View source for Delayed ejaculation

{{Short description|Male inability or persistent difficulty in achieving orgasm}}
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'''Delayed ejaculation''' ('''DE''') is a man's inability or persistent difficulty in achieving [[orgasm]], despite typical [[sexual desire]] and [[sexual stimulation]]. Generally, a man can reach orgasm within a few minutes of active thrusting during [[sexual intercourse]], whereas a man with delayed ejaculation either does not have orgasms at all or cannot have an orgasm until after prolonged intercourse which might last for 22 minutes or more.<ref>https://www.smsna.org/patients/did-you-know/how-long-does-it-take-the-average-man-to-ejaculate</ref><ref>{{cite encyclopedia |last=Knowles |first=David R. |encyclopedia=A.D.A.M. Medical Encyclopedia |title=Delayed ejaculation |url=https://www.nlm.nih.gov/medlineplus/ency/article/001954.htm |access-date=2007-05-24 |date=2005-06-01 |publisher=A.D.A.M., Inc.}}</ref> Delayed ejaculation is closely related to [[anorgasmia]].

In the ''[[DSM-5|Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition]]'', the definition of DE requires 1 of 2 symptoms: either a marked delay in or a marked infrequency or absence of ejaculation on 75% to 100% of occasions for at least 6 months of partnered sexual activity without the individual desiring delay, and causing significant distress to the individual. DE is meant to describe any and all of the ejaculatory disorders that result in a delay or absence of ejaculation. The Third International Consultation on Sexual Medicine defined DE as an [[intravaginal ejaculation latency time]] threshold beyond 20 to 25
minutes of sexual activity, as well as negative personal consequences such as bother or distress. Of note, most men's intravaginal ejaculation latency time range is approximately 4 to 10 minutes. While ejaculatory latency and control were significant criteria to differentiate men with DE from those without ejaculatory disorders, bother/distress did not emerge as a significant factor.<ref>{{cite journal |vauthors=Rowland DL, Cote-Leger P |title=Moving Toward Empirically Based Standardization in the Diagnosis of Delayed Ejaculation |journal=J Sex Med |volume=17 |issue=10 |pages=1896–1902 |date=October 2020 |pmid=32828700 |doi=10.1016/j.jsxm.2020.07.017 }}</ref>

Delayed ejaculation is the least common of the male sexual dysfunctions, and can result as a side effect of some medications. In one survey, 8% of men reported being unable to achieve orgasm over a two-month period or longer in the previous year.<ref name = Oxford2009>{{cite book |last=Strassberg |first=D.S. |last2=Perelman |first2=M.A. |chapter=Part III Other Axis I Syndromes 15. Sexual Dysfunctions |chapter-url={{GBurl|5bAPxqDyFxUC|p=399}} |editor-first=P.H. |editor-last=Blaney |editor2-first=T. |editor2-last=Millon |title=Oxford textbook of psychopathology |publisher=Oxford University Press |edition=2nd |date=2009 |isbn=978-0-19-970582-5 |pages=399–430 }}</ref> DEs are either primary and lifelong or acquired. Acquired DEs may be situational. While most men do experience occasional or short term delayed ejaculation issues, the prevalence of lifelong DE and acquired long-term DE is estimated around 1% and 4%, respectively.<ref>{{cite journal |vauthors=Di Sante S, Mollaioli D, Gravina GL, Ciocca G, Limoncin E, Carosa E, Lenzi A, Jannini EA |title=Epidemiology of delayed ejaculation |journal=Transl Androl Urol |volume=5 |issue=4 |pages=541–8 |date=August 2016 |pmid=27652226 |pmc=5002002 |doi=10.21037/tau.2016.05.10 |doi-access=free}}</ref>

