Out of the various male sexual disorders, erectile dysfunction (ED) has probably garnered the most attention.
A less-discussed sexual disorder that men can experience is delayed ejaculation, or difficulty reaching orgasm. The exact incidence of delayed ejaculation is unclear because many men do not seek treatment for it, a Cleveland Clinic expert says, but it can be a source of distress for those who experience it.
“Delayed ejaculation of varying degrees is probably more common than we realize, but of men seeking care for this, it’s actually pretty rare,” says Petar Bajic, MD, a Cleveland Clinic urologist and sexual medicine specialist. “And there are a lot of different things we have to consider that may be factoring in.”
Though it may be a sensitive subject, discussing delayed ejaculation with your healthcare provider and your partner can help you identify what’s causing the problem and find solutions for it.
What Is Delayed Ejaculation
There’s no universally agreed-upon definition for delayed ejaculation (also known as delayed orgasm). However, most experts generally recognize it as a marked delay in or marked infrequency or absence of ejaculation in the majority of sexual encounters.
Some men have lifelong (primary) delayed ejaculation, while acquired (secondary) delayed ejaculation develops at some point in their life. Some men experience intermittent problems with delayed ejaculation, while others cannot ejaculate at all (anejaculation) or reach orgasm (anorgasmia).
“There are varying definitions, but the consensus is it needs to be bothersome, it needs to be common and not just once in a while, and it should be easily explained by some other medical reason,” Dr. Bajic says. “By far, the majority of men I see who are complaining about this have secondary, or acquired, delayed ejaculation, meaning they haven’t had it their whole life.”
Whatever the definition, delayed ejaculation is characterized by trouble ejaculating during sex (with or without a partner) and requiring prolonged stimulation to ejaculate. “And, it can definitely be associated with a great degree of bother,” Dr. Bajic adds.
What Causes Delayed Ejaculation?
A number of physical factors can cause or contribute to delayed ejaculation, including:
- Medications. They include many types of antidepressants, particularly those in a class known as selective serotonin reuptake inhibitors (SSRIs). “In fact, we use SSRIs to treat premature ejaculation and prolong the ejaculatory latency time,” Dr. Bajic says. Anti-anxiety and antipsychotic drugs also can contribute to delayed ejaculation. Note: Alpha-blocker medications, used to treat benign prostate enlargement and high blood pressure, can sometimes cause retrograde ejaculation (in which semen flows backward into the bladder instead of being expelled out of the penis during orgasm), but it typically does not affect orgasm.
- Nerve damage (neuropathy). Conditions that negatively affect your nerves—including poorly controlled diabetes, stroke, spine issues, and multiple sclerosis, among others—can decrease penile sensitivity and cause slow ejaculation.
- Surgery. Certain interventional procedures and pelvic surgeries involving the prostate or bladder can result in delayed ejaculation.
- Pain. Chronic pain from musculoskeletal, neurological, or other issues can affect sex drive and cause problems reaching orgasm.
- Hormonal problems. An underactive thyroid (hypothyroidism) has been shown to contribute to delayed ejaculation. Also, “Men who have low testosterone may have a lower sex drive, but they also may be at greater risk of delayed orgasm or ejaculation,” Dr. Bajic says. The same may apply to medications that suppress testosterone production, such as opioids and certain drugs used to treat prostate cancer.
- Alcohol/substance use. Use of alcohol, marijuana, or other controlled substances can delay ejaculation.
Understand, too, that as you get older, the refractory period—the time it takes after an orgasm before you can have another one—increases, so if you have sex during this time, you may have problems ejaculating. “I have patients who are in their 70s or 80s where that refractory period may be as long as a week,” Dr. Bajic says. “They may have one normal sexual encounter with orgasm, and then they may try again in subsequent days and be unable to reach orgasm, and that can be very frustrating. Many men don’t know about that.”
Several of the factors underlying delayed ejaculation also contribute to erection problems, which in turn can affect your ability to reach orgasm, Dr. Bajic says. “Sometimes, for the guys who have both ED and delayed ejaculation, treating the ED is often all they need,” he says.
Psychological Causes
Men with ED can develop performance anxiety and worry about whether they can maintain an erection during sex. This and other psychological issues, such as depression, generalized anxiety, emotional stress, and relationship problems, can play a role in delayed ejaculation. Negative or distracting thoughts also can affect arousal, the mental part of sex, and delay ejaculation.
“I’ve had patients who have lost a partner and are now with a new partner, and they may have some thoughts that derail that whole arousal process. That can make it more challenging,” Dr. Bajic says. “I commonly refer men with this problem to sex therapy, and one of the things they do with the sex therapists is try to work through some of that anxiety component and compartmentalize that in a way that doesn’t negatively impact their ability to build on their arousal and stimulation.”
How Delayed Ejaculation Is Treated
Unless delayed ejaculation is distressing to you and/or your partner, you might not require treatment, Dr. Bajic says: “The distress is really the key differentiator.”
Oftentimes, managing the factors that cause delayed ejaculation—for example, treating ED or diabetes, curbing alcohol or substance use, correcting a thyroid disorder, or removing a problem medication—can help to resolve bothersome delayed ejaculation. If psychological factors are contributing, psychotherapy or counseling may help.
No medications are approved specifically for delayed ejaculation, but several have been tried “off-label,” with limited success, Dr. Bajic says. “There’s not one that’s been consistently helpful,” he says. “There’s really not any high-quality evidence to support them.”
Dr. Bajic does recommend—and often refers patients to—sex therapy for delayed ejaculation. A therapist can help you overcome any psychological or relationship issues that may be contributing to your delayed ejaculation. He or she also may offer advice about techniques or sexual aids that can improve your arousal and stimulation. For instance, if you can reach orgasm yourself but not with a partner, a therapist might advise you both on how your partner can duplicate the technique to help you climax.
Working with a sex therapist can also help you find ways to open up and discuss an oftentimes uncomfortable subject with your partner and your healthcare provider. The therapist can offer advice for communicating your needs and desires and figuring how to converge them with your partner’s.
“Communication with your partner is extremely important,” Dr. Bajic says. “I think the key here is just being willing to talk about it with your partner and your provider. The prognosis is good, but you have to be willing to start that conversation, and sometimes those conversations can be difficult.
“I feel I’ve had a lot of success in helping guys in this area, but it takes someone willing to talk to a sex therapist and follow some of these tips that they might not necessarily be eager to do. If they’re diligent about this and ruling out these various possible contributing factors, generally speaking, I think the prognosis is quite good.”
What You Can Do
You can find ways to overcome delayed ejaculation or minimize its effects on your quality of life. Consider these tips:
- Talk to your primary care doctor about any issues with delayed ejaculation or problems reaching orgasm. Discuss a referral to a sex therapist and/or a urologist experienced in treating sexual dysfunction.
- Work with your provider to address any underlying delayed ejaculation risk factors, such as medications, alcohol/substance use, diabetes, thyroid dysfunction, chronic pain, low testosterone, and erectile dysfunction.
- Seek an evaluation from a mental health professional if mood disorders, relationship issues, or other emotional or psychological factors are contributing to delayed ejaculation.
- Be open with your partner. Share your concerns, desires and needs, and consider working together with a sex therapist.
