What is considered delayed ejaculation?
There is no uniform standard for time, and focusing on specific numbers is incorrect. The diagnosis is made based on a combination of symptoms.
- Значительная задержка семяизвержения или его полное отсутствие при большинстве половых контактов
- Ситуация сохраняется на протяжении нескольких месяцев
- Это вызывает переживания у мужчины, партнёрши или обоих
A distinction is made between a lifelong form, which exists from the beginning of sexual activity, and an acquired form, which appears after a period of normal function. The acquired form almost always has a specific cause that is worth looking for. It is also important whether this happens in all situations or only with the partner - with intact ejaculation during self-stimulation, the leading role is usually played by a psychological or behavioral component.
Reasons
- Medications - the most common and most reversible group: antidepressants, especially certain classes, antipsychotics, some blood pressure medications, opioid painkillers
- Alcohol and drugs
- Testosterone deficiency
- Thyroid diseases
- Elevated prolactin
- Diabetes mellitus with autonomic neuropathy
- Age-related decrease in sensitivity and nerve conduction
- Surgeries and injuries of the pelvic organs, retroperitoneal lymphadenectomy
- Spinal cord injury, multiple sclerosis
- Chronic prostatitis
- Features of habitual self-stimulation: intense or atypical technique in which normal sexual intercourse does not lead to the desired level of stimulation
- Psychological factors: anxiety, depression, guilt, conflicts in the couple, fear of conception or, conversely, pressure to conceive
How is this different from other conditions?
- Delayed ejaculation - ejaculation occurs, but for a very long time or not always
- Anejaculation - no ejaculation at all
- Retrograde ejaculation - there is an orgasm, but the sperm goes into the bladder; urine after intercourse is cloudy
- Anorgasmia - there is no sensation of orgasm, although ejaculation can occur
- Aspermia - seminal fluid is not produced
A simple step can help distinguish between these conditions: a urine test after orgasm. It immediately separates retrograde ejaculation from true absence of ejaculation and saves time in the examination.
Diagnostics
- Detailed conversation: since when, in all situations, is there ejaculation during self-stimulation, what medications are taken
- Examination by an andrologist with assessment of the genital organs and sensitivity
- Urine analysis after ejaculation - exclusion of the retrograde form
- Total testosterone, prolactin, LH, TSH
- Blood glucose and glycated hemoglobin
- Prostate evaluation and infection testing if inflammation is suspected
- Neurological examination for suspected nervous system damage
- Assessing erectile function and anxiety levels
- Conversation with the participation of the partner with her consent
Treatment
- Reviewing medications taken together with the doctor who prescribed them - if there is a medicinal reason, this is the main and most effective step
- Correction of hormonal disorders: testosterone deficiency, increased prolactin, thyroid pathology
- Compensation for diabetes mellitus
- Treatment of chronic prostatitis when detected
- Changing self-stimulation habits: reducing intensity, abandoning atypical techniques, taking a temporary break
- Increasing the duration and variety of foreplay, changing positions and techniques
- Involving the partner in the treatment process
- Working with anxiety, psychotherapy and couples therapy
- Limiting alcohol
- Vibration stimulation and special techniques - for neurogenic forms, including for obtaining sperm when planning pregnancy
- Medication support - limited use, as prescribed by a doctor
If a couple is planning a pregnancy
- If ejaculation is preserved during self-stimulation, it is possible to use the resulting sperm for intrauterine insemination
- For neurogenic forms, vibration stimulation and electroejaculation are used
- If it is impossible to obtain an ejaculate, sperm can be obtained directly from the testicle or epididymis for ICSI
- Cryopreservation of sperm is advisable before operations that can disrupt ejaculation
- The couple is examined jointly by an andrologist and a reproductologist
Where to get examined in Tashkent
The examination includes an appointment with an andrologist, a hormonal profile, a urine test after ejaculation and, if necessary, an assessment of the prostate and neurological status.
In Tashkent, such examination and treatment are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Be sure to bring to your appointment a list of all the medications you are taking, including those prescribed by other specialists: medicinal causes are the most common and at the same time the most easily eliminated. Clinic contacts are below.
