Medical Edge Newspaper Column

Several Factors Can Cause Delayed Ejaculation

November 5, 2007
Dear Mayo Clinic:
Two years ago I began to notice a decrease in my ability to ejaculate. Now I almost never ejaculate. I have consulted two urologists and my general practitioner. They prescribed ED drugs such as Cialis or Viagra. I do not have difficulty getting or maintaining an erection. I am 65 years old, my wife and I make love every week, and I am in good physical condition with excellent mental health. I take four kinds of medication for other health concerns. Do you have any insights?

Answer:
Delayed ejaculation — when a man either is unable to ejaculate or ejaculation takes 30 minutes or more — can have several causes. Nerves in your pelvis control ejaculation, and damage to those nerves can cause this problem. Pelvic nerve damage may result from injury or surgery, or it can be a complication of diabetes (diabetic neuropathy). A stroke or injury to the nerve roots in the lower part of the spine also may cause delayed ejaculation.

In some cases, excessive alcohol use may be part of the problem. Delayed ejaculation also can be a side effect of certain medications. For this reason, you should discuss the possible side effects of your medications with your physician.

For some men, the underlying cause isn't a medical condition. Instead, it's psychological. For example, the condition may stem from worries about sexual performance, past sexual history, or cultural or religious taboos.

Treatment depends on the underlying cause. As you've already found out, erectile dysfunction (ED) drugs generally aren't effective in treating delayed ejaculation. But don't change or stop taking any of your regular medications without talking to your doctor first. If you drink alcohol, consider cutting down to no more than two drinks a day, or quit entirely.

For a comprehensive assessment of your condition, I recommend you seek another opinion from a urologist who specializes in men's sexual health. To find out if an underlying medical condition is causing delayed ejaculation, you may need a complete physical evaluation, as well as a neurological exam. If the cause appears to be psychological, your physician may recommend that you meet with a therapist who focuses on sexual issues.

— Ajay Nehra, M.D., Urology, Mayo Clinic, Rochester, Minn.