Ejaculatory Dysfunction Treatment
Delayed ejaculation (also referred to as ejaculatory dysfunction or impaired ejaculation) is a common condition in males that is marked by a significant delay in ejaculation, despite ample sexual stimulation. In some cases, the male may not be able to ejaculate at all.
Some possible causes of delayed ejaculation include certain surgeries involving spine or inguinal region, chronic use of certain medication and serious medical/ health issues. Other notable reasons include poor mental health including anxiety and depression, substance abuse, and some psychological or physical problems. The treatment of ejaculatory dysfunction is dependent on the primary cause and pathophysiology of condition.
Many normal males can experience delayed ejaculation (several times during active sexual life), but it is generally not problematic unless it stays for a long period of time or unless it is stressing you or your partner.
Treatments and Medication
The treatment of delayed ejaculation depends on the inciting cause. It is imperative to seek professional help as poorly managed 
ejaculatory dysfunction can negatively affect the quality of relationships. Research data indicates that most men develop a lack of interest in engaging in the sexual activity due to frustration and experiences less frequent erections, significant fatigue and other related issues. In all such cases, it is also recommended to investigate the existing medication/ drug regimen in order to evaluate the pathophysiology. If a drug/ medication is causing delayed ejaculation, it is advised to see a doctor to explore alternative options. Psychological and couple counseling also helps in many cases.
1. Medication
Switching medications to alternative pharmacological agents or dose modification is needed if a certain drug is causing delayed ejaculation. For example, according to a new study reported in the British Journal of Urology International (1), suggested that alpha-blockers causes some degree of ejaculatory dysfunction in over 90% patients. Sometimes, adding and taking new medications also help. No drugs have been approved for treating delayed ejaculation but certain pharmacological agents can definitely help in improving the quality of sexual experience.
Some recommended medications to treat delayed ejaculation include:
- Amantadine (if ejaculatory dysfunction is due to Parkinson’s disease)
- Cyproheptadine(allergy)
- Buspirone (antidepressant)
2. Psychological Counseling (Psychotherapy):
Psychotherapy can also be used to address the underlying problems related to mental health causing delayed ejaculation including anxiety and depression. You can visit a psychologist or a counselor for mental health evaluation. In addition, it is recommended to talk to a sex therapist, or a relationship expert if ejaculatory dysfunction is situational or pertinent to some partner/s or scenarios.
Perelman, renowned sex therapist reported his findings in the International Society of Sexual Medicine journal (3); according to which most men experiences ejaculatory dysfunction due to severe performance anxiety and poor image of self that interferes with the genital stimulation. It also divert a man’s focus from the erotic cues that are helpful in enhancing the quality of sexual experience. Perelman argued that the most reliable, effective and promising form of therapy is masturbatory retraining; that employ a combined approach of using bodily improvement and sexual fantasies to improve the quality and intensity of sexual stimulation during coitus. Clinicians should provide counseling to these individuals to limit the masturbatory functions and orgasmic release only for sexual intercourse with partner.
Other reliable options include:
- Penile Vibratory Stimulation (PVS): An inexpensive and non-invasive therapy that improves sexual stimulation by improving orgasmic friction of penile shaft.
- Androgen therapy (if patient has moderate testosterone deficiency). According to latest statistics, 40% of all the males who report ejaculatory dysfunction have an underlying testosterone deficiency. Replacement of testosterone in these subjects, helps in the resolution of symptoms.
Coping and Support
Emotional and mental stress is usually a result of an ongoing dispute between partners. If you face occasional delayed ejaculation, don’t assume that you have a permanent issue or it will happen again next time. Occasional delayed ejaculation could be due to stress or fatigue; and can be improved with time and relaxation.
In case of persistent problem, inform your sexual partner to make sure that you still have sexual interest. Make good communication with partner to make treatment more effective. Visiting a counselor with partner is always a good idea too.
References:
1. Muir, G. (2015). Ejaculatory dysfunction after treatment for lower urinary tract symptoms: retrograde ejaculation or retrograde thinking?.
2. Cutting, F. G., Easy, N. M., & Easy, P. M. Understanding and Treating Retarded Ejaculation: A Sex Therapist’s Perspective.
3. Cutting, Female Genital, Nanomedicine Made Easy, and Priapism Made Easy. “Understanding and Treating Retarded Ejaculation: A Sex Therapist’s Perspective.”
4. Paduch, D. A., Polzer, P. K., Ni, X., & Basaria, S. (2015). Testosterone replacement in androgen-deficient men with ejaculatory dysfunction: A randomized controlled trial. The Journal of Clinical Endocrinology & Metabolism, 100(8), 2956-2962.