Commonly, the couple is advised to go through three stages. At the first stage, a man masturbates in the presence of his partner. Sometimes, this is not an easy matter as a man may be used to having orgasms alone. After a man learns to ejaculate in the presence of his partner, the mans hand is replaced with the hand of his partner. In the final stage, the receptive partner inserts the insertive partners penis into the partners vagina, anus, or mouth as soon as the ejaculation is felt to be imminent. Thus, a man gradually learns to ejaculate inside the desired orifice by an incremental process. Medication
There is as yet no reliable medication for all cases of delayed ejaculation. Some studies have found that PDE5 inhibitors such as Viagra have little effect. Viagra can have a delaying effect on ejaculation, possibly through additional effect in the brain or decrease of sensitivity in the head of the penis.Cabergoline, an agonist of dopamine D2 receptors which inhibits prolactin production, was found in a small study to fully restore orgasm in one third of anorgasmic subjects, and partially restore orgasm in another third. Limited data has shown that the drug amantadine may help to relieve SSRI-induced orgasmic dysfunction. Cyproheptadine, buspirone, stimulants such as amphetamines (including the antidepressant bupropion), nefazodone has been used to treat SSRI-induced anorgasmia. Reducing the SSRI dosage may also resolve anorgasmia problems. Yohimbine has been shown to be effective in the treatment of orgasmic dysfunction in men. Other
Meditation has demonstrated effectiveness in case studies.
In one survey, 8% of men reported being unable to achieve orgasm over a two-month period or longer in the previous year. DEs are either primary and lifelong or acquired. Acquired DEs may be situational. While most men do experience occasional or short term delayed ejaculation issues, the prevalence of lifelong DE and acquired long term DE is estimated around 1% and 4%, respectively. Signs and symptoms
Delayed ejaculation can be mild (men who still experience orgasm during intercourse, but only under certain conditions), moderate (cannot ejaculate during intercourse, but can during fellatio or manual stimulation), severe (can ejaculate only when alone), or most severe (cannot ejaculate at all). All forms may result in a sense of sexual frustration. In most cases, delayed ejaculation presents the condition in which the man can climax and ejaculate only during masturbation, but not during sexual intercourse. Causes
The etiologies of delayed ejaculation can be age-related, organic, psychological, or pharmacological.Primary lifelong DEs are poorly understood and rarely explained by few congenital anatomic causes (viz., Müllerian duct cyst, Wolfian duct abnormalities, prune belly syndrome, imperforate anus, congenital ejaculatory duct obstruction, genetic abnormalities including cystic fibrosis, etc.) Anatomic causes (acquired ejaculatory duct obstruction)
Infective/Inflammation (residual damage from acute infections, chronic infections, urethritis, prostatitis, orchitis, genitourinary tuberculosis, schistosomiasis, lichen sclerosis, etc.) Neurogenic causes (diabetic autonomic neuropathy, spinal cord or nerve root injury from trauma or disc prolapse, multiple sclerosis, etc.).