Delayed ejaculation

Last updated
Delayed ejaculation
Other namesRetarded ejaculation, inhibited ejaculation
Specialty Urology

Delayed ejaculation (DE) describes a man's inability or persistent difficulty in achieving orgasm, despite typical sexual desire and sexual stimulation. Generally, a man can reach orgasm within a few minutes of active thrusting during sexual intercourse, whereas a man with delayed ejaculation either does not have orgasms at all or cannot have an orgasm until after prolonged intercourse which might last for 30–45 minutes or more. [1] Delayed ejaculation is closely related to anorgasmia.

Contents

In the Diagnostic and Statistical Manual of Mental Disorders (DSM), fifth edition, the definition of DE requires 1 of 2 symptoms: either a marked delay in or a marked infrequency or absence of ejaculation on 75% to 100% of occasions for at least 6 months of partnered sexual activity without the individual desiring delay, and causing significant distress to the individual. DE is meant to describe any and all of the ejaculatory disorders that result in a delay or absence of ejaculation. The Third International Consultation on Sexual Medicine defined DE as an IELT threshold beyond 20 to 25 minutes of sexual activity, as well as negative personal consequences such as bother or distress. Of note, most men's intravaginal ejaculation latency time range is approximately 4 to 10 minutes. While ejaculatory latency and control were significant criteria to differentiate men with DE from those without ejaculatory disorders, bother/distress did not emerge as a significant factor. [2]

Delayed ejaculation is the least common of the male sexual dysfunctions, and can result as a side effect of some medications. In one survey, 8% of men reported being unable to achieve orgasm over a two-month period or longer in the previous year. [3] DEs are either primary and lifelong or acquired. Acquired DEs may be situational. While most men do experience occasional or short term delayed ejaculation issues, the prevalence of lifelong DE and acquired long term DE is estimated around 1% and 4%, respectively. [4]

Signs and symptoms

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 fellatio or a handjob), severe (can ejaculate only when alone), or most severe (cannot ejaculate at all). [3] All forms may result in a sense of sexual frustration. [5] In most cases, delayed ejaculation presents the condition in which the man can climax and ejaculate only during masturbation, but not during sexual intercourse. As of 2015, the DSM-V uses the term "delayed ejaculation" instead of older terms such as "inhibited ejaculation", "impotent ejaculation" or "retarded ejaculation". [6] 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 standard deviation of 7.1 minutes). [7] 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. [8]

Causes

The etiologies of delayed ejaculation can be age-related, organic, psychological, or pharmacological. [9]

Primary lifelong DEs are poorly understood and rarely explained by few congenital anatomic causes (viz., Müllerian duct cyst, Wolfian duct abnormalities, prune belly syndrome, imperforate anus, congenital ejaculatory duct obstruction, genetic abnormalities including cystic fibrosis, etc.)

Diagnosis

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. [34]

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.

Treatment

Primary, lifelong DEs are poorly understood and hence less well studied. Organic causes in the acquired DEs should be addresses 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. [35]

Sex therapy

Therapy usually involves homework assignments and exercises intended to help a man get used to having orgasms through insertional intercourse, 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. [36] 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 in sertive partner's penis 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. [3]

Medication

There is as yet no reliable medication for all cases of delayed ejaculation. Some studies have found that PDE5 inhibitors such as Viagra have little effect. [37] 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. [38]

Cabergoline, an agonist of dopamine D2 receptors 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 amantadine may help to relieve SSRI-induced orgasmic dysfunction. [39] [40] [41] Cyproheptadine, buspirone, stimulants such as amphetamines (including the antidepressant bupropion), nefazodone has been used to treat SSRI-induced anorgasmia. [42] Reducing the SSRI dosage may also resolve anorgasmia problems. Yohimbine has been shown to be effective in the treatment of orgasmic dysfunction in men. [43]

Other

Meditation has demonstrated effectiveness in case studies. [44]

See also

Related Research Articles

<span class="mw-page-title-main">Orgasm</span> Intense physical sensation of sexual release

Orgasm, or sexual climax, is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic, involuntary muscular contractions in the pelvic region characterized by sexual pleasure. Experienced by males and females, orgasms are controlled by the involuntary or autonomic nervous system. They are usually associated with involuntary actions, including muscular spasms in multiple areas of the body, a general euphoric sensation, and, frequently, body movements and vocalizations. The period after orgasm is typically a relaxing experience, attributed to the release of the neurohormones oxytocin and prolactin as well as endorphins.

