Of all the male sexual dysfunctions, delayed ejaculation (DE) is the least understood, least common and least studied. This paper aims to review and integrate the diverse psychological theories and proposed psychological interventions for DE. Clinicians will then be able to more clearly discern the relevant psychological/interpersonal issues of the patient/couple and implement systematically based effective interventions. After reviewing the literature, it is clear that no one theory accounts for all the varied presentations of DE, and no theory by itself has strong empirical support. However, awareness of the diverse points of view helps clinicians conduct better assessments and broaden their understanding of the patient's ejaculatory dysfunction. Similarly, no one psychological intervention works for all patients, nor will unsystematic random selection of interventions. This paper stresses on the need to clearly identify the source of the dysfunction and select treatments based upon the precipitating and maintaining factors. Much work remains to be done with regard to our understanding and treatment of DE. Specifically, we need to craft an evidence-based definition, assess the true prevalence of the dysfunction, demonstrate the efficacy of psychological interventions and design validated outcome measures.
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McMahon CG, Rowland DL, Abdo C, Jannini E, Chen J, Waldinger M et al. Disorders of orgasm and ejaculation in men. In: Montorsi F, Basson R, Adaikan G et al. (eds). Sexual Medicine: Sexual Disorders in Men and Women, Edition 2010: Paris, 2010.
Perelman M, McMahon C, Barada J . Evaluation and treatment of ejaculation disorders. In: Lue T (ed). Atlas of Male Sexual Dysfunction. Current Medicine Inc.: Philadelphia, 2004, pp 126–157.
Waldinger M, Schweitzer D . Retarded ejaculation in men: an overview of psychological and neurobiological insights. World J Urol 2006; 23: 76–81.
Waldinger MD . Premature ejaculation and delayed ejaculation. In: Levine S, Risen C, Althof S (eds). Handbook of Clinical Sexuality for Mental Health Practitioners, 2nd edn. Routledge: New York, 2010.
Rowland DL, Keeney C, Slob K . Sexual response in men with inhibited or retarded ejaculation. Int J Impot Res 2004; 16: 270–274.
Althof S, McCabe M, Assalian P, Chevret-Measson M, Leiblum SR, Simonelli C et al. Psychological and interpersonal dimensions of sexual function and dysfunction. In: Montorsi F, Basson R, Adaikan G, et al. (eds). Sexual Medicine: Sexual Disorders in Men and Women, 2010 edn. Paris, 2010.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Text Revision. American Psychiatric Association: Washington, DC, 2000.
Segraves R . Considerations for a better definition of male orgasmic disorder in DSM V. J Sex Med 2010; 7: 690–699.
Wylie K, Ralph D, Levin R, Corona G, Perelman M . Comments on (considerations for a better definition of male orgasmic disorder in DSM-V). J Sex Med 2010; 7: 695–699.
McMahon CG, Althof SE, Waldinger MD, Porst H, Dean J, Sharlip I et al. An evidence-based definition of lifelong premature ejaculation: report of the International Society for Sexual Medicine (ISSM) ad hoc committee for the definition of premature ejaculation. J Sex Med 2008; 5: 1590–1606.
Waldinger M, McIntosh J, Schweitzer DH . A five-nation survey to assess the distribution of the intravaginal ejaculatory latency time among the general male population. J Sex Med 2009; 6: 2888–2895.
Perelman MA, Rowland DL . Retarded ejaculation. World J Urol 2006; 24: 645–652.
Masters W, Johnson V . Human Sexual Inadequacy. Little, Brown: Boston, 1970.
Bancroft J . 3rd edn. Churchill Livingstone: Edinburgh, 2008.
Perelman MA . Idiosyncratic masturbation patterns: a key unexplored variable in the treatment of retarded ejaculation by the practicing urologist. J Urol 2005; 173: 340.
Apfelbaum B . The diagnosis and treatment of retarded ejaculation. In: Leiblum S, Rosen R (eds). Principles and Practice of Sex Therapy: Update for the 1990s. Guilford Press: New York, 1989, pp 168–206.
Alexander F . Psychosomatic medicine. Norton: New York, 1950.
Bergler E . Some special varieties of ejaculatory disturbance not hitherto described. Int J Psychoanal 1935; 16.
Fenichel O . The Psychoanalytic Theory of Neurosis. Norton: New York, 1945.
Ferenczi S . The Symbolism of the Bridge. Basic Books: New York, 1950.
Friedman M . Success phobia and retarded ejaculation. Am J Psychother 1973; 27: 78–84.
Kaplan H . The New Sex Therapy. Brunner/Mazel: New York, 1974.
Levine S . Marital sexual dysfunction: ejaculation disturbances. Ann Intern Med 1976; 84: 575–579.
Ovesey L, Meyers H . Retarded ejaculation. Psychodynamics and psychotherapy. Am J Psychother 1968; 22: 185–201.
McCarthy B . Cognitive-behavioral strategies and techniques in the treatment of early ejaculation. In: Leiblum S, Rosen R (eds). Principles and Practice of Sex Therapy: Update for the 90s. Guilford Press: New York, 1990, pp 141–167.
Dr Althof is a principal or sub-investigator for Boehringer-Ingelheim, Endocutics, Palitan Technologies and United Biosource. He is also a consultant to Boehringer-Ingelheim, Eli Lilly, Palitan and Shionogi. He serves on Advisory Boards for Bayer, Boehringer-Ingelheim, Eli Lilly, Palitan Technologies and Shionogi.
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Althof, S. Psychological interventions for delayed ejaculation/orgasm. Int J Impot Res 24, 131–136 (2012). https://doi.org/10.1038/ijir.2012.2
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International Journal of Impotence Research (2023)
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