Opóźniona ejakulacja – Diagnostyka i diagnoza

Opóźniona ejakulacja
Diagnostyka i diagnoza

Opóźniona ejakulacja (DE) to zaburzenie seksualne charakteryzujące się znacznym opóźnieniem lub niemożnością osiągnięcia wytrysku pomimo odpowiedniej stymulacji i pragnienia, utrzymujące się co najmniej 6 miesięcy i powodujące istotny dystres. Diagnoza opiera się głównie na wywiadzie klinicznym, z uwzględnieniem kryteriów DSM-5, ICD-11 oraz definicji AUA, które podkreślają konieczność oceny częstotliwości wytrysku (75-100% aktywności seksualnej) oraz różnicowania form całożyciowej i nabytej, uogólnionej i sytuacyjnej. Diagnostyka obejmuje szczegółowy wywiad medyczny, seksualny i psychoseksualny, badanie fizykalne z oceną czucia narządów płciowych oraz badania dodatkowe, takie jak ocena poziomów hormonów (testosteron całkowity i biodostępny, TSH, estradiol, prolaktyna, witamina D), badania moczu, nasienia, biotezjometrię i potencjały somatosensoryczne nerwu sromowego (SSEP). Należy wykluczyć inne zaburzenia, takie jak wytrysk wsteczny, anorgazmia, zaburzenia erekcji, niedrożność dróg wyprowadzających nasienie oraz wpływ leków (np. SSRI, trójpierścieniowe leki przeciwdepresyjne, neuroleptyki) i substancji psychoaktywnych.

Diagnostyka opóźnionej ejakulacji

Opóźniona ejakulacja to zaburzenie seksualne charakteryzujące się znacznym opóźnieniem lub niemożnością osiągnięcia wytrysku, pomimo odpowiedniej stymulacji seksualnej i pragnienia wytrysku. Obecnie nie istnieje złoty standard diagnostyczny dla tej przypadłości, ponieważ kryteria operacyjne nie zostały precyzyjnie określone. Wywiad kliniczny stanowi kluczowy element diagnozy tego zaburzenia¹².

Kryteria diagnostyczne

Według DSM-5 (Diagnostyczny i Statystyczny Podręcznik Zaburzeń Psychicznych), opóźniona ejakulacja jest diagnozowana, gdy występuje jeden z dwóch objawów: znaczne opóźnienie wytrysku lub wyraźna rzadkość/brak wytrysku występujące w 75-100% przypadków aktywności seksualnej z partnerem przez co najmniej 6 miesięcy, powodujące istotny dyskomfort u pacjenta¹².

Klasyfikacja Międzynarodowa Chorób (ICD-11) definiuje opóźnioną ejakulację jako niezdolność do osiągnięcia wytrysku lub nadmierne/zwiększone opóźnienie wytrysku, pomimo odpowiedniej stymulacji seksualnej i pragnienia ejakulacji. Zaburzenie to występuje epizodycznie lub utrzymuje się przez okres co najmniej kilku miesięcy i wiąże się z klinicznie istotnym dystresem³⁴.

Amerykańskie Towarzystwo Urologiczne (AUA) definiuje opóźnioną ejakulację jako spójną, uciążliwą niezdolność do osiągnięcia wytrysku lub nadmierne (w przypadku całożyciowego DE) lub zwiększone (w przypadku nabytego DE) opóźnienie wytrysku, pomimo odpowiedniej stymulacji seksualnej i pragnienia ejakulacji¹².

Badanie podmiotowe i przedmiotowe

Ocena pacjenta z opóźnioną ejakulacją powinna rozpocząć się od dokładnego wywiadu medycznego i seksualnego oraz ukierunkowanego badania fizykalnego¹. Kliniczne badanie diagnostyczne opóźnionej ejakulacji wymaga kompleksowego podejścia obejmującego:

Badanie fizykalne ze szczególnym uwzględnieniem narządów płciowych¹
Ocenę czucia w obrębie narządów płciowych za pomocą dotyku¹
Wywiad dotyczący historii medycznej, chirurgicznej, psychiatrycznej, seksualnej, społecznej i religijnej¹

Podczas wywiadu lekarz powinien skupić się na zrozumieniu szczegółów reakcji wytryskowej, częstotliwości aktywności seksualnej, technikach stymulacji oraz jakości cyklu seksualnego (pożądanie, podniecenie, wytrysk, orgazm i okres refrakcji)¹.

Kluczowym elementem diagnostyki jest określenie, czy opóźniona ejakulacja występuje od początku życia seksualnego (całożyciowa) czy została nabyta po okresie normalnego funkcjonowania seksualnego (nabyta), a także czy jest uogólniona (występuje niezależnie od partnera i rodzaju stymulacji) czy sytuacyjna (występuje tylko w określonych warunkach)¹².

Istotnym aspektem diagnostycznym jest porównanie doświadczeń pacjenta podczas seksu z partnerem i podczas masturbacji. W znacznej liczbie przypadków opóźnionej ejakulacji pacjent nie jest w stanie osiągnąć wytrysku w obecności partnera (zwłaszcza podczas stosunku), ale może osiągnąć orgazm i wytrysk podczas samodzielnej masturbacji¹².

Badania laboratoryjne i dodatkowe

W procesie diagnostycznym opóźnionej ejakulacji lekarz może zlecić dodatkowe badania w celu wykluczenia lub potwierdzenia organicznych przyczyn zaburzenia¹:

Badania krwi – umożliwiają ocenę poziomu hormonów, w tym testosteronu całkowitego i biodostępnego, hormonów tarczycy (TSH), witaminy D, estradiolu i prolaktyny, a także wykrywają choroby układu sercowo-naczyniowego, cukrzycę i inne schorzenia¹²
Badania moczu (urynaliza) – pozwalają wykryć cukrzycę, infekcje i inne schorzenia¹²
Badanie nasienia – szczególnie ważne, jeśli pacjent stara się o biologiczne dziecko¹
Badania dodatkowe – mogą obejmować biotezjometrię lub potencjały somatosensoryczne wywołane z nerwu sromowego (SSEP) w celu oceny utraty wrażliwości prącia¹

W niektórych przypadkach lekarz może zalecić badanie reakcji prącia na wibrator, co może pomóc w ustaleniu, czy problem ma podłoże psychologiczne czy fizyczne¹. Badanie neurologiczne może ujawnić inne problemy nerwowe związane z opóźnioną ejakulacją¹.

USG może wykazać blokadę przewodów wytryskowych, co może być przyczyną zaburzenia¹. W niektórych przypadkach może być konieczne przeprowadzenie bardziej szczegółowych badań obrazowych, takich jak USG prostaty i pęcherzyków nasiennych¹.

Diagnostyka różnicowa opóźnionej ejakulacji

Diagnostyka różnicowa opóźnionej ejakulacji obejmuje wykluczenie innych zaburzeń i stanów, które mogą być mylnie diagnozowane jako opóźniona ejakulacja¹.

Wykluczenie innych zaburzeń seksualnych

W procesie diagnostycznym należy wykluczyć inne zaburzenia seksualne, które mogą być błędnie rozpoznawane jako opóźniona ejakulacja¹:

Wytrysk wsteczny – podczas orgazmu nasienie przemieszcza się w złym kierunku, z powrotem do pęcherza moczowego¹
Brak dojrzałości płciowej – zaburzenie rozwojowe¹
Niedrożność dróg wyprowadzających nasienie – problem anatomiczny¹
Anorgazmia – niezdolność do osiągnięcia orgazmu, różna od opóźnionej ejakulacji¹²
Zaburzenia erekcji – mogą współistnieć z opóźnioną ejakulacją¹
Obniżone libido – subtelnie zmniejszone pożądanie seksualne¹
Ból podczas wytrysku – problem który może wpływać na zdolność do ejakulacji¹

Ważne jest również, aby odróżnić opóźnioną ejakulację od normalnego okresu refrakcji (okresu po wytrysku, podczas którego mężczyźni są fizycznie niezdolni do ponownego wytrysku)¹.

