Delayed ejaculation — sometimes called impaired ejaculation — is a condition in which it takes an extended period of sexual stimulation for men to reach sexual climax and release semen from the penis ejaculate. Some men with delayed ejaculation are unable to ejaculate at all. Delayed ejaculation can be temporary or a lifelong problem. Possible causes of delayed ejaculation include certain chronic health conditions, surgeries and medications. Treatment for delayed ejaculation depends on the underlying cause.
Brief reactive psychosis Schizoaffective disorder Schizophreniform disorder. Fifth Edition. Therapy usually involves homework assignments and exercises intended to help a man get used to having orgasms through insertional intercoursevaginal, anal, or oral, that is through the way to which he is not accustomed. The most important lesson to be learned by Ejaculation delay problems and their partners is that there is Wally sheer and there are therapies that can help resolve the distress of ejaculatory difficulties. This helps to insure a successful treatment. The patient must be checked to see if there are reversible causes before being given medication. The most common cause of retrograde ejaculation is surgery to the prostate or the bladder neck.
Traditional deductive model steps. Exams and Tests
First, consult your doctor. Keep in mind that for most men what really works is, in fact, a combination of all these techniques along with psychological counselling, if it is necessary. This can affect ejaculation with and without a partner. Delayed ejaculation can have psychological or physical causes. But after 50, the context becomes increasingly Ejaculation delay problems. Sex therapists say that several emotional stressors may be associated with the relay anger at one's lover, fear of pregnancy or sexual infections, or fundamentalist Ejaculation delay problems. Alternatively, you can get local anaesthetic creams and gels. There are Crossdressing high school available for premature ejaculation specifically. What Are Erection Problems? Please tell us what was missing? He is a comp Read Full Bio. Fast, discreet delivery Your medicine or test kit is dispatched by our pharmacy. Philadelphia, Pa.
Delayed ejaculation is a medical condition in which a male cannot ejaculate.
- Delayed ejaculation DE is a common medical condition.
- Premature ejaculation is the most common ejaculation-related health condition.
- Premature ejaculation is the most common male sexual dysfunction.
A single pathogenetic pathway does not exist for sexual disorders generally and that is also true for DE specifically. High frequency negative thoughts may neutralize erotic cognitions fantasy and subsequently delay, ameliorate, or inhibit ejaculation, while partner stimulation friction may prove unsatisfying.
Assessment requires a thorough sexual history including inquiry into masturbatory methods. Differentiate DE from other sexual problems and review the conditions under which the man can ejaculate. Perceived partner attractiveness, the use of fantasy during sex, anxiety-surrounding coitus and masturbatory patterns require meticulous exploration. Identify important DE causes by juxtaposing an awareness of his cognitions and the sexual stimulation experienced during masturbation, versus a partnered experience.
Assist the man in identifying behaviors that enhance immersion in excitation and minimize inhibiting thoughts, in order to reach ejaculation in his preferred manner. Discontinuing, reducing or altering masturbation is often required, which evokes patient resistance.
Coaching tips are offered on how to ensure adherence to this suspension, manage resistance and facilitate success. Depending on motivation level, masturbation interruption may be compromised and negotiated.
Success will require most men to be taught to learn bodily movements and fantasies that approximate the thoughts and sensations experienced in masturbation. Drug treatment would benefit men particularly with severe DE, regardless of concomitant psychosocial-behavioral and cultural complications.
Treatment is patient-centered, holistic and integrates a variety of therapies as needed. Healthcare clinicians HCC may find DE difficult to treat and may not grasp the interpersonal and psychological distress it causes.
A single pathogenetic pathway does not exist for sexual disorders generally and the same is true for DE specifically 2. Assessment requires a thorough sexual history including inquiry into masturbatory methods to ascertain the information needed for proper diagnosis and treatment 3 , 4.
The STP is the interaction of constitutional sexual capacity with various bio-psychosocial-behavioral and cultural factors. The STP model can illustrate such intra and inter-individual variability characterizing sexual response and its disorders for both men and women Figure 1. The STP can be easily used to explain etiology and highlight treatment targets for patients.
Teaching the STP model to the patient and partner helps reduce despair and anger. Ejaculatory difficulty may occur in all situations generalized or limited to certain experiences situational. It may be lifelong primary or acquired secondary. A man typically reports an inability to ejaculate in the presence of a partner especially during coitus , but has little difficulty reaching orgasm and ejaculation during solo masturbation.
