Treatment and pathophysiology of delayed ejaculation?
Male orgasm is defined as a subjective, perceptual-cognitive event of peak sexual pleasure that in normal conditions coincides with the moment of ejaculation. Delayed ejaculation is typically a self-reported diagnosis; there is no firm consensus on what constitutes a reasonable time frame for reaching orgasm. The presence of a normal sexual excitement phase is a prerequisite for male orgasmic disorder (MOD). In other words, if the absence of orgasm follows a decreased desire for sexual activity, an aversion to genital sexual contact, or a decreased lubrication-swelling response, diagnoses such as hypoactive sexual desire disorder, sexual aversion disorder, or male erectile disorder might be more appropriate, even if they all have a final common outcome (ie, anorgasmia, defined as failure to experience an orgasm).
@abhik The succession of erection, emission, ejaculation, and orgasm creates the impression that these events might have a common physiologic substrate. In reality, they are separate events. This separateness is clearly illustrated by the typical patient with MOD, who complains of sustaining hard erections without being able to ejaculate, or by the typical patient with erectile dysfunction, who complains of ejaculating through a flaccid penis.
When pharmacotherapy for delayed ejaculation is under consideration, it is important to eliminate iatrogenic causes, including medications (eg, alpha-adrenergic blockers, other antihypertensives, antidepressants, and antipsychotics). In the case of antidepressant-induced inhibited male orgasm, consideration may be given to switching to bupropion (also used as adjunctive therapy), mirtazapine, nefazodone, or vilazodone, which have fewer sexual side effects than selective serotonin reuptake inhibitors (SSRIs) do.