Miscellaneous Topics - Delayed (retarded) ejaculation

What is delayed (or retarded) ejaculation?

Delayed ejaculation, also called retarded ejaculation, is difficulty ejaculating even with a firm erection and sufficient sexual arousal and stimulation. Retarded 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 retarded 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 refered 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 an urologist) usually can determine the cause of a man’s delayed ejaculation.

Retarded ejaculation is often caused by:

• Medication side-effects - Antidepressants, antianxiety drugs and blood pressure medications can slow the ejaculatory response. Retarded ejaculation is estimated to occur in 16-37% of men taking SSRIs (a type of antidepressant). Some research suggests that treatments for erectile dysfunction have also been shown, in some cases, to cause delayed ejaculation
• 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
• Conditioning by use of unique sexual stimulation may cause men to experience delayed ejaculation. This man may not gain a sufficient amount of penile stimulation during intercourse to achieve ejaculation. For example, a man who is used to masturbating with a very fast motion may find it difficult to climax with the slower process of intercourse.

Many experts believe that the majority of delayed ejaculation problems don't have an underlying physical cause since85% of men with either primary or secondary retarded ejaculation are able to achieve orgasm through masturbation. Therefore it is likely that these man do not have a significant physical problem that is causing their delayed ejaculation, but rather a psychological issue that needs to be addressed.

Are there treatments for delayed ejaculation?

There are several treatments for retarded 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 retarded 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.

Sincemany 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.

If the man is not able to get to the point where he is able to ejaculate inside the vagina, but the couple wishes to have a child, these couples can achieve pregnancy through several measures.

These men can produce an ejaculate by the use of electrical stimulation of the prostate area, called electroejaculation,following which IVF can be done to conceive. If this is not successful and fertility is still a concern, it is also possible for a trained physician to extract sperm from the testicles and use artificial insemination in order to initiate pregnancy. If artificial insemination fails, in vitro fertilization (IVF) (egg-sperm fertilization in a test tube and then inserted into uterus of mother) or single sperm injection can be attempted.