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Premature and delayed ejaculation: Causes and management
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Premature and delayed ejaculation: Causes and management

Psychological factors like stress, anxiety, and relationship issues can be a common cause for both premature and delayed ejaculation
An individual with delayed ejaculation often fails to ejaculate or reach orgasm even after intercourse for two to three minutes.
Ejaculation related issues can cause distress to either one or both partners.

While conditions like erectile dysfunction can be worrying for men in maintaining their intimate health, conditions like premature and delayed ejaculation have effects on men’s sexual health. Premature Ejaculation (PE) is a condition where ejaculation occurs sooner than desired, either shortly after or before intercourse, causing distress to either one or both partners, said Dr Justin Houman, urologist and men’s sexual and reproductive health specialist in Los Angeles, California in an email interview with Happiest Health. Delayed Ejaculation (DE), on the other hand, is when there is a marked delay in achieving ejaculation, or it doesn’t occur at all, causing distress.

Difference between premature ejaculation and delayed ejaculation

Premature ejaculation (PE)

Houman highlighted a case of a 35-year-old man from Los Angeles, who had a history of ejaculating within one minute of intercourse. He explained saying that this man was facing PE for over a year, causing marital distress. However, no significant medical history was noted.

“To treat this, we used a combination of behavioural therapy and short-term use of a Selective Serotonin Reuptake Inhibitors (SSRI), an antidepressant, which resulted in significant improvement,” he added.

Premature Ejaculation is measured by a method called Intravaginal Ejaculation Latency Time (IELT) which is the time taken to ejaculate during an intercourse, says Dr Vasan SS, Uro-andrologist, director of Ankur Healthcare, Bangalore. He also added that PE can be a condition that has been there in an individual for a long time or can be situational PE, which may be due to anxiety and stress.

In an article published in BMC Urology in 2021, a cross-sectional observational study observed that the prevalence of PE was 37.1% amongst their participants.

Delayed Ejaculation

Highlighting another case, Dr Houman said that a 50-year-old man came to him with a history of diabetes and hypertension, who also reported difficulty in achieving ejaculation. His medications included antihypertensives (Blood pressure medications) and antidepressants. He mentioned how managing his diabetes more effectively through diet and exercise, along with counseling, showed a gradual improvement in his condition.

An individual with delayed ejaculation often fails to ejaculate or reach orgasm even after intercourse for two to three minutes, explains Dr Amar Kumar K, consultant urologist, andrologist and reconstructive surgeon, Apollo Hospitals, Bangalore. He also added that compared to premature or early ejaculation, delayed ejaculation is one of the sexual dysfunctions which is difficult to treat.

A study published in the journal, “Sexual Medicine” in 2023 August revealed that DE affects 2% to 6 % of men and may be increasingly prevalent in older men. The condition was also associated with other medical conditions like chronic prostatitis, depression and testosterone deficiency.

Causes of premature ejaculation and delayed ejaculation

According to Dr Houman, the diagnosis of PE involves the frequency, timing, level of control over ejaculation, and the emotional and relational impact. Sometimes, physical examination or laboratory tests are conducted to rule out underlying conditions. Psychological factors like stress, anxiety, and relationship issues can be a common cause for both PE and DE.

Premature ejaculation can be caused due to abnormal hormone levels, inflammation, infection of the prostate or urethra, and genetic traits. Another causative factor can be extreme hypersensitivity of the glands in the front part of the penis. “This sensitivity is due to the contraction of bulbospongiosus muscle which is located at the base of the penis,” says Dr Vasan.

Delayed ejaculation may also be due to medications, chronic health conditions, surgeries, and hormonal imbalances. “Like PE, the diagnosis is based on medical and sexual history, considering factors like the consistency of the delay, associated feelings, and effects on sexual satisfaction. Hence, physical and neurological examinations may be needed,” added Dr Houman.

Managing premature ejaculation and delayed ejaculation

All three experts recommend the following techniques to manage PE and DE:

  1. Stop-start technique
    This is a behavioural technique where the individual can pause the intercourse or reduce stimulation when they feel they are about to ejaculate. Repeating this process about two or three times before ejaculating can help in building control.
  2. Squeeze technique
    In this technique, the end of the penis is squeezed just when the individual is about to ejaculate. This process can be done several times before ejaculation can happen.
  3. Counseling or psychotherapy
    Some individuals may be hesitant to ejaculate due to their problem or their partner’s. Through counseling and psychotherapy, the stress and inhibitions of the individual can be reduced.
  4. Use of SSRI
    Antidepressants such as selective serotonin reuptake inhibitors (SSRIs), are used in managing PE.

 

However, experts say that unlike PE, DE is a condition which may be difficult to treat but can be managed by psychological counseling, treating underlying health issues, and sometimes using medications that aid ejaculation.

Takeaways

  • Premature ejaculation is a condition where ejaculation occurs sooner than desired, either shortly after or before penetration, while DE is a condition where there is a prolonged time to achieve ejaculation.
  • PE and DE may be caused due to biological, psychological and neurological factors.
  • While behavioural techniques like start-stop and squeeze can be used for managing PE, DE can be managed through psychological counseling.

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