==Signs and symptoms==
Delayed ejaculation can be mild (men who still experience orgasm during intercourse, but only under certain conditions), moderate (cannot ejaculate during intercourse, but can during [[fellatio]] or a [[handjob]]), severe (can ejaculate only when alone), or most severe (cannot ejaculate at all).<ref name = Oxford2009/> All forms may result in a sense of [[sexual frustration]].<ref>{{cite journal |vauthors=Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, Vardi Y, Wespes E |title=Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation |journal=Eur Urol |volume=57 |issue=5 |pages=804–14 |date=May 2010 |pmid=20189712 |doi=10.1016/j.eururo.2010.02.020 }}</ref> In most cases, delayed ejaculation presents the condition in which the man can climax and ejaculate only during [[masturbation]], but not during sexual intercourse. As of 2015, the ''DSM-V'' uses the term "delayed ejaculation" instead of older terms such as "inhibited ejaculation", "impotent ejaculation" or "retarded ejaculation".<ref>{{harvnb|Wincze|Weisberg|2015|p=39}}</ref> To determine what amount of time counts as delayed, one source uses a measurement of the mean time for a man to achieve ejaculation in a study of 500 couples having heterosexual vaginal intercourse, which was 8 minutes (with a [[standard deviation]] of 7.1 minutes).<ref>{{harvnb|Wincze|Weisberg|2015|p=40}}</ref> Due to men's reputation for being reliably able to ejaculate during sex, in cases where a man faces delayed ejaculation, the woman may perceive that it is due to her not being attractive or due to a fault in her sexual techniques.<ref>{{harvnb|Strassberg|Mackaronis|Perelman|2014|p=444}}</ref>

==Causes==
The etiologies of delayed ejaculation can be age-related, organic, psychological, or pharmacological.<ref>{{cite journal |vauthors=Abdel-Hamid IA, Ali OI |title=Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment |journal=World J Mens Health |volume=36 |issue=1 |pages=22–40 |date=January 2018 |pmid=29299903 |pmc=5756804 |doi=10.5534/wjmh.17051 }}</ref>

Primary lifelong DEs are poorly understood and rarely explained by few congenital anatomic causes (viz., [[Müllerian duct]] cyst, [[Mesonephric duct|Wolffian duct]] abnormalities, [[prune belly syndrome]], [[imperforate anus]], congenital [[ejaculatory duct]] obstruction, genetic abnormalities including [[cystic fibrosis]], etc.)

