Delayed ejaculation: causes, treatment

The article is expertly consulted by MSc Vo Thien Ngon - Urologist, Vinmec Danang International General Hospital.

Delayed ejaculation is a phenomenon in which a man takes a long time of sexual stimulation to reach orgasm and then ejaculate. This is one of the forms of ejaculation disorder, although not as common as premature ejaculation, but also not uncommon.

Ejaculation in men is the end of intercourse with their partner. The time from the beginning of intercourse to the time of ejaculation is about 5 to 15 minutes. During that time, in order for a man to reach orgasm, the body needs to go through a complex series of different phenomena to ejaculate. In the final stage, it takes at least 3 consecutive phenomena for the male body to secrete semen, create pressure in the seminal vesicles, and then expel and ejaculate out.
Delayed ejaculation in men is when a man loses the ability to ejaculate according to their desire despite all the conditions such as sexual desire, sexual stimulation, and an erect penis.
Delayed ejaculation occurs in the case of intercourse with a partner and also in the case of masturbation. This type of ejaculation disorder results in a longer time to ejaculate, resulting in a man feeling tired but unable to ejaculate as he wants. In some cases of delayed ejaculation, a man may not be able to ejaculate despite reaching orgasm during intercourse or masturbation. Among the types of ejaculation disorders, delayed ejaculation accounts for 2-6%.

2.1 Psychological causes Psychological problems lead to delayed ejaculation such as:
Depression, anxiety, low self-esteem, inferiority complex; Worry about intercourse performance; Fear of pregnancy; Decreased sexual arousal due to insufficient stimulation by the partner; fear, or conflicts in your relationship with your partner; Customary or religious concerns; The difference between actual sex and imaginary sex images.

2.2 Physical causes The physical causes of delayed ejaculation are many, including:
Birth defects in the male reproductive system affecting the sexual intercourse; Damage to the nerves in the perineum area, so you can't control the feeling of orgasm; Infections such as urinary tract infections; Have undergone prostate surgery such as surgical removal of the prostate gland or prostatectomy; Diseases that cause nerve damage such as diabetes, stroke; Hormonal problems such as low thyroid hormone, low testosterone; Retrograde ejaculation, semen goes into the bladder but not out of the penis; Spinal cord injury; Large lymph node surgery; Drug use, alcoholism also contribute to delayed ejaculation; Due to the use of anti-adrenergic drugs, such as drugs for premature ejaculation in men, alpha-blockers, selective serotonin reuptake inhibitors, also have an effect on delayed ejaculation.

Signs and symptoms of delayed ejaculation include:
Men need about 30 minutes or more of sexual stimulation to achieve orgasm and ejaculate; May not be able to ejaculate; Fatigue, arousal, loss of erection during intercourse; Size and density of 2 testicles atrophied; Palpable vas deferens on both sides.

When treating delayed ejaculation, it is necessary to find out whether the cause of delayed ejaculation is psychological or physical, then there will be appropriate treatment.
4.1 Psychological treatment For the treatment of delayed ejaculation with psychology, the doctor must initially create an atmosphere of comfort and openness for the patient, but still be delicate, in order to build trust in the patient for the treatment. most effective. Psychotherapy is counseling, helping patients deal with health problems, psychosexuality, feelings of stress, anxiety in life and in sex life.
4.2 Drug treatment Using drugs to treat delayed ejaculation should follow the principle of increasing the process of adrenergic excitement. If you are taking a medication that delays ejaculation, reduce the dose or change the medication you are taking. Medicines for delayed ejaculation are usually those intended to treat other conditions including:
Amantadine for Parkinson's disease; Buspirone for sedation; Cyproheptadine treats allergies. 4.3 Other measures Some other measures are used to treat delayed ejaculation such as:
Blocking the cauda equina at the end of the vertebrae to adjust the balance between the sympathetic and parasympathetic nervous systems, and then acupuncture; Surgery by placing an impulse wave generator through the anus to stimulate the seminal vesicles to make ejaculation easier; Electrical stimulation or penile vibration, massage the prostate area. When there are symptoms of delayed ejaculation, men should not panic and worry, but go to a medical facility to find out about the cause of the disease, thereby having the most effective treatment for delayed ejaculation. Psychological problems have a lot to do with delayed ejaculation, so patients should not be too worried and stressed because it can make the condition worse.