“The Right to Sex” by Amia Srinivasan
The DSM-5 (2013) defines delayed ejaculation (DE) as “difficulty or inability to ejaculate despite of the presence of adequate sexual stimulation and the desire to ejaculate.” Jenkins and Mulhall (2015) believe that delayed orgasm (DO) is the correct term as some men fail to ejaculate for medical reasons but still experience orgasm. The lack of a consistent definition and variations in research methodology has contributed to unclear prevalence rates, with recent population surveys and cross-sectional observations indicating that DE is a common form of male sexual dysfunction (Di Sante et al., 2016).
Unfortunately, of all the male sexual dysfunctions, DE is the least understood and least studied (Althof, 2012), making it difficult to treat (Butcher et al., 2015). It could be caused by medical, psychological and/or lifestyle factors (McMahon et al., 2013). For example, Teloken et al (2012) found that DE could be caused by SSRI use, low testosterone, abnormal penile sensation, chronic/idiosyncratic penile (hyper)stimulation, and psychogenic issues. Age-related hormonal declines and loss of peripheral nerve conduction may account for the increased onset over age 50 (Jenkins & Mulhall, 2015).
DE may also be caused by fear and anxiety during sex, such as hurting or impregnating the partner, childhood sexual abuse, sexual trauma, repressive sexual education/religion, sexual anxiety, general anxiety, “spilling of seed,” and conflict in men in their first sexual relationship after becoming widowed or divorced (Waldinger & Schweitzer, 2005). Similarly, Sandström and Fugl-Meyer (2021) consider some instances of DE to be a physical manifestation of psychological difficulties, such as the need for control of emotions and impulses, embarrassment and inhibition, and difficulty expressing wishes, needs, playfulness, and fantasies.
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