The negative impact described in the ED and PE literature also applies to men with DE, in terms of relationship distress, anxiety over sexual performance, and general health issues, versus sexually functional men. Men with DE may fake orgasm to avoid negative partner reaction 8. Some nomenclature confusion arises over ejaculation and orgasm usually occurring simultaneously, despite being separate physiological phenomena.
Orgasm is typically coincident with ejaculation, but is a central sensory event that has significant subjective variation. Sexual dysfunction not due to a substance or known physiological condition is diagnosed as F Amongst other sources, these two committees and subsequent International Consultations for Sexual Medicine relied upon Patrick, and Waldinger et al. In addition to the Waldinger et al. A more relaxed screening standard implicitly recognized etiological variability and multidimensionality, which can become overshadowed when dysfunction is over-defined because of latency time.
Elegantly, the same temporal screening standard would apply to lifelong and acquired PE, as well as DE. Loosened latency criteria could result in false positive diagnoses, but requiring a licensed HCC evaluation of the control and distress criteria reduced that risk. There is substantial evidence that satisfactory sexual intercourse and the distress related to both PE and DE are probably mediated more by perceived control over ejaculation than by latency time 30 - Jern et al.
Similar to the ISSM recommendations, the definition would be further qualified as lifelong primary or acquired secondary , global or situational. Analogous to DSM 5 definitions would then be specified as mild, moderate, or severe. It must be emphasized that the preceding conceptualization of how both PE and DE could be redefined does not mean that everyone outside the 4—10 minutes IELT range would be diagnosed with a sexual disorder.
For instance, a man who usually ejaculates in 3 minutes, who is not distressed would not be labeled PE, nor would a man who ejaculates in 15 minutes who is not distressed be labeled DE.
As biological causes of DE are reviewed elsewhere in this journal, this article focuses on psychosocial-behavioral and cultural causes. However, medical examination, laboratory testing and sexual history to rule out anatomical, hormonal, neurological abnormalities which may result in DE, should be obtained for every patient whenever possible.
Certainly, there is significant pre-clinical research indicating the importance of biological predisposition in EjD. Genetically predetermined ejaculatory thresholds do have a prodigious impact on ejaculatory ease and latency time, and distribute similarly to other human characteristics 5 , Yet, scatter clouds rather than trigger points are better metaphors for ejaculatory threshold.
The timing of a particular ejaculation is the result of a variety of psychosocial-cultural and behavioral factors influencing that biologically predetermined range Such a multilayered conceptualization is different from current animal models that postulate an exclusive neurobiological threshold model Yet, the very nature of genetic predisposition and its manifestations are variable.
A man whose IELT is greater than 35 minutes may be suffering from DE that is primarily biological in its etiology, secondary to genetic predisposition, disease or pharmaceutical side effects.
Such a man should be diagnosed with a life-long primary DE even if his bio-psychosocial-cultural factors are not yet fully comprehended. Nosology and etiology are related but separate constructs. Presumably he suffers from a susceptibility that interacted with a variety of psychosocial, environmental, cultural and medical risk factors resulting in dysfunction 5 , 7.
Although a biopsychosocial model is the ideal lens to view etiology, there is benefit from reviewing the earlier psychological and behavioral theories which variously emphasized ineffective sexual communication, cultural and religious prohibitions, mood disorders, fatigue, trauma, and feeling overly pressured to have sex. Additional presumed causes of DE included: anxiety, lack of confidence, poor body image, etc.
Depression can lead to DE as it is the most important clinical condition affecting sexual desire; this relationship is bidirectional Although medications for depression may affect desire through shared underlying mechanisms, studies have demonstrated that depression itself may have a more significant adverse effect on desire and orgasmic capacity than anti-depressant medication side effects 40 - Subsequent work supported his observations that these men often present due to partner pressure 10 , Perelman documented DE cases caused by men confusing ED medication induced vasocongestion, with genuine sexual arousal Fantasy refers to all erotic thoughts and feelings that are associated with a given sexual experience.
