Menu
Home
People
Places
Arts
History
Plants & Animals
Science
Life & Culture
Technology
Reference.org
Delayed ejaculation
open-in-new
<h2 id="signs-and-symptoms">Signs and symptoms</h2> <p>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 <a href="/facts/Fellatio/F72SIY2p">fellatio</a> or a <a href="/facts/Handjob/eME278Fu">handjob</a>), severe (can ejaculate only when alone), or most severe (cannot ejaculate at all).<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a> All forms may result in a sense of <a href="/facts/Sexual_frustration/qM3XVoo3">sexual frustration</a>.<a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a> In most cases, delayed ejaculation presents the condition in which the man can climax and ejaculate only during <a href="/facts/Masturbation/7uGXPrVc">masturbation</a>, but not during sexual intercourse. As of 2015, the <i>DSM-V</i> uses the term "delayed ejaculation" instead of older terms such as "inhibited ejaculation", "impotent ejaculation" or "retarded ejaculation".<a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a> To determine what amount of time counts as delayed, one source uses a measurement of the mean time for a man to achieve ejaculation in a study of 500 couples having heterosexual vaginal intercourse, which was 8 minutes (with a <a href="/facts/Standard_deviation/qSug9BRl">standard deviation</a> of 7.1 minutes).<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> Due to men's reputation for being reliably able to ejaculate during sex, in cases where a man faces delayed ejaculation, the woman may perceive that it is due to her not being attractive or due to a fault in her sexual techniques.<a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a> </p> <h2 id="causes">Causes</h2> <p>The etiologies of delayed ejaculation can be age-related, organic, psychological, or pharmacological.<a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a> </p><p>Primary lifelong DEs are poorly understood and rarely explained by few congenital anatomic causes (viz., <a href="/facts/M%25C3%25BCllerian_duct/lF4oBxmP">Müllerian duct</a> cyst, <a href="/facts/Mesonephric_duct/I0qRRaVx">Wolffian duct</a> abnormalities, <a href="/facts/Prune_belly_syndrome/bxPf473q">prune belly syndrome</a>, <a href="/facts/Imperforate_anus/UBCbVsDL">imperforate anus</a>, congenital <a href="/facts/Ejaculatory_duct/dnJHMVeo">ejaculatory duct</a> obstruction, genetic abnormalities including <a href="/facts/Cystic_fibrosis/tlNK5BAH">cystic fibrosis</a>, etc.) </p> <ul><li>Anatomic causes (acquired ejaculatory duct obstruction)</li> <li>Infective/Inflammation (residual damage from acute infections, chronic infections, urethritis, prostatitis, orchitis, genitourinary tuberculosis, schistosomiasis, lichen sclerosis, etc.)</li> <li>Neurogenic causes (diabetic autonomic neuropathy, spinal cord or nerve root injury from trauma or disc prolapse, <a href="/facts/Multiple_sclerosis/vghXl0IQ">multiple sclerosis</a>, etc.). DE can be due to the injury to pelvic nerves responsible for orgasm from <a href="/facts/Physical_trauma/PJ7CbnMQ">trauma</a> as a result of <a href="/facts/Pelvic/8Fq9z3TY">pelvic</a> <a href="/facts/Surgery/fG8tWf5Y">surgery</a> (viz., <a href="/facts/Prostate/mrBdSsf7">prostate</a> surgery including transurethral resection of prostate and bladder neck incision, <a href="/facts/Proctocolectomy/BccH9nHd">proctocolectomy</a>, bilateral sympathectomy, abdominal aortic aneurysmectomy, para-aortic lymphadenectomy etc.). Some men report a lack of sensation in the nerves of the <a href="/facts/Glans_penis/Fw1W4sQc">glans penis</a>, which may or may not be related to external factors, including a history of <a href="/facts/Circumcision/Ya1aD8H6">circumcision</a>.<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a></li> <li>Some researchers believe that circumcision has a negative effect on men's ejaculation during sex, while others believe that circumcision has no effect.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a><a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a><a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a><a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a> Those who believe in the negative effects of circumcision, such as a reduction of sexual sensitivity in the penis, claim that the part of the penis that is removed during circumcision is one of the most important and sensitive parts involved in receiving sexual pleasure, and that after its removal, sexual pleasure decreases.