Definition Of Delayed
Ejaculation
|
Just what is delayed ejaculation?Under 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 reference to premature ejaculation as an ejaculation disorder. This lack of accurate classification leads us to suppose that orgasm and ejaculation are at least overlapping if not simultaneous events. Yet many sex researchers acknowledge that disorders of orgasm and disorder of ejaculation are quite different: for example, disorders in the latter category would include delayed ejaculation, and retrograde ejaculation, ejaculatory insufficiency, and primary or complete anejaculation with the presence of an orgasm. We certainly know that orgasm can occur without ejaculation - this is seen in prepubescent children and adult males practicing certain Tantric sexual techniques. The diagnostic conditions for delayed ejaculation are as follows. 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):
There are variations of delayed ejaculation or retarded ejaculation. These are:
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 delayed ejaculation 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 delayed ejaculationThis 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 an ejaculation. 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 this condition 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 delayed ejaculation. 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 their delayed ejaculation issue would be discussed with anyone else, not even 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 male orgasmic disorder or 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 or delayed ejaculation 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 was imprecise and the figure may therefore include other conditions than delayed ejaculation. 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 delayed ejaculation 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. Psychological factors in delayed ejaculationPsychological factors may include a history of sexual trauma, guilt around sex, a fear of getting the partner pregnant, or hostility towards one woman or all women. These variables have all been associated with delayed ejaculation. Obviously any intervention aimed at curing delayed ejaculation has to address not only the historical aspects of the condition but also the current factors that may be responsible for a man's inability to come during sex. Among the current known factors that may cause delayed ejaculation we can include the following: Sexual performance anxiety This would be addressed by cognitive behavioral interventions aimed at reducing a man's overall level of anxiety; in addition there would also be merit in providing sexual education and information to overcome any inhibitions due to a lack of knowledge or misinformation; it's also helpful to use guided imagery in conjunction with some kind of sensate focusing technique to increase a man's confidence about his ability to complete the sexual act satisfactorily. Relationship issues Very often male orgasmic disorder or delayed ejaculation is the product of relationship issues; in such cases, some kind of sexual psychotherapy is indicated. Stress When stress is the result of factors other than those mentioned above, some kind of therapeutic intervention appropriate to the situation can both reduce anxiety and increase self-confidence. Environmental factors These are the things that are much more under the control of the patient than the therapist: they include, for example, a lack of privacy in which to enjoy intimate relations, lack of warmth, the presence of children, and so on. Historical factors Past sexual experiences which have led to negative beliefs or attitudes about sex (such as childhood sexual trauma, adult sexual trauma, or any other event which has led an individual to conclude that sex is a sin, or that his/her genitals are disgusting or dirty. Psychodynamic psychotherapy aimed at uncovering the original trauma behind delayed ejaculation can reduce current anxiety and guilt and provide a balance to misinformation which may be inhibiting adult sexual performance. It has been suggested that psychodynamic therapy is more appropriate when the trauma lies in the distant past, and relationship counseling is more appropriate where delayed ejaculation appears to be the product of the interaction between two individuals within a relationship. Unfortunately, little is known about the natural progression of delayed ejaculation when it is not treated, although one can speculate that situational and acquired forms of the condition may resolve more easily than generalized and lifelong types. Finally, it's worth mentioning that since the intensity of a man's ejaculation is directly related to the volume of semen that he produces, a reduction in the volume of ejaculate will result in a reduction in sexual pleasure. The significance of this observation is that ejaculation volume decreases with age, since it is testosterone dependent and plasma testosterone levels also fall as a man ages. Older men are therefore likely to experience less sexual pleasure than younger men at the moment of orgasm. Understanding orgasm and ejaculation - and more on the causes of delayed ejaculationWhat we call an orgasm is a peak human emotional and physical experience, whereas ejaculation, no matter how pleasant it may feel, is simply an unconscious reflex that is generated by the prolonged stimulation of nerves in the genital region. Some men have been able to recognize the individual elements of the two processes, enabling them to experience multiple orgasms without the occurrence of ejaculation. After a man has enjoyed an ejaculation, a period of time called the refractory period is required before he can ejaculate again. The same is not true of orgasms. The sensations of orgasm differ between individuals, and over time one person's orgasms are certainly not all the same...that much each of us knows form our own experience! But all orgasms include rhythmic body and pelvic contractions, a higher heart rate, increased muscle tension and a final phase of release of tension.
Our sexual responses are controlled by both
the sympathetic and the parasympathetic nervous systems. The sympathetic
nervous system causes action whereas the parasympathetic system causes
recovery and relaxation. In order for a penis to become erect, its smooth
muscle fibers are relaxed and allow blood to flow into the penis. This
process is mediated by an intricate system of humoral, neurological and
circulatory events controlled by the parasympathetic nervous system.
Orgasm and the associated ejaculation, and the consequent relaxation and
release of sexual arousal are mostly controlled by the sympathetic nervous
system. The cause of delayed ejaculation may be physical, but is more often psychological.
The physical causes include hormonal
problems such as hypogonadism, hyperthyroidism, hypothyroidism, and
excessive production of the hormone prolactin. Other physical causes
include some drugs, including drugs to treat high blood pressure, and
antidepressants. Delayed ejaculation occurs in men of all races and sexual orientations. It may develop around puberty or it may start later in life. Physiological etiology of retarded ejaculationHaving said all of that, it is certainly true that we should not overlook the physiological conditions which are capable of inhibiting a man's orgasmic response. Endocrinologists report that excessive prolactin levels can interfere with orgasm, so that the presence of a pituitary disorder may need to be considered. Similarly, neurological diseases, especially those which have an impact on the peripheral sensory nervous system, or which affect the functioning of the sympathetic nervous system, or any injury to the spinal-cord, can certainly affect a man's ability to ejaculate. It's actually possible for man to lose the ability to reach orgasm and ejaculate even though he can maintain erectile function. The ejaculatory reflex appears to be more sensitive to disruptions that the erection reflex. Inhibition of orgasm and ejaculation can also be observed after surgery in some areas of the abdomen including procedures such as abdominoperitoneal or anterior resection of the rectum, sympathectomy, retroperitoneal lymphadenectomy, aortoiliac reconstruction, and surgery for bladder cancer. The common operation for benign prostate enlargement -- transurethral prostatectomy -- produces a slightly different condition known as retrograde ejaculation although orgasm itself proceeds normally. It is also known that any drug which has a sedating effect or inhibits sympathetic arousal, or raises serotonin levels in the brain, may markedly inhibit or even totally prevent orgasm and ejaculation. Interestingly enough, these agents include alcohol antidepressants, antihypertensives, antipsychotic, and antianxiety medications. In particular, men with low sex drive may require investigation of hormonal levels as well as potential problems with their sexual response cycle. This is especially true of men over the age of 50 who may be experiencing the male andropause, or declining testosterone levels with associated symptoms. In other cases, the best treatment is effective psychotherapy and counseling, involving both sexual psychotherapy and relationship therapy if this is necessary.
|