In fact, some men report penile irritation and erythema secondary to their masturbatory pattern 13 , Almost universally, these men fail to communicate their preferences to either the partners or doctors , because of embarrassment. Disparity between the reality of sex with their partner and their preferred sexual fantasy whether or not unconventional used during masturbation is another cause of DE That disparity takes many forms, such as partner attractiveness, body type, sexual orientation, and the specific sex activity performed 10 , Clinical experience affirms that bifurcating etiology into a rigid duality such as psychogenic and biologic is too categorical.
Genetic predispositions affect the typical speed and ease of ejaculation for any particular organism; however, many of these components are then influenced by experience and present context Biogenic and psychogenic etiologies are neither independent nor mutually exclusive.
The STP and other biopsychosocial-cultural models all explain this variation both between and within given individuals, and provide a better theoretical basis for understanding DE 5 , The evaluation of DE focuses on uncovering causes of the disorder. A urologist will often conduct a genitourinary examination and medical history that may identify physical anomalies, as well as contributory neurologic and endocrinologic especially androgen levels factors Evaluate for illnesses that result in neuropathies, e.
While objective diagnostic procedures have scientific and research appeal, in clinical settings the diagnosis of DE is often subjective and imprecise. There are no syndrome-specific tests or inventories to support a more objective diagnosis, and the most valuable diagnostic tool is a focused sex history sex status 3 , Just as pathophysiology should not be assumed without medical investigation, a psychogenic etiology should not be assumed and a sex status is critical A sex status typically begins by differentiating DE from other sexual problems and reviewing the conditions under which the man can ejaculate.
Perceived partner attractiveness, the use of fantasy during sex, anxiety-surrounding coitus and masturbatory patterns all require meticulous exploration. Identify important causes of DE by juxtaposing an awareness of his cognitions and the sexual stimulation he experiences during masturbation versus a partnered experience.
Additional questions will identify other etiological factors that improve or worsen performance, particularly those related to psychosexual arousal. Investigate previous treatment approaches, including the use of herbal therapies, home remedies, etc. Sexual and relationship inventories in general and even ones specific to ejaculation, like the MSHQ 55 may improve research methodology, but regrettably provide limited clinical utility.
A safe effective medication for DE does not yet exist. Patient and partner when present education should be integrated into the history taking process to the extent it does not interfere with rapport building or obtaining the necessary information. Be sensitive to patient preference regarding partner participation, as patient and partner cooperation is more critical to successful treatment than partner attendance at all office visits Before the evaluation concludes, offer the patient a formulation that highlights the immediate cause of his problem and how it can be alleviated.
Explain how the mental and physical erotic stimulation he is receiving is insufficient for him to ejaculate in the manner he desires manual, oral, coital, etc. Usually the patient will ask about prognosis. Help the man identify behaviors that enhance his ability to be immersed in excitation and minimize inhibiting thoughts, in order to reach ejaculation in his preferred manner. Discussion of a potential biologic predisposition is useful in reducing patient and partner anxiety and mutual recriminations, while improving therapeutic alliance 8.
Current treatments usually emphasizes integrating behavioral masturbatory retraining, within a nuanced sex therapy 2 , 37 , 45 , 53 , 58 , Masturbation can serve as rehearsal for partnered sex. By informing the patient how masturbation conditioned his response, stigma is minimized and partner cooperation can be evoked. Of course, masturbation retraining is only a means to an end; the goal of DE therapy is evoking higher levels of psychosexual arousal within mutually satisfying experiences.
Men with primary DE need to identify their sexual arousal preferences through self-exploration and stimulation. Masturbation training is similar to models described for women; yet the use of vibrators, often recommended by urologists, are rarely needed Fantasizing and use of erotica including internet pornography can help block thoughts that might otherwise interfere with arousal.
Validate not encourage an auto-sexual orientation when encountering it in a man, and assist in removing stigma suggesting withholding toward his partner. Finally, encourage the man and his partner to share their preferences, so that both their needs are met. For both primary and secondary DE as soon as therapeutically possible obtain an agreement from the patient to temporarily refrain from ejaculating alone.
If he initially insists on continuing to masturbate alone, it is essential he do so in a manner different from his normal routine. Transitioning from manual to oral, to coital stimulation is typical, as each provides progressively less friction than the other. Twenty-five years ago, lack of adequate stimulation was the salient variable for an early primary DE case of this author.