<span class="mw-page-title-main">Sexual intercourse</span> Copulation or penetrative sexual activity for reproduction or sexual pleasure

Sexual intercourse is sexual activity involving the insertion and thrusting of the male penis inside the female vagina for sexual pleasure, reproduction, or both. This is also known as vaginal intercourse or vaginal sex. Other forms of penetrative sexual intercourse include anal sex, oral sex, fingering and penetration by use of a dildo, and vibrators These activities involve physical intimacy between two or more individuals and are usually used among humans solely for physical or emotional pleasure and can contribute to human bonding.

<span class="mw-page-title-main">Pre-ejaculate</span> Clear fluid emitted from the urethra of the penis during arousal

Pre-ejaculate is a clear, colorless, viscous fluid that is emitted from the urethra of the penis during sexual arousal. It is similar in composition to semen but has distinct chemical differences. The presence of sperm in the fluid is variable from low to absent. Pre-ejaculate functions as a lubricant and an acid neutralizer.

Anorgasmia is a type of sexual dysfunction in which a person cannot achieve orgasm despite adequate stimulation. Anorgasmia is far more common in females than in males and is especially rare in younger men. The problem is greater in women who are post-menopausal. In males, it is most closely associated with delayed ejaculation. Anorgasmia can often cause sexual frustration.

Premature ejaculation (PE) is a male sexual dysfunction that occurs when a male expels semen soon after beginning sexual activity, and with minimal penile stimulation. It has also been called early ejaculation, rapid ejaculation, rapid climax, premature climax and (historically) ejaculatio praecox. There is no uniform cut-off defining "premature", but a consensus of experts at the International Society for Sexual Medicine endorsed a definition of around one minute after penetration. The International Classification of Diseases (ICD-10) applies a cut-off of 15 seconds from the beginning of sexual intercourse.

Dyspareunia is painful sexual intercourse due to medical or psychological causes. The term dyspareunia covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.

<span class="mw-page-title-main">Retrograde ejaculation</span> Redirection of ejaculated semen into the urinary bladder

Retrograde ejaculation occurs when semen which would be ejaculated via the urethra is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation, sealing the bladder which besides inhibiting the release of urine also prevents a reflux of seminal fluids into the male bladder during ejaculation. The semen is forced to exit via the urethra, the path of least resistance. When the bladder sphincter does not function properly, retrograde ejaculation may occur. It can also be induced deliberately by a male as a primitive form of male birth control or as part of certain alternative medicine practices. The retrograde-ejaculated semen, which goes into the bladder, is excreted with the next urination.

Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction as a "person's inability to participate in a sexual relationship as they would wish". This definition is broad and is subject to many interpretations. A diagnosis of sexual dysfunction under the DSM-5 requires a person to feel extreme distress and interpersonal strain for a minimum of six months. Sexual dysfunction can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.

<span class="mw-page-title-main">Epididymal hypertension</span> Condition that arises during male sexual arousal when seminal fluid is not ejaculated

Epididymal hypertension (EH), informally referred to as blue balls for men or blue vulva for women, is a harmless but uncomfortable sensation in the genital regions during a prolonged state of sexual arousal. It usually resolves within hours unless relieved through an orgasm.

The human sexual response cycle is a four-stage model of physiological responses to sexual stimulation, which, in order of their occurrence, are the excitement, plateau, orgasmic, and resolution phases. This physiological response model was first formulated by William H. Masters and Virginia E. Johnson, in their 1966 book Human Sexual Response. Since that time, other models regarding human sexual response have been formulated by several scholars who have criticized certain inaccuracies in the human sexual response cycle model.

Sexual medicine or psychosexual medicine as defined by Masters and Johnsons in their classic Textbook of Sexual Medicine, is "that branch of medicine that focuses on the evaluation and treatment of sexual disorders, which have a high prevalence rate." Examples of disorders treated with sexual medicine are erectile dysfunction, hypogonadism, and prostate cancer. Sexual medicine often uses a multidisciplinary approach involving physicians, mental health professionals, social workers, and sex therapists. Sexual medicine physicians often approach treatment with medicine and surgery, while sex therapists often focus on behavioral treatments.

<span class="mw-page-title-main">Sexual frustration</span> Frustration resulting from lack of desired sexual activity

Sexual frustration is a sense of dissatisfaction stemming from a discrepancy between a person's desired and achieved sexual activity. It may result from physical, mental, emotional, social, financial, religious or spiritual barriers. It can derive from displeasure during sex due to issues such as anorgasmia, anaphrodisia, premature ejaculation, delayed ejaculation or erectile dysfunction. A sense of incompatibility or discrepancy in libido between partners may be involved. It may also relate to broader existential frustration.

