Male Orgasm Disorders

Premature Ejaculation (Premature) and Voluntary Control

Premature ejaculation is a persistent pattern where ejaculation occurs with minimal stimulation and before the person desires it, typically within a minute of penetration (or even sooner).

The key criterion is not only the timing, but the feeling of lack of control over the ejaculatory reflex and the discomfort this generates. This disorder usually has a strong psychological and learning basis.

It can be lifelong (primary) or acquired after a period of normal functioning.

In severe cases, ejaculation can occur within seconds, preventing any satisfactory sexual interaction.

Treatment focuses on behavioral techniques to improve sensory perception and control.

Delayed or inhibited ejaculation

At the other end of the spectrum, delayed ejaculation involves a marked delay or inability to ejaculate, despite having an adequate erection and sufficient stimulation.

For diagnosis, this must occur in most sexual relations and be unwanted by the patient (as occurs in certain tantric practices).

Often, this disorder is linked to psychological factors such as a restrictive upbringing, fear of pregnancy, hostility towards a partner, or an idiosyncratic masturbation style that cannot be replicated during intercourse.

It is less common than premature ejaculation, but can be equally frustrating and exhausting for both partners.

Subjective perception of time vs. clinical reality

It is common to find in consultation a cognitive distortion regarding the "normal" duration of coitus.

Many patients come in concerned about alleged premature or delayed ejaculation based on unrealistic standards, often derived from pornography.

A patient might report premature ejaculation when it actually lasts 15 to 20 minutes, which exceeds the population average. The use of behavioral time recording is essential here.

Objectifying the actual duration helps to depathologize behaviors that are within the biological norm.

If the discrepancy between reality and expectation is the source of discomfort, the intervention is psychoeducational: adjusting unrealistic expectations rather than treating a nonexistent physiolog