Schorzenia współistniejące

W diagnostyce różnicowej należy uwzględnić choroby współistniejące, które mogą przyczyniać się do wystąpienia opóźnionej ejakulacji¹:

Cukrzyca – może powodować zmiany mikronaczyniowe i neuronaczyniowe¹
Nadciśnienie tętnicze – jedna z najczęstszych chorób związanych z trudnościami seksualnymi¹
Choroby układu nerwowego – takie jak udar, uszkodzenie nerwów rdzenia kręgowego lub pleców¹
Stwardnienie rozsiane – choroba demielinizacyjna układu nerwowego¹
Zaburzenia hormonalne – takie jak niski poziom hormonów tarczycy lub testosteronu¹
Wyniszczające choroby medyczne – zmniejszające pożądanie seksualne i wydolność¹

W diagnostyce różnicowej należy również uwzględnić zespoły bólowe, duszność, dławicę piersiową i osłabienie mięśni¹.

Wpływ leków i substancji psychoaktywnych

Istotnym elementem diagnostyki różnicowej jest ocena wpływu leków i substancji psychoaktywnych na zdolność do ejakulacji¹:

Leki blokujące receptory alfa-adrenergiczne – prazosyna i terazosyna (wytrysk wsteczny)¹
Leki blokujące receptory alfa i beta-adrenergiczne – labetalol (zahamowanie wytrysku)¹
Leki blokujące nerwy współczulne – guanetydyna (zaburzenia erekcji i wytrysk wsteczny)¹
Leki przeciwwrzodowe – cymetydyna (zmniejszone libido)¹
Trójpierścieniowe leki przeciwdepresyjne – amitryptylina, dezypramina, doksepina, imipramina, maprotylina, nortryptylina, protryptylina (zahamowanie wytrysku)¹
Inhibitory monoaminooksydazy – izokarboksazyd, fenelzyna i tranylcypromina (zahamowanie wytrysku i zmniejszone libido)¹
Selektywne inhibitory wychwytu zwrotnego serotoniny (SSRI) – fluoksetyna (anorgazmia w 8-30%) i paroksetyna (anorgazmia)¹
Inne leki przeciwdepresyjne – wenlafaksyna (anorgazmia)¹
Leki neuroleptyczne – pierwszej generacji (haloperydol, tiotyksen, perfenazyna i trifluoperazyna) i drugiej generacji (risperidon) (zahamowanie wytrysku, zmniejszone libido)¹
Stabilizatory nastroju – topiramat (anorgazmia)¹

Nadmierne spożycie alkoholu lub stosowanie innych substancji rekreacyjnych może mieć bezpośredni hamujący wpływ na układ naczyniowo-nerwowy narządów płciowych, pośredni wpływ poprzez zwiększone wydzielanie prolaktyny lub zmniejszoną produkcję testosteronu, lub oba te skutki¹. Palenie papierosów może powodować niewydolność naczyniową oraz obniżenie poziomu tlenku azotu w prąciu¹.

Ocena psychoseksualna w diagnostyce opóźnionej ejakulacji

Ocena psychoseksualna stanowi istotny element diagnostyki opóźnionej ejakulacji, ponieważ czynniki psychologiczne mogą w znacznym stopniu przyczyniać się do wystąpienia tego zaburzenia¹.

Badanie stanu psychoseksualnego

Najważniejszym narzędziem diagnostycznym dostępnym dla pracowników służby zdrowia w diagnozowaniu zaburzeń seksualnych jest badanie stanu seksualnego (sex status exam). Jest to szczegółowy, ukierunkowany wywiad diagnostyczny, który analizuje wszystkie aspekty aktualnego funkcjonowania seksualnego w połączeniu z potencjalnie istotnymi doświadczeniami historycznymi¹².

Kluczowe elementy oceny psychoseksualnej obejmują¹²:

Ocenę aktualnych postaw i doświadczeń seksualnych
Identyfikację czynników poprzedzających (wczesnych przyczyn) i/lub podtrzymujących problemy seksualne
Analizę różnic między doświadczeniami seksualnymi z partnerem a samostymulacją
Ocenę wszystkich istotnych, bezpośrednio działających czynników związanych z doświadczeniem seksualnym
Zbadanie wpływu tych czynników na pożądanie, podniecenie i orgazm

Badania wykazały, że wszystkie powyższe informacje są kluczowe dla skutecznego rozwiązania problemu opóźnionej ejakulacji¹.

Identyfikacja czynników psychologicznych

W procesie diagnostycznym ważne jest zidentyfikowanie potencjalnych czynników psychologicznych, które mogą przyczyniać się do wystąpienia opóźnionej ejakulacji¹:

Problemy w związku – napięcia i konflikty z partnerem¹
Stres – zarówno związany z życiem seksualnym, jak i ogólny¹
Depresja – może wpływać na funkcjonowanie seksualne¹
Lęk o wydolność seksualną – mężczyźni z opóźnioną ejakulacją często wykazują wysoki poziom niepokoju związanego z ich wydolnością seksualną¹
Niezadowolenie seksualne – często towarzyszące zaburzeniom ejakulacji¹
Dystres w związku – mężczyźni z opóźnioną ejakulacją często doświadczają wysokiego poziomu stresu w relacji¹
Niższa częstotliwość aktywności seksualnej – w porównaniu z mężczyznami bez zaburzeń seksualnych¹

Idiosynkratyczne wzorce masturbacji w połączeniu z rozbieżnością między fantazjami a rzeczywistym partnerem często predysponują mężczyzn do doświadczania problemów z podnieceniem i ejakulacją¹.

Ocena wpływu na jakość życia

W procesie diagnostycznym należy ocenić wpływ opóźnionej ejakulacji na jakość życia pacjenta i jego partnera/partnerki¹.

Potencjalne konsekwencje opóźnionej ejakulacji obejmują¹²:

Zmniejszenie przyjemności seksualnej dla pacjenta i partnera
Unikanie kontaktów seksualnych
Zahamowanie pożądania seksualnego
Stres w związku
Niezadowolenie seksualne
Trudności z poczęciem i zajściem w ciążę

Opóźniona ejakulacja jest problemem tylko wtedy, gdy utrzymuje się przez dłuższy czas lub powoduje stres lub niepokój dla pacjenta i/lub jego partnera¹. Dlatego ocena poziomu dystresu związanego z zaburzeniem stanowi istotny element procesu diagnostycznego¹².

Specjalistyczna diagnostyka opóźnionej ejakulacji

W niektórych przypadkach konieczna jest bardziej specjalistyczna diagnostyka opóźnionej ejakulacji, szczególnie gdy podejrzewa się organiczne przyczyny zaburzenia¹.

Konsultacje specjalistyczne

W procesie diagnostycznym opóźnionej ejakulacji może być konieczna konsultacja z różnymi specjalistami¹:

Urolog – specjalista w zakresie chorób układu moczowo-płciowego, często przeprowadza badanie fizykalne i wywiad medyczny w celu zidentyfikowania fizycznych czynników przyczyniających się do opóźnionej ejakulacji¹
Seksuolog – specjalista zajmujący się zaburzeniami seksualnymi, może przeprowadzić ocenę psychoseksualną¹
Psycholog lub psychiatra – szczególnie w przypadku podejrzenia psychologicznych przyczyn zaburzenia¹
Endokrynolog – w przypadku zaburzeń hormonalnych¹

Amerykańskie Towarzystwo Urologiczne zaleca, aby klinicyści rozważyli skierowanie mężczyzn z całożyciową lub nabytą opóźnioną ejakulacją do specjalisty ds. zdrowia psychicznego z doświadczeniem w zakresie zdrowia seksualnego¹.

Specjalistyczne testy diagnostyczne

W przypadku podejrzenia organicznych przyczyn opóźnionej ejakulacji mogą być konieczne bardziej zaawansowane testy diagnostyczne¹:

Biotezjometria – badanie służące do oceny wrażliwości prącia¹
Potencjały somatosensoryczne wywołane z nerwu sromowego (SSEP) – badanie oceniające funkcję nerwów w obszarze narządów płciowych¹
Badanie neurologiczne – może ujawnić problemy nerwowe związane z opóźnioną ejakulacją¹
Obrazowanie diagnostyczne prostaty i pęcherzyków nasiennych – może być przeprowadzone w ramach diagnostyki¹

Elektrodiagnostyka zaburzeń ejakulacji może obejmować wypełnione kwestionariusze do oceny zaburzeń ejakulacji¹.

