About Delayed Ejaculation
Delayed ejaculation is the inability of a man to achieve climax within a reasonable amount of time, and can be an extremely frustrating condition for a man. As is true in rapid ejaculation, that timeframe can vary and be different for the partner. From a female’s perspective, if she has achieved climax well before her partner, her vaginal lubrication can run out and sex can be uncomfortable without re-lubricating.
Everyone has a unique, personal response to various forms of sexual stimulation. For some men, maybe the only way they can climax is through masturbation or oral, but not vaginal intercourse. For others it may be just the opposite. All of these experiences are normal and everyone is different. Sometimes just knowing what “does it for you” can provide some clarity. Often female partners may take it as a failure on their part if the man does not climax, even though this is a perfectly normal and common experience. Some men simply cannot achieve ejaculation through vaginal penetration and must rely on alternative sexual acts to climax (oral or masturbation). Some men will lose their erection prior to achieving climax and be left frustrated. Some men will reach the point of orgasm but just can’t finish and are left feeling very uncomfortable.
Delayed ejaculation is a neurological, hormonal and psychological event. If a man has had damage to the nerves in his pelvis or had a spinal cord injury, he may lose the ability to ejaculate. He lacks the nerve connection from the ejaculation nerves at the tip of his penis back to his spinal cord. More commonly, he may have a hormonal imbalance in serotonin, prolactin or testosterone. Men taking antidepressants whose serotonin levels are skewed by the pills, frequently suffer from delayed or loss of ejaculation. Men with low testosterone also can have difficulty ejaculating. There is also a straightforward age-related decline in the ejaculatory response. As men age, their prolactin levels increase, which increases the “latency time” between ejaculatory events. When we were 18, we could probably go 5 times a day without issue. Very few men can sustain this level of regularity as they get older. Too bad we don’t have a time machine for this.
40%
efficacy for Oxytocin when used as a treatment for delayed ejaculation.
50-60%
efficacy for Vylessi® when used as a treatment for hypoactive female sexual desire disorder.
Signs and Symptoms of Delayed Ejaculation
LOSS OF ERECTION
prior to achieving climax
Increased latency time
between ejaculatory events
Hormonal imbalance
in serotonin, prolactin or testosterone
Treatment Options for Delayed Ejaculation
Treatment for delayed ejaculation depends on its cause. For men with nerve injuries, sometimes they respond to medical vibrators placed at the tip of the penis to retrain the nerves to fire more rapidly. Some couples will incorporate vibrators into their sexual activity to help stimulate the man to climax during intercourse. Checking hormone lab tests is a critical part of figuring out if there is a hormone imbalance. Testosterone therapy can elevate blood flow to the penis, engorging it more and making the nerves more sensitive. Testosterone also tends to make men more “horny” which can make it easier to climax. Don’t underestimate the critical importance of estrogen either. Even though many men think they want to keep estrogen levels super low, having too little estrogen actually inhibits male orgasm. Estrogen is a goldilocks hormone in men – you need just the right amount – not too much, not too little either. Men with high prolactin levels can have a non-cancerous tumor in the pituitary gland that churns out prolactin and blocks ejaculation. Treatment with either medicine or surgery to reduce prolactin levels will help a man climax easier.
If a man has diminished penile hardness, he may respond to oral impotence drugs like sildenafil (Viagra) or tadalafil (Cialis) to increase penile engorgement and sensitivity. If a man suffers delayed or loss of ejaculation caused by antidepressants, he may want to discuss alternative treatments with his psychiatrist or prescribing physician. There are a few antidepressants that may not be as harmful to ejaculation (Wellbutrin) but still effective in treating depression. Psychological treatments for delayed ejaculation revolve around exploring reasons why a man may not be able to achieve climax. A sexual therapist is a great resource to explore these issues and come up with a good treatment plan.
Unfortunately, there are no FDA-approved medications specifically for the treatment of delayed orgasm. That isn’t to say that we haven’t tried all sorts of things in Men over the years. Cabergoline, a medication which reduces prolactin levels, can potentially be tried in a man with elevated prolactin to shorten his “latency window” between ejaculations. Oxytocin, commonly known as the “love hormone,” can be compounded into a nasal spray or subinguinal lozenge. This has been used since about the 90s and has an approximately 40% efficacy. Not bad, not great. One new development is the peptide hormone PT-141, called Bremelanotide, and FDA approved as Vylessi® for use to treat hypoactive female sexual desire disorder (basically, to make women hornier) – sounds great doesn’t it? Although we can’t get this drug in men, a compounded form exists taken as a nasal spray before intercourse. This is probably the best thing we currently have from a data perspective, but even still, it is about 50-60% effective. Again, not bad, not great.
Delayed ejaculation is a frustrating clinical condition for the man and his partner. There may be a variety of causes and different treatment options that we can try. A full workup includes a detailed history, exam, and hormone testing to evaluate for obvious issues. Your Men’s Health specialist at UPNT will guide you through these options to find the best one for your unique situation.