Anejaculation is the pathological inability to ejaculate despite an erection in males, with (orgasmic) or without (anorgasmic) orgasm.

Ejaculatory dysfunction can refer to:

<span class="mw-page-title-main">Masturbation</span> Sexual stimulation of ones own genitals

Masturbation is a form of autoeroticism in which a person sexually stimulates their own genitals for sexual arousal or other sexual pleasure, usually to the point of orgasm. The stimulation may involve the use of hands, everyday objects, sex toys, or more rarely, the mouth. Masturbation may also be performed with a sex partner, either masturbating together or watching the other partner masturbate.

<span class="mw-page-title-main">Human penis</span> Human male external reproductive organ

In human anatomy, the penis is an external male sex organ that additionally serves as the urinary duct. The main parts are the root (radix); the body (corpus); and the epithelium of the penis including the shaft skin and the foreskin (prepuce) covering the glans penis. The body of the penis is made up of three columns of tissue: two corpora cavernosa on the dorsal side and corpus spongiosum between them on the ventral side. The human male urethra passes through the prostate gland, where it is joined by the ejaculatory duct, and then through the penis. The urethra traverses the corpus spongiosum, and its opening, the meatus, lies on the tip of the glans penis. It is a passage both for urination and ejaculation of semen.

Intravaginal ejaculation latency time (IELT) is the time it takes to ejaculate during vaginal penetration. Average IELT varies between people and tends to decrease with age.

<span class="mw-page-title-main">Ejaculation</span> Euphoric stimulative semen discharge of the male reproductive tract

Ejaculation is the discharge of semen from the male reproductive tract. It is normally linked with orgasm, which involves involuntary contractions of the pelvic floor. It is the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. Ejaculation can occur spontaneously during sleep, and is a normal part of human sexual development. In rare cases, ejaculation occurs because of prostatic disease. Anejaculation is the condition of being unable to ejaculate. Ejaculation is usually very pleasurable for men; dysejaculation is an ejaculation that is painful or uncomfortable. Retrograde ejaculation is the condition where semen travels backwards into the bladder rather than out of the urethra.

Postorgasmic illness syndrome (POIS) is a syndrome in which human males have chronic physical and cognitive symptoms following ejaculation. The symptoms usually onset within seconds, minutes, or hours, and last for up to a week. The cause and prevalence are unknown; it is considered a rare disease.

Ejaculation disorders are the most common sexual dysfunction in men. Common ejaculatory disorders include: premature ejaculation, retrograde ejaculation, delayed ejaculation, anejaculation, inhibited ejaculation, and anorgasmia.