Diagnostyka w kontekście niepłodności

Opóźniona ejakulacja może utrudniać poczęcie dziecka, dlatego w przypadku par starających się o biologiczne potomstwo, diagnostyka może obejmować dodatkowe elementy¹:

Analiza nasienia – kluczowa rola w diagnostyce niepłodności męskiej¹
Ocena objętości ejakulatu – podstawowy parametr analizy nasienia¹
Badanie po wytrysku – może pomóc w diagnostyce problemów z ejakulacją¹

Problemy z ejakulacją wpływają na jakość nasienia u niepłodnych mężczyzn, co skutkuje niższą objętością ejakulatu. Dlatego rutynowe badanie objętości ejakulatu jest konieczne do zidentyfikowania i leczenia niskiej objętości nasienia związanej z problemami z ejakulacją w kontekście niepłodności¹.

W przypadku mężczyzn z niepłodnością można zastosować różne podejścia, w tym zbieranie emisji nocnych, energiczny masaż prostaty, cewnikowanie cewki moczowej prostaty, stymulację wibracyjną prącia, elektrostymulację ejakulacji przez odbytnicę, pobranie plemników z nasieniowodu lub najądrza, lub ekstrakcję plemników z jąder¹².

Wyzwania diagnostyczne i kierunki rozwoju

Diagnostyka opóźnionej ejakulacji napotyka na szereg wyzwań, a obszar ten wymaga dalszych badań i rozwoju¹.

Ograniczenia obecnych metod diagnostycznych

Obecne metody diagnostyczne opóźnionej ejakulacji mają pewne ograniczenia¹²:

Brak złotego standardu diagnostycznego, ponieważ kryteria operacyjne nie zostały precyzyjnie określone
Brak obiektywnych miar czasu opóźnienia ejakulacji w kryteriach diagnostycznych DSM-5, co utrudnia określenie częstości występowania zaburzenia¹
Różnice w definicjach proponowanych przez różne organizacje zawodowe i medyczne, co może utrudniać proces identyfikacji i diagnozowania opóźnionej ejakulacji¹²
Subiektywny i nieprecyzyjny charakter diagnozy w warunkach klinicznych, pomimo naukowej i badawczej atrakcyjności obiektywnych procedur diagnostycznych¹

Brak empirycznie opartych kryteriów diagnostycznych dla opóźnionej ejakulacji nie tylko podważa zaufanie do raportowanych wskaźników występowania tego zaburzenia seksualnego, ale także doprowadził do braku zwalidowanych wyników zgłaszanych przez pacjentów (PROs) do oceny tego stanu¹.

Nowe podejścia diagnostyczne

Prowadzone są badania mające na celu opracowanie lepszych metod diagnostycznych dla opóźnionej ejakulacji¹²:

Badanie i ocena sześciu ważnych zmiennych, które wcześniej wykazały zdolność do rozróżniania między mężczyznami z i bez opóźnionej ejakulacji, pod kątem ich użyteczności jako miar diagnostycznych
Opracowanie wewnętrznie wiarygodnego wyniku zgłaszanego przez pacjenta (PRO), który nie tylko ma wykazaną zdolność do rozróżniania między mężczyznami z i bez opóźnionej ejakulacji, ale także reprezentuje odpowiednią równowagę dotyczącą wkładu każdego konstruktu w diagnozę

Autorzy sugerują, że najlepszym sposobem diagnozy opóźnionej ejakulacji jest rozpoczęcie od samooceny zdolności ejakulacji przez pacjenta, a następnie zebranie informacji na temat procentu przypadków, kiedy ejakuluje podczas aktywności seksualnej z partnerem. Według autorów, czas opóźnienia ejakulacji mógłby być wykorzystywany jako dodatkowa miara przy diagnozowaniu opóźnionej ejakulacji, ponieważ może być mniej dokładny, gdy jest używany jako jedyna miara¹.

Przyszłość diagnostyki opóźnionej ejakulacji

Przyszłe kierunki rozwoju diagnostyki opóźnionej ejakulacji obejmują¹:

Opracowanie uniwersalnej definicji opóźnionej ejakulacji i anorgazmii
Stworzenie znormalizowanej ścieżki do osiągnięcia obiektywnej oceny i diagnozy
Dalsze badania nad identyfikacją czynników przyczyniających się do opóźnionej ejakulacji
Opracowanie i walidacja lepszych narzędzi diagnostycznych

Istnieje również potrzeba większej liczby badań w celu lepszego zrozumienia przyczyn, diagnozowania i leczenia opóźnionej ejakulacji, zwłaszcza biorąc pod uwagę fakt, że jest to najmniej zbadana i najmniej rozpowszechniona forma męskiej dysfunkcji seksualnej¹².

