Delayed Ejaculation

Delayed ejaculation is a medical condition that makes it difficult or impossible to orgasm and ejaculate. Or, in certain cases, reaching ejaculation may require an extended period of sexual stimulation.

Besides taking longer to orgasm and ejaculate, many men with ejaculatory disorders might find the process of orgasm and ejaculation challenging. Others may only be able to reach orgasm and ejaculate only through alternative sexual experiences or acts, such as masturbation or when using a vibrator.

What Is Delayed Ejaculation?

Delayed ejaculation is a rare condition, affecting an estimated one to four percent of the male population. It’s referred to by a range of terms, including inhibited ejaculation, inadequate ejaculation, and ejaculatory insufficiency.

Longer-lasting sex may sound like a good thing at first. But the reality is, delayed ejaculation — like erectile dysfunction (ED) and other sexual dysfunction disorders — can cause stress, frustration, and discomfort, both for men affected by the condition and for their partners.

Symptoms of Delayed Ejaculation

It may seem like there’s one sign of delayed ejaculation, but this type of sexual dysfunction can vary in severity and cause several symptoms.

You may be affected by delayed ejaculation if you:

• Need 25-30 minutes or more of sexual stimulation to ejaculate. You might find it hard to orgasm and ejaculate within a reasonable amount of time during sex with your partner or while masturbating.

• Find it difficult or impossible to ejaculate at all. Typically referred to as anejaculation, you might not be able to ejaculate following sexual stimulation. Anejaculation can happen with or without orgasm.

• Can only ejaculate while masturbating. Some men with delayed ejaculation can orgasm and ejaculate normally from masturbation but not sexual intercourse or other partnered sexual activity.

• Need to stop or take a break from sex. You may get too tired during sex to continue. You (and potentially your partner) might feel physically irritated, or you may lose your erection during sex.

• Feel distress or frustration. You and/or your partner may be distressed, frustrated, or unhappy about your inability to orgasm and ejaculate. This could even cause relationship problems or tension in your sex life.

Lifelong vs. Acquired Delayed Ejaculation

The exact symptoms of delayed ejaculation can vary. To diagnose and treat cases, most men’s health experts categorize delayed ejaculation into two types:

• Lifelong delayed ejaculation. This form of delayed ejaculation is there from the start of sexual maturity. Men with lifelong delayed ejaculation may have always had a hard time reaching orgasm and ejaculating.

• Acquired delayed ejaculation. This form of delayed ejaculation happens after a period of normal sexual function.

Generalized vs. Situational Delayed Ejaculation

Besides being either lifelong or acquired, delayed ejaculation is often categorized as generalized or situational:

• Generalized delayed ejaculation. Men with generalized delayed ejaculation experience symptoms with all sexual partners and all types of sexual stimulation.

• Situational delayed ejaculation. Guys with situational delayed ejaculation may only find it difficult to orgasm and ejaculate in certain situations, like with a specific sexual partner or with a particular type of sexual stimulation.

What Causes Delayed Ejaculation?

Numerous factors can play a role in delayed ejaculation causes, from psychological issues to health problems or even the use of certain medications. Sometimes, there are multiple causes.

Psychological Causes of Delayed Ejaculation

In many instances, delayed ejaculation is caused by a psychological factor, like depression or sexual performance anxiety.

Potential psychological causes of delayed ejaculation include:

• Fear of intimacy or pregnancy. Fear of intimacy or concerns about impregnating a sexual partner could affect your ability to ejaculate and contribute to delayed ejaculation. You may also worry about contracting an STI (sexually transmitted infection).

• Mental health conditions. Various mental health conditions are linked to delayed ejaculation, including depression, anxiety, and obsessive-compulsive disorder (OCD), as well as decreased sexual desire. Some research shows that psychological stress may elevate a man’s prolactin levels, which can then lead to delayed ejaculation. (Prolactin is a hormone that can influence arousal and other hormones affecting sexual function.)

• Sexual performance anxiety. Even if you don’t have an anxiety disorder, it’s common to feel anxious before sex. This is called sexual performance anxiety, and it may cause symptoms such as erectile dysfunction or difficulty ejaculating.

