Delayed or impaired Ejaculation; Definition,causes, symptoms,Treatment and management

DELAYED/ IMPAIRED EJACULATION

Delayed ejaculation or impaired ejaculation — is one of the male sexual dysfunction in which there is difficulty or inability for a man to reach an orgasm and to ejaculate semen. It takes an extended period of 30 minutes or more of penetrative sex for men to reach sexual climax and release semen from the penis.

Delayed ejaculation affects about 1-4 % of men according to American Urologist Association. It can result in distress for both the man and his partner. Most men will experience delayed ejaculation at some point in their lives, but for some, it is a lifelong problem. Most causes are psychological, but organic reasons are also possible and are ruled out first during diagnosis.

TYPES

Delayed ejaculation is divided into the following types based on symptoms:

  • With lifelong delayed ejaculation, the problem is present from the time of sexual maturity.
  • Acquired delayed ejaculation occurs after a period of normal sexual functioning.
  • Generalized delayed ejaculation isn’t limited to certain sex partners or certain kinds of stimulation.
  • Situational delayed ejaculation occurs only under certain circumstances.

These categories help in diagnosing an underlying cause and determining what might be the most effective treatment.

CAUSES

Like premature ejaculation, delayed ejaculation can be caused by psychological and physical factors.

 Psychological causes

  • early sexual trauma
  • strict upbringing,
  • relationship problems such as poor communication
  • Stress
  • Anxiety
  • Cultural and religious taboos which gives sex a negative connotations
  • Fear of pregnancy

Physical causes

  • diabetes
  • Heart Disease
  • spinal cord injuries
  • Certain birth defects affecting the male reproductive system
  • Injury to the pelvic nerves that control orgasm
  • Certain infections, such as a urinary tract infection
  • Prostate surgery, such as transurethral resection of the prostate or prostate removal, surgery to the bladder etc.
  • Neurological diseases, such as diabetic neuropathy, multiple sclerosis, stroke or nerve damage to the spinal cord
  • Hormone-related conditions, such as low thyroid hormone level (hypothyroidism) or low testosterone level (hypogonadism)
  • Old Age-This is because the nerve endings of the penis are now less sensitive and also aged men are more prone to Impaired erection / erectile dysfunction.

Medications

  • Antidepressants particularly selective serotonin reuptake inhibitors (SSRIs) e.g fluoxetine (Prozac)
  • Antihypertensive Drugs such as beta blockers eg. Propanalol (inderal).
  • Antipsychotic drugs such as thioridazine (Mellaril)
  • Muscle relaxants such as balcofen, which is widely used to treat motor neurone disease and multiple sclerosis
  • Powerful painkillers, such as methadone (which is also widely used to treat people addicted to heroin)
  • Diuretics drugs
  • Anti seizures

Lifestyle

  • Substance Misuse
  • Alcoholism
  • Masturbation- which involves intense pressure, speed which cannot have the same when having sex with a partner. Michael Perelman, clinical professor of psychiatry, reproductive medicine and urology at the Weill Medical College of Cornell University, New York, observed that most men he had seen with delayed ejaculation reported no problems reaching an orgasm and ejaculating via masturbation.

 

SYMPTOMS

  • Need 30 minutes or more of sexual stimulation to have an orgasm and ejaculate.
  • Inability to ejaculate at all (anejaculation ).
  • distress or frustration
  • Loss of Sexual activity due to fatigue, physical irritation, loss of erection or a request from your partner.
  • Difficulty in reaching orgasm during sexual intercourse or other sexual activities with a partner.
  • Some men can ejaculate only when masturbating.
  • Low sexual libido.
  • Male Infertility.
  • Relationship and marital problem

  Prognosis

Successful treatment depends on the cause of the delayed ejaculation and the type of treatment

Diagnosis

Delayed Ejaculation can be diagnosed through History taking, Physical Examination, and other necessary investigations like blood and urine test to rule out other potential medical problems, such as infections, hormonal imbalance, and so on.

Treatment

Treatment of delayed ejaculation treatment depends on the underlying cause, which might include using one of the following approaches:

  1. Medications

This involves the Doctor checking through the medications the patient have been on  which contribute to delayed ejaculation so as to substitute  or discontinue it if possible. There aren’t any drugs that have been specifically approved for the treatment of delayed ejaculation. Medications used to treat delayed ejaculation are primarily used to treat other conditions.

Medications sometimes used to treat delayed ejaculation include:

  • Cyproheptadine ( Novogold, Periactin), which is an anti-histamine medication
  • amantadine (Symmetrel), which is a drug used to treat  Parkinson’s disease
  • buspirone (Buspar), which is an anti-anxiety medication
  • Pseudoephedrine: This medicine shows a high efficacy  in treating delayed ejaculation but it hasn’t been licensed for this particular use It is only use as decongestant.
  • amantadine – originally designed to treat viral infections
  • buproprion – usually prescribed to help people quit smoking
  • yohimbine – originally designed to treat erectile dysfunction

These help block some of the chemical effects of SSRIs that may contribute towards delayed ejaculation

 

  1. Psychological counseling (psychotherapy)

Psychotherapy can help by addressing underlying mental health problems leading to delayed ejaculation, such as depression or anxiety. The mental and emotional stress contributed by Delayed ejaculation is allayed. They are assured and encouraged not to be weigh down with this few episodes as it can be due to temporary factors which can improves when the underlying causes gets better. He is advised to communicate openly and honestly with his partner about your condition as treatment is often more successful if couples work together as a team.

  1. Specialist referral

Here the Doctor refer the patient to a specialist depending on the underlying conditions such as :

  • Urologist: If the underlying causes is from the genitals.
  • Endocrinologist: If it is a hormonal factor.
  • Psychiatrist: If it is a psychological factor.
  • Neurologist: If the cause is from the nerves.

 

  1. Sex therapy

Is a form of counseling that uses a combination of psychotherapy and structured changes in an individual sex life. This can help to increase your feeling of enjoyment during sex, and help make ejaculation easier.

Sex therapy may also be useful in addressing the underlying cause of sexual dysfunction. Here the individual is always advised to involve his partner where they interact with the therapist depending on their particular concerns.

The Sex therapist may recommend the following activities which include:

  • viewing erotic videos and magazines before having sex to increase the feeling of stimulation
  • erotic fantasies and “sex games” to make your lovemaking more exciting
  • using lubricating creams, or jellies, to make the physical act of sex more comfortable and relaxing
  • using sexual aids, such as vibrators, to increase pleasure

 

  1. Lifestyle Modification

Here, Lifestyles that lead to delayed ejaculation such as Alcohol and substance abused as curtailed . For a person who indulged in chronic Masturbation, Perelman urges that hewill at least to alter his masturbation style (i.e) to switch hands in order to break old habits. Perelman encourages men to fantasize about a sexual experience with their partners while they masturbate. He tells them to try “to approximate, in terms of speed, pressure and technique, the stimulation he likely will experience through manual, oral, or vaginal stimulation with his partner.

 

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