Delayed Ejaculation Treatment & Management

Updated: Sep 20, 2018
  • Author: Adrian Preda, MD; Chief Editor: David Bienenfeld, MD  more...
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Treatment

Pharmacotherapy

When pharmacotherapy for delayed ejaculation is under consideration, it is important to eliminate iatrogenic causes, including medications (eg, alpha-adrenergic blockers, other antihypertensives, antidepressants, and antipsychotics). In the case of antidepressant-induced inhibited male orgasm, consideration may be given to switching to bupropion (also used as adjunctive therapy [27] ), mirtazapine, nefazodone, or vilazodone, which have fewer sexual side effects than selective serotonin reuptake inhibitors (SSRIs) do.

Adjunctive therapies should be considered. Alpha sympathomimetics (eg, ephedrine or a combination of chlorpheniramine maleate and phenylpropanolamine hydrochloride [withdrawn from the US market]) have been used successfully in patients with retrograde ejaculation.

Sildenafil [28] and imipramine [29] appear to be effective in psychotropic-induced male orgasmic disorder (MOD).

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Psychological Interventions

Any psychological intervention [30] must address both historical factors and current factors that might contribute to the present dysfunction.

Historical factors that can contribute to anorgasmia include the following:

  • Traumatic or unpleasant past sexual experiences

  • Negative cognitions about sex (eg, sex seen as a sin or genitals seen as dirty) based on a strict or rigid religious or moral background

A psychodynamic-oriented treatment aims to explore and understand such factors, decrease secondary feelings such as anxiety and guilt, and correct negative cognitions that can result in psychological inhibition and orgasmic dysfunction. A psychodynamic approach is recommended for persistent, treatment-resistant anorgasmia. Psychodynamic treatment can also be classified as a short-term approach, as opposed to an open-ended one.

Current factors that can contribute to anorgasmia include the following:

  • Performance anxiety – Cognitive-behavioral interventions to decrease anxiety include sexual education (to dispel misconceptions about sexuality or relieve feelings of inadequacy or inappropriate guilt), guided imagery, and sensate focus

  • Relationship problems – If anorgasmia appears to be secondary to relationship problems, couples or marital therapy might be indicated

  • Stress (due to causes other than relationship difficulties or sexual problems)

  • Environmental factors (eg, lack of privacy or uncomfortable room temperature)

Counseling should be provided for patients who have normal wet dreams but cannot achieve orgasm and ejaculation during sexual activity.

In addition to psychotherapy, anecdotal reports suggest that an electrovibrator applied at the lower surface of the glans penis can be an effective intervention in cases of primary male anorgasmia. [31]

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