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Materiały źródłowe

#1 Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC5756804/
Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. […] There is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. […] Unfortunately, there is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. […] The history is the key to the diagnosis of DE/AE. Evaluation begins by exclusion of retrograde ejaculation, absence of puberty, genital tract obstruction, anorgasmia, and other sexual dysfunctions that may be misdiagnosed as DE/AE, such as erectile dysfunction, a subtly decreased libido, ejaculatory pain, the partner’s sexual dysfunction, sexual orientation conflicts, or paraphilic inclinations/interests.
#1 Delayed Ejaculation DSM-5 302.74 (N53.11)
https://www.theravive.com/therapedia/delayed-ejaculation-dsm–5-302.74-(n53.11)
Delayed Ejaculation is a DSM -5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) sexual disorder in which a man is unable to ejaculate during sexual activity, specifically after 25 minutes to 30 minutes of continuous sexual stimulation. This disorder is also known as DO (Delayed Orgasm) retarded ejaculation, or inhibited ejaculation. Nelson (2012) noted it is the least understood of the sexual dysfunctions. For most men, DE is not linked to erectile dysfunction. DE is a sexual dysfunction which can cause anxiety, dissatisfaction and frustration around sex, and can both contribute to and be caused by interpersonal conflicts with a partner. […] According to the DSM-5, delayed ejaculation is defined by four symptoms with a choice of seven specifiers. 1. an inability to climax during sex with a partner about 75-100% of the time, with either a delay in ejaculation or infrequent or absent ejaculation. 2. The symptoms described above have persisted for at least six months, 3., the symptoms produce marked distress in the individual, and 4. The delayed ejaculation is not better accounted for by another mental disorder, use of a medication known for causing ejaculatory delay or failure, or due to stressors within or external to the relationship.
#1 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
Lifelong delayed ejaculation is defined as lifelong, consistent, bothersome inability to achieve ejaculation, or excessive latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. (Expert Opinion) […] Acquired delayed ejaculation is defined as an acquired, consistent, bothersome inability to achieve ejaculation, or an increased latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. (Expert Opinion) […] Clinicians should assess medical, relationship, and sexual history and perform a focused physical exam to evaluate a patient with delayed ejaculation. (Clinical Principle) […] Clinicians may utilize additional testing as clinically indicated for the evaluation of delayed ejaculation. (Conditional Recommendation; Evidence Level: Grade C)
#1 Delayed ejaculation – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube
https://www.augustahealth.com/disease/delayed-ejaculation/
These categories help in diagnosing an underlying cause and determining what might be the most effective treatment. […] A physical exam and medical history might be all that are needed to recommend treatment for delayed ejaculation. However, if delayed ejaculation appears to be caused by an underlying problem that might need treatment, you might need further tests or you might need to see a specialist. […] Tests for underlying problems can include: Physical exam. This might include careful examination of your penis and testicles. The doctor will use light touch to make sure you have normal sensation in your genitals. […] Blood tests. Your health care provider might take a blood sample and send it to a lab to check for signs of cardiovascular disease, diabetes, a low testosterone level and other health problems. […] Urine tests (urinalysis). Urine tests are used to look for signs of diabetes, infection and other underlying health conditions.
#1 Delayed Ejaculation: Causes, Symptoms, Treatment & More
https://www.prepladder.com/neet-pg-study-material/obstetrics-and-gynaecology/delayed-ejaculation-causes-symptoms-risk-factors-diagnosis-treatment-and-complications
If therapy advice for delayed ejaculation is to be made, a physical examination and medical history may be sufficient. However, if delayed ejaculation appears to be the result of an underlying problem that would need to be treated, you might wish to be further tested or see a doctor. […] Examinations for underlying problems could include: […] Physical assessment: Your penis and testicles may need to be examined closely for this. The doctor will lightly touch your genitalia to make sure you have normal sensation in them. […] Blood tests: Your doctor may take blood and send it to a laboratory to check for signs of diabetes, cardiovascular disease, low testosterone, and other health problems. […] Urine testing (urinalysis): Urine tests are used to screen for diabetes, infections, and other underlying medical conditions.
#1 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research
https://www.nature.com/articles/s41443-023-00692-7
The International Classification of Diseases (ICD)-11 defines DE as an inability to achieve ejaculation or an excessive or increased latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. […] For both DO and AO, these patterns of orgasmic dysfunction have occurred episodically or persistently over a period of at least several months and is associated with clinically significant distress. […] Initial evaluation of a patient presenting with DO involves a thorough history and physical examination. […] Critical components of the history intake include medical, surgical, psychiatric, sexual, social, and religious history. […] To date, no studies have identified an association between orgasmic dysfunction and recreational drug use, pornography use, or painful intercourse, but these still represent important components of the social history.
#1 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/disorders-of-ejaculation
The aetiology of DE can be psychological, organic (e.g., incomplete spinal cord lesion or iatrogenic penile nerve damage), or pharmacological (e.g., SSRIs, antihypertensive drugs, or antipsychotics). Other factors that may play a role in the aetiology of DE include tactile sensitivity and tissue atrophy. […] Patients should have a full medical and sexual history performed along with a detailed physical examination when evaluating for DE. Understanding the details of the ejaculatory response, sensation, frequency, and sexual activity/techniques; cultural context and history of the disorder; quality of the sexual response cycle (desire, arousal, ejaculation, orgasm, and refractory period); partners assessment of the disorder and if the partner suffers from any sexual dysfunction her/himself; and the overall satisfaction of the sexual relationship are all important to garner during history-taking.
#1 Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC5756804/
The evaluation may involve determining whether DE is lifelong or acquired and global or situational. […] In a considerable number of cases of DE/AE, the patient is typically unable to ejaculate in the presence of a partner (especially during coitus) but is able to orgasm and ejaculate during solo masturbation. […] The third step is to uncover the predisposing issues and the potential risk factors that are believed to participate in the pathogenesis of DE/AE. […] There are many approaches to treatment planning. A rigid treatment plan is not suitable for all patients. […] Treatment should be cause-specific. […] A number of approaches can be employed for infertile men, including collection of nocturnal emissions, vigorous prostatic massage, prostatic urethra catheterization, PVS, rectal probe EEJ, sperm retrieval from either the vas deferens or the epididymis, or testicular sperm extraction.
#1 Delayed ejaculation – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/diagnosis-treatment/drc-20371363
A physical exam and medical history might be all that are needed to suggest treatment for delayed ejaculation. But there might be a problem causing delayed ejaculation that needs treatment. Then you might need more tests, or you might need to see a specialist. […] Besides a physical exam of the penis and testicles, you might have: […] Blood tests. A blood sample sent to a lab can check for heart disease, diabetes, hormone levels and other health conditions. […] Urine tests, called urinalysis. Urine tests look for signs of diabetes, infection and other health conditions. […] For delayed ejaculation, some basic questions to ask include: […] What tests do I need? […] What treatments are there? Which one do you suggest for me? […] Your healthcare professional may ask: […] Are you able to ejaculate during sexual intercourse? Or are you able to ejaculate only when your partner directly touches your penis or when you masturbate? […] Have you had changes in sexual desire or any other sexual problems?
#1 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research
https://www.nature.com/articles/s41443-023-00692-7
Hormonal evaluation serves as the basis for laboratory testing when evaluating a patient with DO. […] The mainstay of hormonal laboratory testing is total and calculated bioavailable/free T, TSH, vitamin D, estradiol, and PRL. […] Adjunctive testing includes biothesiometry or pudendal somatosensory-evoked potential (SSEP) to evaluate for loss of penile sensitivity. […] There is no standardized treatment plan for DO. […] Treatment plans are often multidisciplinary, involving urologists, primary care providers and mental health professionals to adequately address biopsychosocial factors. […] If DO is associated with SSRIs or other medications, patients should discuss medication adjustment with the prescribing physician. […] Testosterone replacement is indicated for men with testosterone deficiency in accordance with available guidelines.
#1 Delayed Ejaculation: Causes, Diagnosis & Treatment
https://my.clevelandclinic.org/health/diseases/22125-delayed-ejaculation
If you have delayed ejaculation, you or your partner may find sexual intercourse frustrating instead of pleasurable because of the time it takes you to ejaculate. The first step is to talk to a provider and get a physical exam. Treatment may include therapy or changes to your medications. […] A healthcare provider will ask you questions about your medical history, sexual habits and ejaculation patterns. […] A provider may perform a physical examination and order tests to help identify or rule out other conditions. These tests may include: Blood tests, Urinalysis (pee test), Semen analysis, particularly if you’re trying to conceive a biological child. […] A healthcare provider may offer several different delayed ejaculation treatments. There isn’t one clear way to treat the condition unless the cause involves certain medications, nonprescription drug use or alcohol use.
#1 Delayed Ejaculation: Causes, Symptoms, & Diagnosis
https://www.healthline.com/health/delayed-ejaculation
