function. There is minimal evidence concerni ng the course of acquired delayed ejacula-
tion. The prevalence of delaye d ejaculation appears to remain relatively constant until
around age 50 years, when the incidence begins  to increase significantly. Men in their 80s
report twice as much difficulty ejac ulating as men younger than 59 years.
Risk and Prognostic Factors
Genetic and physiological. Age-related loss of the fast-conducting peripheral sensory
nerves and age-related decreased sex steroid secretion may be associated with the increase
in delayed ejaculation in men older than 50 years.
Culture-Related Diagnostic Issues
Complaints of ejaculatory delay vary across countries and cultures. Such complaints are
more common among men in Asian population s than in men living in Europe, Australia,
or the United States. This variation may be attributable to cultural or genetic differences
between cultures.
Functional Consequences  of Delayed Ejaculation
Difficulty with ejaculation may contribute to  difficulties in conception. Delayed ejacula-
tion is often associated with considerable psychological distre ss in one or both partners.
Differential Diagnosis
Another medical condition. The major differential diagnosis  is between delayed ejacu-
lation fully explained by another medical illness or injury and delayed ejaculation with a
psychogenic, idiopathic, or combined psycho logical and medical etiology. A situational
aspect to the complaint is suggestive of a psychological basis for the problem (e.g., men
who can ejaculate during sexual activity with one sex but not the other; men who can ejac-
ulate with one partner but not another of the same sex; men with paraphilic arousal pat-