<a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a><a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a><a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a><a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a> However, researchers who argue against the negative effects of circumcision on men's sexual pleasure, citing the research and conclusions of international medical bodies such as the <a href="/facts/World_Health_Organization/YNN3bgug">World Health Organization</a> and important academic centers, state that circumcision does not have a noticeable effect on the sensitivity of the penis.<a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a><a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a><a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a><a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a></li> <li>Endocrine (<a href="/facts/Hypogonadism/mqu59lNo">hypogonadism</a>, <a href="/facts/Pituitary/gdrQyldF">pituitary</a> disorders such as <a href="/facts/Hyperprolactinaemia/cTdwMNlP">hyperprolactinaemia</a> and <a href="/facts/Cushing%2527s_disease/HqfLkI5J">Cushing's disease</a>, <a href="/facts/Thyroid/bjovTJVu">thyroid</a> disorders, etc.). Although low testosterone level had been considered a risk factor in the past, more recent studies have not confirmed any association between ejaculation times and serum testosterone levels.<a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a><a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a></li> <li>Delayed ejaculation is a possible <a href="/facts/Adverse_effect/vAhfbr1J">side effect</a> of <a href="/facts/Alcohol_(drug)/IeK2fVd5">alcohol</a><a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a> and certain <a href="/facts/Medications/h9mhwWP2">medications</a>, including antipsychotics, antidepressants including <a href="/facts/SSRI/L6jjcmEH">selective serotonin reuptake inhibitors</a> (SSRIs), <a href="/facts/Opiates/IHfQkMkU">opiates</a> such as <a href="/facts/Morphine/8ngpXHDc">morphine</a> or <a href="/facts/Oxycodone/mv95L2c7">oxycodone</a>, many <a href="/facts/Benzodiazepines/IgbJr4jy">benzodiazepines</a> such as <a href="/facts/Diazepam/h7lIGqkM">Valium</a> or <a href="/facts/Alprazolam/nfMPlLFa">Xanax</a>, and certain <a href="/facts/Antihypertensives/K63MbxN0">antihypertensives</a> including thiazide diuretics, alpha-adrenergic blockers and ganglion blockers.<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a><a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> Although they may increase sexual desire, <a href="/facts/Stimulant/nmBdAXM5">stimulants</a> such as <a href="/facts/Substituted_amphetamine/KlmrodPb">amphetamines</a> and <a href="/facts/Cocaine/rdQP4zwF">cocaine</a> have an inhibitory effect on ejaculation, and can cause erectile dysfunction and reduced penile sensitivity via their <a href="/facts/Vasoconstriction/9hdY0aR2">vasoconstrictive</a> effects.<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a></li> <li>Psychological (acute psychological distress, relationship distress, psychosexual skill deficit, disconnect between arousal and sexual situations, masturbation style and frequency, etc.) <ul><li>Psychological and lifestyle factors have been discussed as potential contributors, including insufficient sleep, distraction due to worry, distraction from the environment, anxiety about pleasing their partner and anxiety about relationship problems.<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a></li> <li>Religious guilt over sex can cause delayed ejaculation.<a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a></li> <li>"Spectatoring", the problem of perceiving sex as a performance rather than a mutual experience and process of pleasure "in the moment" can cause delayed ejaculation.<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a></li> <li>Men who are solely aroused by <a href="/facts/Sexual_fetish/f2UrwNMN">sexual fetishes</a> may be unable to ejaculate from regular intercourse.<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a></li> <li>Idiosyncratic masturbation (also known as "idiosyncratic masturbatory style")<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a> and lack of desire for stimuli are also proposed risk factors for DE.<a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> The word "idiosyncratic" means something that pertains to an individual. In this case, it means a person who has a way of masturbating that is unique (or out of the ordinary). Most men stroke their penis with their hand in a way that vaguely imitates the stimulation from intercourse. An idiosyncratic style is defined as a technique not easily duplicated by a partner utilizing their hand, mouth, anus, or vagina. In these patients, delayed ejaculation is adaptation to a certain masturbatory technique.