Delayed ejaculation refers to a difficulty or inability of a man to reach an orgasm and to ejaculate semen. The causes can be physical or psychological.

Language matters

We use the term “men” and “male” in this article to refer to sex assigned at birth and to reflect terms historically used to gender people. Sex and gender exist on spectrums and a person’s gender identity may not align with these terms.

If a person with a penis takes longer than 30 minutes to ejaculate, despite a typical erection, it is considered delayed ejaculation.

Delayed ejaculation affects around 1–4% of the male population.

It can result in distress for both the man and his partner. It can trigger anxiety about general health, low libido, and sexual dissatisfaction. Relationship problems include a fear of rejection for both parties and concern for couples who wish to start a family.

Most men will experience delayed ejaculation at some point in their lives, but for some, it is a lifelong problem.

Fast facts on delayed ejaculation

  • 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.”
  • Some causes are psychological, but organic reasons are also possible and may be ruled out first during diagnosis.
  • No pharmacological therapies are available for psychological causes of delayed ejaculation.

Delayed ejaculation can have a psychological or biological cause. There can also be an overlap between the two. It can be a lifelong condition, where a person has always had difficulty reaching an orgasm.

However, more commonly, delayed ejaculation occurs after a period of typical function.

Physical causes of delayed ejaculation include the following:

  • Medication side effects can be a reason. Delayed ejaculation may be an adverse effect of:
  • Alcohol or the use of certain recreational drugs can have an impact.
  • Hormone changes, such as hypogonadism (low testosterone), can impact orgasms.
  • Hyperprolactinemia, or excess prolactin, can have an effect.
  • Prostate issues like prostatitis, or inflammation of the prostate gland, could be a factor.
  • Nerve damage, including stroke, spinal cord injury, surgery, multiple sclerosis, and severe diabetes, can lead to atypical 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 psychological factors that may contribute to delayed ejaculation include:

  • early life history, including abuse, difficulties bonding, neglect by parents, or a negative sexual upbringing
  • unexpressed anger
  • inability to enjoy pleasure
  • religious belief, perhaps that sexual activity is a sin
  • fear of, for instance, semen or female genitalia, or fear 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

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
  • being unable to easily duplicate the learned style with a partner’s hand, mouth, or vagina
  • having a sex partner who differs from the fantasy used during masturbation to reach an orgasm

The specialist observed that most men with delayed ejaculation reported no problems reaching an orgasm or ejaculating via masturbation.

Some men with the condition needed to employ an “idiosyncratic” form of self-manipulation to reach an orgasm, such as rubbing the penis against the bedsheets or masturbating with pressure on a particular spot while looking at erotic materials.

Delayed ejaculation is diagnosed when a person 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.

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, such as infections, hormonal imbalance, and so on. This may involve using blood and urine tests.

Treatment for delayed ejaculation depends on the cause. For instance, if SSRIs are the issue, a doctor may prescribe an alternative drug.

If alcohol or nonprescription drug use are factors, reducing or eliminating these may help. If there are other medical conditions, managing the primary condition, such as a neurological problem, may help resolve the delayed ejaculation.

Primary causes of delayed ejaculation may not be straightforward to treat. They often require the help of professional counselors, such as:

  • psychologists
  • psychotherapists
  • psychosexual counselors
  • sex therapists
  • couple’s therapists

Psychologists recognize that there is no single intervention that works for all people. They know 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 when used off-label, but none have been specifically approved to treat it yet.

Drugs with some reported benefits include:

  • cyproheptadine (Periactin), an allergy medication
  • amantadine (Symmetrel), a drug used to treat Parkinson’s disease
  • buspirone (Buspar), an antianxiety medication
  • cabergoline (Dostinex), a dopaminergic medication
  • oxytocin (Pitocin), a type of hormone

Successful treatment of delayed ejaculation depends on the cause of the delayed ejaculation and the type of treatment. Each individual will have different needs and outcomes.

Anyone who has concerns about sexual function should speak with a doctor and potentially also a mental health professional so that they can take the right course of action.