Delayed ejaculation (DE) occurs when a man needs more than 30 minutes of sexual stimulation to reach orgasm and ejaculate. […] A physical examination and explanation of your symptoms are necessary to make an initial diagnosis. If a chronic health problem is suspected as the underlying cause, more testing may need to be done. This includes blood tests and urine tests. […] Testing the reaction of your penis to a vibrator may reveal if the problem is psychological or physical.
#1 Ejaculation Disorders I Ohio State Urology Department
https://wexnermedical.osu.edu/urology/ejaculation
Ohio State urologists can diagnose and treat premature or delayed ejaculation. […] Delayed ejaculation is a medical condition in which a male cannot ejaculate, either during intercourse or by manual stimulation. […] Your Ohio State urologist can help determine the cause of your ejaculation condition by discussing your health history and a physical examination. […] A neurological examination may reveal other nerve problems that are associated with delayed ejaculation.
#1 Delayed ejaculation: MedlinePlus Medical EncyclopediaLock
https://medlineplus.gov/ency/article/001954.htm
Delayed ejaculation is a medical condition in which a male cannot ejaculate easily or at all. It may occur either during intercourse or by manual stimulation with or without a partner. Ejaculation is when semen is released from the penis. […] Delayed ejaculation can have psychological or physical causes. […] Physical causes may include: Blockage of the ducts that semen passes through, Use of certain medicines, Nervous system diseases, such as stroke or nerve damage to the spinal cord or back, Nerve damage during surgery in the pelvis. […] Stimulating the penis with a vibrator or other device may determine whether you have a physical problem. This is often a nervous system problem. A nervous system (neurological) exam may reveal other nerve problems that are connected with delayed ejaculation. An ultrasound can show a blockage of the ejaculatory ducts.
#1 Ejaculation Disorders Infertility Causes, Types & Treatment
https://www.artfertilityclinics.com/en/male-infertility/ejaculation-problems
Delayed ejaculation refers to a condition where ejaculation takes a longer time. This condition may arise due to medications, certain chronic health conditions, surgeries, and psychological causes. […] Ejaculation problems are a significant cause of infertility in young males. Sometimes premature ejaculation can cause difficulty in achieving successful pregnancy as ejaculation may not occur intravaginally. Semen quality is also reduced in premature ejaculation, which may lead to infertility. Men with retrograde ejaculation and anejaculation may experience infertility during their reproductive period. […] Semen analysis plays a crucial role in the diagnosis of male infertility. Ejaculate volume is the primary parameter of semen analysis. Ejaculation problems impact the semen quality of infertile men, which results in lower ejaculate volumes. Hence, routine investigation of ejaculate volume is necessary to identify and manage the low semen volume of ejaculation problems related to infertility. […] Physical examination, post ejaculate, and blood tests also help to diagnose ejaculation problems. Besides that, diagnostic imaging of prostate and seminal vesicles can also carry out as part of the diagnosis.
#1 Delayed Ejaculation: Informed Diagnosis and Treatment | Psychology Today
https://www.psychologytoday.com/us/blog/sexual-tipping-point/201812/delayed-ejaculation-informed-diagnosis-and-treatment
Men with DE find it difficult or impossible to ejaculate and/or experience orgasm. DE is a failure to ejaculate during masturbation and/or partner manual, oral, coital, or anal stimulation. Diagnosis of DE requires distress about the symptom(s), adequate sexual stimulation, and a conscious desire to achieve orgasm. […] It is frequently useful for a physician (usually a urologist) to conduct a physical examination and medical history to help identify any Physical factors contributing to DE. […] Additionally, DE is one of many ejaculation problems that can be confused with each other, and/or can occur together. The doctor will differentiate anejaculation (no cum), painful ejaculation, and retrograde ejaculation (during the climax, the semen goes in the wrong direction back into the bladder), decreased volume/force/sensation of ejaculation, and the very rare post-orgasmic illness syndrome. DE is distinct from erectile dysfunction (ED), the condition where a man is unable to attain or maintain an erection rigid enough for sexual activity). DE is also different from the normal refractory period, the length of time after an ejaculation during which men are physically incapable of having a repeat ejaculation. DE is also different from anorgasmia (inability to experience orgasm or sexual climax).
#1 Delayed Ejaculation Differential Diagnoses
https://emedicine.medscape.com/article/2184956-differential
Debilitating medical conditions that have the potential to decrease sexual desire and performance can result in secondary inhibited male orgasm. The most common medical conditions associated with sexual difficulties are diabetes mellitus and hypertension, possibly because of the microvascular and neurovascular changes that are inherent in these conditions. […] Pain syndromes, shortness of breath, angina pectoris, and muscle weakness should be included in the differential diagnosis. Cigarette smoking can cause vascular insufficiency, as well as a decrease in intrapenile nitrous oxide (NO) levels. Excessive consumption of alcohol or the use of other recreational drugs can have a direct inhibitory effect on the genital neurovascular system, an indirect effect via increased prolactin or decreased testosterone production, or both.
#1 Delayed Ejaculation DSM-5 302.74 (N53.11)
https://www.theravive.com/therapedia/delayed-ejaculation-dsm–5-302.74-(n53.11)
The DSM-5 notes that normal age related changes in men include loss of genital sensitivity and decline of testosterone, which can be causal in delayed ejaculation. The DSM-5 also notes it is the least common male sexual complaint. […] According to the DSM-5, The aging process will inevitably produce predictable sexual changes, including delay of ejaculation, or ejaculatory failure. The DSM-5 notes comorbidity with major depressive disorder. […] The DSM -5 does not provide specific treatment options. Treatment recommendations will vary depending on the underlying cause. If illicit drug or excessive alcohol use is identified as causal, then group or individual counseling for chemical abuse and dependency is indicated. […] Delayed ejaculation may complicate efforts at conception, and create frustration with sexual activity, avoidance, and resultant relationship difficulties. The DSM -5 notes a number of medical conditions that can precipitate delayed ejaculation, such as traumatic surgical injury to the groin or genitals, multiple sclerosis, or diabetes.
#1 Delayed ejaculation: what is it, symptoms and treatment | Top Doctors
https://www.topdoctors.co.uk/medical-dictionary/delayed-ejaculation
There is not really a specific time that indicates a diagnosis of delayed ejaculation, but signs of the condition may include stress, frustration and loss of an erection. […] Delayed ejaculation may be caused by physical or psychological reasons. […] Physical problems may include neurological problems such as diabetic neuropathy, stroke, multiple sclerosis or damage to the spinal cord. Hormone-related issues such as low thyroid hormone level or low testosterone levels also cause delayed ejaculation. The psychological causes of delayed ejaculation include depression, anxiety (about sexual performance) and poor body image. […] Medications such as some antidepressants, high blood pressure and anti-seizure medication, as well as excessive alcohol consumption can cause delayed ejaculation.
#1 Delayed Ejaculation Differential Diagnoses
https://emedicine.medscape.com/article/2184956-differential
The following classes of prescribed medications should be considered in the differential diagnosis: Alpha-adrenergic blockers Prazosin and terazosin (retrograde ejaculation); Combined alpha- and beta-adrenergic blockers – Labetalol (inhibited ejaculation); Sympathetic nerve blockers – Guanethidine (erectile dysfunction and retrograde ejaculation); Antiulcer medications – Cimetidine (decreased libido); Tricyclic antidepressants (via increased serotonin) – Amitriptyline, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline (inhibited ejaculation); clomipramine was reported to induce anorgasmia within days of starting treatment, which persisted with minimal tolerance over 5 months of clomipramine therapy; Monoamine oxidase inhibitors (via increased serotonin) – Isocarboxazid, phenelzine, and tranylcypromine (inhibited ejaculation and decreased libido); Selective serotonin reuptake inhibitors (via increased serotonin) – Fluoxetine (anorgasmia in 830%) and paroxetine (anorgasmia); Other antidepressants – Venlafaxine (anorgasmia); Neuroleptics (mainly via increased prolactin) First-generation or typical (haloperidol, thiothixene, perphenazine, and trifluoperazine) and second-generation (risperidone) (inhibited ejaculation, decreased libido); Mood stabilizers – Topiramate (anorgasmia).
#1 Delayed Ejaculation
https://labs.la.utexas.edu/mestonlab/male-orgasmic-disorder/
A medical doctor or clinical psychologist assesses for delayed ejaculation with an interview to determine ejaculation latency and to discuss reactions to this problem. The most common treatments incorporate behavioral techniques. […] Both physical and psychological assessment are necessary in order to gain a thorough understanding of the factors contributing to DE. […] There has been limited success in the development and testing of pharmacological agents aimed at treating DE. […] If the disorder is determined to be primarily psychological in origin, there are a number of psychosocial interventions that have been shown to effectively reduce ejaculation latency.
#1 Delayed Ejaculation: Informed Diagnosis and Treatment | Psychology Today
https://www.psychologytoday.com/us/blog/sexual-tipping-point/201812/delayed-ejaculation-informed-diagnosis-and-treatment
Many physicians, for better and sometimes for worse, will begin treatment by rst prescribing pharmaceuticals, lubricants, and devices (e.g. vibrators). Unfortunately, there are no FDA approved treatment for DE and the drugs that doctors typically use have only anecdotal (here and there reports) of success. […] The most important tool available to any healthcare professional for diagnosing any sexual disorder is a sex status exam. A sex status exam is not a lab test or a questionnaire. It is a detailed focused diagnostic interview that examines all aspects of current sexual functioning in combination with potentially relevant historical experiences. […] The difference between what a man experiences in coupled sex, versus self-stimulation, must be explored. […] In summary, high-frequency idiosyncratic masturbation, combined with fantasypartner disparity, often predispose men to experience problems with arousal and ejaculation. The MAP Education Research Foundations Sexual Tipping Point Model provides a useful framework for helping men (and their partners) understand the cause(s) of DE and how treatment will proceed. A sex therapist should be able to explain how the mental and physical erotic stimulation a man is receiving is insufficient for him to ejaculate in the manner he prefers, and how this can be changed to achieve the desired result. Of course, successful treatment will depend on a mans willingness to follow therapeutic recommendations, which will be influenced by the extent of organic/medical complications, relational issues, and potentially deeper patient/partner psychodynamic problems. When a safe and effective drug becomes available, a shift toward combining drug treatment and sex therapy when treating DE will occur, which has already happened for the treatment of ED. But as of right now, sex therapy is the preferred treatment for DE.
