Sexual Problems Delayed ejaculation
Ejaculatory incompetence; Sex - delayed ejaculation; Retarded ejaculation
Delayed
ejaculation is a medical condition in which a male cannot ejaculate,
either during intercourse or by manual stimulation with a partner.
Ejaculation is when semen is released from the penis.
Causes
Most
men ejaculate within a few minutes of starting to thrust during
intercourse. Men with delayed ejaculation may be unable to ejaculate
(for example, during intercourse), or may only be able to ejaculate with
great effort after having intercourse for a long time (for example, 30
to 45 minutes).
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 unusual 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 (such as prozac, mellaril, and guanethidine)
- Nervous system diseases, such as a stroke or nerve damage to the spinal cord or back
Exams and Tests
Stimulating
the penis with a vibrator or other device may determine whether you
have a physical (often nervous system) problem. A nervous system
(neurological) examination may reveal other nerve problems that are
associated with delayed ejaculation.
Treatment
If
you have never ejaculated through any form of stimulation (such as wet
dreams, masturbation, or intercourse), see a urologist to determine if
the problem has a physical cause.
If you are able to ejaculate in a
reasonable period of time by some form of stimulation, see a therapist
who specializes in ejaculation problems. Sex therapy usually includes
both partners. The therapist will usually teach you about the sexual
response, and how to communicate and guide your partner to provide the
right stimulation.
Therapy often involves a series of "homework"
assignments. In the privacy of your home, you and your partner engage in
sexual activities that reduce performance pressure and focus on
pleasure.
Typically, you will not have sexual intercourse for a
certain period of time, while you gradually learn to enjoy ejaculation
through other types of stimulation.
In cases where there is a
problem with the relationship or a lack of sexual desire, you may need
therapy to improve your relationship and emotional intimacy.
Sometimes
hypnosis may be a helpful addition to therapy, especially if one
partner is not willing to participate in therapy. Trying to self-treat
this problem is often not successful.
If a medication is believed
to be the cause of the problem, discuss other medication options with
your health care provider. Never stop taking any medicine without first
talking to your health care provider.
Outlook (Prognosis)
Treatment commonly requires about 12 - 18 sessions. The average success rate is 70 - 80%.
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 toward your sexual partner
- You are motivated to get treated
- You do not have serious psychological problems
If
medications are causing the problem, your health care provider may
recommond switching or stopping the medicine (if possible). A full
recovery is possible if this can be done.
Possible Complications
If the problem is not addressed and treated, the following may occur:
- Avoidance of sexual contact
- Inhibited sexual desire
- Marital stress
- Sexual dissatisfaction
If
you and your partner are trying to get pregnant, sperm may have to be
collected using other methods because of the lack of ejaculation.
Prevention
Having
a healthy attitude about your sexuality and genitals helps prevent
delayed ejaculation. Realize that you cannot force yourself to have a
sexual response, just as you cannot force yourself to go to sleep or to
perspire. The harder you try to have a certain sexual response, the
harder it becomes to respond.
To reduce the pressure, absorb
yourself in the pleasure of the moment. Do not worry about whether or
when you will ejaculate. Your partner should create a relaxed
atmosphere, and should not pressure you about whether or not you have
ejaculated. Openly discuss any fears or anxieties, such as fear of
pregnancy or disease, with your partner.
References
Burnett AL. Evaluation and management of erectile dysfunction. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 24.
Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. 2010;81:305-312.
Bhasin S, Basson R. Sexual dysfunction in men and women. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 20.
source:http://www.nlm.nih.gov/medlineplus/ency/article/001954.htm
