UPDATE ON RECOMMENDATIONS ON
DELAYED EJACULATION BY BASHH SEXUAL
DYSFUNCTION SIG JUNE 2011
Literature reviewed from 2006 to present using terms delayed ejaculation, retarded
ejaculation and inhibited ejaculation (as well as substituting word “orgasm” for “ejaculation”)
as key phrases on Pubmed search.
1. Terminology- the International Committee for Sexual Medicine (ICSM) uses the
term Delayed Ejaculation (DE) rather than Retarded Ejaculation (1) Level IV
2. Definition - DSM 4- TR has given a more up to date definition of DE- the
persistent or recurrent delay in, or absence of, orgasm after a normal sexual
excitement phase during sexual activity that the clinician, taking into account
the person’s age, judges to be adequate in focus, intensity and duration. The
disturbance causes marked distress or interpersonal difficulty; it should not be
better accounted for by another Axis 1 (clinical) disorder or caused exclusively
by the direct physiological effects of a substance or general medical condition
(2). Level IV
3. Rates- DE rarely exceeds 3% in the literature. Given that most men ejaculate
within 4-10 minutes after intromission, latencies beyond 25 minutes represent 2
standard deviations above the mean(1) (3) Level III
4. A number of recent population and twin studies point to a moderate genetic
influence in the aetiology of lifelong rapid ejaculation. No such effect has been
demonstrated for DE (4).Level IIa
5. Pregabalin has been reported as being associated with DE (5).Level III
6. Prolactin and TSH levels progressively increase from patients with severe rapid
ejaculation towards those with severe DE. Testosterone levels progressively
decrease across the same spectrum. However the levels of Prolactin, TSH and
Testosterone remain within the normal ranges (6) Level III
7. Powerful vibrators e.g. Ferticare , seem useful for men with secondary
idiopathic DE and following spinal cord injury (7)(8).Level III
8. The ICSM (2010) suggests that relevant information to obtain from the patient
includes: (1) Level IV

A basic medical history, including the use of prescribed and recreational
medications;

The cultural context and developmental history of the disorder, including
whether the
premature ejaculation is global or situational, lifelong or recent in
its development;

Measures of the quality of each of the three phases of the sexual response cycle:
desire, arousal, and ejaculation, since the desire and arousal phases may impact
the ejaculatory response;

Details about the ejaculatory response, including the patient's subjective
assessment of his IELT and sense of ejaculatory control, the level of sexual
dissatisfaction and distress, the frequency of sexual activity, and so on;

The partner's assessment of the situation, including whether the partner suffers
from a sexual dysfunction ; and

Assessment of the sexual and overall relationship.
However, in spite of these data, the SIG feels that the 2006 recommendations
and auditable outcomes are current and there is no need to upgrade them.
References
1.Rowland d, McMahon CG, Abdo C,Chen J,Jannini E, Waldinger MD, Ahn TY
Disorders of orgasm and ejaculation in men J Sex Med 2010;7:1668-86
2.American Psychiatric Association. Diagnostic and Statistical manual of mental
disorders. DSM-IV-TR. 4th Edition revised. American Psychiatric Association.
Washington DC 2000
3.Patrick DL,Althof SE, Pryor JL et al Premature ejaculation:An observational study
of men and their partners. J Sex Med 2005;2:358-367
4. Jern P, Santtila P, Johansson A, Sandnabba NK Genetic and environmental effects
on the continuity of ejaculatory dysfunction BJU 2010;105:1698-704
5.Calabro RS, Bramanti P Pregabalin induced severe delayed ejaculation Epilepsy and
Behavior 2010;19:543
6. Corona G, Jannini EA, Lotti F et al Premature and delayed ejaculation: two ends of
a single continuum influenced by hormonal milieu. Int J Andrology 2010;34:41-48
7.Nelson CJ, Ahmed A, Valenzuela R, Parker M, Mulhall JP Assessment of penile
vibratory stimulation as a management strategy in men with secondary retarded
orgasm Urology 2007;69:552-556
8. Hamid R, patki P, Bywater H, Shah PJR, Craggs MD Effects of repeated
ejaculations on semen characteristics following spinal cord injury. Spinal Cord
2006;44:369-373