#1 Delayed Ejaculation: Informed Diagnosis and Treatment — MAP Education & Research Foundation
http://www.mapedfund.org/blog/2019/4/8/delayed-ejaculation-informed-diagnosis-and-treatment
The most important tool available to any healthcare professional for diagnosing any sexual disorder is a sex status exam. […] A description of current sexual attitudes and experiences will help rule out physical causes and help identify antecedents (early causes) and/or maintainers of any sexual problem including DE. […] The difference between what a man experiences in coupled sex, versus self-stimulation, must be explored. […] Research has that shown all the above information is critical to a successful resolution of DE. […] The goal is to identify all the relevant immediately acting factors that are associated with sexual experience and how those factors impact desire, arousal, and orgasm. […] Sex therapists have reported good success rates using cognitive-behavioral techniques.
#1 Ejaculation problems
https://www.nhs.uk/conditions/ejaculation-problems/
Delayed ejaculation (male orgasmic disorder) is classed as either: […] You may have delayed ejaculation if you’re unable to ejaculate more than half the times you have sex. […] Like premature ejaculation, delayed ejaculation can be caused by psychological and physical factors. […] Possible psychological causes of delayed ejaculation are similar to those of premature ejaculation for example, relationship problems, stress or depression. […] Physical causes of delayed ejaculation include: diabetes, spinal cord injuries, multiple sclerosis, surgery to the bladder or prostate gland, increasing age. […] Many medicines are known to cause delayed ejaculation, including: antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), medicines to treat high blood pressure, such as beta-blockers, antipsychotics, used to treat episodes of psychosis.
#1 :: WJMH :: World Journal of Men’s Health
https://wjmh.org/DOIx.php?id=10.5534/wjmh.17051
Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. […] There is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. […] The evaluation may involve determining whether DE is lifelong or acquired and global or situational. […] Men with DE/AE have demonstrated high levels of relationship distress, sexual dissatisfaction, anxiety about their sexual performance, and lower frequencies of coital activity than sexually functional men. […] Unfortunately, there is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. Treatment should be cause-specific.
#1 Delayed Ejaculation: Informed Diagnosis and Treatment — MAP Education & Research Foundation
http://www.mapedfund.org/blog/2019/4/8/delayed-ejaculation-informed-diagnosis-and-treatment
Most urologists find treating DE to be difficult and challenging. […] For many men and couples, it is often possible to successfully overcome DE especially with the guidance of a well-trained sex therapist. […] In summary, high-frequency idiosyncratic masturbation, combined with fantasypartner disparity, often predispose men to experience problems with arousal and ejaculation.
#1 Delayed ejaculation – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/symptoms-causes/syc-20371358
Some medicines, certain ongoing health conditions and surgeries can cause delayed ejaculation. Other causes include substance misuse or a mental health concern, such as depression, anxiety or stress. Often, it’s due to a mix of physical and psychological concerns. […] The following can increase the risk of having delayed ejaculation: Older age. With aging, ejaculation takes longer. […] Complications of delayed ejaculation can include: Less sexual pleasure for you and your partner.
#1 Delayed ejaculation: MedlinePlus Medical EncyclopediaLock
https://medlineplus.gov/ency/article/001954.htm
If you have never ejaculated through any form of stimulation, see your health care provider to determine if the problem has a physical cause. […] Treatment commonly requires about 12 to 18 sessions. The average success rate is 70% to 80%. […] If the problem is not treated, the following may occur: Avoidance of sexual contact, Inhibited sexual desire, Stress within the relationship, Sexual dissatisfaction, Difficulty with conception and getting pregnant. […] Having a healthy attitude about your sexuality and genitals helps prevent delayed ejaculation. Realize that you cannot force yourself to have a sexual response, just as you cannot force yourself to go to sleep or to perspire.
#1 Delayed or Absent Ejaculation | Department of Urology | UPMC
https://www.upmc.com/services/urology/conditions/delayed-or-absent-ejaculation
A delayed or absent ejaculation happens when a man takes an especially long time to ejaculate or can’t come at all. […] DE is only a problem when it goes on for a long time or causes stress for you or your partner. […] There’s no simple test for DE. If it causes distress or physical discomfort to you or your partner, you should see your doctor. […] Your doctor will listen to your symptoms and do an exam. He or she may also order blood and urine tests to rule out issues like infections and hormone imbalances.
#1 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research
https://www.nature.com/articles/s41443-023-00692-7
Male orgasmic dysfunction can be dichotomized as two ends of a spectrum: premature ejaculation (PE) versus DO and anorgasmia (AO). […] In this review, we specifically focus on summarizing the current knowledge regarding the epidemiology, pathophysiology, diagnosis, and treatment of DO/AO. […] The AUA guidelines on disorders of ejaculation recognize that there are multiple terms to refer to delays in ejaculations and/or orgasm including DE and DO. […] The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) states that distressing difficulties with orgasm in men would be considered under delayed ejaculation, which is defined as a marked delay in ejaculation or a marked infrequency of absence of ejaculation on 75-100% of all occasions of partnered sexual activity without the individual desiring delay, persisting for at least 6 months, and causing significant distress to the individual.
#1 Delayed Ejaculation Causes, Diagnosis, Treatment, and Coping
https://www.verywellhealth.com/delayed-ejaculation-3300047
If the cause is believed to be psychological (and no other reasonable explanation can be found), the healthcare provider may refer you to a psychologist or sex therapist trained in treating sexual dysfunction. […] If a disease, medical condition, or surgical complication is believed to be the cause, various lab tests, imaging studies, and diagnostic procedures may be performed to support or rule out the suspicion.
#1 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research
https://www.nature.com/articles/s41443-023-00692-7
Psychosocial evaluation with a sex therapist is recommended for all patients. […] Therapy can include sex education, cognitive-behavioral therapy (CBT), couples therapy, psychodynamic exploration, and mindfulness. […] Exact rates of success are difficult to determine based on existing literature due to variability of therapy methods and lack of large-scale studies. […] Although the current evidence is not conclusive to support the routine use of PVS, the AUA guidelines state that PVS may be recommended for interested patients given the minimal risk. […] A variety of oral pharmacotherapies have been studied for DO/AO, however as noted above most of the evidence is derived from small cohorts with incomplete characterization of other confounding factors. […] The specific treatment should be individualized and guided by an informed patient-provider discussion regarding outcomes and adverse effects.
#1 Disorders of Ejaculation: An AUA/SMSNA Guideline (2020) – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/disorders-of-ejaculation
Clinicians should consider referring men diagnosed with lifelong or acquired delayed ejaculation to a mental health professional with expertise in sexual health. (Expert Opinion) […] Clinicians should advise men with delayed ejaculation that modifying sexual positions or practices to increase arousal may be of benefit. (Expert Opinion) […] Clinicians should suggest replacement, dose adjustment, or staged cessation of medications that may contribute to delayed ejaculation. (Clinical Principle) […] Clinicians should inform patients that there is insufficient evidence to assess the risk-benefit ratio of oral pharmacotherapy for the management of delayed ejaculation. (Expert Opinion) […] Clinicians may offer treatment to normalize serum testosterone levels in patients with delayed ejaculation and testosterone deficiency. (Expert Opinion)
#1 Delayed Ejaculation | San Diego,CA
https://www.sdsm.info/male-issues/delayed-ejaculation
An orgasm is a pleasurable feeling (a cerebral event) usually associated with emission and/or ejaculation. In delayed ejaculation, there is an undue delay in reaching ejaculation during sexual activity. Delayed ejaculation is a particularly troublesome sexual problem. The true prevalence of this ejaculatory disorder is not well studied. […] The diagnosis of an ejaculatory problem is established by history. Physical examination in patients with complaints of delayed ejaculation may reveal diminished penile sensation. Blood testing is indicated in men with ejaculation disorders to measure the calculated free testosterone level. In addition, diminished sensation is associated with thyroid disorders, for which TSH should be measured. Neurologic testing such as biothesiometry is strongly recommended to objectively assess the integrity of the dorsal nerve. There are also validated questionnaires that may be completed for assessment of ejaculatory disorders.
#1 Delayed ejaculation – treatment, causes and diagnosis | healthdirect
https://www.healthdirect.gov.au/delayed-ejaculation
Delayed ejaculation is when you have trouble reaching orgasm and ejaculating. […] Treatment depends on the cause. […] You should talk to your doctor if you have delayed ejaculation and it is bothering you. […] Your doctor will ask about your symptoms and sexual history. They may do a physical examination. […] Your doctor may also recommend tests for some people, including: blood tests, urine tests, an ultrasound scan. […] You should talk to your doctor if you have delayed ejaculation and it is bothering you. […] Your doctor can: provide reassurance, assess you to identify the cause, recommend treatments. […] The treatment for delayed ejaculation depends on the cause. […] Your doctor will be able to give specific advice and treatment options. […] Delayed ejaculation might make it more difficult to conceive a baby. […] Talk with your doctor if you are worried about the effects of delayed ejaculation.