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a> In 1998, psychologist Lawrence Sank wrote about "traumatic masturbatory syndrome", when the sensations a man feels when masturbating may bear little resemblance to the sensations he experiences during intercourse. Factors such as pressure, angle and grip during masturbation can make for an experience so different from sex with a partner that the ability to ejaculate is reduced or eliminated. One in three men with DE report idiosyncratic masturbation. Also, high-frequency masturbation is associated with prolonged DE in penetrative sex with the partner accounting for another one third of the cases. Fantasy/partner disparity – that is to say, variant sexual fantasy during masturbation that was not incorporated into sex with their partner – accounted for one in five DEs.<a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a> According to the <i>DSM-5-TR</i>, "Delayed ejaculation is associated with highly frequent masturbation, use of masturbation techniques not easily duplicated by a partner, and marked disparities between sexual fantasies during masturbation and the reality of sex with a partner."<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a></li> <li>Intravaginal ejaculation disorder is a peculiar Japanese case, but is very similar to "traumatic masturbatory syndrome", which is also mainly caused by intense masturbation.</li></ul></li></ul> <h2 id="diagnosis">Diagnosis</h2> <p>Diagnosis and management of DE warrant one of the most comprehensive medical evaluation in sexual health assessment that includes a full medical and sexual history performed along with a detailed physical examination. Understanding the quality of the sexual response cycle (desire, arousal, ejaculation, orgasm, and refractory period); details of the ejaculatory response, sensation, frequency, and sexual activity/techniques; cultural context and history of the disorder; partner's assessment of the disorder and if the partner has any sexual dysfunction themselves; and the overall satisfaction of the sexual relationship are all important to garner during history-taking.<a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a> </p><p>Relatively normal latency to orgasm with self masturbation as compared to insertive or intravaginal ejaculation latency time reasonably rules out most of the organic causes of DEs. </p> <h2 id="treatment">Treatment</h2> <p>Primary, lifelong DEs are poorly understood and hence less well studied. Organic causes in the acquired DEs should be addressed promptly. Retraining masturbatory practices and re-calibrating the mismatch of sexual fantasies with arousal are essential when these are contributing to DE. Techniques geared towards reduction of anxiety are important skills that can help overcome performance anxiety, as this can often interrupt the natural erectile function through orgasmic progression.<a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a> </p> <h3>Sex therapy</h3> <p>Therapy usually involves homework assignments and exercises intended to help a man get used to having orgasms through <a href="/facts/Sexual_penetration/VgtQH0td">insertional intercourse</a>, vaginal, anal, or oral, that is through the way to which he is not accustomed. Commonly, the couple is advised to go through three stages.<a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a> 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 man's hand is replaced with the hand of his partner. In the final stage, the receptive partner inserts the insertive partner's <a href="/facts/Human_penis/shzvo9ML">penis</a> into the partner's 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.<a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a> </p> <h3>Medication</h3> <p>There is as yet no reliable medication for all cases of delayed ejaculation. Some studies have found that <a href="/facts/PDE5_inhibitors/Ce5r1Qvl">PDE5 inhibitors</a> such as Viagra have little effect.<a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a> 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.<a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a> </p><p><a href="/facts/Cabergoline/PVeYzxbC">Cabergoline</a>, an <a href="/facts/Agonist/nz8U5NNp">agonist</a> of <a href="/facts/Dopamine_receptor_D2/SmmP3QyU">dopamine D2 receptors</a> 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 <a href="/facts/Amantadine/wPfBx4Q4">amantadine</a> may help to relieve SSRI-induced orgasmic dysfunction.