*Anatomic causes (acquired ejaculatory duct obstruction)
*Infective/Inflammation (residual damage from acute infections, chronic infections, urethritis, prostatitis, orchitis, genitourinary tuberculosis, schistosomiasis, lichen sclerosis, etc.)
*Neurogenic causes (diabetic autonomic neuropathy, spinal cord or nerve root injury from trauma or disc prolapse, [[multiple sclerosis]], etc.). DE can be due to the injury to pelvic nerves responsible for orgasm from [[Physical trauma|trauma]] as a result of [[pelvic]] [[surgery]] (viz., [[prostate]] surgery including  transurethral resection of prostate and bladder neck incision, [[proctocolectomy]], bilateral sympathectomy, abdominal aortic aneurysmectomy, para-aortic lymphadenectomy etc.). Some men report a lack of sensation in the nerves of the [[glans penis]], which may or may not be related to external factors, including a history of [[circumcision]].<ref>{{cite journal |vauthors=Dias J, Freitas R, Amorim R, Espiridião P, Xambre L, Ferraz L |title=Adult circumcision and male sexual health: a retrospective analysis |journal=Andrologia |volume=46 |issue=5 |pages=459–64 |date=June 2014 |pmid=23600924 |doi=10.1111/and.12101 }}</ref>
*Some researchers believe that circumcision has a negative effect on men's ejaculation during sex, while others believe that circumcision has no effect.<ref>{{Cite journal |last1=Bañuelos Marco |first1=Beatriz |last2=García Heil |first2=Jessica Leigh |date= 2021|title=Circumcision in childhood and male sexual function: a blessing or a curse? |journal=International Journal of Impotence Research |language=en |volume=33 |issue=2 |pages=139–148 |doi=10.1038/s41443-020-00354-y |pmid=32994555 |pmc=7985026 }}</ref><ref>{{Cite journal |last1=Gao |first1=Jingjing |last2=Xu |first2=Chuan |last3=Zhang |first3=Xiansheng |date= 2016|title=AB221. Effects of adult male circumcision on premature ejaculation: results from a prospective study in China |journal=Translational Andrology and Urology |language=en |volume=5 |issue=Suppl 1 |pages=221 |doi=10.21037/tau.2016.s221 |doi-access=free |pmc=4842720 |issn=2223-4691}}</ref><ref>{{Cite journal |last=Kim |first=Hyuncheol |date=2016-06-08 |title=Long-term Effects of Male Circumcision on Risky Sexual Behaviors and STD Infections: Evidence from Malawian Secondary Schools |url=http://dx.doi.org/10.1257/rct.1335-1.0 |access-date=2024-01-06 |website=AEA Randomized Controlled Trials|doi=10.1257/rct.1335-1.0 |url-access=subscription }}</ref><ref>{{Citation |last1=Warees |first1=Warees M. |title=Circumcision |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK535436/ |work=StatPearls |access-date=2024-01-06 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30571057 |last2=Anand |first2=Sachit |last3=Rodriguez |first3=Alexander M.}}</ref> Those who believe in the negative effects of circumcision, such as a reduction of sexual sensitivity in the penis, claim that the part of the penis that is removed during circumcision is one of the most important and sensitive parts involved in receiving sexual pleasure, and that after its removal, sexual pleasure decreases.<ref>{{cite journal |vauthors=Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS |title=Fine-touch pressure thresholds in the adult penis |journal=BJU Int |volume=99 |issue=4 |pages=864–9 |date=April 2007 |pmid=17378847 |doi=10.1111/j.1464-410X.2006.06685.x }}</ref><ref>{{Cite journal |title=Collins, S., Upshaw, J., Rutchik, S. O., C., Ortenberg, J., & Albertsen, P. (2002). Effects of circumcision on male sexual function: Debunking a myth? J Urol, 167, 2111-2112. |url=https://pubmed.ncbi.nlm.nih.gov/11956452/ |journal=J Urol|date=2002 |pmid=11956452 |last1=Collins |first1=S. |last2=Upshaw |first2=J. |last3=Rutchik |first3=S. |last4=Ohannessian |first4=C. |last5=Ortenberg |first5=J. |last6=Albertsen |first6=P. |volume=167 |issue=5 |pages=2111–2 |doi=10.1016/S0022-5347(05)65097-5 }}</ref><ref>{{Cite journal |title=Coursey, J. W., Morey, A. F., McAninch, J. W., Summerton, D. J., Secrest, C.,White, P., et al. (2001). Erectile function after anterior urethroplasty. J Urol, 166 (6), 2273-2276. |url=https://pubmed.ncbi.nlm.nih.gov/11696750/ |journal=J Urol|date=2001 |pmid=11696750 |last1=Coursey |first1=J. W. |last2=Morey |first2=A. F. |last3=McAninch |first3=J. W. |last4=Summerton |first4=D. J. |last5=Secrest |first5=C. |last6=White |first6=P. |last7=Miller |first7=K. |last8=Pieczonka |first8=C. |last9=Hochberg |first9=D. |last10=Armenakas |first10=N. |volume=166 |issue=6 |pages=2273–6 |doi=10.1016/S0022-5347(05)65549-8 }}</ref><ref>{{Cite book |title=Ahmady, Kameel Et al 2023: Blade of Tradition in the Name of Religion (A Phenomenological Investigation into Male Circumcision in Iran), Scholar's Press Publishing, Republic of Moldova. |author-link=Kameel Ahmady}}</ref> However, researchers who argue against the negative effects of circumcision on men's sexual pleasure, citing the research and conclusions of international medical bodies such as the [[World Health Organization]] and important academic centers, state that circumcision does not have a noticeable effect on the sensitivity of the penis.