Delayed ejaculation is a violation of sexual function in men, characterized by difficulties in the onset of ejaculation. With delayed ejaculation, a man experiences sufficient sexual arousal and has a full erection, but stimulation of the penis does not lead to the desired ejaculation of seminal fluid for a long time from the beginning of sexual intercourse. Delayed ejaculation is accompanied by difficulties in achieving orgasm, physical and psychological dissatisfaction of partners. To find out the reasons for the delay in ejaculation, a man may need to consult an andrologist, sexologist, psychotherapist, neurologist, endocrinologist; ultrasound of the penis and scrotum organs, tests for sexual infections and hormones. The algorithm of treatment of delayed ejaculation depends on the causes of the disorder and may include drug therapy, psychotherapy, physiotherapy.
Delayed ejaculation is an unconscious inhibition of the ejaculation reflex, accompanied by a late ejaculation of seminal fluid or a complete absence of ejaculation in a man, despite the desire and desire of sexual partners to accelerate this moment. Among other forms of ejaculation disorders (premature ejaculation, retrograde ejaculation, painful ejaculation), delayed ejaculation and anejaculation are much less common. According to statistics, 1-2 men out of 1000 suffer from delayed ejaculation. Delayed ejaculation, as a sexual dysfunction, should be distinguished from the conscious, controlled inhibition of ejaculation practiced by some men. Due to the multifactorial nature of the problem of ejaculation disorders, its solution may be in the plane of sexology, psychotherapy, andrology and urology, neurology, endocrinology.
Psychological and organic reasons can lead to delayed ejaculation. In many cases, there is a combination of several factors that requires a man to be examined by various specialists.
The organic basis for delayed ejaculation can be congenital malformations and injuries of the scrotum and penis, sexual infections, prostatitis, urethritis, prostate adenoma, urethral strictures, prostate surgery (adenomectomy, transurethral resection of the prostate). In addition to diseases of the male genital organs, delayed ejaculation may be associated with neurological problems (stroke, diabetic neuropathy, Parkinson's disease, spinal cord diseases) and hormonal disorders (hypothyroidism, hypogonadism, etc.). Nerve damage, as a factor of ejaculation disorders, occurs after surgical interventions on the abdominal cavity and pelvic organs: proctosigmoidectomy, total cystectomy, resection of abdominal aortic aneurysm, retroperitoneal and paraaortic lymphadenectomy, etc.
A factor inhibiting ejaculation may be a disproportion in the structure of the genitals of sexual partners (a small penis in a man, a too wide vagina in a woman), accompanied by a decrease in mechanical stimulation of the penis during frictions.
Psychological factors that cause delayed ejaculation may include depression, emotional stress, problems of interpersonal relations between sexual partners, various kinds of sexual trauma, complexes and restrictions, insufficient sexual attractiveness of the partner. In some cases, delayed ejaculation during normal sexual intercourse is noted in persons suffering from deviant sexual inclinations (homosexual, sadistic, masochistic, etc.). Delayed ejaculation can affect men who have an "autosexual" orientation, i.e. experiencing greater satisfaction from masturbation than from traditional sexual intercourse.
It should be borne in mind that delayed ejaculation may be a side effect of certain types of medications taken by a man (antidepressants, antipsychotics, hypotensive, diuretics), as well as alcohol and narcotic drugs. In addition to these pathophysiological and psychogenic factors, the time of ejaculation is influenced by many other reasons – the age of a man, his sexual experience, the frequency and regularity of sexual contacts, relationships with a partner, etc. In some cases, the delay in ejaculation is a consequence of sexual fatigue associated with excessive sexual activity of a man and is temporary, transient.
Depending on the degree of violation, there is a delay in ejaculation and aneaculation – its extreme form, in which ejaculation does not occur for such a long period that sexual partners are forced to stop sexual intercourse and further sexual stimulation. In addition to the absolute inability to achieve ejaculation, there is also a relative aneaculation, characterized by the absence of ejaculation during sexual intercourse, but its achievement during petting, masturbation, etc.
