Delayed Ejaculation
Everything about the causes, symptoms, and available treatments for men’s difficulty or inability to reach climax.
Symptoms and Causes
Delayed ejaculation is a type of sexual dysfunction in which there is difficulty, or even an inability, to expel semen after a normal phase of sexual arousal. Occasionally, the man reaches orgasm but does not ejaculate.
Depending on how it presents, there are three types of delayed ejaculation:
- Primary delayed ejaculation: occurs in all sexual experiences, including masturbation.
- Secondary delayed ejaculation: develops after a period of normal sexual activity.
- Situational delayed ejaculation: occurs only in specific contexts, but not in all. It may be influenced by posture, location, or whether it involves a partner or masturbation.
Delayed ejaculation is relatively uncommon, affecting approximately 4% of men. The prognosis is generally favorable, as appropriate treatment usually results in significant improvement.
Symptoms
Characteristic symptoms of delayed ejaculation include:
- Delay in semen expulsion following sexual arousal. The duration varies among patients. Generally, a problem is considered if ejaculation takes longer than 25–45 minutes.
- Difficulty ejaculating in more than 75% of sexual encounters; otherwise, it is not considered pathological.
Other signs that may indicate delayed ejaculation include:
- Dry orgasm: no semen or very little semen is expelled during orgasm.
- Low semen volume.
- Cloudy urine: in dry orgasm, semen may be redirected into the bladder and expelled during urination.
- Pain during ejaculation.
Causes
The causes of delayed ejaculation can be diverse:
- Psychological factors:
- Depression
- Anxiety
- Stress
- Body image rejection
- Performance anxiety (excessive pressure to delay ejaculation and meet the social expectations of the "ideal lover")
- Medications:
- Antidepressants
- Antipsychotics
- Diuretics
- Anticonvulsants
- Urinary tract infections
- Pelvic nerve injury
- Abnormalities in the seminal ducts
- Neurological disorders (stroke, diabetic neuropathy, spinal cord injury)
- Hormonal disorders (low testosterone levels, hypothyroidism, hypogonadism)
Risk Factors
Some factors that increase the risk of delayed ejaculation include:
- Age: more frequent in older individuals, as ejaculation tends to slow naturally with age.
- Transurethral prostate surgery
- Certain underlying medical conditions
- Specific medications, as noted above
- Relationship problems
- Unrealistic sexual expectations
- Alcoholism
Complications
The most common complications of delayed ejaculation are:
- Infertility
- Reduced sexual pleasure
- Avoidance of sexual activity
Prevention
Delayed ejaculation cannot always be prevented, but the following measures may be helpful in some cases:
- Avoid stress and anxiety whenever possible
- Maintain open communication with the partner
- Avoid alcohol or harmful substances
- Avoid excessive masturbation
- Maintain realistic sexual expectations
Which Specialist Treats Delayed Ejaculation?
Delayed ejaculation is managed by specialists in urology and clinical psychology.
Diagnosis
The diagnosis of delayed ejaculation combines symptom evaluation with specific tests to rule out other conditions or identify physical causes:
- Medical history: a detailed assessment of the patient’s personal and family medical history, lifestyle, general health, and perceived symptoms.
- Physical examination: inspection and palpation of the genitalia, penis, and rectum to assess their condition and rule out anomalies.
- Blood tests: to evaluate hormone levels or signs of potential infection.
- Urinalysis: to detect semen or infection.
- Neurological examination: assessment of nerve function to determine if perineal reflexes are impaired. Electromyography provides information on the electrical activity of muscles controlling the urethra and rectum.
- Transrectal ultrasound: evaluates the condition of the prostate and ejaculatory ducts.
- Psychological evaluation: helps determine whether the cause of delayed ejaculation is mental.
Treatment
Most patients require a combination of treatments to achieve the desired outcomes. The most common approaches include:
- Pharmacological treatment: although there is no specific medication for delayed ejaculation, certain drugs used for other conditions can be beneficial:
- Dopaminergic agents: increase dopamine levels
- Selective serotonin reuptake inhibitors (SSRIs): block serotonin reabsorption
- Sympathomimetic agents: stimulate the nervous system
- Psychological therapy: focuses on addressing underlying causes (depression, anxiety), as well as relationship issues and management of expectations.