• Conditioning due to masturbation. If you masturbate frequently or in a way that is difficult to reproduce with a sexual partner, it could contribute to sexual dysfunction, including delayed or impaired ejaculation. Some limited research suggests a connection between porn use and delayed ejaculation, but more clinical data is needed to prove a causal relationship.

• Relationship issues or lack of attraction. You might not maintain a sexual response long enough to ejaculate if you lack sexual attraction to your partner — or if you currently feel unhappy with your partner due to a relationship conflict.

• Feelings of guilt due to religious or cultural conviction. If you have a religious or cultural background that makes you view sex as sinful or inappropriate, it could affect your ability to orgasm and ejaculate.

• Traumatic events. Traumatic events, especially those related to sex or masturbation, might make it harder to orgasm and ejaculate.

Physical Causes of Delayed Ejaculation

Sometimes, delayed ejaculation is linked to a physical factor, like nerve damage or taking a certain type of medication.

Potential physical causes of delayed ejaculation include:

• Insufficient sexual stimulation. One study found that ​​men with delayed ejaculation had decreased sensitivity in the penile shaft. To achieve pleasure, they adopted “idiosyncratic” masturbation techniques but found it difficult to duplicate the same responses during partnered sex.

• Use of certain medications. Some medications may affect your ability to orgasm and ejaculate. Prescription drugs associated with delayed ejaculation include antidepressants like SSRIs (selective serotonin reuptake inhibitors), diuretics, high blood pressure (hypertension) medications, anti-seizure meds, and antipsychotics.

• Alcohol consumption. Alcohol can affect a man sexually in numerous ways. Drinking excessively could make it harder to get or maintain an erection, or it could cause delayed ejaculation.

• Nerve damage. Damage to the pelvic nerves (those responsible for controlling the ability to orgasm and ejaculate) can cause delayed ejaculation. It can also make it harder to get an erection (referred to as neurogenic or neurological ED). Nervous system conditions and neurological issues that can cause nerve damage include stroke, multiple sclerosis, and diabetic neuropathy. A spinal cord injury or pinched nerve may also lead to delayed ejaculation.

• Retrograde ejaculation. This condition causes semen to release into the bladder instead of outward from the penis. With retrograde ejaculation, you might be able to reach orgasm but ejaculate a very small volume of semen — or no semen at all.

• Pelvis surgery. Some prostate surgeries, like prostate removal or transurethral resection of the prostate, may cause ejaculation disorders.

• Hormone conditions. Conditions like low testosterone or hypothyroidism (underactive thyroid) could affect sexual performance and the ability to reach orgasm and ejaculate.

Risk Factors for Delayed Ejaculation

Some men have a higher risk of experiencing delayed ejaculation due to factors like age, health conditions, or lifestyle habits.

Risk factors for delayed ejaculation include:

• Age. Delayed ejaculation can happen to men of all ages, but studies show it’s more common in older men. Some researchers attribute this problem to a loss of penile receptors and sensory axons (nerves that respond to sexual stimuli) that occurs with age, leading to decreased sensitivity.

• Chronic health conditions. From spinal cord injuries to health conditions affecting the nervous system, various medical conditions can increase your risk of experiencing delayed ejaculation.

• Mental health conditions. You may struggle with delayed ejaculation if you suffer from depression, anxiety, or another mental health condition.

• Religious or cultural background. You might find it difficult to reach ejaculation or orgasm (or even maintain an erection) if you have a strict religious or cultural background that makes you feel guilty about sex.  

• Medications. You could have a higher risk if you take one of the medications associated with delayed ejaculation, such as antidepressants. One study found that SSRI users have a ​​seven-fold risk of delayed ejaculation and anejaculation. People who took SSRIs also reported less enjoyment during masturbation and decreased partner desire.

Diagnosing Delayed Ejaculation

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a diagnosis of delayed ejaculation requires one of two symptoms:

• A marked delay, infrequency, or absence of ejaculation on 75 to 100 percent of occasions for at least six months of partnered sex 

• Delayed ejaculation that causes significant distress to the individual

If you’re taking 25 to 30 minutes to ejaculate and it’s causing distress for you or your partner, you should see a healthcare provider, such as someone specializing in urology or sexual medicine.