#1 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research
https://www.nature.com/articles/s41443-023-00692-7
Some more invasive non-pharmacological therapies have been explored including intracavernosal injections of platelet rich plasma, pudendal nerves release, and surgical procedures. […] Given the lack of validated studies demonstrating their effectiveness and significant risks that come with invasive procedures, these interventions are not currently recommended as forms of treatment for DO/AO. […] Future directions include developing a universal definition of DO and AO as well as a standardized pathway to achieve objective evaluation and diagnosis.
#1 Delayed Ejaculation
https://labs.la.utexas.edu/mestonlab/male-orgasmic-disorder/
Delayed ejaculation (DE) is defined in DSM-5 as a persistent difficulty or inability to achieve orgasm despite the presence of adequate desire, arousal, and stimulation. In order to be diagnosed with the disorder, patients must present with one of two symptoms: either a delay in or an infrequency of ejaculation on 75-100% of occasions for at least six months. […] It is important to note that men who are experiencing retrograde ejaculation do not meet the diagnostic criteria for DE. […] A delay in ejaculation suggests that there are normative amounts of time in which ejaculation typically occurs. […] Though these values are illuminating from a research perspective, it is noteworthy that the DSM-5 does not include any objective measures of latency in the diagnostic criteria of the disorder, which makes it challenging to determine prevalence rates.
#1 Identifying and Diagnosing Delayed Ejaculation – ISSM
https://www.issm.info/sexual-health-headlines/identifying-and-diagnosing-delayed-ejaculation
Identifying and Diagnosing Delayed Ejaculation […] Delayed ejaculation (DE) is a condition in which it takes an individual an unusually long period of time to ejaculate during partnered sexual activity. Some people with DE may find that they are unable to ejaculate at all during partnered sexual activity. […] However, currently, there are several definitions of DE proposed by multiple professional and medical groups, which can make the process of identifying and diagnosing DE difficult. […] For example, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition defines DE as a marked delay in ejaculation or marked infrequency or absence of ejaculation present in 75% or more of partnered sexual encounters and persistent over at least the last 6 months (and the experience of) personal distress.
#1 Psychosexual therapy for delayed ejaculation based on the Sexual Tipping Point model – Perelman – Translational Andrology and Urology
https://tau.amegroups.org/article/view/11164/html
The Sexual Tipping Point (STP) model is an integrated approach to the etiology, diagnosis and treatment of men with delayed ejaculation (DE), including all subtypes manifesting ejaculatory delay or absence. Assessment requires a thorough sexual history including inquiry into masturbatory methods to ascertain the information needed for proper diagnosis and treatment. The clinicians most valuable diagnostic tool is a focused sex history (sex status). Differentiate DE from other sexual problems and review the conditions under which the man can ejaculate. Identify important DE causes by juxtaposing an awareness of his cognitions and the sexual stimulation experienced during masturbation, versus a partnered experience. A urologist will often conduct a genitourinary examination and medical history that may identify physical anomalies, as well as contributory neurologic and endocrinologic factors. While objective diagnostic procedures have scientific and research appeal, in clinical settings the diagnosis of DE is often subjective and imprecise. A sex status typically begins by differentiating DE from other sexual problems and reviewing the conditions under which the man can ejaculate. The evaluation of DE focuses on uncovering causes of the disorder.
#1 Description of and Relationships among Potential Variables Supported for the Diagnosis of Delayed Ejaculation
https://www.mdpi.com/2411-5118/4/1/5
The lack of empirically based diagnostic criteria for delayed ejaculation (DE) not only undermines confidence in the reported prevalence rates for this sexual dysfunction, but it has also resulted in a lack of validated patient reported outcomes (PROs) for assessing this condition. […] The current study was designed to describe and evaluate six face-valid variables previously shown to discriminate between men with and without DE for their utility as diagnostic measures for DE. […] Results indicated that five of the six proposed items showed moderate intercorrelations, suggesting that each constituted a distinct (i.e., non-redundant) though relevant criterion related to the diagnosis of DE. […] Based on the level of interrelatedness, the better items representing each construct were included in commonality analysis to assess their unique contributions to the diagnosis of DE.
#1 Identifying and Diagnosing Delayed Ejaculation – ISSM
https://www.issm.info/sexual-health-headlines/identifying-and-diagnosing-delayed-ejaculation
The authors suggest that the best way to diagnose DE is to begin with an individual’s self-assessment of their ability to ejaculate, then collect information on the percentage of times when they ejaculate during partnered sexual activity. According to the authors, ejaculation latency could be used as a supplemental measure when diagnosing DE, because it may be less accurate when it is used as the only measure.
#1 Delayed Ejaculation: Informed Diagnosis and Treatment — MAP Education & Research Foundation
http://www.mapedfund.org/blog/2019/4/8/delayed-ejaculation-informed-diagnosis-and-treatment
Men with DE find it difficult or impossible to ejaculate and/or experience orgasm. […] Diagnosis of DE requires distress about the symptom(s), adequate sexual stimulation, and a conscious desire to achieve orgasm. […] It is frequently useful for a physician (usually a urologist) to conduct a physical examination and medical history to help identify any Physical factors contributing to DE. […] A physician will know that any procedure or disease that disrupts the nervous systems path to the genitals (spinal cord injury, multiple sclerosis, pelvic-region surgery, severe diabetes, alcoholism, etc. — all have the potential to interfere with ejaculation and orgasm. […] DE is one of many ejaculation problems that can be confused with each other, and/or can occur together. […] Many physicians, for better and sometimes for worse, will begin treatment by rst prescribing pharmaceuticals, lubricants, and devices (e.g. vibrators).
#2 Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment – PubMed
https://pubmed.ncbi.nlm.nih.gov/29299903/
Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. […] There is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. […] Treatment should be cause-specific.
#2 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research
https://www.nature.com/articles/s41443-023-00692-7
Male orgasmic dysfunction can be dichotomized as two ends of a spectrum: premature ejaculation (PE) versus DO and anorgasmia (AO). […] In this review, we specifically focus on summarizing the current knowledge regarding the epidemiology, pathophysiology, diagnosis, and treatment of DO/AO. […] The AUA guidelines on disorders of ejaculation recognize that there are multiple terms to refer to delays in ejaculations and/or orgasm including DE and DO. […] The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) states that distressing difficulties with orgasm in men would be considered under delayed ejaculation, which is defined as a marked delay in ejaculation or a marked infrequency of absence of ejaculation on 75-100% of all occasions of partnered sexual activity without the individual desiring delay, persisting for at least 6 months, and causing significant distress to the individual.
#2 Identifying and Diagnosing Delayed Ejaculation – ISSM
https://www.issm.info/sexual-health-headlines/identifying-and-diagnosing-delayed-ejaculation
On the other hand, the Eleventh Revision of the International Classification of Diseases describes DE as the inability to achieve ejaculation or an excessive or increased latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate which has occurred episodically or persistently over at least several months and is associated with clinically significant distress. […] Lastly, the American Urological Association defines DE as consistent, bothersome inability to achieve ejaculation, or excessive (lifelong DE) or increased (acquired DE) latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. […] Given the general nature of these three definitions of DE, patients and health care providers alike might struggle to accurately identify and diagnose this condition.
#2 Is delayed ejaculation normal? | Nebraska Medicine Omaha, NE
https://www.nebraskamed.com/health/conditions-and-services/mens-health/is-delayed-ejaculation-normal
Providers divide delayed ejaculation into four distinct categories based on your symptoms: lifelong versus acquired and generalized versus situational. Lifelong delayed ejaculation means the issue has been present from the time of your sexual maturity. Conversely, acquired delayed ejaculation occurs after a period of typical sexual functioning. […] Generalized delayed ejaculation means your delay isnt limited to certain sex partners or kinds of arousal. In contrast, situational delayed ejaculation happens only under specific conditions. Regardless of which type of delayed ejaculation youre experiencing, Dr. Deibert and Nebraska Medicine treats them all. However, I see more men with the acquired or generalized-acquired delay, says Dr. Deibert. […] Note, regardless of the type of delayed ejaculation youre experiencing, its important to understand theres a little bit of a natural delay that occurs with aging. Its not uncommon for guys between 60 to 80 years old to take a lot longer or not be able to ejaculate or orgasm at all, says Dr. Deibert.
#2 Delayed Ejaculation: Informed Diagnosis and Treatment | Psychology Today
https://www.psychologytoday.com/us/blog/sexual-tipping-point/201812/delayed-ejaculation-informed-diagnosis-and-treatment