We do NOT intend for the information presented through our articles to replace the medical relationship with a qualified physician, nor does it represent specialized advice. In rare cases, DE is a sign of a worsening health problem such as heart disease or diabetes. Free and fast delivery. Advertising revenue supports our not-for-profit mission. Campbell-Walsh Urology.
Ejaculation delay problems. What counts as having premature ejaculation?
What is premature ejaculation? It is a common condition in which you or your partner feels that you're reaching orgasm too quickly. We usually mean that it's too fast for you to enjoy sex in general. Somewhere below two minutes is often recognized as premature ejaculation. While there's no cure to premature ejaculation, there are treatments and exercises you can use to stop premature ejaculation. Keep in mind that for most men what really works is, in fact, a combination of all these techniques along with psychological counselling, if it is necessary.
Quite often, it is about solving a mix of anxiety, stress, but also bad habits of ejaculating too early. As to treatments, there are two very effective solutions.
One is the EMLA Cream that numbs the sensation of your penis so you don't get too much stimulation and therefore you can last much longer. The other is known as Priligy or Dapoxetine, which is a very effective oral tablet that you take before sex. On average Priligy has been shown to help men last, at least, three times longer than usual. Complete a simple online questionnaire to get a prescription and order either EMLA Cream or Priligy and get it delivered to your home.
Dr Nicholas Antonakopoulos graduated from the University of London in He did his postgraduate training in hospitals in the London area, and he trained for four years in Trauma and Orthopaedic Surgery before completing his training in General practice in Althof, S.
J Sex Med , Sep; 7: Hatzimouratidis, K. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. European Urology , May; McMahon, C. The pathophysiology of acquired premature ejaculation. Transl Androl Urol , Jun; 6: Parnham, A. Classification and definition of premature ejaculation.
Transl Androl Urol , Mar; 5: Xia, Y. Relationship between premature ejaculation and depression. Medicine , Mar; 95 Zava offers oral tablets and topical creams to help you delay ejaculation. UK doctors review every order. Complete confidentiality. Free and fast delivery. How to Delay Ejaculation. Tips and techniques to stop premature ejaculation.
Medically reviewed by: Dr Nicholas Antonakopoulos. Contents of this article. Order premature ejaculation treatment. Men who are most at risk of developing premature ejaculation might: be under a lot of stress have erectile dysfunction have depression be overweight drink too much alcohol smoke There are treatments available for premature ejaculation specifically.
There are two types of premature ejaculation, primary and secondary. For example, some men condition themselves to ejaculate quickly during adolescence to avoid being caught, which leads to ejaculating too quickly with a partner.
There are also physical causes of secondary premature ejaculation , including: Thyroid problems High blood pressure Prostate disease Binge drinking Conditions like multiple sclerosis or nerve damage Relationship issues are also seen as a common cause of premature ejaculation. If relationship problems are a cause of premature ejaculation, it may be due to: Different sexual needs Anxiety around sexual satisfaction Lack of communication Fear of sex. They include: Priligy : this is an oral medication used to treat premature ejaculation.
It contains the active ingredient dapoxetine, and is used by men who normally ejaculate within minutes of having sex. Men who use it find it helps them to last longer. Priligy is a type of antidepressant, which helps to raise serotonin levels EMLA : unlike Priligy, EMLA is a topical cream which is rubbed onto the penis to make it less sensitive.
This can help to slow down ejaculation. It contains two local anaesthetics painkillers , lidocaine and prilocaine. Ejaculatory incompetence; Sex - delayed ejaculation; Retarded ejaculation; Anejaculation; Infertility - delayed ejaculation. Bhasin S, Basson R. Sexual dysfunction in men and women. Williams Textbook of Endocrinology. Philadelphia, PA: Elsevier; chap McMahon CG. Disorders of male orgasm and ejaculation. Campbell-Walsh Urology. Shafer LC. Sexual disorders or sexual dysfunction.
Updated by: Sovrin M. Review provided by VeriMed Healthcare Network. Editorial team. Delayed ejaculation. Delayed ejaculation can have psychological or physical causes.
Common psychological causes include: Religious background that makes the person view sex as sinful Lack of attraction for a partner Conditioning caused by a habit of excessive masturbation Traumatic events such as being discovered masturbating or having 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: Blockage of the ducts that semen passes through Use of certain drugs Nervous system diseases, such as stroke or nerve damage to the spinal cord or back Nerve damage during surgery in the pelvis.
