For T, a 32-year-old peripatetic service engineer, a visit to a gynecologist with his wife was somewhat “uncomfortable and embarrassing”. His wife was having difficulty getting pregnant as he had problems releasing the semen during sexual intercourse. They had been married for 2 years.
“When I first got married, I was able to attain orgasm and ejaculate normally,” he recounted anxiously. “I have been travelling regularly for work and the frequency of intimacy with my wife has been low. During the periods when I was away, I masturbated often. I gradually noticed that I took a longer time to reach sexual climax and ejaculation during sexual intercourse with my wife. The more anxious I was during the sexual act, the longer I took to release my sperm. For the last 6 months, I simply couldn’t ejaculate even though I have the erection. This has also caused conflicts in our relationship.”
Delayed ejaculation (DE) or retarded ejaculation is a condition in which an extended period of sexual stimulation is required for men to reach sexual climax and ejaculation. In severe cases, the patients are unable to ejaculate at all as in T’s case. It is a problem if it's ongoing or causes distress for the couple.
DE can be a lifelong problem or it may develop later in life. In some men, DE occurs in all sexual situations, while in others, it only occurs with certain partners or in certain circumstances. This is known as “situational delayed ejaculation.”
Prevalence of DE
Because of the lack of a precise definition of DE and as the condition is typically self-reported, the actual prevalence of DE is not known. Studies have estimated that it affects between 1% to 4 % of men.
Causes of DE
DE is a poorly understood ejaculation problem. There are many possible causes. They include;
Psychological causes such as relationship problems, depression, performance anxiety, cultural and religious taboos.
Frequent masturbation: This may increase the threshold of arousal necessary for orgasm.
Excessive alcohol consumption.
Medications such as antidepressants, anti-hypertensive medicines, anti-seizure medications.
Age: The incidence of DE increases after the age of 50 years. Compared with men younger than 59 years, men in their 80s report twice as much difficulty in ejaculating.
Race: In general, DE is more commonly reported by men in Asian populations than by men living in the United States, Australia, or Europe. Such variation may be due to cultural or genetic differences.
Chronic health conditions such as stroke or diabetes and prostate surgery.
How is DE diagnosed?
There is no consensus on what constitutes a reasonable time frame for ejaculation to occur. In general, DE is assumed to be present if orgasm and ejaculation do not occur after 30 minutes or more of sexual stimulation.
Complications of DE
While DE does not pose any serious medical risks, it reduces sexual pleasure and desire. This may cause stress and anxiety during sexual performance. Fertility issues will further aggravate relationship problems resulting in marital discord.
T’s physical examination, blood tests and urine investigations were normal. His semen analysis and the blood levels of testosterone were normal. He was given anti-anxiety medication and was referred to a psychiatrist for counseling. He was advised to curtail his habit of masturbation and reduce the frequency of his travels. He gradually regained his confidence. His symptoms of DE slowly resolved he was very happy when his wife eventually became pregnant after 8 months of therapy.