To diagnose delayed ejaculation, your provider might perform a physical exam and ask about your medical history, symptoms, and sexual habits.

They may also run blood or urine tests to rule out other health conditions that could be affecting your ejaculation, like hormonal imbalances.

How to Fix Delayed Ejaculation

Treatment for delayed ejaculation is available, and you’ve got several options.

For some guys, delayed ejaculation treatment can involve medication. Others may benefit from therapy, such as sex therapy or relationship-focused therapy.

Medications

Unfortunately, there aren’t currently any medications specifically approved bv the FDA (U.S. Food and Drug Administration) specifically to treat delayed ejaculation.

However, This means a urologist or another healthcare provider may recommend using a medication off-label to treat delayed ejaculation symptoms. (Off-label is when a drug is prescribed to treat something other than what it’s FDA-approved for.)

If you also have ED, there is evidence that tadalafil or other ED medications can effectively treat delayed ejaculation and ED at the same time..  

Other medications used off-label to treat delayed ejaculation may include:

• Testosterone

• Cyproheptadine

• Cabergoline

• Bupropion

• Amantadine

• Lisdexamfetamine dimesylate

• Oxytocin

• Yohimbine

• Pseudoephedrine

• Bethanechol

• Buspirone

• Ephedrine

• Midodrine

While the list of medications associated with delayed ejaculation treatment is extensive, not all have proven effective in testing.

Like any medication, these off-label treatments for delayed ejaculation may cause side effects like insomnia, dizziness, nausea, and dry mouth.

On the other hand, if delayed ejaculation is caused by an existing medication, a healthcare provider might recommend switching medications or reducing the dosage.

Therapy

Several forms of therapy may help treat delayed ejaculation, including psychotherapy for underlying conditions or sex therapy.

If a relationship issue is causing delayed ejaculation, seeing a sex therapist might involve working on your relationship and intimacy with your partner.

You can see a therapist in person or try online therapy with professional counselors.

Lifestyle Changes

If your delayed ejaculation is caused by a lifestyle factor, like drinking too much or a lack of intimacy with your partner, making changes to your lifestyle might help.

Here’s what you can try:

• Communicate with your partner. Delayed ejaculation can be a result of performance anxiety. If you have sex-related worries, try talking openly with your partner to ease anxiety and make sex more relaxing and enjoyable.

• Seek treatment for alcohol or substance use disorder. Alcohol and drug use might contribute to delayed ejaculation and other sexual dysfunction issues. If you have an alcohol or drug use disorder, consider seeking treatment.

Explore different sexual techniques. If you think you have low sensitivity in the penis, you may benefit from new sexual techniques or a vibrating sex toy. According to research, penile vibratory stimulation might effectively treat up to 72 percent of patients with delayed ejaculation and anorgasmia.

Delayed Ejaculation Prevention Tips

Since delayed ejaculation can be caused by uncontrolled diabetes, being sure to carefully monitor your blood sugar and staying on top of your diabetes management can prevent the development of delayed ejaculation. In other cases, though, delayed ejaculation results from other health conditions outside your control, such as nerve damage or aging. In these cases, there’s not much you can do to prevent it.

However, there are ways to prevent delayed ejaculation if the root cause is psychological or triggered by certain lifestyle habits.

To lower your risk of delayed ejaculation, try to:

• Practice mindfulness to be more present during sex

• Communicate sexual desires openly with your partner

• Challenge limiting beliefs about sex (e.g., that sex is shameful or bad)

• Take the pressure off by not forcing yourself to have a sexual response

• Avoid excessive drinking and drug use

Though it’s an uncommon sexual dysfunction, delayed ejaculation does happen. If left untreated, this sexual health problem can lead to numerous complications like low self-esteem, relationship conflicts, infertility, and low sexual satisfaction.

But there are ways to treat delayed ejaculation, especially if you’re willing to identify the underlying cause with your healthcare provider’s support.

Delayed ejaculation is just one form of sexual dysfunction. If you’re struggling with erectile dysfunction or premature ejaculation (PE) — two of the most common sexual problems affecting men — seek advice from a medical professional.

A healthcare provider can recommend erectile dysfunction medications or premature ejaculation treatment options.