Exams and Tests. Outlook Prognosis. Treatment commonly requires about 12 to 18 sessions. You will have a better outcome if: You have a past history of satisfying sexual experiences.
The problem has not been occurring for a long time. You have feelings of sexual desire. You feel love or attraction toward your sexual partner. You are motivated to get treated. You do not have serious psychological problems. Possible Complications. If the problem is not treated, the following may occur: Avoidance of sexual contact Inhibited sexual desire Stress within the relationship Sexual dissatisfaction Difficulty with conception and getting pregnant If you and your partner are trying to get pregnant, sperm can be collected using other methods.
Alternative Names. Male reproductive system Prostate gland Pathway of sperm. Sexual Problems in Men Read more. Health Topics A-Z Read more.
Ejaculation problems - NHS
Delayed ejaculation affects around 1 to 4 percent of men. It can result in distress for both the man and his partner. It can trigger anxiety about general health, low libido, and sexual dissatisfaction. Relationship problems include a fear of rejection for both parties and concern for couples who wish to start a family. Most men will experience delayed ejaculation at some point in their lives, but for some, it is a lifelong problem. Here are some key points about delayed ejaculation.
More detail and supporting information is in the body of this article. Delayed ejaculation can have a psychological or biological cause. There can also be overlap between the two. It can be a lifelong condition, where a man has always had difficulty reaching an orgasm, but more commonly, delayed ejaculation occurs after a period of normal function. An acquired case is usually determined as having a psychological cause if it only happens in specific situations.
For example, it is more likely that delayed ejaculation has a psychological basis if a man is able to ejaculate normally when masturbating, but experiences a delay during sex with a partner. One specialist in delayed ejaculation found a relationship between the condition and the following masturbatory patterns:. Michael Perelman, clinical professor of psychiatry, reproductive medicine and urology at the Weill Medical College of Cornell University, New York, observed that most men he had seen with delayed ejaculation reported no problems reaching an orgasm and ejaculating via masturbation.
Some men with the condition needed to employ an "idiosyncratic" form of self-manipulation to reach orgasm, such as rubbing the penis against the bed sheets, masturbating with pressure on a particular spot when reading erotic books, and even masturbating by "urethral instrumentation" - inserting a foreign body down into the opening of the penis.
Expert, evidence-based advice delivered straight to your inbox to help you take control of your health. Delayed ejaculation is diagnosed when a man is concerned about a marked delay or infrequency of achieving ejaculation during most sexual encounters over a period of 6 months or more, and when other problems have been ruled out. To reach a diagnosis, a doctor will speak with the individual about symptoms and how often they occur. They will then rule out other potential medical problems, such as infections, hormonal imbalance, and so on.
This may involve using blood and urine tests. Treatment for delayed ejaculation depends on the cause. For instance, if SSRIs are the issue, an alternative drug may be prescribed. If excessive alcohol or non-prescription drug use are factors, reducing or eliminating these may help. If there are other medical conditions, managing the primary condition, such as a neurological problem, may help resolve the delayed ejaculation.
Primary cases of delayed ejaculation may not be straightforward to treat. They often require the help of professional counselors such as psychologists, psychotherapists, psychosexual counselors, sex therapists, or couple's therapists. Psychologists recognize that there is no single intervention that works for all patients and that the key to successful treatment is to identify the source of the problem and to use appropriate, targeted therapy to deal with the psychological factors that trigger or contribute to the problem.
Some medications may help improve the symptoms of delayed ejaculation, but none have yet been specifically approved to treat it. Anyone who has concerns about sexual function speaks with a doctor so that the right course of action can be taken. Table of contents Causes Diagnosis Treatment Outlook. Fast facts on delayed ejaculation Here are some key points about delayed ejaculation.
Delayed ejaculation is a form of sexual dysfunction affecting a man's ability to reach an orgasm. The average time it takes for ejaculation to occur upon stimulation varies between individuals, with no strict figure given for what is "normal". Most causes are psychological, but organic reasons are also possible and are ruled out first during diagnosis. No pharmacological therapies are available for psychological causes of delayed ejaculation.
Men with a persistent problem of delayed ejaculation are likely to be distressed by it. Stay in the know. Expert, evidence-based advice delivered straight to your inbox to help you take control of your health Sign Up. Professional counselors may try to treat delayed ejaculation by identifying the source of the problem.