Delayed Ejaculation
Delayed ejaculation is a disorder in which a man takes a prolonged time to ejaculate during sexual stimulation or intercourse. This could be due to psychological or physical causes.
Diagnosis
For the diagnosis of delayed ejaculation, at least 1 of the 2 following symptoms needs to be present for at least 6 months.
These symptoms need to be experienced during at least 74% of all sexual activity:
Delayed ejaculation can cause psychological distress.
- Marked Delay in Ejaculation
- Marked Absence or Infrequency of Ejaculation
If either of the above 2 symptoms have been present for at least 6 months, delayed ejaculation can be diagnosed. Furthermore the following considerations also need to be fulfilled to make a positive diagnosis:
- The problems continues to cause significant distress to the individual.
- The problem causes significant impairment.
- The sexual disorder or dysfunction is not due to any non-psychiatric disorder or due to the effects of drugs or by relationship stress, violence in a partner or other stressors.
In order to determine and confirm whether a patient has a physical problem, mostly associated with the nervous system, the penis must be stimulated using a vibrator or any other similar device. The examination of the nervous system or a neurological examination is essential to confirm or reveal the presence of any nerve problems that may be related to delayed ejaculation.
Treatments
A Urologist should be consulted if the patient has never previously ejaculated to some type of sexual stimulation which may include intercourse, wet dreams or masturbation. This will aid in determining whether the delayed ejaculation is associated with a physical cause. If the ejaculation occurs within a normal duration of time with the help of some form of stimulation, but fails with a partner, consult a therapist who may be able to help the patient in discovering the cause or root of the problem. In case of sex therapy, usually both the partners are required. The therapy involves learning about sexual response and different ways to communicate with ones partner and the therapist guides them to work on areas that may be problematic.
Therapy
There is a series of different homework assignment that are given during a therapy. Within the complete privacy of one’s home, a person may engage in various sexual activities with their partner that allows an effective reduction in the performance pressure. These activities are basically aimed at focusing on pleasure in contrast to performance.
For a certain duration of time, the patient is not supposed to engage in sexual intercourse with their partner so that other methods of stimulation and arousal are explored. There are many cases whereby there is a lack of sexual desire felt. This may be because of relationship problems as. In these cases, it is advised to consult a therapist in order to improve and enhance emotional intimacy towards the partner, thus paving a way for a better relationship.
In some cases, hypnosis may prove to be an effective addition to the therapy session. This is used when one partner is not interested or willing to take part in the therapy. Attempting to self treat this particular problem is not successful in majority of the cases. In case the patient is on some form of medication, it is important to discuss whether the delayed ejaculation may be caused by that medication with a health care provider, who might prescribe an alternate option. It is important to note that no medication must be discontinued before consulting a doctor or physician.
Is it Sexual Pain Disorder?
If you are experiencing symptoms of pain during or after sexual intercourse, or related actions, you may have a pain disorder. These can normally be treated, and the prognosis is good.
Prognosis
There are approximately 12 to 18 sessions required for the treatment to get completed, and the success rate of this treatment is nearly 80%. Some of the factors that may contribute to a better outcome include:
- Having a history of previous sexual experiences that have proved to be satisfying.
- A feeling of intimacy and affection towards the sexual partner is felt.
- This problem has not occurred for a significant period of time.
- The patient does not have any psychological disorders or diseases which may affect his sexual needs.
- The patient has a natural sexual desire.
- The patient has an urge or need to get treated for the problem.
Prevention
Sexual dysfunctions are present in all cultures and ethnicities around the world. In order to prevent delayed ejaculation, it is important to maintain a healthy attitude towards sexuality. It is important to understand that acquiring a sexual response cannot be forced, just like sleep or perspiration cannot be forced. Sexual responses become harder with every time they are tried to be acquired forcibly. In order to feel a significant reduction in the pressure, patients are encouraged to concentrate on the pleasure of that particular moment. Ejaculation should not be the most primary concern. Pressure from a spouse or partner should also not be felt and the sexual partner should be told not to pressurize the patient constantly about the problem. Healthy discussions regarding the patient’s anxieties tend to help a lot as well.
References:
http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=173
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002678/
Clinical Manual of Sexual Disorders: Richard Balon MD, R. Taylor Segraves MD, PhD
