Ejaculatory Dysfunction – Symptoms and Diagnosis

When the sexual climax in men is achieved after extended period of sexual stimulation; the condition is referred to as ejaculatory dysfunction or impaired ejaculation. It is a fairly common condition that may be temporary (transient) or permanent (chronic).

Men experiencing delayed ejaculation requires sexual stimulation for 30 minutes or more to get an orgasm and/or to ejaculate; sometimes anejaculation can also occur. But unfortunately, no one can define a time period of sexual stimulation necessary, to establish the diagnosis of delayed ejaculation. Research and clinical data indicates that stress and frustration due to the delayed ejaculation can further worsen this issue.

In men with ejaculatory dysfunction, males experiences difficulty in attaining orgasm during sexual intercourse or other sexual activities. Some men are only able to ejaculate during masturbation. The symptoms of delayed ejaculation can be mainly described as:

• Lifetime and acquired: In case of lifetime delayed ejaculation, the issue is identified when the man enters in the phase of sexual maturity.

• Generalized and situational: Generalized delayed ejaculation is not restricted to a certain sexual partner or on certain stimulations. Whereas, in situational variety, males develop ejaculatory dysfunction in certain circumstances only or with some partners.

These types helps in the exploration of pathophysiology and appropriate treatment to address ejaculatory dysfunction in males.

When to see a doctor?

If you are experiencing delayed ejaculation in the following scenario, it is highly recommended that you see a doctor at earliest convenience:

• The nature of sexual dysfunction is directly interfering with the quality of your relationship.
• You have other health problems related to delayed ejaculation, or you are using medications that are possibly causing ejaculatory dysfunction (or other sexual disorders).
• You are experiencing other symptoms related or not related to delayed ejaculation.

What are some notable causes of Ejaculatory Dysfunction?

Certain health problems, medications and surgeries can cause delayed ejaculation.

The physical causes include:

• Development disorders of reproductive system in males.
• Injured Pelvic nerves that regulate orgasm.
• Infections like urinary tract infection.
• Prostate surgeries or removal of prostate.
• Neurological disorders including nerve damage of spinal cord or stroke.
• Conditions related to hormones, like low thyroid hormones or low testosterones.
• Retrograde ejaculation, when semen doesn't come out of penis and travels back to the bladder instead.

Some psychological causes include:

• Mental illness like depression and stress.
• Relationship issues and bad communication.
• Anxiety before performing (performance anxiety)
• Bad physique
• Taboos (religious/cultural)
• Sex life not as good as sexual fantasies.

Medications and other causes (2):

• Certain antidepressants
• Antihypertensive agents
• Diuretics.
• Certain antipsychotic medicines
• Certain anti-seizure medicines
• Alcohol

Some men gets panicked, which further worsens the condition.

What are some risk factors that may cause Ejaculatory Dysfunction?

• Old aged men take more time to ejaculate.
• Psychological situations including stress and depression.
• Medical situations like diabetes and sclerosis.
• Surgeries like prostate surgery.
• Medicines, especially antidepressants, high BP medicines.
• Relationship issues including bad communication and understanding.
• Long term and heavy drinking.

Complications of Poorly managed Erectile Dysfunction in males

Investigators and healthcare professionals advise proper investigation and optimal management to minimize the risk of following complications.

• Lack of sexual interest and pleasure by the individual or partner.
• Stressful sexual performance.
• Relationship or marital problems caused by unpleased sex life.
• Infertility in males.

Test and Diagnosis

To find the best possible treatment, the two most important elements required are medical history and physical examination. Further tests and diagnostic modalities may be needed if there are underlying causes behind the delayed ejaculation.

Some tests required for delayed ejaculation include:

• Physical Examination:

The penis and testicles needs to be examined carefully. Doctors test the sense of touch in genitals by sensory tests.

• Blood Examination:

Detection of health issues such as diabetes, heart problem, lower level of testosterones and other health issues is made by sending a sample of blood to the laboratory.

• Urinalysis (urine test):

Signs of acute urinary tract infection, diabetes and other health problems are assessed by urological testing; depending upon the associated symptoms.

If you or your partner is experiencing delayed ejaculation, it is very important to see a doctor for early management.

References:

1. Althof, S. E. (2012). Psychological interventions for delayed ejaculation/orgasm. International journal of impotence research, 24(4), 131-136.

2. Waldinger, M. D., Berendsen, H. H., Blok, B. F., Olivier, B., & Holstege, G. (1998). Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: the involvement of the serotonergic system. Behavioural brain research, 92(2), 111-118.

3. Kirby, M., Chapple, C., Jackson, G., Eardley, I., Edwards, D., Hackett, G., ... & Wylie, K. (2013). Erectile dysfunction and lower urinary tract symptoms: a consensus on the importance of co‐diagnosis. International journal of clinical practice, 67(7), 606-618.