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Delayed Ejaculation

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DELAYED EJACULATION:

Delayed ejaculation is a particular troublesome sexual problem. The true prevalence of this ejaculatory disorder is not well studied. The diagnosis of an ejaculatory problem is established by history. Delayed ejaculation is common in men who have decreased feelings in their genitals, history of excessive alcohol use, symptoms of testosterone deficiency such as muscle weakness or depression, diabetes or take medications that are inhibitory to sexual activity such as selective serotonin reuptake inhibitors (SSRI’s). Delayed ejaculation is also a common problem of the aging male. Like premature ejaculation, the problem is manifested with the partner as well as the patient, as fatigue before sexual release is common

Physical examination in patients with complaints of delayed ejaculation may reveal diminished penile sensation. Blood testing is indicated in men with ejaculation disorders to measure the free testosterone level. In addition, diminished sensation is associated with thyroid disorders, for which TSH should be measured. Neurologic testing such as biothesiometry is strongly recommended to objectively assess the integrity of the dorsal nerve. There are also validated questionnaire that may be completed for assessment of ejaculatory disorders.

Since ejaculation requires sympathetic nerve activity, surgeries that interfere with sympathetic nerves, such as retroperitoneal lymph node dissection or surgeries involving aortic reconstruction can interfere with ejaculation. In younger men with this syndrome, the problem is expressed by difficulty with fertility.

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