The delay in ejaculation can be primary (accompanying a man from the beginning of sexual life) and secondary, acquired (occurring after a certain period of normal sexual life). Depending on the circumstances and frequency of repetition, a constant (independent of the situation and recurring regularly) is distinguished and situational delay of ejaculation (occurring from time to time under certain conditions).
The main objective sign of delayed ejaculation is the prolongation of sexual intercourse contrary to the desire of partners and the desire to bring the moment of ejaculation and orgasm in a man. At the same time, 75% of men suffering from the impossibility of intravaginal ejaculation can accelerate or achieve ejaculation with masturbation, and 50% - with the help of other types of stimulation with the participation of a partner, but outside of sexual intercourse. Normative criteria for the duration of sexual intercourse are very conditional and variable. Nevertheless, the delay in ejaculation is considered to be the absence of ejaculation for more than 20-30 minutes after the start of sexual intercourse, if this causes physical and psychological discomfort in sexual partners.
At the beginning of sexual relations, a delay in ejaculation may be perceived by the partner as a desirable moment, since an increase in the duration of sexual intercourse allows her to experience several orgasms. Meanwhile, further awareness of the fact that a man cannot complete sexual intercourse replaces a positive reaction with a negative one, as the partner begins to feel sexually unattractive and unwanted in the eyes of the partner. In the event that a couple seeks to conceive a child, delayed ejaculation and anejaculation can become a reason for serious conflicts and even a breakup of relations.
A man suffering from delayed ejaculation is often inclined to see the cause of his problems in a particular woman, and not in himself, which increases mutual reproaches and claims. As a result, both partners have a hostile attitude, both to sexual intercourse and to each other.
The main task of diagnostics is to identify the causes of delayed ejaculation. To do this, in case of violation of ejaculation, a man needs to contact a urologist, andrologist or andrologist-sexologist. After finding out the anamnesis and examination of the external genitalia, the specialist will decide on the appointment of tests, diagnostic studies and additional consultations.
To identify the organic causes of delayed ejaculation, it is necessary to conduct a rectal examination, ultrasound of the penis and organs of the scrotum, prostate gland. In order to exclude STDs, prostate secretions, urethral smear are examined by PCR and bakposev. As part of the assessment of hormonal status, a study of the androgenic profile (total and free testosterone, GSPS) is shown. In the presence of data indicating concomitant pathology, a man suffering from delayed ejaculation should be consulted by narrow specialists - a neurologist, endocrinologist, cardiologist, etc. In the absence of organic and psychological reasons, a psychosexual examination of the patient is necessary.
The approach to the treatment of delayed ejaculation is always individual and depends on the identified disorders. It may include drug therapy of the underlying disease, psychotherapy, physical therapy, treatment of alcohol or drug addiction. In case of delayed ejaculation caused by taking medications, the dosage of drugs is adjusted or replaced.
If the delay in ejaculation is caused by psychogenic reasons, most likely, the patient will need the help of a psychotherapist or a sex therapist. To eliminate interpersonal problems, it is necessary to involve a partner in the treatment process. For pharmacotherapy of delayed ejaculation, dopaminergic (amantadine), antiserotonergic (ciproheptadine) drugs, calcium channel blockers (yohimbine), etc. are used. In addition to the main therapy for delayed ejaculation, acupuncture, laser acupuncture, electroacupuncture, peloidotherapy, therapeutic baths (coniferous, iodine-bromine), ascending shower are successfully used. Physiotherapy methods are used to correct neuroendocrine regulation of ejaculation: transcranial electrostimulation, electroson, galvanization of the collar and panty zones, endonasal electrophoresis, rectal electrostimulation, SMT, ultrasound therapy.
The success of the treatment of delayed ejaculation largely depends on the willingness of both partners to cooperate with specialists and find harmony in sexual relations.