<a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a><a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a><a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a> <a href="/facts/Cyproheptadine/qsprhcYl">Cyproheptadine</a>, <a href="/facts/Buspirone/IeoGp3eD">buspirone</a>, stimulants such as <a href="/facts/Amphetamines/KlmrodPb">amphetamines</a> (including the antidepressant <a href="/facts/Bupropion/wjWDPxmr">bupropion</a>), <a href="/facts/Nefazodone/E0X334wJ">nefazodone</a> has been used to treat SSRI-induced anorgasmia.<a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a> Reducing the SSRI dosage may also resolve anorgasmia problems. <a href="/facts/Yohimbine/5HcoTsKu">Yohimbine</a> has been shown to be effective in the treatment of orgasmic dysfunction in men.<a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a> </p> <h3>Other</h3> <p><a href="/facts/Meditation/mlU2nUt7">Meditation</a> has demonstrated effectiveness in case studies.<a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a> </p> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/Anorgasmia/RxDBIR6J">Anorgasmia</a></li> <li><a href="/facts/Edging_(sexual_practice)/mstvzFNQ">Edging (sexual practice)</a></li> <li><a href="/facts/Premature_ejaculation/SFCHo2KE">Premature ejaculation</a></li> <li><a href="/facts/Retrograde_ejaculation/eqffEfxx">Retrograde ejaculation</a></li> <li><a href="/facts/Sexual_repression/kY9qwdye">Sexual repression</a></li></ul> <h2 id="bibliography">Bibliography</h2> <ul><li><a href="/facts/Kameel_Ahmady/GeQx1uz6">Ahmady, Kameel</a>; et al. (2023). <a href="https://books.google.com/books?id=lhTTEAAAQBAJ&pg=PA2"><i>Blade of Tradition in the Name of Religion: A Phenomenological Investigation into Male Circumcision in Iran</i></a>. Avaye Buf. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-87-94295-53-6.</li> <li>Wincze, John P; Weisberg, Risa B. (2015). "4. Delayed Ejaculation". <a href="https://books.google.com/books?id=I02hCAAAQBAJ&pg=PR8"><i>Sexual Dysfunction: A Guide for Assessment and Treatment</i></a>. Guilford Publications. pp. 38–45. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-1-4625-2061-9. <a href="/facts/OCLC_(identifier)/Yqad8waq">OCLC</a> <a href="https://search.worldcat.org/oclc/1475740918">1475740918</a>.</li> <li>Strassberg, D.S.; Mackaronis, J.E.; Perelman, M.A. (2014). "Part III Other Clinical Syndromes 15. Sexual Dysfunctions". In Blaney, Paul H; Krueger, Robert F.; Millon, Theodore (eds.). <a href="https://books.google.com/books?id=VoEZBAAAQBAJ&pg=PR6"><i>Oxford Textbook of Psychopathology</i></a>. Oxford University Press. pp. 421–462. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 978-0-19-981184-7. <a href="/facts/OCLC_(identifier)/Yqad8waq">OCLC</a> <a href="https://search.worldcat.org/oclc/1475733343">1475733343</a>.</li></ul> <h2 id="external-links">External links</h2> <ul><li><i><a href="/facts/MedlinePlus/bl3BjdjK">MedlinePlus Encyclopedia</a></i>: <a href="https://medlineplus.gov/ency/article/001954.htm">Delayed ejaculation</a></li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>https://www.smsna.org/patients/did-you-know/how-long-does-it-take-the-average-man-to-ejaculate <a href="https://www.smsna.org/patients/did-you-know/how-long-does-it-take-the-average-man-to-ejaculate" target="_blank">https://www.smsna.org/patients/did-you-know/how-long-does-it-take-the-average-man-to-ejaculate</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>Knowles, David R. (2005-06-01). "Delayed ejaculation". A.D.A.M. Medical Encyclopedia. A.D.A.M., Inc. Retrieved 2007-05-24. <a href="https://www.nlm.nih.gov/medlineplus/ency/article/001954.htm" target="_blank">https://www.nlm.nih.gov/medlineplus/ency/article/001954.htm</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>Rowland DL, Cote-Leger P (October 2020). "Moving Toward Empirically Based Standardization in the Diagnosis of Delayed Ejaculation". J Sex Med. 17 (10): 1896–1902. doi:10.1016/j.jsxm.2020.07.017. PMID 32828700. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Strassberg, D.S.; Perelman, M.A. (2009). "Part III Other Axis I Syndromes 15. Sexual Dysfunctions". In Blaney, P.H.; Millon, T. (eds.). Oxford textbook of psychopathology (2nd ed.). Oxford University Press. pp. 399–430. ISBN 978-0-19-970582-5. <a href="978-0-19-970582-5" target="_blank">978-0-19-970582-5</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>Di Sante S, Mollaioli D, Gravina GL, Ciocca G, Limoncin E, Carosa E, Lenzi A, Jannini EA (August 2016). "Epidemiology of delayed ejaculation". Transl Androl Urol. 5 (4): 541–8. doi:10.21037/tau.2016.05.10. PMC 5002002. PMID 27652226. