Delayed Ejaculation: Causes and Solutions

Inability to ejaculate?

There could be several reasons for delayed ejaculation during sexual intercourse.
It might be related to psychological factors such as anxiety, stress, or performance pressure.
Physical factors, including hormonal imbalances, certain medications, or underlying health conditions, can also contribute.
It's important to consult a healthcare professional for a thorough evaluation and personalized advice.

Ying, 20~29 year old female. Ask Date: 2001/12/19

Dr. Pan Zhenqin reply Urology

Men do not experience pleasure without ejaculation.
The majority of men with delayed ejaculation are not completely unable to ejaculate; rather, they can achieve ejaculation under specific circumstances.
The most common scenario is that men can reach orgasm and ejaculation through masturbation or oral/hand stimulation by a partner, but they are unable to ejaculate during vaginal intercourse.
Patients with delayed ejaculation often experience anxiety related to sexual performance; the more they focus on the need to ejaculate, the more difficult it becomes.
Essentially, delayed ejaculation is a psychological issue.

The principle of treating delayed ejaculation is to alleviate anxiety related to sexual techniques and ensure that the body receives adequate stimulation.
Partners can be taught to stimulate the male's penis with their hands or mouth until an erection is achieved, then stop stimulation just before ejaculation to reduce the anxiety associated with sexual performance.
Once it is confirmed that orgasm can be achieved through manual or oral stimulation, vaginal intercourse can be attempted.

Reply Date: 2001/12/19

More Info

Delayed ejaculation (DE) is a condition where a man has difficulty achieving ejaculation during sexual intercourse, despite adequate sexual stimulation. This can be a frustrating experience for both partners and can stem from a variety of causes, including psychological, physiological, and relational factors.

Causes of Delayed Ejaculation
1. Psychological Factors: Anxiety, stress, and depression can significantly impact sexual performance. Performance anxiety, in particular, can create a cycle of fear and tension that makes it difficult to ejaculate. Past traumatic sexual experiences or negative associations with sex can also contribute to DE.

2. Medical Conditions: Certain medical conditions, such as diabetes, multiple sclerosis, or hormonal imbalances, can affect nerve function and blood flow, leading to difficulties with ejaculation. Additionally, medications for depression, anxiety, or high blood pressure can have side effects that include delayed ejaculation.

3. Substance Use: Alcohol and recreational drugs can impair sexual function. While alcohol may initially lower inhibitions, excessive consumption can lead to difficulties in achieving ejaculation.

4. Relationship Issues: Emotional intimacy and communication between partners play a crucial role in sexual satisfaction. If there are unresolved conflicts or lack of connection, it may affect sexual performance.

5. Age: As men age, changes in hormone levels and sexual function can lead to DE. It is not uncommon for older men to experience changes in their sexual response.

Solutions and Management Strategies
1. Open Communication: Discussing the issue with your partner can help alleviate anxiety and create a supportive environment. Understanding each other's needs and concerns can enhance intimacy and reduce pressure.

2. Consult a Healthcare Professional: If DE persists, it is advisable to consult a healthcare provider. They can help identify any underlying medical conditions or medication side effects that may be contributing to the problem. A urologist or a sexual health specialist can provide tailored advice and treatment options.

3. Therapy: Cognitive-behavioral therapy (CBT) or sex therapy can be beneficial in addressing psychological factors. A therapist can help you explore any underlying issues, develop coping strategies, and improve sexual confidence.

4. Medication Adjustments: If medications are contributing to DE, a healthcare provider may suggest alternatives or adjustments. It is essential not to stop or change medications without professional guidance.

5. Relaxation Techniques: Practicing relaxation techniques such as deep breathing, mindfulness, or yoga can help reduce anxiety and improve sexual performance. These techniques can help you feel more relaxed and present during intimate moments.

6. Focus on Foreplay: Engaging in extended foreplay can enhance arousal and intimacy, making it easier to achieve ejaculation. Experimenting with different forms of stimulation, including manual or oral stimulation, can also be beneficial.

7. Limit Alcohol and Substance Use: Reducing alcohol consumption and avoiding recreational drugs can improve sexual function. Being mindful of how these substances affect your body can lead to better sexual experiences.

8. Physical Health: Maintaining a healthy lifestyle through regular exercise, a balanced diet, and adequate sleep can improve overall well-being and sexual health. Addressing any chronic health issues, such as diabetes or hypertension, is also essential.

In conclusion, delayed ejaculation can be a complex issue with various contributing factors. Understanding the underlying causes and exploring solutions with your partner and healthcare professionals can lead to improved sexual satisfaction and intimacy. Remember, it is essential to approach this topic with patience and openness, as finding the right solution may take time.

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