<ref>{{Cite journal |last1=Ongun |first1=Sakir |last2=Dursun |first2=Murat |last3=Egriboyun |first3=Sedat |date= 2020|title=The effect of post-circumcision mucosal cuff length on premature ejaculation |journal=Canadian Urological Association Journal |volume=14 |issue=7 |pages=E309–E312 |doi=10.5489/cuaj.6016 |issn=1911-6470 |pmc=7337711 |pmid=32017696}}</ref><ref>{{Cite journal |last1=Gao |first1=Jingjing |last2=Xu |first2=Chuan |last3=Zhang |first3=Jingjing |last4=Liang |first4=Chaozhao |last5=Su |first5=Puyu |last6=Peng |first6=Zhen |last7=Shi |first7=Kai |last8=Tang |first8=Dongdong |last9=Gao |first9=Pan |last10=Lu |first10=Zhaoxiang |last11=Liu |first11=Jishuang |last12=Xia |first12=Lei |last13=Yang |first13=Jiajia |last14=Hao |first14=Zongyao |last15=Zhou |first15=Jun |date=2015-01-28 |title=Effects of Adult Male Circumcision on Premature Ejaculation: Results from a Prospective Study in China |journal=BioMed Research International |language=en |volume=2015 |pages=e417846 |doi=10.1155/2015/417846 |doi-access=free |pmid=25695078 |pmc=4324807 |issn=2314-6133}}</ref><ref>{{Cite journal |last1=Namavar |first1=Mohammad Reza |last2=Robati |first2=Boroomand |date=2011 |title=Removal of foreskin remnants in circumcised adults for treatment of premature ejaculation |journal=Urology Annals |volume=3 |issue=2 |pages=87–92 |doi=10.4103/0974-7796.82175 |doi-access=free |issn=0974-7796 |pmc=3130485 |pmid=21747599}}</ref><ref>{{Cite web |title=Circumcision and Sexual Medicine |url=https://academic.oup.com/smr/article-abstract/11/4/412/7135857?redirectedFrom=fulltext |access-date=2024-01-06 |journal=Sexual Medicine Reviews| date=October 2023 | volume=11 | issue=4 | pages=412–420 | doi=10.1093/sxmrev/qead009 | last1=Bernaschina-Rivera | first1=Sebastián A. | last2=López-Chaim | first2=Alexandra I. | last3=Cordero-Pacheco | first3=José A. | last4=Fernández-Crespo | first4=Raúl | last5=Quesada-Olarte | first5=José | last6=Carrión | first6=Rafael | pmid=37085961 }}</ref>
*Endocrine ([[hypogonadism]], [[pituitary]] disorders such as [[hyperprolactinaemia]] and [[Cushing's disease]], [[thyroid]] disorders, etc.). Although low testosterone level had been considered a risk factor in the past, more recent studies have not confirmed any association between ejaculation times and serum testosterone levels.<ref>{{cite journal |vauthors=Morgentaler A, Polzer P, Althof S, Bolyakov A, Donatucci C, Ni X, Patel AB, Basaria S |title=Delayed Ejaculation and Associated Complaints: Relationship to Ejaculation Times and Serum Testosterone Levels |journal=J Sex Med |volume=14 |issue=9 |pages=1116–24 |date=September 2017 |pmid=28807505 |doi=10.1016/j.jsxm.2017.06.013 }}</ref><ref>{{cite journal |vauthors=Paduch DA, Polzer P, Morgentaler A, Althof S, Donatucci C, Ni X, Patel AB, Basaria S |title=Clinical and Demographic Correlates of Ejaculatory Dysfunctions Other Than Premature Ejaculation: A Prospective, Observational Study |journal=J Sex Med |volume=12 |issue=12 |pages=2276–86 |date=December 2015 |pmid=26511106 |doi=10.1111/jsm.13027 }}</ref>
*Delayed ejaculation is a possible [[adverse effect|side effect]] of [[alcohol (drug)|alcohol]]<ref name=Oxford2009/>  and certain [[medications]], including antipsychotics, antidepressants including [[SSRI|selective serotonin reuptake inhibitor]]s (SSRIs), [[opiates]] such as [[morphine]] or [[oxycodone]], many [[benzodiazepines]] such as [[Diazepam|Valium]] or [[Alprazolam|Xanax]], and certain [[antihypertensives]] including thiazide diuretics, alpha-adrenergic blockers and ganglion blockers.<ref>[https://www.drugs.com/enc/delayed-ejaculation.html drugs.com Delayed ejaculation] {{Webarchive|url=https://web.archive.org/web/20190220181300/https://www.drugs.com/enc/delayed-ejaculation.html |date=2019-02-20 }} Review Date: 6/5/2007. Reviewed By: Marc Greenstein, DO, Urologist, North Jersey Center for Urologic Care</ref><ref>{{cite journal | last = Smith | first = Shubulade | author2=Robin Murray |author3=Veronica O'Keane | title = Sexual dysfunction in patients taking conventional antipsychotic medication | journal = The British Journal of Psychiatry | volume = 181 | pages = 49–55 | year = 2002 | doi = 10.1192/bjp.181.1.49 | pmid = 12091263| doi-access = free }}</ref> Although they may increase sexual desire, [[stimulant]]s such as [[Substituted amphetamine|amphetamines]] and [[cocaine]] have an inhibitory effect on ejaculation, and can cause erectile dysfunction and reduced penile sensitivity via their [[Vasoconstriction|vasoconstrictive]] effects.<ref>{{Cite journal|doi=10.1177/2631831819849365|title=Sexual Dysfunction in Persons with Substance Use Disorders|year=2019|last1=Ghadigaonkar|first1=Deepak S.|last2=Murthy|first2=Pratima|journal=Journal of Psychosexual Health|volume=1|issue=2|pages=117–121|s2cid=196538029|doi-access=free}}</ref>
