mentioned, the cutoff time for what constitutes premature is variable, depending on the organization defining the problem. The treatment can be medical or nonmedical. Some men will distract themselves or control their sexual behavior in order to increase the latency time. Other men will use more than one condom to decrease penile sensation. Sex therapy can help, which makes use of Kegel exercises to strengthen the pelvic floor muscles, the squeeze technique, which involves squeezing the head of the penis to stop the ejaculatory reflex, and the stop-start technique, which involves stopping for a period of time to slow the process. Medications can be used successfully to treat premature ejaculation. SSRI drugs like paroxetine and dapoxetine have been used to delay ejaculation but these are not without side effects. Desensitizing medications like topical lidocaine can block the sensation to the penis. Tramadol and clomipramine can be used as well. Surgery to disrupt the nerve supply to the penis in severe cases is common only in South Korea.
DELAYED EJACULATION Delayed ejaculation involves the inability to have an orgasm and ejaculate even if there is sexual desire and adequate sexual stimulation. In some cases, it can take in excess of 45 minutes to ejaculate if it happens at all. Some cases only involve delayed ejaculation with a sexual partner and not with masturbation. As a sexual disorder by itself, it is not very common and, if present, is generally the side effect of a medication. The problem can be minor or very severe, without the ability to ejaculate at all. Medical reasons for delayed ejaculation include drug or alcohol abuse, Cushing’s disease, thyroid dysfunction, prostate surgery, and hypogonadism or immature gonads. Trauma to the pelvic nerves that affects penile sensation can cause this problem. Many medications can be causative, such as SSRIs, opiates, benzodiazepines, blood pressure medications, and antipsychotic drugs. There are some psychological or lifestyle factors that can contribute to delayed ejaculation. Lack of sleep, stress, anxiety, distraction, and overactive masturbation can contribute to delaying of ejaculation. Different sensations found in masturbation can lead to a decrease in the ability to have ejaculation with vaginal penetration. 98
