Acquired Delayed Ejaculation

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Psychological Factors

The only way to determine the cause(s) of delayed ejaculation is the clinical interview. There are no specific characteristics of psychologically induced acquired delayed ejaculation. Obviously, the ejaculation disturbance has not existed previously. In addition, the onset may be sudden, the delay may be situational and also intermittent. Some factors may be related to the development of acquired delayed ejaculation, such as a psychological trauma (for example, the discovery of the partner's infidelity), or lack of sexual and psychological stimulation (inadequate technique or lack of attention on sexual cues).

Organic Factors

The onset of ejaculation delay may be sudden or gradual and deteriorates progressively to global unremitting ejaculatory inhibition. A rather normal delay of ejaculation occurs during aging. Androgen deficiency or hypogonadism may be accompanied by loss of sexual desire and delay of ejaculation. Any neurological disease, injury, or surgical procedure that traumatizes the lumbar sympathetic ganglia and the connecting nerves (multiple sclerosis, diabetic neuropathy, abdo-minoperineal resection, lumbar sympathectomy) may lead to a delay or failure of ejaculation. A wide range of drugs (SSRIs, tricyclic antidepressants, antipsychotics, alpha-sympathicolytics) can impair the ejaculatory process through central and peripheral mechanisms. Alcohol can delay or abolish ejaculation by a direct effect after acute abuse and indirectly by neurological or hormonal disturbances during chronic abuse.

Treatment of Acquired Delayed Ejaculation

In order to exclude pharmacological causes of delayed ejaculation, one has to carefully review the patients concomitant drugs that are likely to inhibit ejaculation. In those cases, an alternative drug should be tried, or in case of antidepressants, reduction of dose or antidote may be required (95). Neuropathic inhibition of ejaculation is usually irreversible and the patient should be counseled to optimize his and his partner's enjoyment from the residual sexual functioning. Androgen deficiency requires appropriate testosterone replacement therapy. In the case of inadequate stimulation, pelvic floor exercises may be helpful. Most patients require general advice on reducing precipitating factors, reduction in alcohol use, finding more time for sexual activity when not fatigued.

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