Many physicians, for better and sometimes for worse, will begin treatment by rst prescribing pharmaceuticals, lubricants, and devices (e.g. vibrators). Unfortunately, there are no FDA approved treatment for DE and the drugs that doctors typically use have only anecdotal (here and there reports) of success. […] The most important tool available to any healthcare professional for diagnosing any sexual disorder is a sex status exam. A sex status exam is not a lab test or a questionnaire. It is a detailed focused diagnostic interview that examines all aspects of current sexual functioning in combination with potentially relevant historical experiences. […] The difference between what a man experiences in coupled sex, versus self-stimulation, must be explored. […] In summary, high-frequency idiosyncratic masturbation, combined with fantasypartner disparity, often predispose men to experience problems with arousal and ejaculation. The MAP Education Research Foundations Sexual Tipping Point Model provides a useful framework for helping men (and their partners) understand the cause(s) of DE and how treatment will proceed. A sex therapist should be able to explain how the mental and physical erotic stimulation a man is receiving is insufficient for him to ejaculate in the manner he prefers, and how this can be changed to achieve the desired result. Of course, successful treatment will depend on a mans willingness to follow therapeutic recommendations, which will be influenced by the extent of organic/medical complications, relational issues, and potentially deeper patient/partner psychodynamic problems. When a safe and effective drug becomes available, a shift toward combining drug treatment and sex therapy when treating DE will occur, which has already happened for the treatment of ED. But as of right now, sex therapy is the preferred treatment for DE.
#2 Delayed ejaculation – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/diagnosis-treatment/drc-20371363
A physical exam and medical history might be all that are needed to suggest treatment for delayed ejaculation. But there might be a problem causing delayed ejaculation that needs treatment. Then you might need more tests, or you might need to see a specialist. […] Besides a physical exam of the penis and testicles, you might have: […] Blood tests. A blood sample sent to a lab can check for heart disease, diabetes, hormone levels and other health conditions. […] Urine tests, called urinalysis. Urine tests look for signs of diabetes, infection and other health conditions. […] For delayed ejaculation, some basic questions to ask include: […] What tests do I need? […] What treatments are there? Which one do you suggest for me? […] Your healthcare professional may ask: […] Are you able to ejaculate during sexual intercourse? Or are you able to ejaculate only when your partner directly touches your penis or when you masturbate? […] Have you had changes in sexual desire or any other sexual problems?
#2 Delayed Ejaculation: Informed Diagnosis and Treatment | Psychology Today
https://www.psychologytoday.com/us/blog/sexual-tipping-point/201812/delayed-ejaculation-informed-diagnosis-and-treatment
Men with DE find it difficult or impossible to ejaculate and/or experience orgasm. DE is a failure to ejaculate during masturbation and/or partner manual, oral, coital, or anal stimulation. Diagnosis of DE requires distress about the symptom(s), adequate sexual stimulation, and a conscious desire to achieve orgasm. […] It is frequently useful for a physician (usually a urologist) to conduct a physical examination and medical history to help identify any Physical factors contributing to DE. […] Additionally, DE is one of many ejaculation problems that can be confused with each other, and/or can occur together. The doctor will differentiate anejaculation (no cum), painful ejaculation, and retrograde ejaculation (during the climax, the semen goes in the wrong direction back into the bladder), decreased volume/force/sensation of ejaculation, and the very rare post-orgasmic illness syndrome. DE is distinct from erectile dysfunction (ED), the condition where a man is unable to attain or maintain an erection rigid enough for sexual activity). DE is also different from the normal refractory period, the length of time after an ejaculation during which men are physically incapable of having a repeat ejaculation. DE is also different from anorgasmia (inability to experience orgasm or sexual climax).
#2 Delayed Ejaculation: Informed Diagnosis and Treatment — MAP Education & Research Foundation
http://www.mapedfund.org/blog/2019/4/8/delayed-ejaculation-informed-diagnosis-and-treatment
The most important tool available to any healthcare professional for diagnosing any sexual disorder is a sex status exam. […] A description of current sexual attitudes and experiences will help rule out physical causes and help identify antecedents (early causes) and/or maintainers of any sexual problem including DE. […] The difference between what a man experiences in coupled sex, versus self-stimulation, must be explored. […] Research has that shown all the above information is critical to a successful resolution of DE. […] The goal is to identify all the relevant immediately acting factors that are associated with sexual experience and how those factors impact desire, arousal, and orgasm. […] Sex therapists have reported good success rates using cognitive-behavioral techniques.
#2 Delayed ejaculation – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/delayed-ejaculation/symptoms-causes/syc-20371358
Some medicines, certain ongoing health conditions and surgeries can cause delayed ejaculation. Other causes include substance misuse or a mental health concern, such as depression, anxiety or stress. Often, it’s due to a mix of physical and psychological concerns. […] The following can increase the risk of having delayed ejaculation: Older age. With aging, ejaculation takes longer. […] Complications of delayed ejaculation can include: Less sexual pleasure for you and your partner.
#2 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research
https://www.nature.com/articles/s41443-023-00692-7
The International Classification of Diseases (ICD)-11 defines DE as an inability to achieve ejaculation or an excessive or increased latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. […] For both DO and AO, these patterns of orgasmic dysfunction have occurred episodically or persistently over a period of at least several months and is associated with clinically significant distress. […] Initial evaluation of a patient presenting with DO involves a thorough history and physical examination. […] Critical components of the history intake include medical, surgical, psychiatric, sexual, social, and religious history. […] To date, no studies have identified an association between orgasmic dysfunction and recreational drug use, pornography use, or painful intercourse, but these still represent important components of the social history.
#2 :: WJMH :: World Journal of Men’s Health
https://wjmh.org/DOIx.php?id=10.5534/wjmh.17051
There are many approaches to treatment planning, including various psychological interventions, pharmacotherapy, and specific treatments for infertile men. No approved drug therapy exists. […] A number of approaches can be employed for infertile men, including collection of nocturnal emissions, vigorous prostatic massage, prostatic urethra catheterization, PVS, rectal probe EEJ, sperm retrieval from either the vas deferens or the epididymis, or testicular sperm extraction.
#2 Description of and Relationships among Potential Variables Supported for the Diagnosis of Delayed Ejaculation
https://www.mdpi.com/2411-5118/4/1/5
The relevance of these findings to developing a patient report outcome (PRO) for diagnosing DE that considers both empirically supported questions/items and an appropriate balance of items regarding the three constructs was discussed. […] Although various professional organizations have suggested definitions for DE, all have been based on expert opinion rather than empirical evidence. […] In general, proposed diagnostic criteria for DE have paralleled those for premature ejaculation (PE), which has included three constructs: (1) ejaculation that occurs shortly after the initiation of partnered sex; (2) a lack of ability to better modulate/control/delay the timing of ejaculation (a problem of âself-efficacyâ); and (3) negative effects (e.g., sexual bother/distress) resulting from the PE.
#2 Delayed Ejaculation in Adults
https://www.mindyra.com/solutions/adults/delayedejaculation
Delayed ejaculation is a psychiatric disorder that affects less than 1% of males. Delayed ejaculation is defined by a delay or absence of ejaculation in almost all or all occasions of partnered sexual activity. […] There are five factors that should be taken into consideration during the assessment and diagnosis of delayed ejaculation: Partners sexual history and health status, Relationship quality such as ability to effectively communicate or differences in sexual activity preference, Individual factors such as body image, history of physical or sexual abuse, psychiatric comorbidity, life stressors, Cultural and religious background such as rules and attitudes towards sexual activity and sexuality, Medical background and treatment. […] Delayed ejaculation is treatable. However, the disorder is under researched and under reported as it is the least common male sexual complaint. Clinical treatment recommendations for delayed ejaculation are outlined in the International Journal of Impotence Research. […] Clinical research suggests that the treatments should be selected based on the underlying etiology, and may include patient or couple psycho-education, psychosexual therapy, pharmacotherapy, or integrated treatment.
#3 Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers | International Journal of Impotence Research
https://www.nature.com/articles/s41443-023-00692-7
The International Classification of Diseases (ICD)-11 defines DE as an inability to achieve ejaculation or an excessive or increased latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. […] For both DO and AO, these patterns of orgasmic dysfunction have occurred episodically or persistently over a period of at least several months and is associated with clinically significant distress. […] Initial evaluation of a patient presenting with DO involves a thorough history and physical examination. […] Critical components of the history intake include medical, surgical, psychiatric, sexual, social, and religious history. […] To date, no studies have identified an association between orgasmic dysfunction and recreational drug use, pornography use, or painful intercourse, but these still represent important components of the social history.
#4 Identifying and Diagnosing Delayed Ejaculation – ISSM
https://www.issm.info/sexual-health-headlines/identifying-and-diagnosing-delayed-ejaculation
On the other hand, the Eleventh Revision of the International Classification of Diseases describes DE as the inability to achieve ejaculation or an excessive or increased latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate which has occurred episodically or persistently over at least several months and is associated with clinically significant distress. […] Lastly, the American Urological Association defines DE as consistent, bothersome inability to achieve ejaculation, or excessive (lifelong DE) or increased (acquired DE) latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. […] Given the general nature of these three definitions of DE, patients and health care providers alike might struggle to accurately identify and diagnose this condition.