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Delayed ejaculation(also known as ejaculatio retardata, ejaculatory incompetence and retarded ejaculation) means complete inability to ejaculate or persistent difficulty in achieving orgasm despite the presence of normal sexual desire and sexual stimulation. Normally a man achieves orgasm within 2-4 minutes  after the beginning of sexual intercourse, whereas a man with delayed ejaculation either does not orgasm at all or orgasms after prolonged intercourse which might last 30-45 minutes or more. In most cases delayed ejaculation presents the condition in which the man can climax and ejaculate only during masturbation, but not during sexual intercourse.
Delayed ejaculation can be caused by physical and psychological reasons. Psychological causes are more common than physical.
Psychological causes of delayed ejaculation
Psychological causes of delayed ejaculation might include numerous factors that prevent a man from achieving orgasm during sexual intercourse.
The most common psychological cause [How to reference and link to summary or text] of delayed ejaculation is being normalized to orgasm through masturbation. Commonly during masturbation, men exert much stronger pressure with their hands than is y provided through sexual intercourse. Thus they train themselves to have a sexual response only to very strong pressure which they cannot get through friction inside the female vagina[How to reference and link to summary or text].
Delayed ejaculation might be caused by a strict religious background, which makes a person consider sex and enjoyment associated with it to be sinful. Therefore, a feeling of guilt does not allow the man to freely enjoy sexual intercourse and prevents him from reaching climax. A man can be prevented from ejaculating by some fears, such as the fear to cause pregnancy or considering the vagina to be a dirty place. Another factor causing delayed ejaculation is being so focused on the partner's pleasure that prevents a man from getting enjoyment during sexual intercourse.
Delayed ejaculation can also be the result of some deep conflicts associated with the partner's personality, for example sexual trauma caused by real or supposed partner's unfaithfulness. Sometimes delayed ejaculation is caused by presence of a Paraphilia which prevent a man from having orgasm due to absence of some certain conditions, for example a man might be able to orgasm only during a BDSM session.
Physical causes of delayed ejaculation imply some diseases and conditions which affect a man's ability to orgasm.. These include many neurological (for example stroke or damage to the back or spinal cord) and endocrine diseases (diabetes), prostate problems, some allergies and high blood pressure. As well difficulty in achieving orgasm can result from pelvic surgery that involved trauma to pelvic nerves which are responsible for orgasm.
Delayed ejaculation might be a side effect of some medications, usually of some antidepressants. Another reason for delayed ejaculation is excessive use of alcohol. In this case physical and psychological causes might co-exist. Alcohol addiction often implies psychological disorders which cause a man to become nervous and jealous without any reason. Thus two causes join and deepen the problem.
Delayed ejaculation causes a great deal of complications for a man who suffers from it as well as for his partner. To be precise in some cases delayed ejaculation can even contribute to sexual satisfaction of female partner who can orgasm for a few times during long lasting intercourse. However, after some time this is likely to become annoying for both a woman and a man who in spite of all efforts cannot achieve orgasm or achieves it after very long time. With the course of time the situation gets worse: both partners begin avoiding sex contacts which do not result in orgasm. Consequently, both partners suffer from sexual dissatisfaction and become likely to lose sexual desire. As the result relationships between partners worsen and often break. Divorces and breakups are especially widespread among those couples who plan to have children but cannot conceive due to the male partner's inability to ejaculate inside the vagina.
Treatment of delayed ejaculation depends on severity of the disorder and on its causes.
If a man has never had ejaculation through any kind of sexual stimulation (such as vaginal or anal intercourse, oral sex, masturbation, wet dreams) than he should consult a urologist in order to find out whether there is a physical abnormality and then get necessary treatment which depends on the abnormality revealed.
If the disorder is not so severe and a man can ejaculate through some form of stimulation, he should apply to a sex therapist specializing in this area. This is very important in cases when a man can ejaculate through any form of stimulation but intercourse. Usually treatment for this disorder includes both partners.
Therapy usually involves homework assignments and exercises intended to help a man get used to orgasm through vaginal intercourse i.e through the way he is not accustomed to. Commonly the couple is advised to go through three stages[How to reference and link to summary or text]. At the first stage a man masturbates in the presence of his partner. Sometimes this is not an easy matter as a man might be used to orgasm alone. After a man learns to ejaculate in the presence of his partner, the couple gets to another stage where the man's hand is replaced with the hand of his partner. Step by step a man learns to ejaculate closer and closer to the vagina. In the final stage a woman inserts her partner's penis into her vagina as soon as she realizes he is about to ejaculate. Thus a man gradually learns to ejaculate inside the vagina.
If relationships in a couple are found problematic, therapy intended to enhance emotional intimacy might be required as preliminary step.
Naturally, if delayed ejaculation is caused by a disease, the disease is first of all treated. In those cases when delayed ejaculation is a side effect of medication the man's physician is to review other medication options.
In the case of alcohol addiction a man should get necessary treatment intended to help treat his addiction.
A typical treatment for delayed ejaculation requires from 12 to 18 sessions which on average is successful in 70-80 per cent of cases[How to reference and link to summary or text].
The following factors are signs of better outcome: having sexual desire, being in love with the sexual partner, being eager to get rid of the problem, absence of deep psychological problems, short duration of the disorder and having satisfying sexual experiences before.
Success of treatment for delayed ejaculation caused by medication recovery totally depends on whether the physician can discontinue the medication.
First of all a man should have healthy attitude towards sexuality and his sexual response. He should be fully aware of the fact that anxiety and fears cannot contribute to a normal and satisfying sexual experience.
A man who wants to avoid ejaculation problems should concentrate on the pleasure he gets rather than worrying about when and whether his ejaculation is going to occur. The partner should also be tactful and should not put pressure on the man by asking him whether he has ejaculated or not. Instead a partner should create a relaxed atmosphere in which a man will feel free and enjoy sexual pleasure without worrying about ejaculation. And of course, open discussing of anxieties and fears contribute to better sexual relationships and normal sexual satisfaction.