*Psychological (acute psychological distress, relationship distress, psychosexual skill deficit, disconnect between arousal and sexual situations, masturbation style and frequency, etc.) 
**Psychological and lifestyle factors have been discussed as potential contributors, including insufficient sleep, distraction due to worry, distraction from the environment, anxiety about pleasing their partner and anxiety about relationship problems.<ref>{{cite journal | last = Mann | first = Jay | title = Retarded ejaculation and treatment | journal = International Congress of Sexology | year = 1976}}</ref>
**Religious guilt over sex can cause delayed ejaculation.<ref name=Wincze15p42>{{harvnb|Wincze|Weisberg|2015|p=42}}</ref>
**"Spectatoring", the problem of perceiving sex as a performance rather than a mutual experience and process of pleasure "in the moment" can cause delayed ejaculation.<ref name=Wincze15p42/>
**Men who are solely aroused by [[sexual fetish]]es may be unable to ejaculate from regular intercourse.<ref name=Wincze15p42/>
**Idiosyncratic masturbation (also known as "idiosyncratic masturbatory style")<ref>{{cite journal |last1=Bronner |first1=Gila |last2=Ben-Zion |first2=Itzhak Z. |date=July 2014 |title=Unusual Masturbatory Practice as an Etiological Factor in the Diagnosis and Treatment of Sexual Dysfunction in Young Men |url=https://www.sciencedirect.com/science/article/abs/pii/S1743609515308109 |journal=The Journal of Sexual Medicine |volume=11 |issue=7 |pages=1798–1806 |doi=10.1111/jsm.12501 |pmid=24674621 |access-date=31 October 2024|url-access=subscription }}</ref> and lack of desire for stimuli are also proposed risk factors for DE.<ref>{{cite journal |vauthors=Althof SE |title=Psychological interventions for delayed ejaculation/orgasm |journal=Int J Impot Res |volume=24 |issue=4 |pages=131–6 |date=2012 |pmid=22378496 |doi=10.1038/ijir.2012.2 }}</ref> The word "idiosyncratic" means something that pertains to an individual. In this case, it means a person who has a way of masturbating that is unique (or out of the ordinary). Most men stroke their penis with their hand in a way that vaguely imitates the stimulation from intercourse. An idiosyncratic style is defined as a technique not easily duplicated by a partner utilizing their hand, mouth, anus, or vagina. In these patients, delayed ejaculation is adaptation to a certain masturbatory technique.<ref>{{cite journal | last = Sank | first = Lawrence | title = Traumatic masturbatory syndrome | journal = Journal of Sex & Marital Therapy | volume = 24 | issue = 1 | pages = 37–42 | year = 1998 | doi = 10.1080/00926239808414667| pmid = 9509379 }}</ref> In 1998, psychologist Lawrence Sank wrote about "traumatic masturbatory syndrome", when the sensations a man feels when masturbating may bear little resemblance to the sensations he experiences during intercourse. Factors such as pressure, angle and grip during masturbation can make for an experience so different from sex with a partner that the ability to ejaculate is reduced or eliminated. One in three men with DE report idiosyncratic masturbation. Also, high-frequency masturbation is associated with prolonged DE in penetrative sex with the partner accounting for another one third of the cases. Fantasy/partner disparity – that is to say, variant sexual fantasy during masturbation that was not incorporated into sex with their partner – accounted for one in five DEs.<ref>{{cite journal |vauthors=Perelman MA, Rowland DL |title=Retarded ejaculation |journal=World J Urol |volume=24 |issue=6 |pages=645–52 |date=December 2006 |pmid=17082938 |doi=10.1007/s00345-006-0127-6 }}</ref> According to the ''DSM-5-TR'', "Delayed ejaculation is associated with highly frequent masturbation, use of masturbation techniques not easily duplicated by a partner, and marked disparities between sexual fantasies during masturbation and the reality of sex with a partner."<ref name="American Psychiatric Association 2022 ch. 16">{{cite book | author=American Psychiatric Association | title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR(tm)) | publisher=American Psychiatric Association Publishing | series=G - Reference,Information and Interdisciplinary Subjects Series | year=2022 | isbn=978-0-89042-576-3 | url=https://books.google.com/books?id=PIGizgEACAAJ | chapter=Sexual Dysfunctions | page=479 }}</ref>
**[[:JA:膣内射精障害|Intravaginal ejaculation disorder]] is a peculiar Japanese case, but is very similar to "traumatic masturbatory syndrome", which is also mainly caused by intense masturbation.

