What is delayed ejaculation?

Delayed ejaculation, is difficulty ejaculating even with a firm erection and sufficient sexual arousal and stimulation. Delayed ejaculation is estimated to occur in 1-4% of men.

Delayed ejaculation can be classified as either primary or secondary. Primary delayed ejaculation is when a man has never been able to ejaculate during sexual intercourse. Secondary delayed ejaculation is when a man was able to ejaculate during intercourse at one time in his life, but no longer is able to, or he does so infrequently.

Delayed ejaculation usually occurs during sexual intercourse but much less frequently during masturbation. In fact 85% of men with either primary or secondary delayed ejaculation are usually able to achieve orgasm through masturbation. In some circumstances delayed ejaculation occurs in both situations, therefore the man is unable to ejaculate, or may only be able to ejaculate after prolonged intercourse or masturbation. This problem can be frustrating and causes distress for both partners involved.

In some circumstances, a man can reach pleasurable orgasm without ejaculating semen. This is often referred to as ‘dry orgasm’ (but only if this occurs in the absence of retrograde ejaculation).

What are the causes of delayed ejaculation?

Through a detailed medical/emotional/sexual history, as well as a physical (and possibly neurological) exam, a physician (typically a urologist) usually can determine the cause of a man’s delayed ejaculation.

Delayed ejaculation is often caused by:

• Medication side-effects - Antidepressants, antianxiety drugs and blood pressure medications can slow the ejaculatory response.
• Alcohol or illicit drug use.
• Neurological damage – Nerve damage caused by strokes and spinal cord injury or conditions such as multiple sclerosis can also create problems with achieving ejaculation.
• Psychological causes – Sexual performance anxiety, depression, relationship issues, etc. may cause delayed ejaculation.
• A man who is used to masturbating with a very fast motion may find it difficult to climax with the slower process of intercourse.

Are there treatments for delayed ejaculation?

There are several treatments for delayed ejaculation. Treatment is mainly determined by the suspected cause of the problem.

• If a prescribed medication is suspected to be the cause of the man’s delayed ejaculation, finding an alternative prescription with a doctor’s guidance can usually solve the problem. Certain essential prescriptions can neither be removed nor replaced, though, so never discontinue a prescribed medication without consulting the prescribing physician.
• Since delayed ejaculation and erection problems are very common among excessive drinkers, the solution to this is simple: limit drinking. The same is true of individuals whose use of illicit drugs is the suspected cause of their delayed ejaculation.
• Since many experts think that the majority of delayed ejaculation problems are due to psychological causes, counseling and sex therapy with a licensed professional specializing in this area is the primary treatment for restoring complete sexual function.

Generally, the object of all psychological therapy is to gradually diffuse the man’s sexual anxieties so that he can comfortably climax inside his partner without difficulty.

In males, retrograde ejaculation occurs when semen, which would normally be ejaculated via the urethra, is redirected to the urinary bladder