It can be a potential source of psychological stress for both the individual and their partners but has received little research.
Most men will experience delayed ejaculation at some point in their lives, but for some, it is a lifelong problem.
This article explains what delayed ejaculation is, why it happens, and how it is treated and diagnosed.
Here are some key points about delayed ejaculation. More detail and supporting information is in the body of this article.
- Delayed ejaculation is a form of sexual dysfunction affecting a man's ability to reach an orgasm
- The average time it takes for ejaculation to occur upon stimulation varies between individuals, with no strict figure given for what is "normal"
- Most causes are psychological, but organic reasons are also possible and are ruled out first during diagnosis
- No pharmacological therapies are available for psychological causes of delayed ejaculation
What is delayed ejaculation?
"Does he really desire me?" Partners of men having difficulty reaching orgasm may be troubled by such questions.
Delayed ejaculation is a type of ejaculatory dysfunction, and probably the least understood.
It is also the least common form of male sexual dysfunction, affecting an estimated 1-4 percent of men; compared with 15-30 percent of men who report having a problem with rapid ejaculation.
In short, delayed ejaculation is a difficulty or inability of a man to reach an orgasm and to ejaculate semen. In general, if it takes longer than 30 minutes of penetrative sex, despite a normal erection, it is considered delayed ejaculation.
Delayed ejaculation can cause significant psychological distress in both the man and his partner. It can cause relationship problems, worries about general health, low libido, and sexual dissatisfaction for both parties.
The condition can cause misunderstandings between partners. For instance, the partner may believe that the individual with delayed ejaculation does not find them attractive.
Psychosocial distress and relationship difficulties that result from delayed ejaculation are often worse for couples trying to start a family.
Delayed ejaculation is diagnosed when a man is concerned about a marked delay or infrequency of achieving ejaculation during most sexual encounters over a period of 6 months or more, and when other problems have been ruled out.
Causes of delayed ejaculation
Delayed ejaculation can have a psychological or biological cause. There can also be overlap between the two. It can be a lifelong condition, where a man has always had difficulty reaching an orgasm, but more commonly, delayed ejaculation occurs after a period of normal function.
Physical causes of delayed ejaculation include:
- Medication side effects - delayed ejaculation may be an adverse effect of antidepressants (especially SSRIs - selective serotonin reuptake inhibitors), anti-anxiety drugs, blood pressure drugs (antihypertensive agents), painkillers, and other medications
- Alcohol or the use of certain recreational drugs (whether legal or illegal)
- Nerve damage (neurological causes) - stroke, spinal cord injury, surgery, multiple sclerosis, and severe diabetes can all lead to abnormal ejaculatory function
- Increasing age can decrease the sensitivity of the penis to sexual stimulation
An acquired case is usually determined as having a psychological cause if it only happens in specific situations. For example, it is more likely that delayed ejaculation has a psychological basis if a man is able to ejaculate normally when masturbating, but experiences a delay during sex with a partner.
Some of the psychological factors thought to be behind cases of delayed ejaculation include:
Men with a persistent problem of delayed ejaculation are likely to be distressed by it.
- Early life history including abuse, difficulties bonding, neglect by parents, negative sexual upbringing
- Unexpressed anger
- Unwillingness to enjoy pleasure
- Religious belief, perhaps that sexual activity is a sin
- Fear of, for instance, semen or female genitalia, or of somehow hurting or defiling a partner through ejaculation
- Fear of pregnancy
- Issues of lost confidence or performance anxiety - for example, anxiety about body image that interrupts the process of sexual stimulation
Previous masturbation is one factor that is strongly related to abnormal ejaculation.
Certain types of masturbatory behavior may play a role in developing delayed ejaculation. One specialist in delayed ejaculation found a relationship between the condition and the following masturbatory patterns:
- Masturbating more often, typically more than three times a week
- Having a style of masturbation that cannot be matched by sexual intercourse - particularly a high speed, high pressure, or high-intensity form
- The partner's hand, mouth, or vagina being unable to easily duplicate the learned style
- The sex partner differing from the fantasy used during masturbation to reach an orgasm
Dr. Michael Perelman, clinical professor of psychiatry, reproductive medicine and urology at the Weill Medical College of Cornell University, New York, observed that most men he had seen with delayed ejaculation reported no problems reaching an orgasm and ejaculating via masturbation.
Some men with the condition needed to employ an "idiosyncratic" form of self-manipulation to reach orgasm, such as rubbing the penis against the bed sheets, masturbating with pressure on a particular spot when reading erotic books, and even masturbating by "urethral instrumentation" - inserting a foreign body down into the opening of the penis.
Diagnosing delayed ejaculation
To reach a diagnosis, a doctor will speak with the individual about symptoms and how often they occur. They will then rule out other potential medical problems - infections, hormonal imbalance, etc. - often using blood and urine tests.
Treatment of delayed ejaculation
Professional counsellors may try to treat delayed ejaculation by identifying the source of the problem.
Treatment for delayed ejaculation depends on the cause. For instance, if SSRIs are the issue, an alternative drug may be prescribed.
Similarly, in cases where excessive alcohol or non-prescription drug use are to blame, reducing or eliminating these factors should help. Where other medical conditions are an underlying issue, managing the primary condition, such as a neurological problem, may help resolve the delayed ejaculation.
Primary cases of delayed ejaculation may not be as straightforward to treat, however, and often require the help of professional counsellors such as psychologists, psychotherapists, psychosexual counsellors, sex therapists, or couple's therapists.
Psychologists recognize that there is no single intervention that works for all patients and that the key to successful treatment is to identify the source of the problem and to use appropriate, targeted therapy to deal with the psychological factors that trigger or contribute to the problem.
Some medications may help improve the symptoms of delayed ejaculation, but none have yet been specifically approved to treat it. Drugs with some reported benefits include:
- Cyproheptadine (Periactin) - an allergy medication
- Amantadine (Symmetrel) - a Parkinson's drug
- Buspirone (Buspar) - an antianxiety medication
Whether or not delayed ejaculation can be successfully treated depends on the cause of the issue and the type of treatment. However, it is important that anyone who has concerns about sexual function speaks with a doctor so that the right course of action can be taken.