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Delayed Ejaculation (DE), Anejaculation, and Anorgasmia
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Delayed (DE), retarded ejaculation (RE), or inhibited
ejaculation (IE) are probably the least common, least
studied, and least understood of the male sexual
dysfunctions.
Problems with “difficulty” in ejaculating may range from
varying delays in the latency to ejaculation to complete
inability to ejaculate (anejaculation). Reductions in the
volume, force, and sensation of ejaculation may occur as
well. At the extremes are anejaculation (time) and
retrograde ejaculation (direction).
The prevalence of ejaculatory disorders is unclear.
A number of pathophysiologies have been associated
with ejaculatory problems. These include congenital
disorders, as well as ones caused by trauma, infection,
disease, and treatment for other disorders.
Traumatic damage may result from prostate surgery.
Various cancers in the pelvic region, as well as their
treatment (surgical or radiotherapy), may interfere with
normal ejaculatory function. Finally, spinal injury and
other neurological disorders are prime candidates for
ejaculatory dysfunction.
In summary, delayed or absent ejaculation can be a
lifelong or an acquired problem. Many psychodynamic
explanations have been offered for DE, and these may
account for the problem in specific individual cases.
Treatment should be etiology specific and address the
issue of infertility in men of a reproductive age.
Before considering a psychological/behavioral approach
toward the treatment of DE, clinicians first need to
exclude probable iatrogenic and pathophysiological
causes.
It is also important to establish whether ejaculation is
retrograde or absent, with the presence of spermatozoa
in urine indicating retrograde ejaculation.
Culture of expressed prostatic secretion and urine will
define the nature of an infective process such as
prostatitis and urine cytology, and serum prostate
specific antigen should be assayed to exclude bladder or
prostatic cancer. Ultrasound scan of the testicles and
epididymes may define any local disease.
Patients with ejaculatory duct obstruction usually
present with infertility. Seminal analysis may simply be
reported as showing azoospermia or oligozoospermia.
The man who presents with DE for whom organic and
pharmacologic causes have been eliminated requires
thorough psychosexual assessment. His partner and the
quality of the relationship also warrant exploration.
Numerous psychotherapeutic processes are described
for the management of delayed or inhibited ejaculation
and some appear to be effective sex education reduction
of goalfocused anxiety; increased, more
genitally-focused stimulation; patient roleplaying an
exaggerated ejaculatory response on his own and in
front of his partner; masturbatory retraining; and
realignment of sexual fantasies and arousal strategies.
Treatment of delayed or inhibited ejaculation with
pharmaceuticals has met with limited success.