==Diagnosis ==
Diagnosis and management of DE warrant one of the most comprehensive medical evaluation in sexual health assessment that includes a full medical and sexual history performed along with a detailed physical examination. Understanding the quality of the sexual response cycle (desire, arousal, ejaculation, orgasm, and refractory period); details of the ejaculatory response, sensation, frequency, and sexual activity/techniques; cultural context and history of the disorder; partner's assessment of the disorder and if the partner has any sexual dysfunction themselves; and the overall satisfaction of the sexual relationship are all important to garner during history-taking.<ref>{{cite journal |vauthors=Rowland D, McMahon CG, Abdo C, Chen J, Jannini E, Waldinger MD, Ahn TY |title=Disorders of orgasm and ejaculation in men |journal=J Sex Med |volume=7 |issue=4 Pt 2 |pages=1668–86 |date=April 2010 |pmid=20388164 |doi=10.1111/j.1743-6109.2010.01782.x }}</ref>

Relatively normal latency to orgasm with self masturbation as compared to insertive or intravaginal ejaculation latency time reasonably rules out most of the organic causes of DEs.

==Treatment==
Primary, lifelong DEs are poorly understood and hence less well studied. Organic causes in the acquired DEs should be addressed promptly. Retraining masturbatory practices and re-calibrating the mismatch of sexual fantasies with arousal are essential when these are contributing to DE. Techniques geared towards reduction of anxiety are important skills that can help overcome performance anxiety, as this can often interrupt the natural erectile function through orgasmic progression.<ref>{{Cite web |title=INTRODUCTION - Uroweb |url=https://uroweb.org/guidelines/sexual-and-reproductive-health |access-date=2024-05-23 |website=Uroweb - European Association of Urology |language=en}}</ref>