References

  1. ↑ Knowles, David R. (2005-06-01). "Delayed ejaculation". A.D.A.M. Medical Encyclopedia. A.D.A.M., Inc. Retrieved 2007-05-24.
  2. ↑ Rowland DL, Cote-Leger P. Moving Toward Empirically Based Standardization in the Diagnosis of Delayed Ejaculation. J Sex Med. 2020 Oct;17(10):1896–1902. doi: 10.1016/j.jsxm.2020.07.017. Epub 2020 Aug 20. PMID 32828700.
  3. 1 2 3 4 Strassberg, D. S., & Perelman, M. A. (2009). Sexual dysfunctions. In P. H. Blaney & T. Millon (Eds.), Oxford textbook of psychopathology (2nd ed.), (pp. 399–430). NY: Oxford University Press.
  4. ↑ Di Sante S, Mollaioli D, Gravina GL, Ciocca G, Limoncin E, Carosa E, Lenzi A, Jannini EA. Epidemiology of delayed ejaculation. Transl Androl Urol. 2016 Aug;5(4):541-8. doi: 10.21037/tau.2016.05.10. PMID 27652226; PMCID: PMC5002002.
  5. ↑ Hatzimouratidis, Konstantinos, et al. "Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation." European urology 57.5 (2010): 804–814.
  6. ↑ Wincze, John P.; Weisberg, Risa B. Sexual Dysfunction: A Guide for Assessment and Treatment. Guilford Publications, 2015. p. 39
  7. ↑ Wincze, John P.; Weisberg, Risa B. Sexual Dysfunction: A Guide for Assessment and Treatment. Guilford Publications, 2015. p. 40
  8. ↑ Blaney, Paul H.; Krueger, Robert F.; Millon, Theodore. Oxford Textbook of Psychopathology. Oxford University Press, 2014. p. 444
  9. ↑ Abdel-Hamid IA, Ali OI. Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment. World J Mens Health. 2018 Jan;36(1):22–40. https://doi.org/10.5534/wjmh.17051
  10. ↑ Dias J, Freitas R, Amorim R, Espiridião P, Xambre L, Ferraz L, Adult circumcision and male sexual health: a retrospective analysis, Andrologia, 20 April 2013 doi : 10.1111/and.12101
  11. ↑ 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. ISSN   1476-5489.
  12. ↑ 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 .
  13. ↑ 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.
  14. ↑ Warees, Warees M.; Anand, Sachit; Rodriguez, Alexander M. (2023), "Circumcision", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30571057 , retrieved 2024-01-06
  15. ↑ "Sorrells, M. L., Snyder, J. L., Reiss, M. D., Eden, C., Milos, M. F., Wilcox, N., & Van Howe, R. S. (2007). Finetouch pressure thresholds in the adult penis. BJU Int, 99 (4), 864-869". BJU.
  16. ↑ 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): 2111–2112. doi:10.1016/S0022-5347(05)65097-5. PMID   11956452.
  17. ↑ 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): 2273–2276. doi:10.1016/S0022-5347(05)65549-8. PMID   11696750.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ "Sebastián A Bernaschina-Rivera, BS, Alexandra I López-Chaim, BS, José A Cordero-Pacheco, BS, Raúl Fernández-Crespo, MD, José Quesada-Olarte, MD, Rafael Carrión, MD Sexual Medicine Reviews, Volume 11, Issue 4, October 2023, Pages 412–420". academic.oup.com. Retrieved 2024-01-06.
  23. ↑ Morgentaler A, Polzer P, Althof S, Bolyakov A, Donatucci C, Ni X, Patel AB, Basaria S. Delayed Ejaculation and Associated Complaints: Relationship to Ejaculation Times and Serum Testosterone Levels. J Sex Med. 2017 Sep;14(9):1116–1124. doi: 10.1016/j.jsxm.2017.06.013. Epub 2017 Aug 12. PMID 28807505.
  24. ↑ Paduch DA, Polzer P, Morgentaler A, Althof S, Donatucci C, Ni X, Patel AB, Basaria S. Clinical and Demographic Correlates of Ejaculatory Dysfunctions Other Than Premature Ejaculation: A Prospective, Observational Study. J Sex Med. 2015 Dec;12(12):2276-86. doi: 10.1111/jsm.13027. Epub 2015 Oct 29. PMID 26511106.
  25. ↑ 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
  26. ↑ 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.
  27. ↑ 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.
  28. ↑ Mann, Jay (1976). "Retarded ejaculation and treatment". International Congress of Sexology.
  29. 1 2 3 Wincze, John P.; Weisberg, Risa B. Sexual Dysfunction: A Guide for Assessment and Treatment. Guilford Publications, 2015. p. 42
  30. ↑ Althof, S. Psychological interventions for delayed ejaculation/orgasm. Int J Impot Res 24, 131–136 (2012). https://doi.org/10.1038/ijir.2012.2
  31. ↑ Sank, Lawrence (1998). "Traumatic masturbatory syndrome". Journal of Sex & Marital Therapy. 24 (1): 37–42. doi:10.1080/00926239808414667. PMID   9509379.
  32. ↑ Perelman MA, Rowland DL. Retarded ejaculation. World J Urol. 2006 Dec;24(6):645-52. doi: 10.1007/s00345-006-0127-6. PMID 17082938.
  33. ↑ 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.
  34. ↑ 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 Apr;7(4 Pt 2):1668–86. doi: 10.1111/j.1743-6109.2010.01782.x. PMID 20388164.
  35. ↑ https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Sexual-and-Reproductive-Health-2021.pdf [ bare URL PDF ]
  36. ↑ Dr. David Delvin (2007-06-25). "Delayed ejaculation (retarded ejaculation)". NetDoctor.co.uk. Retrieved 2007-10-25.
  37. ↑ 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
  38. ↑ WebMD Health News > Viagra, Paxil Help Premature Ejaculation. May 29, 2002. By Martin F. Downs.
  39. ↑ 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.
  40. ↑ 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.
  41. ↑ 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.
  42. ↑ Gitlin, Michael J. (1998). "Treatment of Antidepressant-Induced Sexual Dysfunction". Medscape Psychiatry & Mental Health eJournal. 3 (3). Retrieved 4 April 2018.
  43. ↑ 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.
  44. ↑ 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.

Bibliography

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