Overview

Delayed ejaculation — sometimes called impaired ejaculation — is a condition in which it takes an extended period of sexual stimulation for a man to reach sexual climax and release semen from the penis (ejaculate). Some men with delayed ejaculation are unable to ejaculate at all.

Delayed ejaculation can be temporary or a lifelong problem. Possible causes of delayed ejaculation include certain chronic health conditions, surgeries and medications. Treatment for delayed ejaculation depends on the underlying cause.

It's normal for men to have delayed ejaculation from time to time. Delayed ejaculation is only a problem if it's ongoing or causes stress for you or your partner.

Symptoms

Some men with delayed ejaculation need 30 minutes or more of sexual stimulation to have an orgasm and ejaculate. Or, they may not be able to ejaculate at all (anejaculation).

But, there's no specific time that indicates a diagnosis of delayed ejaculation. Instead, a man is probably experiencing delayed ejaculation if the delay is causing him distress or frustration, or if he has to stop sexual activity due to fatigue, physical irritation, loss of erection or a request from his partner.

Often, a man might have difficulty reaching orgasm during sexual intercourse or other sexual activities with a partner. Some men can ejaculate only when masturbating.

Delayed orgasm is divided into the following types based on symptoms:

  • Lifelong vs. acquired. With lifelong delayed ejaculation, the problem is present from the time a male reaches sexual maturity. Acquired delayed ejaculation occurs after a period of normal sexual functioning.
  • Generalized vs. situational. Generalized delayed ejaculation isn't limited to certain sex partners or certain kinds of stimulation. Situational delayed ejaculation occurs only under certain circumstances.

These categories help in diagnosing an underlying cause, and determining what might be the most effective treatment.

When to see a doctor

Your primary care doctor is a good place to start when you have delayed ejaculation. See your doctor if:

  • Delayed ejaculation is an issue for you or your partner
  • You have another known health problem that may be linked to delayed ejaculation, or you take medications that could be causing the problem
  • You have other symptoms along with delayed ejaculation that may or may not seem related

Causes

Delayed ejaculation can result from certain chronic health conditions, surgeries and medications. Or it may be caused by substance abuse or a mental health concern, such as depression, anxiety or stress. In many cases, delayed ejaculation is due to a combination of physical and psychological concerns.

Physical causes of delayed ejaculation include:

  • Certain birth defects affecting the male reproductive system
  • Injury to the pelvic nerves that control orgasm
  • Certain infections, such as a urinary tract infection
  • Prostate surgery, such as transurethral resection of the prostate (TURP) or prostate removal
  • Neurological diseases, such as diabetic neuropathy, stroke or nerve damage to the spinal cord
  • Hormone-related conditions, such as low thyroid hormone (hypothyroidism) or low testosterone (hypogonadism)
  • Retrograde ejaculation, a condition in which the semen goes backward into the bladder rather than out of the penis

Psychological causes of delayed ejaculation include:

  • Depression, anxiety or other mental health conditions
  • Relationship problems due to stress, poor communication or other concerns
  • Anxiety about performance
  • Poor body image
  • Cultural or religious taboos
  • Differences between the reality of sex with a partner and sexual fantasies

Medications and other substances that can cause delayed ejaculation include:

  • Some antidepressants
  • Certain high blood pressure medications
  • Certain diuretics
  • Some antipsychotic medications
  • Some anti-seizure medications
  • Alcohol — particularly drinking too much (alcohol abuse or alcoholism)

For some men, a minor physical problem that causes a delay in ejaculation may cause anxiety about ejaculating during a sexual encounter. The resulting anxiety may worsen delayed ejaculation.

Risk factors

A number of things can increase your risk of having delayed ejaculation, including:

  • Older age — as men age, it's normal for ejaculation to take longer
  • Psychological conditions, such as depression or anxiety
  • Medical conditions, such as diabetes or multiple sclerosis
  • Certain medical treatments, such as prostate surgery
  • Medications, particularly certain antidepressants, high blood pressure medications or diuretics
  • Relationship problems, such as poor communication with your partner
  • Alcohol abuse, especially if you're a long-term heavy drinker

Complications

Complications of delayed ejaculation can include:

  • Diminished sexual pleasure for a man or his partner
  • Stress or anxiety about sexual performance
  • Marital or relationship problems due to an unsatisfactory sex life
  • Inability to get your partner pregnant (male infertility)
April 17, 2015
References
  1. Sexual dysfunctions. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed March 19, 2015.
  2. McMahon CG. Management of ejaculatory dysfunction. Internal Medicine Journal. 2014;44:124.
  3. Ferri FF. Ejaculation and orgasm disorders. In: Ferri's Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015. http://www.clinicalkey.com. Accessed March 18, 2015.
  4. Althof SE. Psychological interventions for delayed ejaculation/orgasm. International Journal of Impotence Research. 2012;24:131.
  5. Calabro RS. Pregabalin-induced severe delayed ejaculation. Epilepsy & Behavior. 2010;19:543.
  6. Nippoldt TB (expert opinion). Mayo Clinic, Rochester, Minn. March 28, 2015.