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Suggestions For A Useful Definition Of Delayed Ejaculation |
Definition Of the ConditionUnder normal circumstances a man's orgasm coincides with the time of his ejaculation. However, they are in fact different events. Ejaculation is the release of semen. Orgasm is a subjective experience defined by perception of peak sexual pleasure. In men, the absence of ejaculation has become known as delayed ejaculation or retarded ejaculation, and sometimes "male orgasmic disorder". DSM IV, the widely-used "diagnostic and statistical manual", makes no distinction between orgasmic disorders and ejaculation disorders in men, although it does make include premature ejaculation in the latter category. This lack of accurate classification leads us to suppose that the two events involved in the male climax are at least overlapping if not simultaneous. Yet many researchers acknowledge that problems with orgasm and problems with ejaculation are quite different: for example, disorders in the latter category would include delayed ejaculation, retrograde ejaculation, and primary or complete anejaculation accompanied by orgasm. We certainly know that orgasm can occur without ejaculation - this is seen in adult males practicing certain Tantric sexual techniques. The diagnostic conditions for delayed ejaculation are as follows. They also serve as the basis of a definition. Please note that these conditions assume orgasm and ejaculation are more or less the same event, or at least occur simultaneously (which is a good enough assumption for most purposes):
Variations Of the Condition
It's important to emphasize that the definition requires there to be in a normal phase of sexual excitement, because the absence of orgasm may well be expected in other situations: for example, where there is no desire for sexual activity, or where there is aversion to any kind of sexual contact with a partner, or where there is a sexual aversion disorder, or even an erectile disorder. Men who have DE can usually achieve firm erections and engage in normal sexual activity with adequate penetration and can often [although not always] reach orgasm through masturbation or perhaps even oral sex. A typical case of DEThis would be a 30-year-old man presenting with the bald statement that "he cannot come" or some similar complaint. Most men in this category will have no prior psychiatric history, nor will they show any medical signs that might account for the lack of ejaculation (or difficulty in achieving it). A typical client presenting to a sexual psychotherapist with this condition - although few men do in fact seek treatment for it - would report little anxiety, good relationship with friends and family, a normal level of social adjustment and a lack of any other obvious psychological issues. But when one begins to investigate what's going on for these men one soon realizes that there is more in the relationship than might first meet the eye. A typical client presenting with difficulty ejaculating might refer to a new relationship that has only been in existence for a few months. It's possible that from the first time when the couple tried to engage in sexual activity, the man experienced this kind of orgasmic problem, and when questioned about the sex in which he and his partner were engaging he will often makes some telling observation such as: it was unusually vigorous or involved practices which he finds questionable or challenging or unacceptable in some way. An alternative scenario is that he may reveal issues about his relationship which suggest that there are fundamental aspects of the relationship that do not satisfy either the partners' emotional or psychological needs and are causing the man to have trouble ejaculating. Usually men with this condition will report no difficulty in achieving the firm erection, and maintaining it. Indeed they are likely to report long-lasting erections: often they will report that they pretend to reach orgasm so that their partner does not feel guilty or disappointed. Classically none of these issues surrounding DE would be discussed with anyone else, and possibly not even between the sexual partners. So what's going on here? If we examine the events that lead up to the normal climax of male sexual activity there are distinct stages that can be defined as erection, emission (the release of semen into the base of the penis), ejaculation, and orgasm. As we said before, these are separate events. To prove this, you need look no further than the fact that a typical client with delayed ejaculation can sustain a rigid erection for prolonged periods of time (or, indeed, no further than the fact that a man with complete erectile dysfunction may find it easy to ejaculate provided his penis is stimulated in the correct way for sufficient length of time). However a review by Simons and Carey of over 10 years' work suggested that male orgasmic disorder occurred in around 8% of the community, a figure which has been backed up by many other studies, although there some evidence suggests the rate may actually be higher than this, at around 10-12%. The international survey of sexual attitudes and behaviors, the GSSAB, which investigated all aspects of sexual behavior and attitudes, beliefs and outcomes among more than 27,000 men and women between 40 and 80 years of age suggested that the real level of delayed ejaculation in the population was 13%, however the definition of delayed ejaculation (DE) was imprecise and the figure may therefore include other conditions than DE. A lack of well controlled studies in this area is undoubtedly one of the reasons why there is an apparent wide variation in the reported level of DE in the population. It's probably best to take any epidemiological evidence as suggestive or informative rather than definitive at this time: certainly further research is needed to determine an accurate estimate of the de facto incidence of delayed ejaculation in men of various ages, race, country of residence and to determine how it varies with other social variables.
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