Understanding Delayed Ejaculation

Friends, most of the patients who come to us suffer from premature ejaculation, where ejaculation occurs in less than a minute. This condition is found in many individuals. In fact, more than 90% of our patients struggle with premature ejaculation.

However, there is another issue that some men face—delayed ejaculation. This happens when ejaculation takes an unusually long time or does not occur at all. Today, we will discuss delayed ejaculation in detail.

What is Delayed Ejaculation?

As mentioned, delayed ejaculation is when a person takes a long time to ejaculate, sometimes to the extent that both the individual and their partner feel exhausted. In some cases, the partner may experience discomfort, such as a burning sensation or vaginal dryness, making intercourse painful. This can turn a pleasurable experience into a distressing one.

Delayed ejaculation is a serious issue. If ejaculation takes more than 20 to 30 minutes during intercourse, it falls under the category of delayed ejaculation. However, if the delay happens only occasionally, it is not considered a problem. If delayed ejaculation occurs 75–100% of the time and causes distress to both partners, then it is classified as a medical concern.

Types of Delayed Ejaculation

There are different types of delayed ejaculation:

1. Lifelong Delayed Ejaculation – Present since the beginning of sexual activity, affecting around 1% of men.
2. Acquired Delayed Ejaculation – When ejaculation was initially normal but later became delayed, occurring in about 4% of cases.

How Does Ejaculation Work?

Ejaculation involves two glands:

• Seminal Vesicles
• Prostate Gland

The seminal vesicles connect to the ejaculatory duct, which passes through the urethra. When the seminal fluid reaches the ejaculatory duct, the process becomes reflexive and cannot be controlled. The fluid then exits through the urethra with the contraction of pelvic muscles.

Causes of Delayed Ejaculation

There are two main categories of causes: psychological and physical factors.

Psychological Causes

• Guilt or Negative Beliefs About Sex – Some individuals grow up believing sex is wrong, which can create mental blocks.
• Relationship Issues – Lack of excitement or unresolved conflicts with a partner can contribute.
• Anxiety and Stress – Excessive worrying can result in either early or delayed ejaculation.
• Lack of Proper Stimulation – If there is inadequate physical or mental stimulation, ejaculation may be delayed.
• Religious or Cultural Beliefs – Some people internalize the idea that ejaculation should be controlled or avoided.

Physical Causes

• Alcohol and Substance Use – Alcohol numbs the nerves, reducing arousal and leading to delayed ejaculation.
• Medications – Certain antidepressants like SSRIs and SNRIs can interfere with ejaculation.
• Enlarged Prostate or Prostate Surgery – These conditions can affect ejaculation.
• Diabetes and Neuropathy – Diabetes can damage nerves, reducing sensitivity and causing delayed ejaculation.
• Aging – As nerves age, stimulation weakens, leading to delayed ejaculation. In such cases, vibrators and other stimulants can be helpful.
• Neurological Conditions – Conditions like multiple sclerosis or spinal cord injuries can impact ejaculation.

Diagnosis of Delayed Ejaculation

To diagnose delayed ejaculation, we take a detailed patient history, examining:

• Relationship health and emotional state
• Anxiety, stress, or depression levels
• Medications the patient is taking
• Presence of any prostate issues or past surgeries
• Medical conditions such as diabetes

Another related issue is retrograde ejaculation, where semen enters the bladder instead of exiting through the urethra. This often occurs due to diabetes or bladder surgery. In such cases, patients experience an orgasm but no visible ejaculation. To diagnose this, we analyze urine after orgasm to check for sperm.

Treatment of Delayed Ejaculation

The treatment depends on the underlying cause.

Psychological Treatments

• Sex Therapy – Focusing on mindfulness during intercourse helps enhance arousal.
• Cognitive Behavioral Therapy (CBT) – Used for relationship issues or emotional distress.
• Psychotherapy – Helps address stress, anxiety, or any other mental barriers affecting ejaculation.

Physical Treatments

• Vibrators and Stimulation Techniques – Enhancing stimulation can reduce the time taken to ejaculate
• Medical Devices – For severe cases, electric ejaculation devices can be used to collect semen for fertility treatments.
• Medications – Various medicines help increase dopamine levels, improving arousal and ejaculation.

Conclusion

Delayed ejaculation is a complex issue with various causes, ranging from psychological to physical factors. Proper diagnosis and treatment can help individuals overcome this condition and improve their sexual health.

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