SEVERAL men complain of premature ejaculation and actually cannot believe that delayed ejaculation may be a problem. However, it is.

Delayed ejaculation is a condition in which it takes a man an extended period of sexual stimulation to both climax (orgasm) and ejaculate.

For some men, orgasm and ejaculation do not occur at all. This is quite different from what was discussed in the last column, failure to ejaculate, whereby these men actually orgasm but do not ejaculate.

The condition of delayed ejaculation may be lifelong or temporary.

WHAT IS A REASONABLE TIME FRAME FOR ACHIEVING AN ORGASM?

There is no established consensus on what constitutes a reasonable time frame in which to achieve an orgasm. This is quite variable and depends on many factors.

WHAT IS AN ORGASM?

An orgasm is a subjective, cognitive event of peak sexual pleasure that coincides with ejaculation.

DO MEN WITH DELAYED EJACULATION HAVE PROBLEMS WITH ERECTIONS?

These men will typically have normal, firm erections and are able to penetrate during intercourse. They also have sufficient sexual stimulation and arousal.

HOW COMMON IS DELAYED EJACULATION?

The actual prevalence of delayed ejaculation is not known because the definition of the disorder is not precise. Reports of men may be subjective and many societal norms prevent men from presenting for evaluation. However, community samples have reported prevalence rates as high as 35 per cent.

WHAT ARE THE CHIEF COMPLAINTS OF A MAN WITH DELAYED EJACULATION?

The man will typically state that he has a pattern of long and continued thrusting in order to achieve an orgasm, but eventually stops because he is exhausted or has genital discomfort. Many men eventually avoid sexual intercourse and report feelings of anxiety related to intercourse.

ARE THERE ANY PSYCHOLOGICAL CONDITIONS ASSOCIATED WITH DELAYED EJACULATION?

Yes. Depression is associated with delayed ejaculation. Some men may admit to a history of trauma, severe guilt, fear of impregnating their partner or hostility towards women. Other factors that may be associated include performance anxiety, stress, environmental factors – such as lack of privacy, discomfort with room temperature – and relationship problems.

CAN ALCOHOL AND DRUG USE AFFECT EJACULATION?

In contrast to anecdotal reports of the benefits of alcohol and marijuana on sexual prowess, large-scale studies have been done which have associated alcohol and marijuana use with lack of orgasm (anorgasmia). Chronic use of illicit drugs such as cocaine, amphetamines, opioids, and ecstasy are also associated with delayed ejaculation and lack of orgasm.

It is important to exclude all the medical conditions and medications responsible for failure to ejaculate with the preservation of the ability to climax. These include diabetes mellitus, neurological disorders and medications used to treat an enlarged prostate.

HOW CAN THIS CONDITION BE TREATED?

Once a man is evaluated and all medical causes of ejaculatory dysfunction are excluded, the mainstay of treatment is sex therapy. This is usually successful and should involve both partners.

Dr Morrison is a consultant urologist and lecturer at the University of the West Indies and Mona Institute of Medical Sciences, Mona, Kingston 6. Please send questions and comments to belinda.morrison02@uwimona.edu.jm