Ejaculatory incompetence; Sex - delayed ejaculation; Retarded ejaculation
Most men experience a lag time between the ability to ejaculate consecutively, and this lag time varies among men. Age also affects the recovery time; younger men typically recover faster than older men though not necessarily universally so as great variation between individuals is present. During this refractory period it is somewhat difficult to attain another ejaculation. However, many men are able to enjoy sexual stimulation immediately after ejaculation and have fairly short refractory periods on the order of less than 15 or 20 minutes. This allows them to seamlessly continue sexual play from one ejaculation to another as afterplay and foreplay merge into one. Thus, a refractory period is not an unwelcome interruption for sexual activity or a period of "forced full rest" but often a perfect opportunity to turn attention productively to one's sexual partner.
Delayed ejaculation is a medical condition in which a male is unable to ejaculate, either during intercourse or with manual stimulation in the presence of a partner. Ejaculation is the action in which semen is release from the penis.
The most common causes for delayed ejaculation are psychological.
Common psychological causes include:
A strict religious background causing the person to view sex as sinful
Lack of attraction for a partner
Conditioning caused by unique or atypical masturbation patterns
Traumatic events (such as being discovered in masturbation or illicit sex, or learning one's partner is having an affair)
Some factors, such as anger toward the partner, may be involved.
Certain drugs (such as prozac, mellaril, and guanethidine)
Neurological disease such as strokes or nerve damage to the spinal cord or back
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Stimulation of the penis with a vibrator or other stimulatory device may determine if an underlying physical (often neurological) problem exists. A neurological examination may uncover other nerve problems associated with delayed ejaculation.
If the man has never ejaculated through any form of stimulation (such as wet dreams, masturbation, or intercourse), a urologist should be consulted to determine if there is a congenital or physical cause.
If, however, he is able to ejaculate in a reasonable period of time by some form of stimulation, he should seek sex therapy from a therapist specializing in ejaculatory problems. Treatment usually includes both partners. The therapist will usually educate the couple about the fundamentals of sexual response and how to communicate and guide the partner to provide ideal stimulation, rather than trying to make a sexual response occur.
Therapy commonly involves a series of homework assignments wherein the couple, in the privacy of their home, engage in sexual activities that reduce performance pressure and focus on pleasure.
Typically, sexual intercourse will be prohibited for a limited period of time, while the couple gradually enhances their ability to enjoy ejaculation through other types of stimulation.
In cases where there is a problematic relationship or an inhibition of sexual desire between the couple, therapy to enhance the relationship and emotional intimacy may be required as a preliminary step.
Sometimes hypnosis may be a useful adjunct to therapy, particularly if a partner is not willing to participate in therapy. Self-treatment of this problem will probably be unsuccessful in most cases.
If a medication is believed to be the cause of the problem, other medication options may be discussed. (Never stop taking any medicine without first talking to your doctor.) This may be difficult in certain instances, especially when the medication is working appropriately to solve a pre-existing medical or psychological problem.
Outpatient treatment commonly requires about 12 - 18 sessions with an average success rate in the range of 70 - 80%.
A more positive outcome is associated with having a previous history of satisfying sexual experiences, a short duration of the problem, feelings of sexual desire, feelings of love toward one's sexual partner, motivation for treatment, and absence of serious psychological problems.
If medications are causing the problem, your health care provider may recommond switching or stopping the medicine (if possible). A full recovery is possible if this can be done.
Marital stress, sexual dissatisfaction, inhibited sexual desire, and avoidance of sexual contact may result if the problem is not addressed and remedied.
Healthy attitudes toward sexuality and one's own genitals helps prevent delayed ejaculation. It is also vitally important to realize that you cannot will a sexual response, just as you cannot will yourself to go to sleep or to perspire. The harder one tries to have a certain sexual response, the more it becomes inhibited.
To minimize the pressure, a man should absorb himself in the pleasure of the moment, without worrying about whether or when he will ejaculate. The partner should create a relaxed atmosphere, free of pressure, rather than create pressure with questions about whether or not ejaculation has occurred. Finally, any fears or anxieties, such as fear of pregnancy or disease, should be openly discussed.
There are wide variations in how long sexual stimulation can last before ejaculation occurs.
When a man ejaculates before he wants to it is called premature ejaculation. If a man is unable to ejaculate in a timely manner after prolonged sexual stimulation, in spite of his desire to do so, it is called delayed ejaculation or anorgasmia. An orgasm that is not accompanied by ejaculation is known as a dry orgasm.
The health benefits of ejaculation or the detriments of abstaining from ejaculation are not clearly elucidated. No detrimental effects of ejaculation have been determined and such are extremely unlikely to exist from an evolutionary perspective. No such thing as too frequent ejaculation is recognized medically and one cannot ejaculate "too much" or "too frequently". This must be differentiated from sex addiction which is an unhealthy harmful behavior present in either men or women, that may or may not involve ejaculation. Sexual addiction acts and behaviors can be performed without orgasm or ejaculation. Up to date, there has only been one study showing an association between ejaculation and health, specifically, prostate cancer. More frequent ejaculation was associated with lower rates of prostate cancer and lower rates of ejaculation were associated with higher rates of prostate cancer. A causative relationship between ejaculation and prostate cancer is extremely difficult to demonstrate despite multiple available plausible biologic explanations. It must be remembered that these explanations, most involving inflammatory markers, are only theoretical and hypothetical and simply help in our understanding of how things might work and are part of the scientific models we ascribe to these biological phenomena. No direct experimental evidence is currently available to link ejaculation to disease. The molecular and cellular experiments demonstrating causative links between inflammation and carcinogenesis only apply to the experimental conditions themselves and cannot yet be plausibly extended to whole organisms. Medical recommendations about altering ejaculatory frequency can not be currently made with sufficient scientific rigor and in practice are unlike to be carried out anyways.