Delayed Ejaculation 425
sexual activity because of a re petitive pattern of difficulty ejaculating. Some sexual partners
may report feeling less sexually attractive because their partner ca nnot ejaculate easily.
In addition to the subtypes “lifelong/acqu ired” and “generalized/situational,” the fol-
lowing five factors must be considered during assessment and diagnosis of delayed ejacu-
lation, given that they may be relevant to etiology and/or  treatment: 1) partner factors (e.g.,
partner’s sexual pr oblems, partner’s health status); 2) relationship factors (e.g., poor com-
munication, discrepancies in desire for sexual activity); 3) individual  vulnerability factors
(e.g., poor body image; history of sexual or emotional abuse), psychiatric comorbidity (e.g.,
depression, anxiety), or stressor s (e.g., job loss, bereavement); 4) cultural/religious factors
(e.g., inhibitions related to prohibitions agains t sexual activity; attitudes toward sexuality);
and 5) medical factors relevant to prognosis, course, or treatment. Each  of these factors may
contribute differently to the presenting symptoms of different men with this disorder.
Prevalence
Prevalence is unclear because of the lack of a precise definition of this syndrome. It is the
least common male sexual complaint. Only 75% of men report always ejaculating during
sexual activity, and less than 1% of men will complain of problems with reaching ejacula-
tion that last more than 6 months.
Development and Course
Lifelong delayed ejaculation begins with ea rly sexual experiences and continues through-
out life. By definition, acquired  delayed ejaculation begins after a period of normal sexual
function. There is minimal evidence concerni ng the course of acquired delayed ejacula-