Delayed ejaculation

 

Delayed ejaculation

Overview

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.

It's normal for men to have delayed ejaculation from time to time. Delayed ejaculation is only a problem if it's ongoing or causes stress for you or your partner.

Symptoms

Some men with delayed ejaculation need 30 minutes or more of sexual stimulation to have an orgasm and ejaculate. Other men might not be able to ejaculate at all (anejaculation).

But, there's no specific time that indicates a diagnosis of delayed ejaculation. Instead, you are probably experiencing delayed ejaculation if the delay is causing distress or frustration, or if you have to stop sexual activity due to fatigue, physical irritation, loss of erection or a request from your partner.

Often, men might have difficulty reaching orgasm during sexual intercourse or other sexual activities with a partner. Some men can ejaculate only when masturbating.

Delayed ejaculation is divided into the following types based on symptoms:

·         Lifelong vs. acquired. With lifelong delayed ejaculation, the problem is present from the time of sexual maturity. 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.

These categories help in diagnosing an underlying cause and determining what might be the most effective treatment.

When to see a doctor

Your primary care doctor is a good place to start when you have delayed ejaculation. See your doctor if:

·         Delayed ejaculation is an issue for you or your partner

·         You have another known health problem that might be linked to delayed ejaculation, or you take medications that could be causing the problem

·         You have other symptoms along with delayed ejaculation that might or might not seem related

Causes

Delayed ejaculation can result from medications, certain chronic health conditions and surgeries. Or it might be caused by substance misuse or a mental health concern, such as depression, anxiety or stress. In many cases, it is due to a combination of physical and psychological concerns.

Psychological causes of delayed ejaculation include:

·         Depression, anxiety or other mental health conditions

·         Relationship problems due to stress, poor communication or other concerns

·         Anxiety about performance

·         Poor body image

·         Cultural or religious taboos

·         Differences between the reality of sex with a partner and sexual fantasies

Medications and other substances that can cause delayed ejaculation include:

·         Some antidepressants

·         Certain high blood pressure medications

·         Certain diuretics

·         Some antipsychotic medications

·         Some anti-seizure medications

·         Alcohol — particularly drinking too much (excessive alcohol use or alcoholism)

Physical causes of delayed ejaculation include:

·         Certain birth defects affecting the male reproductive system

·         Injury to the pelvic nerves that control orgasm

·         Certain infections, such as a urinary tract infection

·         Prostate surgery, such as transurethral resection of the prostate or prostate removal

·         Neurological diseases, such as diabetic neuropathy, stroke or nerve damage to the spinal cord

·         Hormone-related conditions, such as low thyroid hormone level (hypothyroidism) or low testosterone level (hypogonadism)

·         Retrograde ejaculation, a condition in which the semen goes backward into the bladder rather than out of the penis

For some men, a minor physical problem that causes a delay in ejaculation might cause anxiety about ejaculating during a sexual encounter. The resulting anxiety might worsen delayed ejaculation.

Risk factors

A number of things can increase your risk of having delayed ejaculation, including:

·         Older age — as men age, it's normal for ejaculation to take longer

·         Psychological conditions, such as depression or anxiety

·         Medical conditions, such as diabetes or multiple sclerosis

·         Certain medical treatments, such as prostate surgery

·         Medications, particularly certain antidepressants, high blood pressure medications or diuretics

·         Relationship problems, such as poor communication with your partner

·         Excessive alcohol use, especially if you're a long-term heavy drinker

Complications

Complications of delayed ejaculation can include:

·         Diminished sexual pleasure for you and your partner

·         Stress or anxiety about sexual performance

·         Marital or relationship problems due to an unsatisfactory sex life

·         Inability to get your partner pregnant (male infertility)

Diagnosis

A physical exam and medical history might be all that are needed to recommend treatment for delayed ejaculation. However, if delayed ejaculation appears to be caused by an underlying problem that might need treatment, you might need further tests or you might need to see a specialist.

Tests for underlying problems can include:

·         Physical exam. This might include careful examination of your penis and testicles. The doctor will use light touch to make sure you have normal sensation in your genitals.

·         Blood tests. Your health care provider might take a blood sample and send it to a lab to check for signs of cardiovascular disease, diabetes, a low testosterone level and other health problems.

