Inhibited or delayed ejaculation
Definition inhibited ejaculation
The definition of delayed ejaculation is persistent or recurrent delay or difficulty or absence of orgasm after sufficient sexual stimulation. A well known US sexologist Stan Althof has described three causes of delayed ejaculation, these being insufficient stimulation, psychic conflict and masturbation and desire disorders.
Physiology of inhibited ejaculation
Just as some men are born with premature ejaculation, some men are born with delayed ejaculation as simply part of their makeup. However this problem can appear as a normal part of ageing, in the presence of reduced testosterone level and as a result of diabetes and excessive alcohol intake. Excessive use of porn in some men can habituate their masturbatory style to the point where they struggle to ejaculate in a non-porn sexual situation. Also unusual masturbatory techniques can also result in conditioned habituation where the erect penis cannot achieve enough stimulation with penetration.
Inhibited ejaculation may also be a complication of the use of anti-depressant SSRI medication and can be a result of any form of radical pelvic surgery including removal of prostate cancer by radical prostatectomy.
Men who are unable to ejaculate vaginally are often referred to fertility specialists in order for conception to occur. This situation can be stressful for couples where fertility is sought.
Treatment inhibited ejaculation
Sex therapy always remains an important part of any treatment of delayed ejaculation. This includes coming to terms with how ageing changes sexual function and adjusting sexual technique to deal with these changes. Using vibrators to the end of the penis or vibrating penile sleeves or a device called a Viberect may enhance ejaculation
Bearing in mind that the average ejaculation time is 5.4 minutes, men who struggle to reach an orgasm and persist for a longer period than their partner is willing to be involved in, risk of losing their erection and thus creating an unsatisfactory sexual situation. It is thus encouraged that during sexual intercourse when the partner has reached a point of satisfaction, the man withdraws and seeks to reach a climax with other methods such as with a vibrator or manual stimulation.
There are some medications that may enhance ejaculation such as cabergoline (Dostinix), Buproprion™, oxytocin, Periactin™, Busipirone™, amantadine (Symmetrel™), Sudafed™, Edronax™ and Reboxitine™. These medications are not always effective and only available by a doctor’s prescription. Patients should be encouraged not to buy these medication over the internet, as despite these medications being cheaper and available without a prescription when purchased online, they are counterfeit, possibly containing unknown substances and potentially poisonous and also unlikely to be effective.
Other ejaculation problems can be anejaculation (total absence of orgasm and ejaculation), anorgasmia (no orgasm but ejaculation may occur) and retrograde ejaculation. Often after surgery for benign prostate disease retrograde ejaculation causes the ejaculate to go into the bladder due to changes at the bladder neck and is not expelled externally. This may also occur in chronic conditions affecting the autonomic nervous system such as diabetes and multiple sclerosis. Tamulosin (Flowmaxtra™) used in men with lower urinary tract symptoms commonly causes anejaculation. To investigate these ejaculation disorders an ultrasound of the seminal vesicles and prostate is carried out.
The intention of this handout is for educational purpose only and not to be used as a guide for self-management. Consult with your specialist or GP.
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