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002002" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002002</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>Strassberg, D.S.; Perelman, M.A. (2009). "Part III Other Axis I Syndromes 15. Sexual Dysfunctions". In Blaney, P.H.; Millon, T. (eds.). Oxford textbook of psychopathology (2nd ed.). Oxford University Press. pp. 399–430. ISBN 978-0-19-970582-5. <a href="978-0-19-970582-5" target="_blank">978-0-19-970582-5</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, Vardi Y, Wespes E (May 2010). "Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation". Eur Urol. 57 (5): 804–14. doi:10.1016/j.eururo.2010.02.020. PMID 20189712. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Wincze & Weisberg 2015, p. 39 - Wincze, John P; Weisberg, Risa B. (2015). "4. Delayed Ejaculation". Sexual Dysfunction: A Guide for Assessment and Treatment. Guilford Publications. pp. 38–45. ISBN 978-1-4625-2061-9. OCLC 1475740918. <a href="https://books.google.com/books?id=I02hCAAAQBAJ&pg=PR8" target="_blank">https://books.google.com/books?id=I02hCAAAQBAJ&pg=PR8</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>Wincze & Weisberg 2015, p. 40 - Wincze, John P; Weisberg, Risa B. (2015). "4. Delayed Ejaculation". Sexual Dysfunction: A Guide for Assessment and Treatment. Guilford Publications. pp. 38–45. ISBN 978-1-4625-2061-9. OCLC 1475740918. <a href="https://books.google.com/books?id=I02hCAAAQBAJ&pg=PR8" target="_blank">https://books.google.com/books?id=I02hCAAAQBAJ&pg=PR8</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>Strassberg, Mackaronis & Perelman 2014, p. 444 - Strassberg, D.S.; Mackaronis, J.E.; Perelman, M.A. (2014). "Part III Other Clinical Syndromes 15. Sexual Dysfunctions". In Blaney, Paul H; Krueger, Robert F.; Millon, Theodore (eds.). Oxford Textbook of Psychopathology. Oxford University Press. pp. 421–462. ISBN 978-0-19-981184-7. OCLC 1475733343. <a href="https://books.google.com/books?id=VoEZBAAAQBAJ&pg=PR6" target="_blank">https://books.google.com/books?id=VoEZBAAAQBAJ&pg=PR6</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>Abdel-Hamid IA, Ali OI (January 2018). "Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment". World J Mens Health. 36 (1): 22–40. doi:10.5534/wjmh.17051. PMC 5756804. PMID 29299903. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756804" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756804</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>Dias J, Freitas R, Amorim R, Espiridião P, Xambre L, Ferraz L (June 2014). "Adult circumcision and male sexual health: a retrospective analysis". Andrologia. 46 (5): 459–64. doi:10.1111/and.12101. PMID 23600924. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>Bañuelos Marco, Beatriz; García Heil, Jessica Leigh (2021). "Circumcision in childhood and male sexual function: a blessing or a curse?". International Journal of Impotence Research. 33 (2): 139–148. doi:10.1038/s41443-020-00354-y. PMC 7985026. PMID 32994555. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985026" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985026</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>Gao, Jingjing; Xu, Chuan; Zhang, Xiansheng (2016). "AB221. Effects of adult male circumcision on premature ejaculation: results from a prospective study in China". Translational Andrology and Urology. 5 (Suppl 1): 221. doi:10.21037/tau.2016.s221. ISSN 2223-4691. PMC 4842720. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4842720" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4842720</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>Kim, Hyuncheol (2016-06-08). "Long-term Effects of Male Circumcision on Risky Sexual Behaviors and STD Infections: Evidence from Malawian Secondary Schools". AEA Randomized Controlled Trials. doi:10.1257/rct.1335-1.0. Retrieved 2024-01-06. <a href="https://dx.doi.org/10.1257/rct.1335-1.0" target="_blank">https://dx.doi.org/10.1257/rct.1335-1.0</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>Warees, Warees M.; Anand, Sachit; Rodriguez, Alexander M. (2023), "Circumcision", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30571057, retrieved 2024-01-06 <a href="http://www.ncbi.nlm.nih.gov/books/NBK535436/" target="_blank">http://www.ncbi.nlm.nih.gov/books/NBK535436/</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS (April 2007). "Fine-touch pressure thresholds in the adult penis". BJU Int. 99 (4): 864–9. doi:10.1111/j.1464-410X.2006.06685.x. PMID 17378847. