The American Psychiatric Association Definition Of Delayed Ejaculation

The Diagnostic and Statistical Manual [ DSM edition IV ], produced by the American Psychiatric Association, defines delayed ejaculation (DE for short) as:

A persistent or recurrent delay in (or complete absence of) orgasm, following normal sexual excitement and sexual activity that the doctor judges to be adequate to normally achieve orgasm, taking into account the person’s age and other factors.

This definition emphasizes the similarity between DE and failure of orgasm in women, commonly known as female orgasmic disorder.

However, this is a very inadequate description because orgasm and ejaculation in men are two separate phases of the sexual response cycle.

man woman making love
Male orgasm and ejaculation are two separate events

Orgasm is an event which involves pleasurable sensations in the mind, together with the release of physical tension which has built up during sexual arousal in the body.

Ejaculation, by contrast, is a reflex reaction mediated by the autonomic nervous system, and consists of two phases.

The first is emission, during which semen is released into the back of the urethra, and expulsion, during which the contraction of the pelvic musculature forces the semen out of the penis.

To define inability to ejaculate as a male orgasmic disorder is inaccurate and misleading.

The term delayed ejaculation is actually a much better description because it clearly contrasts this condition with premature or early ejaculation, and there’s no guessing at what causes it – not in the definition, anyway!

Also, there is a large range of ejaculatory latency times in the normal male population anyway. So one simple and perfectly adequate definition of this problem would be as follows:

When a man finds it difficult or impossible to ejaculate despite the adequate sexual stimulation, an erection hard enough for penetration, and a conscious desire to enjoy sexual intercourse.

As you might guess from the information above, many of the criteria used in the Diagnostic and Statistical Manualhave been criticized for their lack of precision, and their subjective assessment of “marked distress” for the man or his partner.

This is a part of the definition that is felt to be inappropriate by many doctors and therapists.

Furthermore, the proliferation of etiological subtypes such as “acquired” and “secondary” may not necessarily be particularly helpful. After all, what’s needed most is an effective cure.

That’s why it’s been proposed that a better definition of delayed ejaculation, or male orgasmic disorder, as it is known in DSM IV, might well exclude these subtypes.

What’s The Way Forward?

Articles relevant to the diagnostic criteria of ejaculation problems published since 1990 have been scrutinized and the findings summarized in an article written by Robert T. Segraves, published in the Journal of Sexual Medicine volume 7, number 2, part 1.

Segraves’ work has made a compelling case that the definition of delayed ejaculation in the DSM manual  should be changed in the fifth edition.

He found that if you do a MEDLINE search from 1990 to the present day, there are minimal uses of the term male orgasmic disorder. Also, retarded ejaculation and ejaculatory delay, he says, are old-fashioned and unhelpful terms.

Segraves also suggested that the requirement of marked distress for this condition to be recognized as delayed ejaculation is inappropriate, and that the categories usually used as diagnostic criteria are eliminated.

Certainly his search of the literature reveal very little information about the psychological causes of this condition. They also demonstrated that male orgasmic disorder is not a term which has achieved any kind of widespread recognition whatsoever. (J Sex Med 2010;7:690–699.)

man and woman making love
Some men find that these sexual dysfunctions are psychological in origin

In short, he recommended that male orgasmic disorder was an ineffective term that should be replaced with the the more accurate one “delayed ejaculation”.

And he also said thatdefinition should be based on both duration of intercourse and theseverity of the ejaculation delay.

And since many ejaculatory problems are idiopathic [an idiopathy is any disease with unknown pathogenesis or apparently spontaneous origin], he suggested it would make sense for the etiological classification (including both psychological and an unspecified “combination” of factors as the cause of delayed ejaculation) to be eliminated in DSM V.

Video – Definition of DE


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