Delayed Ejaculation

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Signs and Symptoms

Men who experience delayed ejaculation, or retarded ejaculation, are unable to ejaculate during sexual intercourse or manual stimulation, or require a prolonged period of stimulation (e.g., 30–45 minutes) to do so. Delayed ejaculation does not result in the inability to achieve or maintain an erection (erectile dysfunction or impotence).

Diagnosis

Diagnosis of delayed ejaculation often involves taking a medical history and performing a physical examination, neurological exam, and diagnostic tests to determine the underlying cause for the condition. In some cases, a device is used to manually stimulate the penis to detect erectile problems.

A medical history includes information about the following:

• Existing diseases and conditions (e.g., diabetes, stroke)
• History of symptoms (e.g., circumstances surrounding the onset of symptoms)
• Injury or trauma (e.g., spinal cord injury, trauma to the back or pelvis)
• Medications (e.g., antidepressants, SSRIs)

A complete physical examination can be performed to rule out physical causes for the condition and a neurological exam can be used to evaluate nerve function. Diagnostic tests may include blood tests (e.g., to detect abnormal hormone levels), glucose tests (e.g., to diagnose diabetes), and neurodiagnostic tests (e.g., EEG, EMG) to detect nerve damage.

Treatment

Treatment for delayed ejaculation varies depending on the cause. The condition often resolves once the underlying physical cause (e.g., injury, disease) is treated successfully. In some cases, learning to better manage stress may be helpful. Avoiding alcohol and illegal drugs, getting enough exercise and sleep, and eating a healthy diet also are important.

Delayed ejaculation caused by medication can be difficult to treat, especially when the prescribed medication is working properly to treat the underlying disease or condition. The decision to put up with this unwanted side effect or to try another medication that may not be as effective can be a difficult one.

Sex therapy and counseling often are used to treat delayed ejaculation caused by psychological factors. In this treatment, which usually involves both partners, a qualified mental health professional or sexual therapist takes a sexual history. A sexual history includes information about early sexual experiences and about past and current sexual relationships. Information about religious values and upbringing also may be important.

Couples may be instructed to avoid sexual relations for a period of time to help reduce anxiety. In some cases, sexual activities that emphasize communication, emotional intimacy, and pleasure, rather than performance, are encouraged. Counseling can help resolve conflicts and personal issues (e.g., resentment, anger) that can contribute to delayed ejaculation. Hypnosis also may be helpful.

Sex therapy and counseling is successful in about 75% of cases. Prompt treatment and the absence of serious psychological or physical problems increase the chances for success. Success rates also may be higher in men who previously had a satisfactory sexual relationship and in those who love their partner and desire sexual intimacy.

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