Causes of delayed ejaculation
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.
Physical causes of delayed ejaculation include:
Medication side effects - delayed ejaculation may be an adverse effect of antidepressants (especially SSRIs - selective serotonin reuptake inhibitors), anti-anxiety drugs, blood pressure drugs (antihypertensive agents), painkillers, and other medications
Alcohol or the use of certain recreational drugs (whether legal or illegal)
Nerve damage (neurological causes) - stroke, spinal cord injury, surgery, multiple sclerosis, and severe diabetes can all lead to abnormal ejaculatory function
Increasing age can decrease the sensitivity of the penis to sexual stimulation
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.
Some of the psychological factors thought to be behind cases of delayed ejaculation include:
man sitting on edge of bed with head in hands
Men with a persistent problem of delayed ejaculation are likely to be distressed by it.
Early life history including abuse, difficulties bonding, neglect by parents, negative sexual upbringing
Unwillingness to enjoy pleasure
Religious belief, perhaps that sexual activity is a sin
Fear of, for instance, semen or female genitalia, or of somehow hurting or defiling a partner through ejaculation
Fear of pregnancy
Issues of lost confidence or performance anxiety - for example, anxiety about body image that interrupts the process of sexual stimulation
Previous masturbation is one factor that is strongly related to abnormal ejaculation.
Certain types of masturbatory behavior may play a role in developing delayed ejaculation. One specialist in delayed ejaculation found a relationship between the condition and the following masturbatory patterns:
Masturbating more often, typically more than three times a week
Having a style of masturbation that cannot be matched by sexual intercourse - particularly a high speed, high pressure, or high-intensity form
The partner's hand, mouth, or vagina being unable to easily duplicate the learned style
The sex partner differing from the fantasy used during masturbation to reach an orgasm
Dr. 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.
Diagnosing delayed ejaculation
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 - infections, hormonal imbalance, etc. - often using blood and urine tests.
Treatment of delayed ejaculation
a therapist takes notes with a patient
Professional counsellors may try to treat delayed ejaculation by identifying the source of the problem.
Treatment for delayed ejaculation depends on the cause. For instance, if SSRIs are the issue, an alternative drug may be prescribed.
Similarly, in cases where excessive alcohol or non-prescription drug use are to blame, reducing or eliminating these factors should help. Where other medical conditions are an underlying issue, managing the primary condition, such as a neurological problem, may help resolve the delayed ejaculation.
Primary cases of delayed ejaculation may not be as straightforward to treat, however, and often require the help of professional counsellors such as psychologists, psychotherapists, psychosexual counsellors, 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. Drugs with some reported benefits include:
Cyproheptadine (Periactin) - an allergy medication
Amantadine (Symmetrel) - a Parkinson's drug
Buspirone (Buspar) - an antianxiety medication