===Sex therapy===
Therapy usually involves homework assignments and exercises intended to help a man get used to having orgasms through [[Sexual penetration|insertional intercourse]], vaginal, anal, or oral, that is through the way to which he is not accustomed. Commonly, the couple is advised to go through three stages.<ref>{{cite news|url=http://www.netdoctor.co.uk/sex_relationships/facts/ejaculatoryincompetence.htm|title=Delayed ejaculation (retarded ejaculation)|publisher=NetDoctor.co.uk|date=2007-06-25|access-date=2007-10-25|author=Dr. David Delvin|newspaper=Netdoctor|archive-date=2015-10-21|archive-url=https://web.archive.org/web/20151021080714/http://www.netdoctor.co.uk/sex_relationships/facts/ejaculatoryincompetence.htm|url-status=dead}}</ref> At the first stage, a man masturbates in the presence of his partner. Sometimes, this is not an easy matter as a man may be used to having orgasms alone. After a man learns to ejaculate in the presence of his partner, the man's hand is replaced with the hand of his partner. In the final stage, the receptive partner inserts the insertive partner's [[Human penis|penis]] into the partner's vagina, anus, or mouth as soon as the ejaculation is felt to be imminent. Thus, a man gradually learns to ejaculate inside the desired orifice by an incremental process.<ref name=Oxford2009/>

===Medication===
There is as yet no reliable medication for all cases of delayed ejaculation. Some studies have found that [[PDE5 inhibitors]] such as Viagra have little effect.<ref>[https://pro.psychcentral.com/pde-5-inhibitors-which-to-choose/ The Carlat Psychiatry Report > PDE-5 Inhibitors: Which to Choose?] {{Webarchive|url=https://web.archive.org/web/20191216194110/https://pro.psychcentral.com/pde-5-inhibitors-which-to-choose/ |date=2019-12-16 }} Published in The Carlat Psychiatry Report. December 2004, Volume 2, Number 12</ref> Viagra can have a delaying effect on ejaculation, possibly through additional effect in the brain or decrease of sensitivity in the head of the penis.<ref>[http://men.webmd.com/news/20020529/viagra-paxil-help-premature-ejaculation WebMD Health News > Viagra, Paxil Help Premature Ejaculation.] May 29, 2002. By Martin F. Downs.</ref>

[[Cabergoline]], an [[agonist]] of [[dopamine receptor D2|dopamine D<sub>2</sub> receptors]] which inhibits prolactin production, was found in a small study to fully restore orgasm in one third of anorgasmic subjects, and partially restore orgasm in another third. Limited data has shown that the drug [[amantadine]] may help to relieve SSRI-induced orgasmic dysfunction.<ref>{{cite journal |vauthors=Shrivastava RK, Shrivastava S, Overweg N, Schmitt M |title=Amantadine in the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors |journal=[[Journal of Clinical Psychopharmacology]] |volume=15 |issue=1 |pages=83–84 |year=1995 |pmid=7714234 |doi= 10.1097/00004714-199502000-00014}}</ref><ref>{{cite journal |vauthors=Balogh S, Hendricks SE, Kang J |title=Treatment of fluoxetine-induced anorgasmia with amantadine |journal=[[The Journal of Clinical Psychiatry]] |volume=53 |issue=6 |pages=212–13 |year=1992 |pmid=1607353}}</ref><ref>{{cite journal |vauthors=Keller Ashton A, Hamer R, Rosen RC |title=Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: a large-scale retrospective study of 596 psychiatric outpatients |journal=[[Journal of Sex & Marital Therapy]] |volume=23 |issue=3 |pages=165–75 |year=1997 |pmid=9292832 |doi=10.1080/00926239708403922}}</ref> [[Cyproheptadine]], [[buspirone]], stimulants such as [[amphetamines]] (including the antidepressant [[bupropion]]), [[nefazodone]] has been used to treat SSRI-induced anorgasmia.<ref>{{cite journal|title=Treatment of Antidepressant-Induced Sexual Dysfunction |first=Michael J. |last=Gitlin |journal=Medscape Psychiatry & Mental Health eJournal |date=1998 |volume=3 |issue=3 |url=http://www.medscape.com/viewarticle/430614_5 |access-date=4 April 2018}}</ref> Reducing the SSRI dosage may also resolve anorgasmia problems. [[Yohimbine]] has been shown to be effective in the treatment of orgasmic dysfunction in men.<ref>{{cite journal |vauthors=Adeniyi AA, Brindley GS, Pryor JP, Ralph DJ |title=Yohimbine in the treatment of orgasmic dysfunction |journal=Asian Journal of Andrology |volume=9 |issue=3 |pages=403–07 |date=May 2007 |pmid=17486282 |doi=10.1111/J.1745-7262.2007.00276.x|doi-access=free }}</ref>

