What is Delayed Ejaculation?
Delayed Ejaculation is a condition affecting males where they tend to have difficulty in ejaculation and reaching orgasm after sexual stimulation. This can be caused as a result of physical ailments or various psychological factors. An individual is said to have delayed ejaculation if it takes more than half an hour of sexual stimulation to reach orgasm. This condition affects around 4% of males in the United States according to some research done on this subject. Delayed Ejaculation can gradually become a matter of significant stress to the affected individual and can even lead to performance anxiety and low self-confidence. It also at times causes a crack in the relationship status of the individual .
It is common to have delayed ejaculation at some point or the other but problem starts when it starts to become a chronic problem. As of now there are no pharmacological therapies available to manage the psychological causes of Delayed Ejaculation. The process of ejaculation involves three states which are named emission, bladder neck closure, and expulsion .
During the emission stage of ejaculation once sexual stimulation starts the seminal fluid reaches posterior urethra. This process is completely controlled by sympathetic innervation. In the next stage, closure of the bladder neck takes place. This is also controlled by the sympathetic innervation. This is necessary to prevent any retrograde ejaculation. In the third stage, that is expulsion, the bulbocavernosus muscles in coordination with the pelvic floor muscles contract together and semen is ejaculated .
The pleasure that is obtained from this process is completely controlled by the cerebrum and has involvement of various neurotransmitters like the dopamine, serotonin, and norepinephrine. This usually occurs in combination with ejaculation but that is not always the case .
What Causes Delayed Ejaculation?
As stated, Delayed Ejaculation can be caused due to psychological issues or a medical condition. It can also be caused due to a combination of the two. For some it is a temporary condition which resolves once the psychological factors or the underlying medical condition is treated; however, in many cases Delayed Ejaculation persists for a very long time, sometimes throughout the life of the individual, where he has difficulty reaching orgasm .
In majority of the cases, however, Delayed Ejaculation occurs after a period of normal sexual function. Some of the medical causes of this condition include side effects of certain medications like antidepressants like SSRIs, anxiolytics, antihypertensives, and certain classes of pain medications. Damage to a nerve is also one of the primary causes of an individual to have Delayed Ejaculation, especially when the nerve gets damaged after a stroke, spinal cord injury, or a surgical procedure .
Medical conditions like uncontrolled diabetes and multiple sclerosis are also some of the causes of Delayed Ejaculation. Additionally, alcohol and drug abuse also play a key role in the individual having Delayed Ejaculation along with the age of the person. It is also believed to be caused by certain psychological factors if it happens only in specific situations like having normal ejaculation when masturbating but having problems during sexual intercourse with a partner .
Some of the psychological factors that play a part in an individual having Delayed Ejaculation include history of childhood abuse and molestation, neglect on the part of parents and relatives, problems with enjoying pleasure, and religious beliefs .
How to Diagnose Delayed Ejaculation?
An individual can be diagnosed with Delayed Ejaculation if he presents to a physician with problems reaching orgasm or having infrequent ejaculations during sexual stimulation for a minimum period of six months or more. The diagnosis is confirmed when other potential causes of ejaculation problems have been ruled out. To begin with, the physician will inquire about the duration and frequency of the symptoms .
A detailed test will be conducted like a blood test and even a urinalysis to rule out any infection, hormone problems, or other conditions that may be causing Delayed Ejaculation. Once all the causes have been ruled out then the individual is given a confirmed diagnosis .
How is Delayed Ejaculation Treated?
The treatment for Delayed Ejaculation is dependent on the underlying cause of the condition. If a psychotropic medication like an SSRI is believed to be the cause of this condition then a change of medication will suffice to solve the problem. Similarly, if alcohol abuse or taking undue amount of over the counter medications is believed to be the cause of Delayed Ejaculation then completely abstaining from them is the preferred treatment .
If a neurological condition is believed to be the cause of Delayed Ejaculation then treatment of the diagnosed disorder in most cases resolves the problem. Psychological problems causing Delayed Ejaculation requires consultation by a professional psychologist or a psychiatrist, sex therapists, or counselors to cope with the problem. It should be noted here that there is no one treatment that may resolve the problem of Delayed Ejaculation .
It is vital to identify and understand the source of the problem and address it adequately to treat the condition. There are also certain medications that are quite promising in treating the problem of Delayed Ejaculation even they have not been approved by the FDA as of yet .
These medications include Cyproheptadine, amantadine, and BuSpar. Some physicians have tried these medications with variable success. However these medications have certain side effect profile which needs to be weighed and discussed with the physician in detail before taking them to treat Delayed Ejaculation .
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