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></p></li> <li id="fn:18"><p>Collins, S.; Upshaw, J.; Rutchik, S.; Ohannessian, C.; Ortenberg, J.; Albertsen, P. (2002). "Collins, S., Upshaw, J., Rutchik, S. O., C., Ortenberg, J., & Albertsen, P. (2002). Effects of circumcision on male sexual function: Debunking a myth? J Urol, 167, 2111-2112". J Urol. 167 (5): 2111–2. doi:10.1016/S0022-5347(05)65097-5. PMID 11956452. <a href="https://pubmed.ncbi.nlm.nih.gov/11956452/" target="_blank">https://pubmed.ncbi.nlm.nih.gov/11956452/</a> <a href="#fnref:18" class="footnote-back-ref">↩</a></p></li> <li id="fn:19"><p>Coursey, J. W.; Morey, A. F.; McAninch, J. W.; Summerton, D. J.; Secrest, C.; White, P.; Miller, K.; Pieczonka, C.; Hochberg, D.; Armenakas, N. (2001). "Coursey, J. W., Morey, A. F., McAninch, J. W., Summerton, D. J., Secrest, C.,White, P., et al. (2001). Erectile function after anterior urethroplasty. J Urol, 166 (6), 2273-2276". J Urol. 166 (6): 2273–6. doi:10.1016/S0022-5347(05)65549-8. PMID 11696750. <a href="https://pubmed.ncbi.nlm.nih.gov/11696750/" target="_blank">https://pubmed.ncbi.nlm.nih.gov/11696750/</a> <a href="#fnref:19" class="footnote-back-ref">↩</a></p></li> <li id="fn:20"><p>Ahmady, Kameel Et al 2023: Blade of Tradition in the Name of Religion (A Phenomenological Investigation into Male Circumcision in Iran), Scholar's Press Publishing, Republic of Moldova. <a href="#fnref:20" class="footnote-back-ref">↩</a></p></li> <li id="fn:21"><p>Ongun, Sakir; Dursun, Murat; Egriboyun, Sedat (2020). "The effect of post-circumcision mucosal cuff length on premature ejaculation". Canadian Urological Association Journal. 14 (7): E309 – E312. doi:10.5489/cuaj.6016. ISSN 1911-6470. PMC 7337711. PMID 32017696. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337711" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337711</a> <a href="#fnref:21" class="footnote-back-ref">↩</a></p></li> <li id="fn:22"><p>Gao, Jingjing; Xu, Chuan; Zhang, Jingjing; Liang, Chaozhao; Su, Puyu; Peng, Zhen; Shi, Kai; Tang, Dongdong; Gao, Pan; Lu, Zhaoxiang; Liu, Jishuang; Xia, Lei; Yang, Jiajia; Hao, Zongyao; Zhou, Jun (2015-01-28). "Effects of Adult Male Circumcision on Premature Ejaculation: Results from a Prospective Study in China". BioMed Research International. 2015: e417846. doi:10.1155/2015/417846. ISSN 2314-6133. PMC 4324807. PMID 25695078. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324807" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324807</a> <a href="#fnref:22" class="footnote-back-ref">↩</a></p></li> <li id="fn:23"><p>Namavar, Mohammad Reza; Robati, Boroomand (2011). "Removal of foreskin remnants in circumcised adults for treatment of premature ejaculation". Urology Annals. 3 (2): 87–92. doi:10.4103/0974-7796.82175. ISSN 0974-7796. PMC 3130485. PMID 21747599. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130485" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130485</a> <a href="#fnref:23" class="footnote-back-ref">↩</a></p></li> <li id="fn:24"><p>Bernaschina-Rivera, Sebastián A.; López-Chaim, Alexandra I.; Cordero-Pacheco, José A.; Fernández-Crespo, Raúl; Quesada-Olarte, José; Carrión, Rafael (October 2023). "Circumcision and Sexual Medicine". Sexual Medicine Reviews. pp. 412–420. doi:10.1093/sxmrev/qead009. PMID 37085961. Retrieved 2024-01-06. <a href="https://academic.oup.com/smr/article-abstract/11/4/412/7135857?redirectedFrom=fulltext" target="_blank">https://academic.oup.com/smr/article-abstract/11/4/412/7135857?redirectedFrom=fulltext</a> <a href="#fnref:24" class="footnote-back-ref">↩</a></p></li> <li id="fn:25"><p>Morgentaler A, Polzer P, Althof S, Bolyakov A, Donatucci C, Ni X, Patel AB, Basaria S (September 2017). "Delayed Ejaculation and Associated Complaints: Relationship to Ejaculation Times and Serum Testosterone Levels". J Sex Med. 14 (9): 1116–24. doi:10.1016/j.jsxm.2017.06.013. PMID 28807505. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:25" class="footnote-back-ref">↩</a></p></li> <li id="fn:26"><p>Paduch DA, Polzer P, Morgentaler A, Althof S, Donatucci C, Ni X, Patel AB, Basaria S (December 2015). "Clinical and Demographic Correlates of Ejaculatory Dysfunctions Other Than Premature Ejaculation: A Prospective, Observational Study". J Sex Med. 12 (12): 2276–86. doi:10.1111/jsm.13027. PMID 26511106. