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Delayed Ejaculation

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Delayed ejaculation (DE) or retarded ejaculation (RE) is a medical condition that occurs when the man takes more than 30-45 minutes before he “comes”. Normally a man comes 2-4 minutes after insertion with constant thrusting. When a man suffers from DE, he has difficulty “coming” inside the vagina, but not with masturbation.{{more}} DE is the third most common sexual disorder after impotence (erectile dysfunction) and premature ejaculation. There are many reasons why men experience DE. Some are psychological (in the mind) and others are physical. Some psychological reasons include fear of pregnancy, stress, strict religious upbringing, latent homosexuality, tiredness or relationship problems. Other psychological problems involve the abuse of drugs such as alcohol or cocaine. The physical causes include neurological diseases like multiple sclerosis, diabetes mellitus and spinal cord injuries. Other diseases, like depression, anxiety states, schizophrenia and the medications used to treat these diseases, can also lead to delayed ejaculation.

There are three reasons why we treat delayed ejaculation. First, the partner may complain that the man stays too long, which may sometimes lead to bruising or exhaustion of one or both partners. Some women say this is a “plus”, since they “enjoy” it more; however, most women find it exhausting. Second, this exhaustion can lead both partners to avoid intimacy, with a subsequent breakdown of the relationship. Finally, for younger couples, the issue of infertility becomes important, as delayed ejaculation and the subsequent avoidance of intimacy leads to the inability to conceive.

The treatment of delayed ejaculation is not straightforward if psychological reasons are to blame. Psychosexual counseling helps only about 55-60% of couples. For example, for men with strict religious upbringing issues, the man needs counseling and psychotherapy to help him debunk some of the myths about sexuality, and sometimes, issues like the “dirty vagina syndrome” have to be addressed. Alcoholics, or those who imbibe alcohol just before sexual intercourse, can also be treated; however, the vast majority of men who suffer from DE need some psychosexual therapy, like that proposed by Masters and Johnson, where the couple go through “progressive treatment”. This involves initially allowing the couple to kiss and cuddle each other without intercourse, followed by masturbation, with the penis just outside the vagina. The woman lowering herself on to the penis just before he “comes” then follows this. This period of treatment takes place over weeks, not in one session. The Kaplan method involves counseling the male to overcome the anxieties related to sexual intercourse and vaginal insertion, by helping him to “let go”. Teaching him to masturbate outside the vagina, then allowing him to “advance” vaginal penetration and ejaculation does this.

Men who suffer from DE due to medications used to treat psychiatric disorders are sometimes helped by changing these medications; and those who suffer from spinal cord injuries can be made to “come” using electroejaculation. Electroejaculation is the process where the prostate and seminal vesicles are stimulated electrically, so the spinal cord injured man can “come” artificially. This is done to facilitate fertility, as the procedure is usually not pleasurable, and if the man has sensation in the area, can sometimes be painful! Having obtained the sperm, his female partner can then be fertilized either by intrauterine insemination, vaginally, or by artificial fertilization and insemination. Couples with fertility problems with whom counseling is unsuccessful can be helped by the same method, except that the sperm is retrieved by masturbation, not electroejaculation.

So far I have discussed the problems of delayed and retrograde ejaculation; next week I will discuss the issues of no ejaculation or anejaculation.

For comments or questions contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: [email protected]

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