Scientific Information About Delayed Ejaculation
The British Association For Sexual Health and HIV (BASHH) has a special interest group which is concerned with sexual dysfunction. Daniel Richardson and David Goldmeier have written a paper which summarizes how the way in which the BASHH believes delayed ejaculation needs to be managed by doctors on behalf of men who are experiencing the condition.
In their paper they review the etiology of the condition, along with the physiology, its prevalence, and how best to assess the condition in individual men who have it. They also describe several possible treatment recommendations, and suggest how the outcome of treatment for delayed ejaculation might be monitored. This paper was published in the International Journal of STD & AIDS 2006; 17: 7-13.
As Richardson and Goldmeier observe, we think of orgasm as the combination of the sensations which are experienced at the moment of ejaculation plus the physical ejaculation of semen. However, they are actually two separate events: the extremely pleasurable feelings that are associated with the man’s climax are not dependent on release of seminal fluid, nor is the release of seminal fluid dependent upon the subjective experience of orgasm. See Wikipedia – orgasm for more information.
The mechanism by which semen is released, which usually occurs simultaneously with the pleasurable feelings of orgasm, is well-known: it’s an autonomic reflex response which is stimulated by pressure generated within the bulb of the urethra when semen is released into it from the seminal vesicles along with fluid from the prostate gland.
This pressure in the urethral bulb is thought to be responsible for closing the aperture of the opening into the bladder, so that seminal fluid is forced out of the body by the subsequent reflex contractions of the pubococcygeal and other pubic muscles. The reflex response involved is determined by action of the autonomic nervous system, more specifically the pudendal and hypogastric nerves, which are branches of the parasympathetic and sympathetic nervous system respectively.
By contrast, there is a lack of knowledge about the location within the brain where the subjective feelings of pleasure that are associated with orgasm are actually generated. Fortunately, this isn’t a matter of great importance, nor does it present a problem in the treatment and management of men who have an ejaculation dysfunction.
Historically, along with many other medical conditions, delayed ejaculation has been through a series of name changes, which have included the now less-used term retarded ejaculation, as well as ejaculatory incompetence, anejaculation, ejaculatory over-control, and inhibited male orgasm. It’s also been referred to as male orgasmic disorder, although this term has not found favor since it refers to the part of the sequence of male climax that is not specifically related to the difficulties associated with ejaculation.
A modern definition which satisfies everybody who has experienced this condition and the therapists who deal with it is: “The persistent or recurrent difficulty or delay in obtaining, or complete absence of, orgasm, even when a man has had enough sexual stimulation to bring him to climax in normal circumstances, and which elicits personal distress.”
It’s immediately obvious that this definition of delayed ejaculation includes an element of subjective judgment on two counts: first, what is regarded as sufficient sexual stimulation to help man the chief climax, and secondly as to whether or not he’s experiencing distress because of it. It would seem more appropriate to include an element of this definition around the distress of the partner, or something to the effect that the condition happens whether or not the partners wish it to happen.
(Although unusual, in the work that I’ve done with men who cannot reach orgasm during sexual relationships with their partner, there have been a few who have regarded it as being of advantage to them since it allowed the man and woman to make love for longer, possibly with the chance of the woman reaching a climax.)
How often does delayed ejaculation occur in the male population?
It’s rather hard to know, because research in this area hasn’t been very extensive. However, we do know that it’s a lot more common than has been supposed for a very long time: surveys on websites run by present reviewer suggest that the frequency is between 10 and 12%, which is much higher than 3.8% suggested by Masters and Johnson back in the 1950s. As time has gone by the estimated frequency of delayed ejaculation has increased: in the 1970s people believed that it was occurring in between 4% and 10% of male population.
One of the reasons why it’s so hard to know how many men experienced delayed ejaculation either on a short or long-term basis is because it’s actually something that men are quite reticent about discussing: there seems to be a high degree of shame associated with retarded ejaculation or any other kind of ejaculatory difficulty for that matter, which is one reason why discussion of the subject needs to be brought out into the open. Only in this way will the full scale of the problem become known.