Delayed ejaculation

Question 1

Define delayed ejaculation

Answer 1

Delayed ejaculation occurs in almost or all occasions (75-100%) either generalised or situational, without the individual desiring the delay.

Question 2

The DSM5 have which 2 criteria

Answer 2

1. Marked delay in ejaculation
2. Marked infrequency or absence of ejaculation

May be life long, acquired, mild, moderate or severe

Question 3

Physiological causes

Answer 3

• Congenital disorders
• Trauma or surgery
• Age
• Infectious disorders
• Neurological disorders e.g. DM, spinal cord injury, alcohol neuropathy
• Depression
• Medication induced e.g. SSRI, phenothiazines, thiazides, some alpha blockers
• Low testosterone levels
• Important to exclude retrograde ejaculation (EJACULATION INTO THE BLADDER)

Question 4

Psychological causes

Answer 4

• Insufficient stimulation/poor sexual arousal
• Masturbation technique
• Individual vulnerability factors e.g. poor body image, history of sexual or emotional abuse.
• Outgrowth of psychic conflict e.g. fear, hostility
• Relationship factors e.g. poor communication, desire discrepancies
• Partner issues e.g. ill health, sexual problems
• Disguised desire disorder
• Secondary to other sexual problems e.g. pain disorder

Question 5

Investigations

Answer 5

• Physical examination – testes, epididymis, vasa, prostate
• Blood tests – FBC, Glucose, Testosterone, B12, Folate, PSA
• Urine sample for presence of spermatozoa and fructose (if retrograde ejaculation suspected)

Question 6

Treatment

Answer 6

• PSGP – personal support growth programme
• Individual therapy
• Couples therapy
• Kegel exercises
• Use of vibration/superstimulation

Question 7

Medications that can cause delayed ejaculation

Answer 7

SSRI, thiazides, alpha-blockers

Question 8

Hormonal causes

Answer 8

Low testosterone