Delayed Ejaculation Clinical Presentation

Updated: Sep 20, 2018
  • Author: Adrian Preda, MD; Chief Editor: David Bienenfeld, MD  more...
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A sexual history should be elicited. In many cases, there is a pattern of long-continued thrusting in an effort to achieve orgasm, which is maintained until the man becomes exhausted or experiences genital discomfort, eventually discontinuing his efforts. A repetitive pattern of difficulty in ejaculating may lead a man to avoid sexual activity altogether. In addition, this ejaculatory difficulty may lead some sexual partners to report feeling less sexually attractive.

Psychological factors (eg, a history of trauma, severe guilt, a fear of impregnation, or hostility toward a woman) have all been associated with primary inhibited male orgasm. Severe forms of major depressive disorder may also be linked with an increased frequency of delayed ejaculation.

A history of injury or surgery may be relevant. Ejaculatory dysfunction has been reported in about 40% of patients with bilateral sympathectomy at the L2 level. High bilateral retroperitoneal lymphadenectomy can cause an even higher percentage of emission failures. Dysfunction of the internal sphincter or the bladder neck (eg, post prostatectomy) following alpha-blocker therapy or autonomic neuropathy due to diabetes can result in retrograde ejaculation.

It should be noted that successful emission and ejaculation without orgasm occur in some patients with spinal cord injury. Phantom orgasm in a paraplegic man has also been described. A history of disease or surgery helps differentiate emission failure from retrograde ejaculation. [20]

A good history of alcohol and illicit drug use is mandatory. In contrast with anecdotal reports of increased duration and intensity of the orgasmic experience associated with marijuana use, a large epidemiologic study of sexual disorders associated with drug use reported that in a sample of 3004 adult men and women, marijuana and alcohol use were clearly associated with anorgasmia. [21]

Chronic use of cocaine, opioids, and amphetamines has also been reported to induce sexual disorders and anorgasmia in a high proportion of users. 3,4-Methylenedioxy-N-methylmphetamine (MDMA), most commonly known under the street name of ecstasy, has been associated with both delayed orgasm and anorgasmia. [22]