serum Testosterone Levels. J Sex Med. 2017 Sep;14(9):1116–1124. doi: 10.1016/j.jsxm.2017.06.013. Epub 2017 Aug 12. PMID 28807505.
  20. ↑ Paduch DA, Polzer P, Morgentaler A, Althof S, Donatucci C, Ni X, Patel AB, Basaria S. Clinical and Demographic Correlates of Ejaculatory Dysfunctions Other Than Premature Ejaculation: A Prospective, Observational Study. J Sex Med. 2015 Dec;12(12):2276-86. doi: 10.1111/jsm.13027. Epub 2015 Oct 29. PMID 26511106.
  21. ↑ drugs.com Delayed ejaculation Archived 2019-02-20 at the Wayback Machine Review Date: 6/5/2007. Reviewed By: Marc Greenstein, DO, Urologist, North Jersey Center for Urologic Care
  22. ↑ Smith, Shubulade; Robin Murray; Veronica O'Keane (2002). "Sexual dysfunction in patients taking conventional antipsychotic medication". The British Journal of Psychiatry. 181: 49–55. doi:10.1192/bjp.181.1.49. PMID 12091263.
  23. ↑ Ghadigaonkar, Deepak S.; Murthy, Pratima (2019). "Sexual Dysfunction in Persons with Substance Use Disorders". Journal of Psychosexual Health. 1 (2): 117–121. doi:10.1177/2631831819849365. S2CID 196538029.
  24. ↑ Mann, Jay (1976). "Retarded ejaculation and treatment". International Congress of Sexology.
  25. ↑ 25.0 25.1 25.2 Wincze, John P.; Weisberg, Risa B. Sexual Dysfunction: A Guide for Assessment and Treatment. Guilford Publications, 2015. p. 42
  26. ↑ Rowland D, McMahon CG, Abdo C, Chen J, Jannini E, Waldinger MD, Ahn TY. Disorders of orgasm and ejaculation in men. J Sex Med. 2010 Apr;7(4 Pt 2):1668–86. doi: 10.1111/j.1743-6109.2010.01782.x. PMID 20388164.
  27. ↑ The Carlat Psychiatry Report > PDE-5 Inhibitors: Which to Choose? Archived 2019-12-16 at the Wayback Machine Published in The Carlat Psychiatry Report. December 2004, Volume 2, Number 12
  28. ↑ WebMD Health News > Viagra, Paxil Help Premature Ejaculation. May 29, 2002. By Martin F. Downs.
  29. ↑ Shrivastava RK, Shrivastava S, Overweg N, Schmitt M (1995). "Amantadine in the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors". Journal of Clinical Psychopharmacology. 15 (1): 83–84. doi:10.1097/00004714-199502000-00014. PMID 7714234.
  30. ↑ Balogh S, Hendricks SE, Kang J (1992). "Treatment of fluoxetine-induced anorgasmia with amantadine". The Journal of Clinical Psychiatry. 53 (6): 212–13. PMID 1607353.
  31. ↑ Keller Ashton A, Hamer R, Rosen RC (1997). "Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: a large-scale retrospective study of 596 psychiatric outpatients". Journal of Sex & Marital Therapy. 23 (3): 165–75. doi:10.1080/00926239708403922. PMID 9292832.
  32. ↑ Gitlin, Michael J. (1998). "Treatment of Antidepressant-Induced Sexual Dysfunction". Medscape Psychiatry & Mental Health eJournal. 3 (3). Retrieved 4 April 2018.
  33. ↑ Adeniyi AA, Brindley GS, Pryor JP, Ralph DJ (May 2007). "Yohimbine in the treatment of orgasmic dysfunction". Asian Journal of Andrology. 9 (3): 403–07. doi:10.1111/J.1745-7262.2007.00276.x. PMID 17486282.
  34. ↑ M. M. Delmonte (June 1984). "Case reports on the use of meditative relaxation as an intervention strategy with retarded ejaculation". Biofeedback and Self-Regulation. 9 (2): 209–214. doi:10.1007/BF00998835. PMID 6391563. S2CID 40959207.

Bibliography

  • Ahmady, Kameel Et al 2023: Blade of Tradition in the Name of Religion (A Phenomenological Investigation into Male Circumcision in Iran), Scholar's Press Publishing, Republic of Moldova.
  • Wincze, John P 2015: Weisberg, Risa B. Sexual Dysfunction: A Guide for Assessment and Treatment. Guilford Publications.
  • Blaney, Paul H 2014: Krueger, Robert F.; Millon, Theodore. Oxford Textbook of Psychopathology. Oxford University Press.

External links

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