·         Urine tests (urinalysis). Urine tests are used to look for signs of diabetes, infection and other underlying health conditions.

Treatment

Delayed ejaculation treatment depends on the underlying cause, but it might include taking a medication or making changes to medications you currently take, undergoing psychological counseling, or addressing alcohol or illegal drug use.

Medications

If you're taking medication that might be causing delayed ejaculation, reducing the dose of a medication or switching medications might fix the problem. Sometimes, adding a medication might help.

There aren't any drugs that have been specifically approved for the treatment of delayed ejaculation. Medications used to treat delayed ejaculation are primarily used to treat other conditions.

Medications sometimes used to treat delayed ejaculation include:

·         Amantadine, a Parkinson's medication

·         Buspirone, an anti-anxiety medication

·         Cyproheptadine, an allergy medication

Psychological counseling (psychotherapy)

Psychotherapy can help by addressing underlying mental health problems leading to delayed ejaculation, such as depression or anxiety. It's also used to address psychological issues that directly affect your ability to ejaculate.

Counseling might involve seeing a psychologist or mental health counselor on your own or along with your partner. Depending on the underlying cause, you might benefit most from seeing a sex therapist — a mental health counselor who specializes in talk therapy for sexual problems. The type of counseling that's best for you will depend on your particular concerns.

Coping and support

If it's an ongoing concern, delayed ejaculation can cause mental and emotional stress for you and your partner. If you have delayed ejaculation only on occasion, try not to assume that you have a permanent problem or to expect it to happen again during your next sexual encounter. Remember, occasional delayed ejaculation due to stress or other temporary factors might improve when the underlying cause gets better.

In addition, if you experience occasional or persistent delayed ejaculation, it's important to reassure your sexual partner. Your partner might think your inability to reach climax is a sign of diminished sexual interest.

Communicate openly and honestly with your partner about your condition. Treatment is often more successful if couples work together as a team. You might even want to see a counselor with your partner. This can help you address concerns you both might have about delayed ejaculation.

Preparing for your appointment

If you've been having trouble achieving orgasm, talk with your primary care doctor. Your doctor might refer you to a specialist — such as a doctor who specializes in male genital problems (urologist), a doctor who specializes in the hormonal systems (endocrinologist), a doctor who diagnoses and treats mental health problems (psychiatrist), or another type of specialist.

Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

To prepare for your appointment:

·         Write down any symptoms you've had, including any that might seem unrelated to delayed ejaculation.

·         Write down key personal information, including any major stresses or recent life changes, illnesses, or changes in medications you take.

·         Make a list of all medications, vitamins, herbal remedies and supplements you take.

·         Take your partner along, if possible. Your partner might be able to provide information that will assist in diagnosing and treating the problem.

·         Write down questions to ask your doctor.

Questions to ask your doctor

For delayed ejaculation, some basic questions to ask your doctor include:

·         What's the most likely cause of my delayed ejaculation?

·         What kinds of tests do I need?

·         Is this problem temporary?

·         What treatments are available, and which one do you recommend for me?

·         I have other health conditions. How can I best manage these conditions together?

·         Is there a generic alternative to the medicine you're prescribing me?

·         Should I see a specialist?

·         Where can I find more information about my condition?

What to expect from your doctor

Being ready to answer your doctor's questions might allow time to go over any points you want to spend extra time on. Your doctor may ask:

·         How long have you had trouble ejaculating? Does it happen only now and then, or is it an ongoing problem?

·         Are you able to ejaculate during sexual intercourse? Or are you able to ejaculate only when your partner directly touches your penis or when you masturbate?

·         If you're able to ejaculate, how long does it take after sexual activity starts?

·         Have you had any changes in sexual desire or any other sexual problems?

·         Are there any problems in your relationship with your sexual partner?

·         Have you had any recent surgeries? Or have you had surgery to the pelvic area, such as surgery to treat an enlarged prostate?

·         What health problems or chronic conditions do you have? Are you taking any medications for these conditions?

·         Have you had any other sexual problems, such as trouble getting or maintaining an erection (erectile dysfunction)?

·         Do you drink alcohol or use illegal drugs? If so, how much?