===Other===
[[Meditation]] has demonstrated effectiveness in case studies.<ref>{{cite journal|title=Case reports on the use of meditative relaxation as an intervention strategy with retarded ejaculation |date=June 1984|author=M. M. Delmonte|doi=10.1007/BF00998835|pmid=6391563|volume=9|issue=2 |journal=Biofeedback and Self-Regulation|pages=209–214|s2cid=40959207}}</ref>

==See also==
* [[Anorgasmia]]
* [[Edging (sexual practice)]]
* [[Premature ejaculation]]
* [[Retrograde ejaculation]]
* [[Sexual repression]]

==References==
{{Reflist}}

== Bibliography ==

*{{cite book |author-link=Kameel Ahmady |first=Kameel |last=Ahmady |display-authors=etal |title=Blade of Tradition in the Name of Religion: A Phenomenological Investigation into Male Circumcision in Iran |publisher=Avaye Buf |date=2023 |isbn=978-87-94295-53-6 |url={{GBurl|lhTTEAAAQBAJ|p=2}} }}
*{{cite book |last=Wincze |first=John P |last2=Weisberg |first2=Risa B. |chapter=4. Delayed Ejaculation |title=Sexual Dysfunction: A Guide for Assessment and Treatment |publisher=Guilford Publications |date=2015 |isbn=978-1-4625-2061-9 |oclc=1475740918 |pages=38–45 |url={{GBurl|I02hCAAAQBAJ|pg=PR8}} }}
*{{cite book |last=Strassberg |first=D.S. |last2=Mackaronis |first2=J.E. |last3=Perelman |first3=M.A. |chapter=Part III Other Clinical Syndromes 15. Sexual Dysfunctions |editor-last=Blaney |editor-first=Paul H |editor-last2=Krueger |editor-first2=Robert F. |editor-last3=Millon |editor-first3=Theodore |title=Oxford Textbook of Psychopathology |publisher=Oxford University Press |date=2014 |isbn=978-0-19-981184-7 |oclc=1475733343 |pages=421–462 |url={{GBurl|VoEZBAAAQBAJ|pg=PR6}} }}

== External links ==
{{Medical resources
|  DiseasesDB      = 
|  ICD10           = {{ICD10|N53.11}}
|  ICD9            = {{ICD9|608.89}}
|  ICDO            = 
|  OMIM            = 
|  MedlinePlus     = 001954
|  MeSH            = 
|  GeneReviewsNBK  = 
|  = 
}}
*{{MedlinePlus|001954|Delayed ejaculation}}

{{sex|state=expand}} 
{{Mental and behavioural disorders|selected = physical}}
{{Authority control}}

[[Category:Sexual health]]
[[Category:Orgasm]]
[[Category:Ejaculation]]