A provider with a patient complaining of IELT longer than 22 minutes will theoretically qualify him for the diagnosis of DO. A population-based survey established that the median intravaginal ejaculatory latency time (IELT) was 5.4 minutes and 2 standard deviations above was approximately 22 minutes ( 4– 6). Some males will reach orgasm with one partner in 15 minutes and have no distress, but with another partner it may cause severe distress because the partner may complain of pain with prolonged intercourse. Time threshold for distress is dependent on the partners involved. There is no set time threshold for what defines DO. Situational dysfunction implies the man has problems in a particular scenario or scenarios while functioning normally in others. An acquired dysfunction establishes that the patient previously had normal orgasm timing. The sexual dysfunction is not explained by another non-sexual disorder, medication or significant relation/life distress/stressors.ĭO is further classified as lifelong/acquired, generalized/situational, and mild/moderate/severe.
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The Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5) defines delayed orgasm as a marked delay in ejaculation or a marked infrequency or absence of ejaculation on almost all or all occasions (75–100%) of partnered sexual activity without the individual desiring delay, persisting for at least 6 months and causing significant distress to the individual ( 3). The International Consultation on Sexual Medicine defines anorgasmia as the perceived absence of orgasm, independent of the presence of ejaculation.
The best definition is probably that of the World Health Organization 2nd Consultation on Sexual Dysfunction defines DO as the persistent or recurrent difficulty, delay in, or absence of attaining orgasm after sufficient sexual stimulation, which causes personal distress ( 2). However, men with anorgasmia will not ejaculate. In the clinical setting, most men with failure to ejaculate (retrograde ejaculation, failure of emission both addressed elsewhere in this issue) experience orgasm (although a man with failure to ejaculate for medical reasons may also have DO or anorgasmia). It is critically important to understand that orgasm is an entirely separate process from ejaculation, although they are designed to occur simultaneously. Men with DO may develop anxiety and frustration, which may lead to other sexual problems such as erectile dysfunction (ED) and loss of sex drive.
One of the major concerns with DO and in particular anorgasmia, young males or men with reproductive interest, is the failure to inseminate and therefore male infertility. We believe that DO is the correct term as some men fail to ejaculate for medical reasons but still experience orgasm (retroperitoneal surgery, radical prostatectomy). DO has also been termed retarded orgasm, inhibited orgasm, retarded ejaculation and or inhibited ejaculation. DO/AO defined as the persistent or recurrent difficulty, delay in, or absence of attaining orgasm after sufficient sexual stimulation, which causes personal distress. Delayed orgasm (DO) and anorgasmia (AO) have been described as one end of a spectrum of orgasm timing disorders with the other end being premature ejaculation ( 1).