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Delayed ejaculationDelayed ejaculation refers to an inhibition of ejaculation. The male is unable to ejaculate, either during sexual intercourse, or with manual stimulationin the presence of a partner, in spite of his wish to do so.
CausesMost men ejaculate within two to four minutes after onset of active thrusting in intercourse. Men with retarded ejaculation may be entirely unable to ejaculate in some circumstances (for example, during intercourse), or may only be able to ejaculate with great effort and after prolonged intercourse (for example 30 to 45 minutes). The most common causes are psychological. Common postulated causes include:
Some factors such as anger toward the partner may be involved; however, organic causes are sometimes present. A variety of drugs (such as Prozac, Mellaril, guanethidine, tricyclic antidepressants, nortriptyline and alcohol) may sometimes impair ejaculation. Neurological diseasemay also cause delayed or inability to ejaculate such as strokesand nerve damageto the spinal cordor back. Congenital conditions of the penis such as phimosisand frenulum brevein which the foreskin cannot retract behind the head of the glans, may prevent the sufficient stimulation required to ejaculate. SignsIf the man is unable to ejaculate in a reasonable length of time with some form of stimulation (as with masturbation), it is a good indicator that organic factors are likely to play a role in the problem. Stimulation of the peniswith a vibratoror other increased stimulatory device may determine if an underlying physical, often neurological, problem exists. A neurological examination may uncover other neurological defects associated with delayed ejaculation. TreatmentIf the man has never ejaculated through any form of stimulation (such as wet dreams, masturbation, or intercourse) in his life, a urologistshould be consulted to determine if there is a congenitalor physical abnormality. If, however, he is able to ejaculate in a reasonable period of time by some form of stimulation, he should seek sex therapyfrom a therapistspecializing in this area. Treatment usually includes both partners. The therapist will usually educate the couple about the fundamentals of human sexual responseand how to communicate and guide the partner to provide ideal stimulation, rather than trying to will a sexual response to occur. Therapy then commonly involves a series of homework assignments wherein the couple, in the privacy of their home, engage in sexual activities that minimize performance pressure and maximize focusing on pleasure. Typically, sexual intercourse will be prohibited for a limited period of time, while the couple gradually enhances their ability to enjoy ejaculation through other types of stimulation. In cases where there is a problematic relationship or an inhibition of sexual desire between the couple, therapy to enhance the relationship and emotional intimacy may be required as a preliminary step. Sometimes hypnosismay be a useful adjunct to therapy, particularly if a partner is not willing to participate in therapy. Self-treatmentof this problem will probably be unsuccessful in most cases. If a medicationis believed to be the cause of the problem, the man's physician should review other medication options. (Never discontinue a prescribed medication without consulting the prescribing physician). This may be difficult in certain instances, especially when the medication is working appropriately to solve a pre-existing medical or psychological problem. Phimosisis treatable with routine stretching of the phimotic ring using a topical steroid cream over a period of months, or alternatively a partial or full circumcision. Frenulum breveusually requires surgery in which the frenulumcan be removed completely or preserved to a degree and sewn into the penis. The latter option is preferable as the frenulum plays host to many highly sensitive and pleasurable nerves. ExpectationsOutpatient treatment commonly requires about 12 to 18 sessions with an average success rate in the range of 70 percent to 80 percent. A more positive outcome is associated with having a previous history of satisfying sexual experiences, a short duration of the problem, feelings of sexual desire, feelings of lovetoward one's sexual partner, motivation for treatment, and absence of serious psychological problems. If medications are the source of the problem, a full recovery should be expected if the physician is able to switch or discontinue the medication. External links
Categories: Andrology| Penis
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