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:26" class="footnote-back-ref">↩</a></p></li> <li id="fn:27"><p>Strassberg, D.S.; Perelman, M.A. (2009). "Part III Other Axis I Syndromes 15. Sexual Dysfunctions". In Blaney, P.H.; Millon, T. (eds.). Oxford textbook of psychopathology (2nd ed.). Oxford University Press. pp. 399–430. ISBN 978-0-19-970582-5. <a href="978-0-19-970582-5" target="_blank">978-0-19-970582-5</a> <a href="#fnref:27" class="footnote-back-ref">↩</a></p></li> <li id="fn:28"><p>drugs.com Delayed ejaculation Archived 2019-02-20 at the Wayback Machine Review Date: 6/5/2007. Reviewed By: Marc Greenstein, DO, Urologist, North Jersey Center for Urologic Care <a href="https://www.drugs.com/enc/delayed-ejaculation.html" target="_blank">https://www.drugs.com/enc/delayed-ejaculation.html</a> <a href="#fnref:28" class="footnote-back-ref">↩</a></p></li> <li id="fn:29"><p>Smith, Shubulade; Robin Murray; Veronica O'Keane (2002). "Sexual dysfunction in patients taking conventional antipsychotic medication". The British Journal of Psychiatry. 181: 49–55. doi:10.1192/bjp.181.1.49. PMID 12091263. <a href="https://doi.org/10.1192%2Fbjp.181.1.49" target="_blank">https://doi.org/10.1192%2Fbjp.181.1.49</a> <a href="#fnref:29" class="footnote-back-ref">↩</a></p></li> <li id="fn:30"><p>Ghadigaonkar, Deepak S.; Murthy, Pratima (2019). "Sexual Dysfunction in Persons with Substance Use Disorders". Journal of Psychosexual Health. 1 (2): 117–121. doi:10.1177/2631831819849365. S2CID 196538029. <a href="https://doi.org/10.1177%2F2631831819849365" target="_blank">https://doi.org/10.1177%2F2631831819849365</a> <a href="#fnref:30" class="footnote-back-ref">↩</a></p></li> <li id="fn:31"><p>Mann, Jay (1976). "Retarded ejaculation and treatment". International Congress of Sexology. <a href="#fnref:31" class="footnote-back-ref">↩</a></p></li> <li id="fn:32"><p>Wincze & Weisberg 2015, p. 42 - Wincze, John P; Weisberg, Risa B. (2015). "4. Delayed Ejaculation". Sexual Dysfunction: A Guide for Assessment and Treatment. Guilford Publications. pp. 38–45. ISBN 978-1-4625-2061-9. OCLC 1475740918. <a href="https://books.google.com/books?id=I02hCAAAQBAJ&pg=PR8" target="_blank">https://books.google.com/books?id=I02hCAAAQBAJ&pg=PR8</a> <a href="#fnref:32" class="footnote-back-ref">↩</a></p></li> <li id="fn:33"><p>Wincze & Weisberg 2015, p. 42 - Wincze, John P; Weisberg, Risa B. (2015). "4. Delayed Ejaculation". Sexual Dysfunction: A Guide for Assessment and Treatment. Guilford Publications. pp. 38–45. ISBN 978-1-4625-2061-9. OCLC 1475740918. <a href="https://books.google.com/books?id=I02hCAAAQBAJ&pg=PR8" target="_blank">https://books.google.com/books?id=I02hCAAAQBAJ&pg=PR8</a> <a href="#fnref:33" class="footnote-back-ref">↩</a></p></li> <li id="fn:34"><p>Wincze & Weisberg 2015, p. 42 - Wincze, John P; Weisberg, Risa B. (2015). "4. Delayed Ejaculation". Sexual Dysfunction: A Guide for Assessment and Treatment. Guilford Publications. pp. 38–45. ISBN 978-1-4625-2061-9. OCLC 1475740918. <a href="https://books.google.com/books?id=I02hCAAAQBAJ&pg=PR8" target="_blank">https://books.google.com/books?id=I02hCAAAQBAJ&pg=PR8</a> <a href="#fnref:34" class="footnote-back-ref">↩</a></p></li> <li id="fn:35"><p>Bronner, Gila; Ben-Zion, Itzhak Z. (July 2014). "Unusual Masturbatory Practice as an Etiological Factor in the Diagnosis and Treatment of Sexual Dysfunction in Young Men". The Journal of Sexual Medicine. 11 (7): 1798–1806. doi:10.1111/jsm.12501. PMID 24674621. Retrieved 31 October 2024. <a href="https://www.sciencedirect.com/science/article/abs/pii/S1743609515308109" target="_blank">https://www.sciencedirect.com/science/article/abs/pii/S1743609515308109</a> <a href="#fnref:35" class="footnote-back-ref">↩</a></p></li> <li id="fn:36"><p>Althof SE (2012). "Psychological interventions for delayed ejaculation/orgasm". Int J Impot Res. 24 (4): 131–6. doi:10.1038/ijir.2012.2. PMID 22378496. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:36" class="footnote-back-ref">↩</a></p></li> <li id="fn:37"><p>Sank, Lawrence (1998). "Traumatic masturbatory syndrome". Journal of Sex & Marital Therapy. 24 (1): 37–42. doi:10.1080/00926239808414667. PMID 9509379. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:37" class="footnote-back-ref">↩</a></p></li> <li id="fn:38"><p>Perelman MA, Rowland DL (December 2006). "Retarded ejaculation". World J Urol. 24 (6): 645–52. doi:10.1007/s00345-006-0127-6. PMID 17082938. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:38" class="footnote-back-ref">↩</a></p></li> <li id="fn:39"><p>American Psychiatric Association (2022). "Sexual Dysfunctions". Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR(tm)). G - Reference,Information and Interdisciplinary Subjects Series. American Psychiatric Association Publishing. p. 479. ISBN 978-0-89042-576-3. <a href="978-0-89042-576-3" target="_blank">978-0-89042-576-3</a> <a href="#fnref:39" class="footnote-back-ref">↩</a></p></li> <li id="fn:40"><p>Rowland D, McMahon CG, Abdo C, Chen J, Jannini E, Waldinger MD, Ahn TY (April 2010). "Disorders of orgasm and ejaculation in men". J Sex Med. 7 (4 Pt 2): 1668–86. doi:10.1111/j.1743-6109.2010.01782.x. PMID 20388164. