Overview of Delayed Ejaculation
Delayed ejaculation is a term used to describe a medical condition in which a man is unable to ejaculate (i.e., eject semen from the penis) during sexual activity, or requires a long period of stimulation to ejaculate. Delayed ejaculation also is called retarded ejaculation.
Ejaculation is an involuntary response (reflex) to sexual stimulation. In most cases, the penis, which is the male sexual organ, becomes hard and stiff prior to ejaculation. This process, called erection, involves the nervous system (brain, spinal cord, and nerves) and the vascular system (blood vessels; i.e., veins, arteries).
Erection is initiated by chemicals in the brain (neurotransmitters), in response to physical or psychological stimulation (arousal). During arousal, nerves send messages to the vascular system, increasing blood flow to the penis (i.e., corpus spongiosum, corpora cavernosa). The organ becomes engorged and expands and fibrous elastic sheathes (called tunicae) in the erectile tissue close to prevent blood from leaving the penis until stimulation ends or ejaculation occurs.
Ejaculation occurs in two stages. First, semen (sperm) and other secretions pass from the prostate gland and seminal vesicles into the urethra. Next, the seminal fluid is expelled from the urethra. Ejaculation occurs as a result of muscle contractions. Sensations associated with ejaculation make up the male orgasm.
In most cases, men ejaculate after about 4 minutes during intercourse. Men who experience delayed ejaculation may require prolonged intercourse (e.g., up to 45 minutes), or may be unable to ejaculate during sexual intercourse or through manual stimulation.
Incidence and Prevalence of Delayed Ejaculation
Sexual responses change with age in both men and women. It is normal for men to require more stimulation to achieve erection and ejaculation as they age; however, delayed ejaculation is not part of the normal aging process. This medical condition is relatively rare and affects approximately 1–4% of men.
Causes and Risk Factors for Delayed Ejaculation
A number of physical and psychological factors can increase the risk for delayed ejaculation. Factors that affect how a man views sexual activity, such as religious background or a strict upbringing, often contribute to the condition. In many cases, stress is a contributing factor.
Other psychological causes include the following:
- Anger toward a partner
- Atypical masturbation habits (e.g., using a very fast motion to stimulate the penis)
- Fear of pregnancy
- Lack of attraction
- Traumatic event involving sex (e.g., being caught in an illicit situation)
Physical causes for delayed ejaculation can include neurological conditions (e.g., stroke, spinal cord injury), trauma or disease that results in nerve damage (e.g., diabetes), and alcohol and drug use. Medications, including antidepressants and selective serotonin reuptake inhibitors (SSRIs) also can cause delayed ejaculation. These drugs include thioridazine (Mellaril), sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac).
Men who have never ejaculated through any means (e.g., sexual intercourse, masturbation, nocturnal emissions [wet dreams]) may have a congenital (i.e., present at birth) abnormality in the reproductive system.