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:40" class="footnote-back-ref">↩</a></p></li> <li id="fn:41"><p>"INTRODUCTION - Uroweb". Uroweb - European Association of Urology. Retrieved 2024-05-23. <a href="https://uroweb.org/guidelines/sexual-and-reproductive-health" target="_blank">https://uroweb.org/guidelines/sexual-and-reproductive-health</a> <a href="#fnref:41" class="footnote-back-ref">↩</a></p></li> <li id="fn:42"><p>Dr. David Delvin (2007-06-25). "Delayed ejaculation (retarded ejaculation)". Netdoctor. NetDoctor.co.uk. Archived from the original on 2015-10-21. Retrieved 2007-10-25. <a href="https://web.archive.org/web/20151021080714/http://www.netdoctor.co.uk/sex_relationships/facts/ejaculatoryincompetence.htm" target="_blank">https://web.archive.org/web/20151021080714/http://www.netdoctor.co.uk/sex_relationships/facts/ejaculatoryincompetence.htm</a> <a href="#fnref:42" class="footnote-back-ref">↩</a></p></li> <li id="fn:43"><p>Strassberg, D.S.; Perelman, M.A. (2009). "Part III Other Axis I Syndromes 15. Sexual Dysfunctions". In Blaney, P.H.; Millon, T. (eds.). Oxford textbook of psychopathology (2nd ed.). Oxford University Press. pp. 399–430. ISBN 978-0-19-970582-5. <a href="978-0-19-970582-5" target="_blank">978-0-19-970582-5</a> <a href="#fnref:43" class="footnote-back-ref">↩</a></p></li> <li id="fn:44"><p>The Carlat Psychiatry Report > PDE-5 Inhibitors: Which to Choose? Archived 2019-12-16 at the Wayback Machine Published in The Carlat Psychiatry Report. December 2004, Volume 2, Number 12 <a href="https://pro.psychcentral.com/pde-5-inhibitors-which-to-choose/" target="_blank">https://pro.psychcentral.com/pde-5-inhibitors-which-to-choose/</a> <a href="#fnref:44" class="footnote-back-ref">↩</a></p></li> <li id="fn:45"><p>WebMD Health News > Viagra, Paxil Help Premature Ejaculation. May 29, 2002. By Martin F. Downs. <a href="http://men.webmd.com/news/20020529/viagra-paxil-help-premature-ejaculation" target="_blank">http://men.webmd.com/news/20020529/viagra-paxil-help-premature-ejaculation</a> <a href="#fnref:45" class="footnote-back-ref">↩</a></p></li> <li id="fn:46"><p>Shrivastava RK, Shrivastava S, Overweg N, Schmitt M (1995). "Amantadine in the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors". Journal of Clinical Psychopharmacology. 15 (1): 83–84. doi:10.1097/00004714-199502000-00014. PMID 7714234. <a href="/wiki/Journal_of_Clinical_Psychopharmacology" target="_blank">/wiki/Journal_of_Clinical_Psychopharmacology</a> <a href="#fnref:46" class="footnote-back-ref">↩</a></p></li> <li id="fn:47"><p>Balogh S, Hendricks SE, Kang J (1992). "Treatment of fluoxetine-induced anorgasmia with amantadine". The Journal of Clinical Psychiatry. 53 (6): 212–13. PMID 1607353. <a href="/wiki/The_Journal_of_Clinical_Psychiatry" target="_blank">/wiki/The_Journal_of_Clinical_Psychiatry</a> <a href="#fnref:47" class="footnote-back-ref">↩</a></p></li> <li id="fn:48"><p>Keller Ashton A, Hamer R, Rosen RC (1997). "Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: a large-scale retrospective study of 596 psychiatric outpatients". Journal of Sex & Marital Therapy. 23 (3): 165–75. doi:10.1080/00926239708403922. PMID 9292832. <a href="/wiki/Journal_of_Sex_%26_Marital_Therapy" target="_blank">/wiki/Journal_of_Sex_%26_Marital_Therapy</a> <a href="#fnref:48" class="footnote-back-ref">↩</a></p></li> <li id="fn:49"><p>Gitlin, Michael J. (1998). "Treatment of Antidepressant-Induced Sexual Dysfunction". Medscape Psychiatry & Mental Health eJournal. 3 (3). Retrieved 4 April 2018. <a href="http://www.medscape.com/viewarticle/430614_5" target="_blank">http://www.medscape.com/viewarticle/430614_5</a> <a href="#fnref:49" class="footnote-back-ref">↩</a></p></li> <li id="fn:50"><p>Adeniyi AA, Brindley GS, Pryor JP, Ralph DJ (May 2007). "Yohimbine in the treatment of orgasmic dysfunction". Asian Journal of Andrology. 9 (3): 403–07. doi:10.1111/J.1745-7262.2007.00276.x. PMID 17486282. <a href="https://doi.org/10.1111%2FJ.1745-7262.2007.00276.x" target="_blank">https://doi.org/10.1111%2FJ.1745-7262.2007.00276.x</a> <a href="#fnref:50" class="footnote-back-ref">↩</a></p></li> <li id="fn:51"><p>M. M. Delmonte (June 1984). "Case reports on the use of meditative relaxation as an intervention strategy with retarded ejaculation". Biofeedback and Self-Regulation. 9 (2): 209–214. doi:10.1007/BF00998835. PMID 6391563. S2CID 40959207. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:51" class="footnote-back-ref">↩</a></p></li> </ol>